Alzheimer’s Disease

Are there any new treatments on the horizon for Alzheimer’s disease?

DEAR DOCTOR K: Is there anything new on the horizon for treatment of Alzheimer's disease?

DEAR READER: Alzheimer's disease affects more than 5 million people in the United States, alone. And that number is expected to more than double by 2050. I spoke to my colleague Dr. Gad Marshall about advances in Alzheimer's treatment. He is an assistant professor of neurology at Harvard Medical School.

My father has Alzheimer’s disease. Does that mean my children and I will eventually develop it too?

DEAR DOCTOR K: My father has been diagnosed with Alzheimer's disease. Does that mean that my children and I will eventually develop Alzheimer's too?

DEAR READER: Many people worry that if a parent had Alzheimer's disease, they are doomed. But that's not true. Having a first-degree relative (parent, sibling or child) with Alzheimer's disease increases a person's risk by about 30 percent. That sounds like a lot, and therefore sounds scary. But what you really want to know is: What is my risk in the first place? If it's a very low number, then raising a low risk by 30 percent won't be a big deal.

What is sundowning?

DEAR DOCTOR K: My husband and I are in our early 80s. Sometimes in the evening he is agitated, confused, and just quite a handful to deal with. The doctor says he has "sundowning." What is it, and is there anything I can do?

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.

What medications treat Alzheimer’s disease?

DEAR DOCTOR K: My mother has been diagnosed with Alzheimer's disease. Can you tell me about medications that are available to treat this disease? What can and can't they do?

DEAR READER: Alzheimer's disease is a form of dementia. It often affects short-term memory early on. It then progresses to impair other cognitive functions such as thinking and judgment. As the disease advances, it can affect a person's mood and behavior. Eventually, most people lose their ability to do normal daily activities.

Are there any medicines that protect against Alzheimer’s?

DEAR DOCTOR K: I've heard that certain common medicines used for other purposes may also protect against Alzheimer's disease. Is there any truth to this?

DEAR READER: You've raised an important question. Unfortunately, research has not so far provided a clear answer. HORMONE THERAPY. For years, doctors believed that hormone therapy might protect women from Alzheimer's disease. This therapy replaces the hormones that a woman no longer makes after menopause. The possibility that hormone therapy might offer protection was raised by studies which found that women who took estrogen were less likely to develop Alzheimer's than those who didn't.

How does Alzheimer’s wreak so much havoc in the brain?

DEAR DOCTOR K: My grandmother has Alzheimer's disease. Over the past few years I have watched the disease take a toll on her judgment, memory, even her personality. How does Alzheimer's wreak so much havoc in the brain?

DEAR READER: In the past 25 years, medical science has learned a great deal about what causes Alzheimer's disease. Before that, we basically knew just that the brains of people with this disease, viewed with a microscope, had some unusual features. We knew that the disease caused brain cells to die prematurely, but we didn't know why. Today, I think we are closing in on understanding some major causes (if not all of the causes) of brain cell death.

Can dementia be treated or reversed?

DEAR DOCTOR K: My mother has started showing signs of dementia. Will it be all downhill from here? Or can dementia ever be treated or reversed?

DEAR READER: There are many different causes of dementia. We can't do much to slow or reverse some of them, but we can reverse and even cure others. Dementia is a catchall term. It covers a variety of illnesses that cause memory loss, confusion, changes in personality and declining ability to perform everyday activities.

What is the outlook for someone as Alzheimer’s progresses?

DEAR DOCTOR K: My mother has Alzheimer's disease. What should I expect in the coming years?

DEAR READER: It's impossible to predict exactly how Alzheimer's disease will affect someone. Symptoms of the disease, and how quickly they progress, can vary widely from person to person. In some people, for reasons we don't understand, the disease progresses very slowly.

What does neuropsychological testing involve?

DEAR DOCTOR K: My husband's doctor suspects that he has Alzheimer's disease and wants him to have neuropsychological testing. What will these tests involve?

DEAR READER: There is no single test that can diagnose Alzheimer's disease. In fact, a doctor cannot make the diagnosis with absolute confidence without studying the brain under the microscope, which is rarely done except in an autopsy. Alzheimer's disease is diagnosed presumptively by a combination of different types of evidence. The disease typically has a slowly progressive onset. Sudden confusion or speech problems, for example, are not caused by Alzheimer's.