The number of Alzheimer’s cases is ever increasing, which leads me to ask why the FDA hasn’t banned this ingredient. Should I be concerned about the Tylenol PM I have been taking?

Thank you for any advice you may be able to give me as I am truly concerned, but I do need help in order to get a good night’s sleep.

DEAR READER: Tylenol PM contains 500 milligrams of acetaminophen (a pain reliever) and 25 milligrams of diphenhydramine, an antihistamine with sedating properties. Antihistamines may help control motion sickness and cough and induce sleep. Diphenhydramine is present in more than 80 different brands of similar products, including Sominex, adult and children’s Benadryl, PediaCare Children’s Allergy and Simply Sleep. The ingredient is in the Food and Drug Administration’s pregnancy category B, implying it is not expected to be harmful to an unborn baby.

The maximum dosage allowed in a 24-hour period is 300 milligrams, and most brands carry only a fraction of that amount. Overdose can lead to confusion, hallucinations, weakness, insomnia and possible seizures. Symptoms of overdose can include palpitations, headache, difficulty breathing, blurred vision and edema of the tongue and lips.

Older adults are strongly advised to check with their primary-care physicians before taking products containing the ingredient, as delirium and reduced cognitive skills have been reported. Until you get a definitive word from him or her, I recommend you hold off on all sleep aids.

As a point of information, melatonin is a hormone produced by a small gland in the brain. It is activated by darkness and causes the body to prepare for sleep. When our bodies are exposed to light, the melatonin is then converted into serotonin, which prepares us for activity.

As we age, the levels our bodies produce drop. This may lead to an increased risk of insomnia or even depression because serotonin aids in normal brain function. To combat this, I recommend you set the stage for a good night’s sleep. If you ordinarily nap during the day, limit those naps to no more than 15 minutes at a time or eliminate them completely. Daily naps might necessitate using an alarm clock to prevent oversleeping. Be sure your bedroom is dark. Draw the shades, keep the room quiet without interruption such as music or television, and schedule yourself so you retire at approximately the same time each night. Don’t drink or eat caffeinated or sugary foods or beverages for several hours before bed to prevent a burst of energy at an inappropriate time.

Your observation regarding products that could be detrimental to your health was an excellent pickup on your part. I commend you on remaining informed on such issues.

My father suffered from some of these symptoms, particularly increasing rigidity. He was later diagnosed at autopsy with Lewy body dementia. He, too, was on Aricept for several years with little or no difference in the condition.

DEAR READER:
Lewy body dementia is a relatively common form of dementia. It is characterized by the loss of the ability to think, reason and remember. This is due to the development of abnormal round structures (Lewy bodies) in the areas of the brain that control thinking and movement. It is unknown why these anomalies develop in the first place.

Symptoms are similar to both Parkinson’s disease and Alzheimer’s disease. A distinctive symptom is hallucinations that can appear very realistic. These can include sounds, shadows, colors, shapes, animals, people and more. Hallucinations are often the first sign of Lewy body dementia. Like Parkinson’s, it can also cause a shuffling gait, slowed movement, tremors and rigid muscles. Like Alzheimer’s, symptoms can include depression, memory loss, confusion, decreased cognition, and delusions.

Unlike other forms of dementia, sufferers of Lewy body dementia can experience large fluctuations in symptoms. They may awaken in the morning and be completely lucid and by late morning be inattentive or unable to stay awake. Symptoms can also worsen based on medication. If initial symptoms present as Parkinson’s disease and medicines designed to treat that condition are given, confusion, delusions, and hallucinations may worsen.

Lewy body dementia primarily affects individuals between the ages of 50 and 85 with a predominance toward men. You are at higher risk of developing this condition if you have a family member who had it. (Diagnosis can only be confirmed at autopsy.)

Unfortunately, there is no cure; however, treatments are available. Alzheimer’s medications seem to have the best results, but for some, like your father, do little good. Using memory aids and providing well structured environments often improve symptoms. Physical therapy, massage and even aromatherapy may also help. Reducing stress and situations that cause agitation, anger and fear are important and it is equally important to provide stimulating activities such as playing games that encourage memory, walking or another physical activity. Anyone with impaired memory needs to be closely monitored during outside activities to ensure they do not wander off and get lost or injured.

Most sufferers of dementia, regardless of the cause, have less drastic changes in mood, behavior and symptoms if given proper care. In the same way you care for a child, such as with bedtime rituals, proper communication, and more, so you should with the sufferer. In essence, rather than growing up, dementia causes people to “grow down”, reverting to childhood, toddler-hood and eventually infancy. It is a devastating process, but until more research is done and causes are found, we can only do our best to provide care, safety and most importantly, love.

Thank you for writing to remind me and my readers of this disorder.

Anyone who is interested in learning more about this form of dementia can go online to www.MayoClinic.com/health/lewy-body-dementia/DS00795. The Alzheimer’s Association also has information on several forms of dementia and can be found at www.Alz.org.

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.

To the best of my knowledge there is no test for Alzheimer’s disease. It can only be diagnosed after death so how is it that people and doctors can say that someone’s symptoms are caused by it? How is it that a doctor can say that someone has early Alzheimer’s if there is no test for diagnosis? Is he or she simply guessing or assuming? I also would like to know about NPH which also has no test or diagnosis until after death.

DEAR READER:
You are mistaken. While you are correct that Alzheimer’s has no medical test, it can be diagnosed based on symptoms. Certain criteria must be met to make the diagnosis; however, it does not have to be a mystery illness, diagnosed only after death.

As for Normal Pressure Hydrocephalus (NPH), tests, primarily MRI, are available to confirm a diagnosis.

Dementia has many causes including simple vitamin deficiency, Alzheimer’s, NPH or even alcoholism. It is important that the affected individual be examined by a neurologist.

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.

My uncle was 89 and my aunt was 85. They were married 65 years on Valentine’s Day 2007 for which we had a surprise drop in party. They loved it. We had as many family and friends there as possible so they could talk and reminisce with them. It was a very enjoyable time for them to say the least. They talked about it for a long time afterwards.

They have been an inseparable couple throughout their whole lives, working side by side on the farm with no outside help, seven days a week, 365 days a year. They never wanted to be apart from each other. They had a devotion for each other that went beyond words. Both displayed anxiety when the other was not by their side.

These same people were in a nursing home for over 2 years in the same room by their request. Their care was the highest level of nursing care due to my uncle’s needs. He had multiple strokes many years ago, was blind, on a wheel chair and had to be nurse-fed with pureed foods. He also was diagnosed with terminal cancer and placed under hospice care. He continued to remain in the same room with his wife. My aunt said that she was glad he made the decision to stay with her through all of this.

My aunt always prided herself in taking care of her husband, even in the nursing home. Shortly after entering the home she was diagnosed with Alzheimer’s, had trouble walking and then had a major stroke. She was placed under hospice care shortly after my uncle was.

I choose to keep them both together in the same nursing home room, rather than sending her to the hospital because I felt it was the best for them both. The nursing staff moved the beds closer together so my uncle could talk to her and hold her hand. She would on occasion respond to is voice. My uncle told me that he had held his wife’s hand more in the nursing home than he had in 65 years of marriage. The nursing staff even said that to see them holding hands was very sweet and endearing. I never regretted keeping them together.

My aunt, before her stroke, always talked about death in a matter of a fact way and saying that one of them would have to die first and she hoped it would be she. After the stroke, several family members started stating their opinions such as “Why isn’t she in the hospital?” or “Did she have that shot?”. These well intentioned people did not know about her true medical condition that the doctor and nurses shared with me nor did they have knowledge of her living will. These same people were never close enough to see or hear what her true wants and wishes were, either. I based my care-taking decisions on the facts from the medical staff, her living will and wishes and consultation from a minister.

What little time my aunt and uncle had left needed togetherness, as they would have wanted it. The staff and I kept hoping that at some point she would be lucid enough to speak to her husband, since he was blind and couldn’t see her. It was something he wanted very badly, to hear his wife’s voice, just one more time. No one thought it would be possible, but our prayers were answered. Just before her passing, my aunt spoke to him and said “I will love you forever and ever, till death do us part and beyond”. Five weeks later, my uncle passed away after telling the nursing staff that he was going home soon to be with his wife and son.

The time they shared at the end was priceless. No amount of additional medical care could have taken the place of their love and time together prior to their earthly parting.

DEAR READER:
Thank you for sharing this inspiring story. This is perhaps one of the best cases of a loved one and medical staff working together to fulfill two patients’ wishes. They seem to have had a love beyond words and I believe that you did everything you could to ensure that they were happy and comfortable to the end.

I am printing your letter in its entirety to show others that, even in this day and age, kindness, compassion and love can prevail. I hope families faced with these hard decisions and medical personnel can draw from your experience and put it into action to make others as happy as your aunt and uncle were at the end.

My wife is 80 years old and we have been married for more than 50 years. Until four years ago she was outgoing, energetic and of sound mind, body and spirit. Since then she has become a shell of her former self. I remember this change was precipitated by her no longer wanting to drive. She came to me, out of the blue and said she no longer felt comfortable driving and wanted to see a neurologist. My wife is a very guarded person and is not fond of going to the doctor so I surmised that she had been experiencing some type of problem. She was diagnosed as having dementia and placed on Aricept, Namenda and (despite telling him she wasn’t depressed) Zoloft. She has since been removed from these medications because they were not helping her. She was switched to Lexapro (for depression I don’t believe she has) and Ibuprofen liquid (for acute pain).

From that point on she began a rapid deterioration, physically, emotionally and mentally. She started complaining of acute pain that radiated from the back of her thighs throughout her lower extremities. I took her to a total of six neurologist and countless other specialists but none could find the cause of her pain. She had had a host of tests including MRIs and CT scans but all they showed was normal aging. She hasn’t had any strokes or other brain damage.

Six months after all this started, she became totally incapacitated. She is no longer able to walk, sit upright (without assistance), move her arms and legs, speak (she does mumble), chew food or feed herself, or perform any routine activities of daily living. Her food has to be pureed and fed to her. She is incontinent and cannot move of her own volition. She remains in whatever position she was last placed in and has to be moved manually. Her vital signs and appetite, however, are excellent.

It has been four very difficult and frustrating years. I love my wife dearly and it greatly pains me to see her like this. I believe that she understands what is being said to her but is unable to respond or express herself. On rare occasions she will say something clearly (often someone’s name or will callout) but then retreats back into silence. She is also very rigid. She keeps her arms and legs tight as if she is tense and resistant to being moved. I see this as her being fearful of what is going on around her so she is guarded and trying to protect herself.

I have exhausted all of my alternatives to finding help for my wife. Can you please assist me?

DEAR READER:
You wife appears to have advanced Alzheimer’s disease, a progressive and fatal neurological disorder. The first stages often include minor memory loss and language problems. As it progresses, memory loss becomes severe with the patient often failing to remember names of loved ones, time, location, and more. Eventually walking, sitting, eating, daily activities, and personal hygiene become impossible without assistance. Finally, speech and the ability to respond are lost, as is all voluntary movement. Muscles become rigid, incontinence occurs and swallowing will be impaired. The body remains intact and in generally good health but the brain and its associated functions fail.

Unfortunately, Alzheimer’s disease is incurable and the treatments available can only slow the progression. Your wife appears to be in the last stages and, in my opinion, is no longer a candidate for treatment. The best thing you can do for your wife at this point is to place her in an assisted living facility or hire 24-hour nursing care for her. You may wish to start her on comfort only care. You also state that you believe that she understands what is going on and is simply unable to respond. However, with Alzheimer’s this is not the case. Patients’ memory and cognitive abilities often decline so much that they simply do not remember where they are, who is around them, and what is happening from one minute to the next. The prognosis is very grim and I am very sorry for you and every other family that has to go through this difficult process. However, research is on going and many breakthroughs have been made. I believe it is only a matter of time before the mechanisms of this disease are better understand and we learn ways to effectively diagnose, treat and even cure this horrendous condition.

DEAR READER: The cause of Alzheimer’s remains a mystery but much active research is in progress. To my knowledge, Alzheimer’s is not related to aspartame. Some individuals are sensitive to aspartame and may experience symptoms from ingestion of it.

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.