My wife is 82 years old and has had dementia for many years. She was diagnosed with Alzheimer’s and given many different medications to try but nothing worked. When she started getting worse her physician prescribed Seroquel.
About four or five weeks into taking the medication, she became really confused. She would wake up at night and want to go home without realizing that she already was home. It scared me so much that I was afraid to go to sleep in case I didn’t hear her get up.

After reading your column, I took my wife off the Seroquel and noticed a dramatic change within a week. She has told me that she is feeling better than ever. She now takes 3 mg of melatonin which helps her sleep all night and she has no more confusion during the day.

DEAR READER:
I am glad to hear that my column helped your wife; however, if she has dementia, she should never have been prescribed the medication.

Seroquel is an anti-psychotic medication used to treat conditions such as bipolar disorder, not Alzheimer’s. There is even a black box warning stating that it should not be used in elderly dementia patients. Assuming your wife really has Alzheimer’s, her physician made a potentially dangerous error.

You say that your wife is feeling better, no longer confused and sleeping all night thanks to stopping the Seroquel and starting melatonin. If she is no longer having symptoms of dementia, perhaps she doesn’t really have Alzheimer’s.

There are several disorders that can cause dementia and other neurological changes. Vitamin deficiencies, normal pressure hydrocephalus, Alzheimer’s, even depression or sleeping abnormalities and more are possible culprits. Some are reversible, others are treatable but until there is a positive diagnosis, there is no way to knowing what will help her.

I urge your wife to undergo testing to determine the cause of her dementia. She should also be under the care of a neurologist if she isn’t already. If she is seeing such a specialist, ask for a referral for a second opinion. If it was her primary care physician who prescribed the Seroquel, perhaps it would be appropriate to find another since he or she has already shown disregard for medication warning labels.

If symptoms persist, but are mild she may be fine without medication, but be sure to speak with her specialist about this. It is also important that you take proper care of yourself. Providing full time care for a dementia patient can be incredibly difficult. You may find it easier and more rewarding if you bring in occasional help from a local visiting nurse association. This type of organization can provide assistance to the care taker as well as the patient.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

My physically healthy husband has no memory of our past 59 years, including yesterday. However, he keeps up his hygiene, does his daily chores, fixes his own meals and more. Out sons are not recognized and our dogs are nameless. I am now the “nice lady” who stays here. He refuses all mental tests claiming that all old men have memory problems and periods of confusion. He seems very serene but nearly every evening he makes bizarre exclamations such as “Those two men came in and said I can’t use the shower”, “Am I supposed to stay overnight?”, “Where did my wife go?” or “This building (meaning our home) is condemned, we have to move.” A few minutes later he won’t even remember saying anything.

Dr. Gott, what is causing these “episodes”?

DEAR READER:
Not all memory loss and confusion leads to Alzheimer’s disease. In fact, I highly doubt that this is what your husband is suffering from because Alzheimer’s patients generally remember the past quite clearly but forget names, dates, and current goings-on.

Dementia is defined as an organic loss of intellectual function. This means that, due to natural causes, memory, cognition, personality and other mental changes occur.

Your husband clearly is having some sort of mental faculty change and, in my opinion, needs to be seen by a neurologist. Given his specific symptoms, there are likely only a few disorders that could cause his situation. It is important that you create a list of his symptoms, when they started and if they were preceded by an accident, injury or other abnormal event.

If you have power of attorney, you should have no problem getting him the testing he desperately needs. However, if you do not, this could become a bit of a sticky situation. He clearly does not want to be seen, but in fact, should be. You may need to prove to a judge that he is incapable of making important decisions and should get a court-approved power-of-attorney.

While this does not sound pleasant, it could be the very thing that saves his life. If his memory loss is the result of a simple, reversible disorder, the longer it goes untreated, the more permanent damage he could be inflicting upon himself. If it is not reversible, however, it is still vital to know what the disorder is. You say you have sons. If not for your husband, find out what it is for them, as many types of dementia can be carried down from family member to family member. As with Alzheimer’s patients, close blood relatives (aunts, uncles, mothers, fathers, children, and siblings) could be at an increased risk.

Your husband does not have age-related memory loss and confusion, but without testing, I cannot tell you what the cause is. Get him the help and testing he won’t get for himself.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Medical Specialists”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

The field of Clinical Neuropsychology is a subspecialty within Clinical Psychology. It has existed as a clinical discipline since about the late 1970’s. Neuropsychologists use detailed standardized testing of a range of brain functions (e.g. memory, attention, perception, executive abilities, language, personality, etc.) Decades of careful research now allow neuropsychologists to recognize the hallmark early features of a range of neurological disorders that affect cognition, and to assist with the diagnosis of these conditions.

As a clinical neuropsychologist, it is often part of my job to differentiate between normal changes in memory that occur with aging, isolated memory problems (that do not constitute dementia), and a range of patterns that are associated with the different dementias. For example, in the early to middle stages, it is possible to differentiate between a subcortical presentation (as you would see in Parkinson’s disease), and presentations that are more cortical (like Alzheimer’s disease). Another common clinical presentation is frontotemporal dementia, with its classic features that are different than Alzheimer’s. Vascular dementia has other patterns. Neuropsychologists also commonly differentiate between depression and dementia.

Alzheimer’s disease, in particular, has been heavily studied for decades. Although it is not a perfect science, we CAN detect early Alzheimer’s classic features, and there are even markers for pre-Alzheimer’s presentations that are under study, allowing us to predict who will go on to develop it.

My goal is to highlight to you the contributions of neuropsychology as an important diagnostic tool in dementia evaluations. All patients who are suspected of having memory problems or other cognitive changes should be seen for neuropsychological testing. Visiting a neurologist, except in rare cases, would not be sufficient for those with subtle or early-to-moderate symptoms. Brain imaging is also not that helpful with the diagnosis of dementia, as it is well-known that many patients with dementia will show no abnormalities on MRI until late in the disease; some with abnormalities will not necessarily have dementia.

Neuropsychologists are clinical psychologists who have completed a two-year postdoctoral residency in clinical neuropsychology and who are board certified or board eligible in the subspecialty. For more information about the field, I recommend going online to www.nanonline.org or www.the-ins.org.

DEAR DOCTOR: I was unaware (as I am sure many other doctors are, as well) of your field and the apparent advancements it has made with respect to the early diagnosis of various dementias. I have printed your letter in the hopes it will bring awareness of your specialty. Both physicians and patients could benefit from being able to refer patients for early diagnosis, or to rule out a diagnosis. Thank you for informing me of your specialty.

For readers who would like more information, I recommend ordering my “Alzheimer’s Disease” Health Report. It is available by sending a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Our family doctor put her on Aricept tablets initially but then switched her to Exelon patches about a year ago. Not seeing any improvement, I stopped her patch and requested a referral to a dementia specialist.

While waiting for the appointment, I heard some people have good results from taking two tablespoons of double virgin coconut oil daily. I began experimenting a week ago with two teaspoons daily added to my wife’s oatmeal. I think it is working. My wife even knows what day of the week it is now. What is your opinion on this alternative treatment?

DEAR READER:
There are numerous herbal remedies, supplements and vitamins promoted as memory enhancers. They include coenzyme Q10, coral calcium, ginkgo biloba and omega-3 fatty acids. Issues that come in to play with supplements are that purity and effectiveness are unknown and may vary between manufacturers or even batches. Makers of these over-the-counter remedies are not required to provide the Food and Drug Administration (FDA) evidence on which they base claims. Further, the suppliers are not required to report any adverse reactions to the FDA. Therefore, while a product might work for one individual, we fail to hear of those on whom it doesn’t work. Claims regarding safety and efficacy are based on testimonials such as yours.

Since the Alzheimer’s Association doesn’t address virgin coconut oil as a recommended supplement to be taken with or in place of FDA approved drugs, I must defer. I recommend you speak with her new specialist and be guided accordingly.

Because your wife is under the care of a cardiologist, you should also speak with him or her to be assured there will be adverse reaction between any prescription medication and over-the-counter supplements.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
First, I will briefly discuss hydrocephalus.

The body produces about eight ounces of cerebrospinal fluid (CSF) each day. Almost all of that fluid is reabsorbed into the bloodstream. When this fails to occur, as with head injury, stroke, meningitis or when a tumor develops, an imbalance occurs. This problem is known as hydrocephalus. There are two known forms, congenital and acquired. Congenital hydrocephalus generally occurs at birth. The acquired form (NPH) most frequently occurs in individuals over the age of 60.

Now, the problem. Symptoms include gait abnormalities, difficulty walking up and down stairs, confusion, urinary frequency and urgency, and short term memory loss. As you pointed out, these are also symptoms tied to Parkinson’s and also to Alzheimer’s.

Normal pressure hydrocephalus differs from congenital hydrocephalus in that pressure in the head may have fluctuations of CSF from high to low or even normal. Some cases are linked to bleeding in the brain or result from a blockage in the flow of CSF through and around the brain and spinal cord.

Diagnosis is made through computed tomography, magnetic resonance imaging, lumbar puncture, gait analysis, NPH protocol and more. The protocol involves a series of screening procedures to assist a physician with proper diagnosis. Part of that screening may be removal of CSF through a catheter over a 36 hour period.

Treatment of choice by a surgeon may be through an implantable shunt. The purpose of the shunt is to drain excess fluid away from the brain and spinal cord. Once the fluid is removed, symptoms can be partially or completely reversed.

Parkinson’s disease, on the other hand, occurs when nerve cells in a part of the brain die or become impaired. These cells produce a chemical known as dopamine in healthy individuals. The dopamine provides a coordinated function of the body’s muscles. When about 80% of the cells are damaged, symptoms of Parkinson’s appear. An individual may be depressed, handwriting may become cramped and illegible, a tremor may be present, there may be gait and postural abnormalities, the sense of smell may be diminished, there may be a loss of facial expression; memory and slow thinking can occur; sleep patterns, and urinary incontinence or constipation can be present.

Evaluation is generally completed by a neurologist who specializes in the disease. There are no x-rays or blood tests to confirm the diagnosis. It is chronic and progressive but affects each individual differently. Some patients may have a noticeable tremor; others may have extremely mild symptoms that don’t progress rapidly.

Medication is available and may be prescribed in conjunction with medications that act like dopamine. Studies are ongoing in treating this difficult disease.

Alzheimer’s disease is a disorder that results from the gradual loss of brain cells. Two brain abnormalities associated with Alzheimer’s include clumps of protein fragments that accumulate on the outside of cells and clumps of altered protein that accumulate within the cells.

Age is the greatest risk for developing Alzheimer’s. Statistics reveal that up to 10% of all people 65 and older and up to 50% of those 85 and older are affected.

Symptoms include memory loss, disorientation as to time and place, difficulty speaking or finding specific words, personality changes, misplacing items around a house, difficulty performing routine tasks, dressing inappropriately for the season, and more. An individual may forget a dentist appointment, not remember how to dial a phone, forget how a radio or television is turned on, or have a dramatic personality change. He or she may become fearful over simple issues and will likely become more dependent on family members or caregivers.

There is no single test to confirm diagnosis. A medical history, status of mental health, gait testing, laboratory testing and more may be required. If memory loss is tied to a drug interaction, vitamin deficiency, thyroid abnormalities and a host of other conditions, reversal of symptoms is possible. For example, vitamin E has been recommended for mild to moderate dementia. Testing is ongoing to determine if folic acid supplements that lower homocysteine levels can treat or prevent the disease. Long-term nursing home care may be needed as a patient’s symptoms progress.

Medical advances are ongoing and extremely promising, and support groups are available for both the patient and families.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease”. Other readers who would like copies should send a self-addressed, stamped, number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the titles.

Can you tell me what causes this? Is it terminal? Her doctors have said there is no cure or help they can offer her. It is very sad to see her struggle like this.

DEAR READER:
Frontotemporal dementia (FTD) is a blanket term for a group of rare disorders that affect the frontal and temporal portions of the brain. These areas are associated with personality, behavior and language. Disorders in the group include Pick’s disease, primary progressive aphasia and semantic dementia. There is currently a debate whether to include corticobasal degeneration and progressive supranuclear palsy. Should this happen, the name would likely be changed again to Pick Complex.

Currently there is no treatment that has been shown to slow FTD. Because the inability to control behavior and personality are the primary symptoms of most of the disorders that make up FTD, behavioral modification, anti-depressants and sedative/tranquilizers to control dangerous or unacceptable behaviors may be necessary. Your daughter has a subtype which causes impairment or loss of the ability to understand and perform speech and other linquistic abilities. Primary progressive aphasia, which your daughter has, affects not only spoken language but written language as well. Speech therapy may be an option.

Some of the subtypes of frontotemporal dementia appear to have a genetic component. Often, however, there is no family history. Researchers are still trying to uncover what causes these conditions but most involve a loss of nerve cells, shrinkage of the frontal and temporal lobes of the brain and deposits of damaged proteins inside nerves.

Unfortunately, at this time, FTD does appear to be a terminal affliction. Some suffers may live only two years and others up to 10. Eventually most will require 24-hour care and monitoring. Each case is different and the rate of deterioration varies.
I suggest you speak with your daughter’s physicians for their prognoses as they are most familiar with her specific case. They may be able to put you in contact with support groups and organizations that can help you prepare to care for her properly. It is important to make your daughter as comfortable as possible and that means knowing what may come next as her disorder progresses.

I recommend that you, and others interested in learning more about frontotemporal dementia, go online to learn more. Excellent information is available from the National Institute of Neurological Disorders and Stroke (www.nihds.nih.gov), the Association for Frontotemporal Dementias (www.FTD-Picks.org or 1-866-507-7222) and the Mayo Clinic (www.MayoClinic.com).

Because FTD is similar to Alzheimer’s disease, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The place he lives in has ticks. Also, a friend of his who lives in the neighborhood has had Lyme disease. What are the symptoms of the disease, therapy, cure and duration?

DEAR READER:
Lyme disease was first recognized in 1975 following an excessive outbreak of arthritis near Lyme, CT. Lyme infection is spread by the bite of a black-legged deer tick (Ixodes scapularis) in the northeast and north-central United States. On the Pacific coast, the culprit is the western black-legged tick (Ixodes pacificus).

Most individuals are infected through bites of immature ticks known as nymphs that are tiny and difficult to see. For the most part, they feed during spring and summer. Adult ticks can also transmit Lyme disease bacteria, but because they are so much larger than nymphs, they are easier for an individual to see and remove from clothing or skin before they have had time to feed. The complete life cycle of an Ixodes is two years; a complete meal can take several days and the tick’s body enlarges as it feeds. The general consensus is that a tick must feed for two days before it can transmit bacteria. However, some physicians take the position that if a tick feeds at all, it can transmit the “disease”.

Ticks attach to animals or humans as they brush against them. They can neither jump nor fly. The risk of exposure is greatest in wooded areas, but keep in mind that animals can carry ticks from a wooded area into your backyard. Hosts such mice and deer can provide food for ticks throughout their stages of life.

Lyme disease is most frequently identified by a characteristic skin rash or rashes, bull’s eye ring or rings, fatigue, muscle and joint pain, headache, chills and fever. The difficulty here is that the symptoms mimic those of the flu. Physicians outside an endemic area will often lean toward a virus or arthritis, rather than Lyme disease during the initial stages. Without a characteristic rash or bull’s eye ring, the most important thing a suspecting individual can present to his or her physician is a complete history of possible exposure to ticks and any classic symptoms. Not all rashes that occur at the site of a bite are Lyme disease. This is because when a tick bites an individual, an allergic reaction to the tick’s saliva results. This reaction ordinarily appears within a few hours to a few days following the bite. It does not enlarge, often itches excessively, and should disappear within a few days to a few weeks.

Some physicians will choose to treat an individual simply by history and symptoms. Others might choose to order laboratory testing to confirm the diagnosis. Unfortunately, testing takes several days, during which a patient can be quite uncomfortable.

Several antibiotics are available for treating Lyme disease. They are given orally during early stages and recovery is often rapid and complete. For those with late-stage Lyme, intravenous antibiotics might be preferred. Some individuals suffer recurrent symptoms and may require a second course of treatment. There is some question on the length of time an individual should remain on antibiotic therapy. Your own physician can best guide you.

Following a walk in the woods or in areas where deer and mice traverse, a complete body check should be made for any ticks that might have attached to skin or clothing. Should a tick be found, there is no need to panic. Remove it with tweezers placed nearest the skin and as close to the head of the tick as possible. Carefully pull the tick away from the skin and dispose of the body. Do not become alarmed if the mouthparts remain in the skin.

Prevention includes avoiding walking in known tick-infested areas, using insect repellent with DEET and wearing protective clothing. Avoid shorts. Tuck long pants inside socks or boots and shirts into pants. And most important of all, remember daily tick checks.

I do not feel your friend’s loss of memory and nervousness are related to Lyme disease. If he is that concerned, a simple blood test will assist. He should visit his primary care physician, explain his concerns and be referred to the appropriate specialists if his doctor cannot pinpoint the problems.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Now, after several embarrassing summers, we are trying to go back to a normal deodorant that actually works as we have been informed that the Alzheimer’s/aluminum theory is invalid. What are your thoughts on this?

DEAR READER:
Years ago, aluminum as an anti-perspirant was considered to be harmful. Although the relation to dementia has been invalidated, I still advise patients to avoid anti-perspirants and stick to aluminum-free deodorants. In my opinion, these are less harmful to the body because they simply block the odor rather than stopping the perspiration. If, however, you wish to switch back to traditional anti-perspirants and deodorants, do so.

On to Alzheimer’s. There is no cure and no sure-fire prevention for this dreadful condition. Emerging science is showing us, however, that there are some foods (such as blueberries) that seem to benefit the brain. It is also important to keep our brains as active and sharp as possible by challenging ourselves with logical thinking and creativity. There are some medications available that slow the progression of Alzheimer’s after diagnosis but there is no way to prevent worsening, only ways to delay its arrival.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Because I can never talk to my doctor (only his assistants) I was hoping you could tell me what this means.

DEAR READER:
The Circle of Willis is an area at the base of the brain where several arteries join together. While all brain aneurysms are potentially dangerous, one situated in the Circle of Willis is especially so because the interior carotid arteries branch off from this area and supply about 80% of the brain’s blood.

Encephalomalacia is an abnormal softening of part of the brain, usually because of a restricted blood supply (ischemia) or death of the tissue (infarction, often due to loss of the blood supply).

The right temporal lobe is responsible for the memory of shapes and sounds. Damage to this area can cause loss of that type of memory and occasionally can cause personality changes such as loss of libido, humorlessness, extreme religiosity and others.

From your brief letter I cannot determine if you had the aneurysm surgically repaired or if it has remained untouched. In either case, the aneurysm may be directly related to your brain softening because the right temporal lobe is in close proximity to the right side of the Circle of Willis.

You need to have a follow-up examination so I urge you to see a neurologist for further testing. He or she can explain in better detail what symptoms may be caused by the abnormality and if there are any possible treatment options. The specialist can also give an accurate outlook about how this may affect you in the future and if it will require any special considerations as you age.

I would like to add that I am disappointed at the hospital doctors and your personal physician for not providing you the diagnosis, prognosis and other vital information. If your doctor cannot be bothered to speak with you about your situation, it is time to find a new physician who will be more caring and attentive. Because of your age, you may find that a gerontologist (practitioner who deals with senior citizens only) is an appropriate choice. These specialists are specially trained to recognize and care for maladies of the elderly. They also serve as general practitioners for normal routine check-ups and more.

To give you related information, I am sending you copies of my Health Reports “Alzheimer’s Disease” and “Parkinson’s Disease”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).