Alzheimer’s Disease

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.

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.