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Date Posted 10/05/10
Question >
Good morning, I support a gentleman who has for information purposes Dowm Syndrome,is 65 years old, and now assessed as having some form of Dementia, (April 2010) his speech appears to be affected his STM is very poor however his LTM seems fair,his concentration levels have diminshed,he is incontinent (doubly), balance is also affected, he has lost the ability to do anything without first being given instructions, he is reluctant to walk, and will not attempt to use the stairs, he has become anxious, verbally aggressive, he shouts out when you try and help him, he has not yet been prescriped any medication as we are waiting the results of tests, ie full bloods, ECG and Chest xray to rule out any other infections they may or could be present. My question is !i understand that there may be a patch for Alzheimers/Dementia, is this correct, and are these medications licenced for people with a handicap? And what is the prefered medication for people who may or have dementia, is it Aricept? and what is the postion of Rember?
Answer >
Thank you for your questions. There is unfortunately a link between Down's syndrome and the development of Alzheimer's disease. This is not fully understood but we know that people who have Down's syndrome can develope the plaques and tangles in the brain that are found in Alzheimer's disease. Your detailed knowledge of this person will be very helpful in highlighting the changes that have occured in this person. One of the great difficulies especially in the earlty stages of Alzheimer's is identifying the changes that have occured.
I note that tests are curently being conducted and that you are waiting for a formal diagnosis. My understanding of the treatments that are currently licensed for Alzheimer's disease is just that. They are licensed for people who have been given a diagnosis of Alzheimer's disease. If a person is deemed suitable for any treatment the potential benefits and risks have to be considered and this is a discussion to have with the local clinician.
You are correct that there is a patch available for the treatment of Alzheimer's disease. It is an EXELON patch and this contains the medicine Rivastigmine which is similar to Aricept (Donepezil).
The most widely used licensed treament for Alzheimer's disease in the U.K. and probably globally is Aricept.
With regard to Rember, the experimental medicine being developed by Tau Rx based in Aberdeen, further trials are possibly going to take place. I would suggest contacting them directly if you wish to be kept appraised of forthcoming developments.
Date Posted 01/05/10
Question >
My brother (age 55) was diagnosed four years ago with early onset alzheimers and vascular dementia. He's been on aricept for some years. I've read various reports that stem cell treatment might be able to reverse the effects. Might you be able to offer me any advice on this?
Answer >
Alzheimer's disease is the commonest form of dementia and you say your brother has been diagnosed with Early Onset Alzheimer's disease and Vascular dementia which of course is quite possible. Many patients with Alzheimer's disease have findings on brain scanning that indicate some underlying vascular pathology. This does not necessarily mean they actually have Vascular dementia as well.
There are actual criteria that can be applied to an MRI scan of the brain that describe the changes and allow a conculsion to be reached as to whether or not the changes are significant enough to meet the diagnostic criteria for vascular dementia. Your brother is receiving treatment with Aricept which is licensed for the treatment of Alzheimer's disease and this is a positive outcome.
Some patients with vascular changes on a brain scan may simply be labelled as Vascular dementia when in fact the changes may be minor and they in fact have underlying Alzheimer's disease. The importance of this is that they may then receive no treatment.
Vascular risk factors are of course important to identify and treat.
In terms of potential stem cell treatment for Alzheimer's disease this is an area that we have no experience of.
Of more relevance possibly is the potential to participate in a vaccine programme. Such programmes are currently designed for those with Alzheimer's disease who may or may not currently be receiving treatment for the condition. The degree of vascular change would have to be asssessed because if it were too great then an individual is likely to be ineligible to participate.
Date Posted 19/04/10
Question >
MY WIFE SUFFERS FROM ALZHEIMERS SHE CAN NOT COMMUNICATE. HER WORDS ARE ALL JUMBLED AND GETS FRUSTRATED WHEN I CAN,T WORK OUT WHAT SHE WANTS? IS THERE ANY FURTHER TREATMENT IN PROGESS THAT MAY ONE DAY GIVE ME BACK THE WIFE I LOST 4 YEARS AGO?
Answer >
I understand the great difficulties and problems this can cause. Alzheimer's disease affects the cortex, the outer layer of the human brain and it is well documented that Alzheimer's disease causes a major disturbance of language. In some patients the word finding problems remain mild for lenghty periods. In others the loss of language is rapid and this is very upsetting. An important thing to remember is that comprehension is often much better than you might imagine. We see this often in research. A person who is still functioning well yet who has a very low memory score because they cannot say the words to answer the questions. Sadly this means that many people are excluded from research studies because their memory scores are too low. You do not say if your wife is currently receiving any treatment or what recent memory scores have been. There are new treatments such as vaccines being studied but to know if your wife would be eligible to participate she would have to be properly evaluated.
Date Posted 13/04/10
Question >
My mother-in-law is on Donepezil but it does not seem to be doing anything. She has been diagnosed as having the first stages of Alzheimer's in early 2008 but is in full denial. She keeps saying that her memory is not as good as it used to be and we both know it is abysmal. She has carers coming to see her twice a day but refuses to admit this. She gets very aggressive as a result. Her short term memory is getting worse. Does this mean that she will be reaching the second stage soon and if so, how would we know and how long would this take. Many thanks for your help and any advice will be very welcome.
Answer >
The scenario you describe is sadly not uncommon. We know that about 50%-60% of patients prescribed an acetylcholinesterase inhibitor,and donepezil (Aricept)is a drug within this class, will show evidence of response to treatment. The remainder for reasons not fully understood do not respopnd. For some doctors response is taken as evidence of stability or no deterioration. Some individuals do positively respond to treatment and this response can be maintained for varying periods of time.
It appears form what you say in your mother-in-laws case that she is not responding to treatment. You do not say what her age is, the current dose of donepezil or mention the result of the memory test that is often done. I am referring to the Mini-Mental State Examination test (MMSE). This is scored out of 30 points. The mild dementia range or early stage you refer to would normally include those individuals with score in the 20-26 range. Once the MMSE score starts to fall below 20 out of 30 then this is more in keeping with moderate dementia.
I think from a practical point of view a discusssion with those involved with her medical care might be helpful. It would be helpful to know what the current memory score is and how it has changed. Is there any room to increase the dose of donepezil? She may already be at the maximum daily dose of 10mg. You also highlight episodes of aggression and this should be discussed and monitored as we know behavioural disturbace occurs not infrequently in this condition and may be amenable to additional treatment.
Date Posted 03/04/10
Question >
My wife is 80 and has quite advanced Alzheimers. She cannot take medication due to an irregular heart beat.Could there be any advantage to her condition by registering.She is at present under care of the local consultants.
Answer >
There are many causes of an irregular heart beat. Often this can be diagnosed from a simple ECG tracing, sometimes more prolongued recording of the heart beat is required. You mention that your wife has quite advanced Alzheimer's disease. If you feel that she would be able to visit the clinic for assessment then we could potentially arrange to see you both.
The method of contact would be for you to telephone the clinic during working hours and explain the reason for your call. A member of the research team will ask you some questions to try and ensure your wife might be potentially suitable. There will be questions about her medical history and current medications. It is possible that a research study might be available that your wife could participate in even though she has been deemed not suitable for prescription medication for her Alzheimer's disease.
Date Posted 01/04/10
Question >
My 79 year old mother developed AMD very quickly last year and has now been registered blind, although she has very limited sight in one eye. She also has acute open angle glaucoma. At the same time that her eyesight deteriorated rapidly, her short term memory seemed to disappear overnight. She was recently assessed as 15/28 on the tests and Alzheimer's was diagnosed, although the memory clinic said it was sometimes difficult to determine between loss of memory and loss of sight in assessing her. A recent brain CT scan from the hospital where she was taken after being hit by a car, and smashing the windscreen with her head, showed evidence of brain shrinkage. She has also suffered four other blows to her head when she has fallen due to her eyesight. She will soon start a course of Aricept. I have done some research on the internet and there seems to be strong evidence of a link between AMD and Altzeimer's. Are there any other studies being undertaken at the present time with regard to this link? The doctor at the memory clinic was unaware of any link, and I wonder whether she will in fact get the correct treatment.
Answer >
This is an interesting issue that you raise. Age related Macular Degeneration is not in my experience a condition that I immediately associate with Alzheimer's disease. In fact in my experience over the 17 years that I have been involved with assessing patients with Alzheimer's disease it occurs infrequently in the Alzheimer population that I have seen. That is of course not to say that there is not an association and it is quite feasible, and certainly worthy of further investigation whether in some cases there is a link. Please see a link below to a recent article highlighting the genetics of AMD
Whilst it is commonly said that Alzheimer's disease is not geneticlly inherited, our understanding of the condition continues to evolve. It is of increasing interest to test the genetic profile of an individual presenting with probable Alzheimer's disease, the APOE4 gene being one in particular. We know in certain cases there is a strong family history of Alzheimer's. You may already have had sight of the article below that links AMD and Alzheimer's throught the APOE4 gene
http://linkinghub.elsevier.com/retrieve/pii/S0002929707607411
I would encourage you therefore to continue to take an interest in this area. Your mothers ophthalmologist may have some thoughts on this. Visual disturbance in Alzheimer's disease is well documented and you may be familiar with the recently highlighted variant of Alzheimer's disease PCA (Posterior Cortical Atrophy) suffered by author Terry Pratchett. Of course the presence of significant visual disturbance does make the diagnosis of Alzheimer's disease more challenging, but I have seen patients, registered blind who are able to read the words and copy the various diagrams often presented in the course of memory testing used in the diagnostic process.
The falls and blows to the head are of course very important in the history of this case. It would be very difficult to attribute the degree of cognitive impairment if any due to these episodes. I think offering a trial of treatment with donepezil seems very reasonable and I hope this is beneficial.
I am not aware of current studies looking specifically at the link between AMD and Alzheimer's.
Date Posted 26/03/10
Question >
My Mother is 85 was diagnosed with Ad 2003 from mini mental test scoring 23 twice. No other medical tests carried out. Prescribed Exelon. Had B12 deficiency diagnosed 2008 now on monthly injections. Had recurrent urine infections & they wanted to put her in a home becasue of aggressiveness. 12 months later she is on permenant antibiotic and infections have stopped. She does remember who we are, she can do things herself but the system has nearly driven her to be an invalid. Only for me keeping on her case have I kept her out of a home. Following an ecoli infection last August I took her off Exelon and she improved no end. Got refered back to hospital and they agreed to keep her off it. After a fall & brain scan it appears the bits on the ends have died and the brain was described as extremely good for her age. I really dont know where to turn for help but I have her at home and she is happy. She lacks lustre & gets very lethargic. Her history from 40 years back is one of sleepless nights, restless leg syndrome, temazepam & co-proximol for years which caused some convulsions. Her night sweats, leg cramps pins & needles all went with B12 injcetions. She sleeps like a log every night now she is off Exelon, doesnt fiddle, wander or take things in & out of drawers. Can I do more for her like vitamins or Q10.
Answer >
The scenario you describe is possibly not that uncommon and highlights a number of issues. The Mini Mental State Examination is a test that is designed to give an indication of cognitive function. An MMSE score of 23 out of 30 is within the mild dementia range. You may wonder if this score was in fact due to the deficiency of Vitamin B12. Many elderly people have low Vitamin B12 levels and it is usually said that the level has to be very low for it to have an impact on memory function. However if the level is low then appropriate replacement therapy is usually given. The memory may not improve with the initiation of B12 therapy but other complications such as anaemia should be avoided. Recurruent urinary infection is common in elderly females and it is good that this problem now appears to have been dealt with. My understanding is that now your mother is on no memory enhancing medication. You wonder if vitamins may be beneficial. A good diet, exercise, fresh air, interacting with others are all important. The actual benefits of taking vitamin supplements (unless for a confirmed deficiency such as the B12 that your mother is taking) in this situation are not really known. It is important to remember that dementia is common in the over 80's and monitoring the memory function even though no treatment is being prescribed may be worthwhile.
Date Posted 18/01/10
Question >
My mother is 67 and starting to forget quite a number of things, mainly words or conversations had etc. She has also got problems with short term memory. Is this an early sign of Alzheimers?
Answer >
Memory impairment is one of the early signs of Alzheimer's disease. The symptoms you descibe should be evaluated.
Many people as they get older experience a decline in memory function, particularly short term memory. For most this is viewed as
part of the ageing process, without significant imapct on daily life. We know however that for some the memory decline continues and eventually it becomes
clear that the problem is more that what is often termed age related memory loss.