Alzheimer’s Disease

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.

What is vascular dementia?

DEAR DOCTOR K: What is vascular dementia? Can it be prevented?

DEAR READER: The term "dementia" describes a serious impairment of mental function. It may include memory loss, confusion, personality changes and the dwindling ability to perform everyday activities. Alzheimer's disease is the most common type of dementia. The second most common is vascular dementia.

Is it unsafe for someone with Alzheimer’s to drive?

DEAR DOCTOR K: My father has Alzheimer's disease. Is it unsafe for him to drive?

DEAR READER: Alzheimer's disease (AD) is a form of dementia that worsens over time. It often affects short-term memory early on, and then progresses to impair other cognitive functions such as thinking and judgment. As AD advances, most people lose their ability to do normal daily activities. Your question -- whether your father should stop driving -- is a common concern for families of a loved one with AD.

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.