Alzheimer’s Disease

Will studies of our genes change medicine and improve our lives?

In yesterday's column, a reader asked whether she should be tested for genes linked to Alzheimer's disease. Today, I thought I'd give you my view on the larger question: Will studies of our genes change the practice of medicine and improve our lives?

My answer: During my career, progress in human genetics has been greater than virtually anyone imagined. However, human genetics also has turned out to be much more complicated than people imagined. As a result, we have not moved as rapidly as we had hoped in changing medical practice.

Will it help to get gene testing for Alzheimer’s if it runs in my family?

DEAR DOCTOR K: Alzheimer's runs in my family. Will it help to get gene testing for this disease?

DEAR READER: Family history is indeed a risk factor for Alzheimer's. If you have a parent or sibling with Alzheimer's, you're more likely to develop the disease than someone who does not have a close relative with this condition. Genetics is most important in families with a history of early-onset Alzheimer's (occurring between ages 30 and 60). The early-onset form accounts for less than 1 percent of all Alzheimer's cases, but in most people with early-onset disease, the cause is one of several altered, or mutated, genes that the person has inherited from a parent.

I often feel guilty and frustrated when taking care of my mother with Alzheimer’s — Can you help me change my outlook?

DEAR DOCTOR K: I do my best to care for my mother, who has Alzheimer's disease. But I often feel guilty and frustrated. Can you help me change my outlook -- for my sake and my mother's?

DEAR READER: Fortunately, I never had to face the challenge that you face, as my parents both died while in full possession of their faculties. But many of my patients and friends are experiencing what you are going through. And like you, they often feel guilty and judge themselves harshly.

My husband has Alzheimer’s — how can I keep him from wandering?

DEAR DOCTOR K: My husband has Alzheimer's disease. Last week he left the house, and it took us hours to find him. How can I prevent him from wandering again?

DEAR READER: One of the most dangerous and distressing symptoms of Alzheimer's is wandering. It may seem unfathomable that a person might suddenly get up at night to go to the post office, or leave home at any hour for no apparent reason. The inability to control wandering is what often drives families to decide to place a loved one in a nursing home.

What is sundowning?

DEAR DOCTOR K: My wife is in her late 70s. Lately she appears very tired and agitated in the evenings. I talked to a doctor friend who said she might be "sundowning." What is sundowning, and what can we do about it?

DEAR READER: Some older people have trouble concentrating, grow agitated or even confused, and become especially fatigued at the end of the day. This phenomenon is known as "sundowning" because its effects tend to coincide with sunset -- usually occurring in the late afternoon into the evening, then settling down late at night.