Alzheimer’s caregivers: Dealing with repeated questions

My mother-in-law has dementia and repeats the same questions over and over.  What is the best way to respond?

Repeating questions is a very common behavior in people with impaired memory.  Some Alzheimer’s caregivers cope with this problem by answering the question each time — recognizing that the interchange is simply a way for the confused person to seek reassurance.  However, this requires tremendous patience.

Another technique to try: If your mother-in-law has retained her ability to read, write the answer to the repeated question on an index card.  Give the index card to your mother-in-law, and when she repeats the question, tell her — in a very matter-of-fact tone — to check the index card.  After a number of reminders, your mother-in-law may eventually learn to check the card to receive reassurance, instead of repeating the question to you.

Alzheimer’s disease: Can exercise prevent memory loss?

Yes, it might.  Exercise has many known benefits, including reducing the risk of cardiovascular disease and diabetes, strengthening the bones and muscles, and reducing stress.  It also appears that regular physical activity benefits the brain. Studies show that people who are physically active are less likely to experience a decline in their mental function and have a lowered risk of developing Alzheimer’s disease.

Exercising several times a week for 30 to 60 minutes may:

  • Keep thinking, reasoning and learning skills sharp for healthy individuals
  • Improve memory, reasoning, judgment and thinking skills (cognitive function) for people with mild Alzheimer’s disease or mild cognitive impairment
  • Delay the start of Alzheimer’s for people at risk of developing the disease or slow the progress of the disease

Physical activity seems to help the brain not only by keeping your blood flowing. It also increases chemicals that protect the brain and tends to counter some of the natural reduction in brain connections that occurs with aging.

More research is needed to know to what degree adding physical activity improves memory or slows the progression of cognitive decline.  Nonetheless, regular exercise is important to stay physically and mentally fit.

Alzheimer’s disease: Does high IQ slow progression?

Is it true that Alzheimer’s disease advances more slowly in people with higher IQs? My father, who is a Ph.D., has had this disease for nine years and can still function pretty well.

Not everyone with Alzheimer’s disease will experience the same symptoms or progress at the same rate.

Some researchers believe that people with higher IQs or advanced education are more resilient to dementia than are those with lower IQs or less education. Other researchers argue that advanced education gives a person more experience with the types of memory and thinking tests used to measure dementia.  This advanced level of education simply may help some people hide their condition longer.  As a result, by the time such a person is diagnosed, he or she may actually decline more rapidly because the disease is more advanced at that point.

There’s no evidence that high IQ or advanced education increases life span or survival rates in people with Alzheimer’s disease.

Alzheimer’s nose spray: New Alzheimer’s treatment?

I recently heard about a new Alzheimer’s treatment, a nose spray containing insulin. How does it work and is there an Alzheimer’s nose spray available?

Insulin — a hormone that helps regulate your blood sugar — appears to play a role in normal memory processes.  Insulin irregularities may contribute to cognitive and brain changes associated with Alzheimer’s disease.

In the past several years, researchers have been investigating the use of insulin to treat Alzheimer’s disease.  One of the challenges is how to provide insulin in such a way that it improves brain function without disrupting your blood sugar levels.  If your blood sugar drops too low, for example, it can create complications, such as confusion, heart palpitations, anxiety and visual disturbances.

Preliminary research suggests that when taken as a nose spray, insulin reaches the brain within a few minutes and improves memory.  However, this research involved small groups of participants who had either early Alzheimer’s disease or mild cognitive impairment.  Although this research is promising, more research on the safety and effectiveness of intranasal insulin therapy for Alzheimer’s disease is necessary.

Alzheimer’s prevention: Does it exist?

Are there any proven Alzheimer’s prevention strategies?

According to a statement from the National Institutes of Health (NIH), a number of factors could play a role in whether you develop Alzheimer’s disease. However, more research is needed before modification of any of these factors can be proved to prevent Alzheimer’s disease.

The NIH report was developed by an independent panel of health professionals and public representatives who reviewed the most current research on Alzheimer’s prevention.  The panel found that studies to date have varied too much in size, scope, criteria and definitions to compare results and draw reliable conclusions.

Although more research is needed to definitively prove which Alzheimer’s prevention strategies are effective, some possible strategies that promote good overall health include:

  • Avoiding smoking
  • Eating a balanced diet rich in vegetables, fruits and lean protein, particularly protein sources containing omega-3 fatty acids
  • Being physically and socially active
  • Taking care of your mental health
  • Using thinking (cognitive) skills, such as memory skills

Alzheimer’s test: Detection at the earliest stages

I read about experimental Alzheimer’s tests that can detect early stages of the disease.  Are these really helpful?

An important first step in developing a treatment plan for any disease is having a clear diagnosis.  New Alzheimer’s tests may help with early detection of the disease.  However, before these become widely available, more research is needed to determine who might benefit from them and what they reveal about the progression of Alzheimer’s and other diseases.

  • Biomarker test. Researchers have proposed an Alzheimer’s test that measures two proteins, beta-amyloid and tau, in cerebrospinal fluid.  The doctor removes a sample of the fluid that surrounds your brain and spinal cord by using a needle inserted into your spinal canal (lumbar puncture). The fluid is examined for evidence of abnormal development of beta-amyloid proteins, which form plaques, and tau proteins, which form tangles.  Both plaques and tangles are thought to contribute to the development of Alzheimer’s disease.  These proteins can help identify people with mild Alzheimer’s disease and mild cognitive impairment (MCI) who are likely to progress to more-serious forms of the disease.
  • Brain imaging (neuroimaging). Brain imaging — using equipment to record images of changes in the brain — is another area of research. Researchers are studying use of imaging techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, used in conjunction with radiotracers.  These radiotracers are charged particles that “light up” Alzheimer’s affected areas in images of the brain — for example, by attaching to proteins associated with Alzheimer’s disease.
  • Cognitive assessment. Technology is also being used to develop software for computer-based assessments that detect cognitive changes and may be useful in the early diagnosis of Alzheimer’s disease.

Early detection and diagnosis of Alzheimer’s disease is an important goal.  Early intervention with medications may slow the progression of the disease and provide a better opportunity to plan for the future.

Alzheimer’s: Can a head injury increase my risk?

Can a head injury cause or hasten Alzheimer’s disease or other types of dementia?

The immediate effects of a head injury can include dementia symptoms, such as confusion, memory loss, and changes in speech, vision and personality. Depending on the severity of your injury, these symptoms may clear up quickly, last a long time or never go away completely. However, such symptoms that begin soon after your injury generally don’t get worse over time as happens with Alzheimer’s disease.

Certain types of head injuries, however, may increase your risk of developing Alzheimer’s disease or other dementias later in life. The greatest increase in future dementia risk seems to occur after a severe head injury that knocks you out for more than 24 hours. A moderately serious head injury that causes unconsciousness for more than 30 minutes, but less than 24 hours, also seems to increase risk to a smaller extent.

There’s no evidence that a single mild head injury that doesn’t knock you out, or that knocks you out for less than 30 minutes, increases your risk of dementia. However, repeated mild injuries may increase risk of future problems with thinking and reasoning.

You’re likely at greatest risk of developing dementia or Alzheimer’s later in life, post-head injury, if you also have other risk factors. For example, carrying one form of the apolipoprotein E (APOE) gene increases the risk of Alzheimer’s in any individual. A head injury in such a person would increase his or her risk further.

It’s important to note that many people who sustain a severe head injury never develop Alzheimer’s disease or later dementia. More research is needed to understand the link.

Alzheimer’s: Can a Mediterranean diet lower my risk?

Can a Mediterranean diet lower my risk of Alzheimer’s?

You may know that a Mediterranean diet — rich in fruits, vegetables, olive oil, legumes, whole grains and fish — offers heart-healthy benefits. But a Mediterranean diet may also benefit your brain. Studies show that people who closely follow a Mediterranean diet seem less likely to develop cognitive decline when compared with people who don’t follow the diet.

Research shows that a Mediterranean diet may:

  • Slow cognitive decline in older adults
  • Reduce the risk of mild cognitive impairment (MCI), a transitional stage between the cognitive decline of normal aging and the more-serious memory problems caused by dementia or Alzheimer’s disease
  • Reduce the risk of MCI progressing into Alzheimer’s disease

It’s unclear why following a Mediterranean diet may protect brain function. Researchers speculate that making healthy food choices may improve cholesterol and blood sugar levels and overall blood vessel health — all factors that may reduce the risk of MCI or Alzheimer’s disease.

Studies of the effects of diet on dementia are dependent on the recall of the participants — problematic when some of those studied have memory troubles. More research is needed to know to what degree a Mediterranean diet prevents Alzheimer’s or slows the progression of cognitive decline. Nonetheless, eating a healthy diet is important to stay physically and mentally fit.