A: The most common reasons to order a brain scan include looking for an aneurysm, tumor, bleeding, causes for headaches, skull fractures and diseases or disorders affecting the skull or blood vessels within the brain. Therefore, this would not likely be the way to begin in most instances, but given your age and cognitive decline, it may be an appropriate part of a workup.

Despite our ages, we all forget things at times. I prefer to tell people I have overloaded circuits when I forget meetings or birthdays. I’m not sure this is accurate but we all forget now and then. We lose our car keys or forget where we put a note, meet someone and draw a blank as to his or her name, forget to take our vitamins or prescription drugs in the morning, and so on. Some degree of memory loss and a minor decline in other thinking skills are simply a common part of aging. It happens. A decline in cognition includes asking the same question repeatedly, getting lost when walking or driving in a familiar neighborhood, forgetting words when speaking with someone, and experiencing mood or behavioral changes for no apparent reason.

The place to begin is with your primary care physician. Make an appointment and be sure to bring a family member or friend along who knows you well. This person may be able to fill in some of the details you are concerned about and will be able to go over what your physician has to say once you leave the office. You doctor will take a history of your concerns, examine you, order blood testing and perhaps other testing. He or she will ask numerous questions in an attempt to provide answers, such as whether you have recently begun a new medication that could have an adverse effect on you. So, I am not suggesting you breathe a sigh of relief but am recommending you work with your doctor to get to the bottom of things.

Addressing memory loss and the possibility of dementia can be troubling; however, if there is a problem, you will have time to consider if you should make some major lifestyle changes. For example, if you own your own home or rent an apartment by yourself you may choose to move in with a relative who can oversee your activities and help with some functions that you feel you require assistance on. If you drive, you may need to make a decision whether you can continue doing so safely or if you should check into public transportation. If you have problems taking medication, you can have someone fill your pill containers on a weekly basis that will remove the burden from your shoulders. If you have difficulties preparing meals, you may wish to check into Meals on Wheels or an equivalent that will deliver to your door. Bill paying can be a task for the best of us. Find someone you trust who can write your checks for you and file those paid invoices away. You will still be in control by signing the checks but will be relieved of the burden of remembering to pay on time. Review your paperwork to be assured you have a Power of Attorney, Health Care Proxy and Living Will in place. If you don’t, take steps to accomplish this promptly. Put all important papers such as life insurance policies and your social security card in a spot where they can be found easily if necessary. Make a list of important telephone numbers to be placed along side your phone or in the drawer of the stand your phone rests on. And, whether your memory is failing or not, much of this should be done by all of us.

There are a number of medical problems that could account for your perceived issues. You could have a vitamin B-12 deficiency, an under-active thyroid gland, depression, anxiety, stress, or be on a medication that is affecting you adversely. So, simple blood tests can put a portion of these possibilities to rest; a review of your medications with your physician can address that aspect; and so forth. Let your physician work with you based on the information you provide. You’ll be glad you did.

Readers who would like related information can order Dr. Gott’s Health Report “Alzheimer’s Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

My doctor ordered blood work and the results were that I had a high CSV level and my vitamin B12 level was too low. She sent me to a hematologist who started me on weekly B12 shots. He reran the blood tests and the results came back with a high CSV level but my B12 was back to normal. He said my symptoms were not CSV-related and referred me to an endocrinologist. That specialist said my thyroid level was in the normal range but started me on Synthroid.

I was previously taking Cymbalta and Seasonale but have stopped those. Since stopping them my blood pressure has returned to normal. With the B12 and Synthroid I feel somewhat better and have not had a migraine in two months but I still don’t feel that my energy level and memory are back to normal. I haven’t been able to lose the weight that I gained either.

After taking the B12 for a month, the hematologist said my CSV level was now on the high side of normal but the endocrinologist said it was still high. If my B12 level is normal, why is my CSV level high? Is the high CSV level causing my problems?

A: You’re question required some work on my part, not being familiar with a high CSV level. I called my local hospital and spoke to a laboratory technician who wasn’t sure what it was either. She then questioned the other lab techs and the pathologist who didn’t know what it was. She also couldn’t find it on the hospital’s laboratory test database. So, after all that, I am still at a loss as to what this is and if it could be the cause of your current lack of energy and memory problems. That said, I do believe I can help you narrow down potential causes.

Cymbalta is an anti-depressant that can also be used to treat some types of chronic pain. Seasonale is a form of birth control that is taken for three months at a time, allowing menstruation only four times a year. Both anti-depressants and birth control pills have been known to cause weight gain in some individuals but given that you experienced all your weight gain over such a short period of time, I don’t feel they are blame.

You don’t give your exact age, but you claim to be middle-aged so I would put you between the ages of 35 and 50. Given that you were on a birth control pill, I can surmise that you were still menstruating. However, you are nearing or at the age that menopause is possibility so perhaps the hormones supplied by the pill where masking some of the other, more recognizable signs of menopause such as abnormal or absent menstruation, hot flashes, etc. Weight gain is also common as the body adjusts to the decline in estrogen.

Abnormal thyroid function can also abnormal menstruation and slows down metabolism which can lead to weight gain; however, this is usually a more gradual gain and/or difficulty losing weight.

You don’t mention what steps you have taken to try to lose the recent weight gain. You also don’t mention if you underwent any physical examination. Were other causes such as the menopause I mentioned ruled out or did your physician only order the lab work then send you on to a specialist? If you didn’t undergo a thorough examination, return to your physician.

In the meantime, try modifying your diet. Include more lean protein, fruits and vegetables. Avoid fatty and sugary foods. Try my No Flour, No Sugar diet. Exercise at least 30 minutes each day by walking, jogging, or taking an aerobics class.

As for your memory problems, you don’t give me any specifics. Do you have a family history of Alzheimer’s disease or dementia? Are you having trouble with recalling names or forget what your doing? Are you having trouble concentrating? How long have you had the memory problems? Perhaps a visit to a neurologist for testing is in order to determine if you have clinic memory loss or are simply having some difficulties, such as due to high stress levels or lack of sleep.

In all, you don’t seem to have yet run the gamut on your available resources for help so I urge you to speak to your family doctor again to determine what else if anything could be at the root of you problem.

Readers who are interested in learning more can order Dr. Gott’s Health Reports “Alzheimer’s Disease”, “Thyroid Disorder” and “Vitamins and Minerals” by sending a self-addressed, stamped number 10 envelope and a $2 (for each report) US check or money order to Peter H. Gott, MD Health Reports, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from my website, www.AskDrGottMD.com.

I was diagnosed and treated for invasive breast cancer (small and no lymph node involvement) late 2010. I am 52 years old and at the time wasn’t experiencing menopause. After a lumpectomy and approximately seven weeks of radiation, I am hoping this is all behind me. In March 2011, I started taking Tamoxifen, which I understand is protocol for non-menopausal women and I will continue to take it daily for five years. I have read and talked to my doctors about some of the side effects, such as hot flashes and leg cramps. The hot flashes have come, as has (it seems) menopause. However, one unusual side effect that seems to have hit me (and I’ve read about it on blogs but not on any published list of side effects) is Tamoxifen’s effect on my memory.

About three weeks after I started taking it, I started noticing incidents of not being able to recall a word or a name. One day while working, when I couldn’t come up with something I absolutely should have known, I started thinking about why I was possibly having trouble. I thought about my amount of sleep, my diet, and anything that might have changed and the only change that came to mind was the Tamoxifen. It’s almost scary how I have forgotten data that is usually very known to me. I have trouble bringing up words and names that I know and have never had a problem remembering things before.

When I looked online, I found that others, too, have had some memory problems while on Tamoxifen so I mentioned it to a couple of my doctors during recent checkups and they both said they haven’t heard of it but that doesn’t rule it out. One doctor talked about “chemo brain” and how it’s possible the Tamoxifen is may be having a similar effect on me.

Do you have any words of advice on this drug? Is it really something that needs to be taken or is this just a precaution? Thank you so much for the daily information you share with the world.

DEAR READER: For those who don’t know, Tamoxifen is an anti-estrogen drug, usually prescribed for women and men with certain types of breast cancer. It is also given to female children with McCune-Albright syndrome, which causes early puberty and menstruation (in some cases as early as four to six months of age) and to women who meet a specific set of criteria that places them at a very high risk of developing breast cancer.

The drug carries a boxed warning that some users may develop serious, potentially fatal side effects such as stroke, pulmonary embolism and uterine malignancies. Beyond that, there are a host of known side effects, many of which mimic menopause because of the drug’s ability to block estrogen. Adverse reactions include vaginal dryness, hot flashes, thinning hair or partial hair loss, depression, insomnia, dizziness, anxiety, tingling of the extremities, and much more. Most of the effects were found to be relatively mild and rarely severe enough to require discontinuation.

As for your memory loss, there is no mention of cognitive/memory impairment; however, a quick internet search of “Tamoxifen, memory problems”, brings up a host of user-generated forum/blog discussions about this very problem. I was unable to locate any studies done on this subject, but if there are any out there, I would surely like to hear about them. Given the amount of anecdotal evidence, I believe it is past time to investigate the possibility.

My recommendations to you are to discuss your current treatment course with your physicians. If your risk of relapse is low, perhaps a reduced dose or discontinuation is possible. If your risk is higher, it may be more prudent to stay on the drug and attempt to cope with the memory problems. This might involve writing notes and keeping a detailed planner of important names, dates, and other pertinent information. I am also told that there are a wealth of memory games available on the internet and for phones and video game devices which may be beneficial in helping you retain or possible regain some of your cognitive abilities back.

DEAR READER: Coconut oil is a tropical oil made from the nut of the coconut palm tree. One single tablespoon of the oil contains 117 calories – not a big deal – but 13.6 grams of fat, which is. Over the years the product has been touted as a cure-all for hypothyroidism, heart health, Alzheimer’s disease, as an energy boost, weight loss product, and a great deal more. As I see it, an individual may eat coconut oil in moderation short-term without having it affect health but I cannot endorse it as a cure-all. The problem as it pertains to Alzheimer’s is that there isn’t sufficient documentation from reputable studies to support the evidence that it can reverse memory loss. I am aware of the occasional anecdotal report that indicates it does help; however, we are talking about a small handful of people who are actually helped, not the masses who aren’t. I would need a great deal more concrete evidence from reputable research before I could ever endorse such a product for this purpose.

The benefits of coconut oil result from the presence of three acids, one of which is lauric that has properties as an anti-fungal, anti-bacterial and antimicrobial. The human body converts the lauric acid into monolaurin which is touted to aid in fighting viruses, bacteria, influenza and even HIV; however, coconut oil, even virgin coconut oil, consists of more than 90% saturated fats, with traces of unsaturated fatty acids and polyunsaturated fatty acids. So, while the product in shampoos or conditioners may make your hair shine, ingesting it long-term can lead to elevated cholesterol levels and the many problems that accompany hypercholesterolemia such as poor brain circulation which can lead to cognitive problems.

Alzheimer’s is the leading cause of dementia in the Western World and age is the greatest risk for development of the disorder. More than half of the population of the United States aged 85 and older are affected. Memory loss, specifically Alzheimer’s, can cause a decline in thinking, logical reasoning and memory. Some of the most common signs are forgetting recently learned information, mixing up important dates such as doctor’s visits or planned activities, forgetting names of people you know well and where you put important things such as your keys or even the sugar bowl. All these situations disrupt daily living. You may be having difficulties concentrating, paying bills on time, completing chores around the house, finding the right words, and may use poor judgment more frequently than you would like.

If this is the case, I recommend you make an appointment with your physician to discuss your failing memory and that of your husband so he or she can either rule out Alzheimer’s or confirm the diagnosis. Early diagnosis is important, since it will provide you necessary time to make important choices, such as whether you will need extra help at home or would fare better in an assisted living arrangement, need help in paying your bills, or getting to appointments. Keep in mind that all memory loss is not associated with Alzheimer’s. You may both have a vitamin deficiency, thyroid issues, or could be on medication with negative side effects. A simple “fix” may be all that is necessary to get back on track. Medical advances are being made every day and support is out there if necessary, so take the burden off your shoulders. Make that call to your primary care physician today.

Readers who would like related information can order my Health Report “Alzheimer’s Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: As we age, the brain loses its capability to function at optimal capacity. It has millions of neurotransmitters, vital for communication. With aging, those neurotransmitters become damaged, resulting in poor concentration and decreased memory capabilities.

Procera AVH is touted as a brain health supplement for anyone who suffers from poor memory, has mental fatigue, or difficulty focusing. It’s a non-prescription supplement developed by a clinical research scientist and a physician who have teamed up with neurosurgeons, neuroscientists, neurologists and cognitive psychologists from several universities and medical schools.

The three primary ingredients in Procera AVH are acetyl-l-carnitine, huperzine and vinpocetine, promoted to increase brain blood flow for mental clarity and sharpness. Let’s see if we can make some sense of these outrageously long words. Acetyl-l-carnitine is an amino acid dietary supplement that is naturally produced in the body where it helps produce energy and is important for heart and brain function, the movement of muscles, and other body processes. It is endorsed by some for Alzheimer’s disease, age-related memory loss, Downs’s syndrome, poor brain circulation, nerve pain from diabetes, and more. Some men use it for low testosterone levels and for Peyronie’s disease.

Huperzine is purified from a plant known as Chinese club moss; however, the product is the result of laboratory manipulation. Huperzine A is used for Alzheimer’s, age-related memory impairment, myasthenia gravis, and for increasing alertness and energy. The product is thought to be beneficial because it causes an increase in the levels of acetylcholine, one of the chemicals our nerves use to communicate in the muscles, brain and other areas.

Vinpocetine is a man-made chemical that resembles a substance found in the periwinkle plant. It is believed this product MIGHT improve blood flow to the brain. Therefore, it is touted as effective in enhancing memory, preventing Alzheimer’s disease and other conditions that affect the aged. Other uses for this product include treatment for chronic fatigue, seizure disorders, the prevention of motion sickness, and symptoms of menopause. It is sold by prescription in Germany and while website advertising claim that more than a hundred safety and effectiveness studies have been funded by its Hungarian manufacturer, few double-blind controlled clinical studies have been published. And, as you might know, double-blind controlled clinical studies are thought to be the gold standard for establishing effectiveness and safety. It isn’t completely known how vinpocetine works, but it is believed to perhaps increase blood flow to the brain.

So, to keep things simple, it appears all three core ingredients are designed to improve the flow of blood in the brain. Viola! Theoretically, this should work, but, do they really? Some people have tried this over-the-counter and claim it is the best thing since sliced bread but, being the skeptic I am, I don’t feel I can endorse it until double blind studies have been reported in reputable medical journals. Many physicians feel the supplement lacks scientific evidence to prove its effectiveness. It is not regulated by the federal government. When you couple vague labeling and minimal regulation, there is no way of knowing how much of the three core ingredients are in any product, nor can you determine what their quality is. Can I or any other physician indicate the product won’t work? Absolutely not. However, it is my opinion that individuals with Alzheimer’s or one of the many other forms of dementia should be on drugs approved by the FDA. If you suffer from memory loss to any extent, make an appointment with your physician who may choose to recommend you see a neurologist. Save your money.

Readers who would like related information can order my Health Reports “Alzheimer’s Disease”, “Parkinson’s Disease”, and “Consumer Tips on Medicine” by sending a self-addressed, stamped envelope and $2 US dollars for each report to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR READER: Sodium is a mineral vital to normal body functioning. It maintains appropriate water and mineral balances and assists nerves and muscles. It is naturally found in grains, fruits, vegetables, dairy and meats in low amounts. Most processed foods have high amounts of salt to enhance flavor and many people add salt to food, either during cooking or once at the table. Sodium is commonly consumed at five times the required amount. For this reason, consequences of high sodium intakes and blood levels are the most commonly discussed issues.

Oddly (or interestingly, depending on how you look at it), both hypernatremia (too much blood sodium) and hyponatremia (too little blood sodium) present in similar ways. Both can cause fatigue, irritability, loss of appetite, vomiting, restlessness, nausea, altered mental status (such as confusion, stupor or hallucinations), convulsions/seizures, and coma. Hyponatremia can also present with headache and muscle weakness, spasms or cramps. Hypernatremia can also present with lethargy, twitching, tremor, ataxia (lack of coordination) and hyper-reflexia (exaggerated reflexes).

Because you specifically mention a sodium level of 120 (normal is between 135 and 145), I will continue my answer in regard to hyponatremia only.

There are two types of low blood sodium; acute and chronic. Acute is much more severe and occurs within a period of 48 hours or less, causing swelling and damage to the brain. Chronic, which occurs over a period of days or weeks, is less severe and swelling is often minimal because the brain has time to adjust to the abnormal levels.

There are three categories of cause. Those related to low total body water, such as from dehydration, vomiting, diarrhea, etc.; those with near-normal total body water levels, such as hypothyroidism (low thyroid hormone levels), SIADH (syndrome of inappropriate anti-diuretic hormone secretion), or Addison’s disease; and those with an increase in the total body water level such as cirrhosis of the liver, congestive heart failure, or various kidney disorders.

Treatment depends on the cause and can include chemotherapy, radiation, medication, intravenous (IV) fluids/nutrition, and fluid restriction. Only after the cause is found should treatment begin.

As to whether your memory loss is directly related to your low sodium level, I cannot say. You don’t provide an age, gender, general health status, or a list of any over-the-counter or prescription medications or supplements you may be on. If you are 25, in good health and on no medications, I would say it was possible. On the other hand, if you were 75, I wouldn’t be so sure, as some degree of memory loss occurs with age.

I urge you to speak with your physician about your concerns. He or she is most familiar with your medical history and overall health and will be your best source of information.

Readers who are interested in learning more can order my Health Report “Vitamins and Minerals” by sending a self-addressed, stamped, number 10 envelope and a $2 to US check or money order to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print an order form from my website, www.AskDrGottMD.com.

During an evaluation at the University of Michigan, Ann Arbor, MI Gerontology Center, she was advised that Ativan is a destroyer of short-term memory. That fact and the damage done to the entire body by chemo and by estrogen earlier in prior years, coupled with a sedentary lifestyle, all played a part in the development of Alzheimer’s, in my opinion.

Thanks for letting me vent. My primary purpose in writing was to talk about the destruction of short-term memory by the Ativan. Thank you for the help you have brought to so many people.

DEAR READER: Ativan (lorazepam) is prescribed for anxiety disorders and anxiety associated with depression. As a general rule, drugs in this category should be prescribed short-term, perhaps up to four weeks. Treatment extension beyond that should not occur without reassessment by the prescribing physician who can determine if extended use of the drug is appropriate. Abrupt withdrawal may result in symptoms of anxiety, tension, depression, confusion, irritability, dysphoria (unease), hallucinations, delirium, agitation, panic attacks, and a great deal more. The effectiveness of lorazepam long-term (more than four months) has not been assessed by systematic clinical studies.

This drug can produce increased central nervous system (CNS) depressant effects when administered with other CNS depressants such as anti-psychotics, antidepressants, narcotic analgesics, alcohol and barbiturates.

In one test study of 3,500 patients treated for anxiety, the most frequent reporting was sedation, followed by dizziness, weakness and unsteadiness. Other adverse reactions included memory impairment, disorientation, confusion, and more. Overdose symptoms can present as lethargy, mental confusion and drowsiness. Elderly and debilitated patients may be more susceptible to the sedative effects than are others.

Breast cancer treated with chemotherapy and radiation must have been traumatic enough within itself for your wife and her loved ones, so I can understand why she may have required a prescription such as lorazepam; however, I am not sure six years on the drug was appropriate. Nonetheless, I do not have access to her medical records and cannot pass judgment. If her medical evaluation brought that to light, then I guess the link has been established. It’s a shame you didn’t have the information available prior to initiation of the drug. Alzheimer’s is, unfortuantely, a common cause of dementia and memory loss. I cannot say whether you wife’s use of Ativan was a contributor, however.

Readers who would like related information can order my Health Report “Alzheimer’s Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Dr. Peter Gott, PO Box 433, Lakeville, CT 06039 or through my website’s direct link www.AskDrGottMD.com/order_form.pdf.

DEAR READER: It is estimated that more than 5 million Americans suffer from a form of Alzheimer’s, the leading cause of dementia in the Western world. There are new guidelines available for diagnosing early-stage Alzheimer’s (pre-Alzheimer’s), indicating that a state of mental decline can begin years prior to the occurrence of other, more classic symptoms.

According to the new strategy, there are three phases, identified as early brain changes, mild cognitive impairment and full-blown Alzheimer’s. Oddly enough, while the phases have been identified clearly, doctors are advised to evaluate and treat patients with symptoms in the same manner as they did previously.

Laboratory or brain images will provide useful information for proper diagnosis. Your father may have a thyroid disorder, vitamin B12 deficiency or some other unrelated condition that is easily treatable. One problem with current biomarker testing through blood and spinal fluid is that there is no standardization between labs, nor are there set levels for how much of a substance indicates impairment or Alzheimer’s. This implies that if I am in one section of the country, I could test positive, while testing negative in another locale. And there is insufficient research to validate that a particular substance or biomarker can predict progression of the disease. It is important to note that the only way to confirm a diagnosis of Alzheimer’s is at autopsy.

Current treatment can ease symptoms, but it doesn’t alter the course or progression of the disease. However, on the flip side of the coin, if you know your father is exhibiting early signs, you can take appropriate steps for him and those around him to learn to cope with potential future changes. Medication, treatment plans and support are available.

Shortly after being diagnosed, she placed in her age class at the Bloomsday road race. We were both runners. Anyway, her height is 5 feet 5 inches, her weight is 115 pounds, and her blood pressure is normal.
Is there any other possible course of treatment? We have been to specialists and more. We did participate in the failed dimebon trial.

DEAR READER: The dimebon trial you refer to did fail. An old Russian antihistamine remedy developed for hay fever and known as dimebon was one of the world’s most promising hopes for the treatment of Alzheimer’s. While originally providing good results in a small trial, a newer one involving a greater number of patients with mild to moderate symptoms failed to show progress after six months for the treatment of cognitive decline, nor did it help the behavioral problems associated with the disease when compared with a placebo. As you can well imagine, the outcome was unexpected and tragic for individuals such as yourself and your wife, as well as for Pfizer, who had been paying for 60 percent of the development costs.

Alzheimer’s is an irreversible and progressive brain disease that destroys memory and thinking. It is estimated that more than 5 million Americans may have the disease, so you can understand why so much hope was placed in the dimebon.

Brain damage for this disorder can begin 10 to 20 years before any symptoms are present. Tangles develop and plaque forms in certain areas of the brain. As this occurs, healthy neurons work less efficiently before they lose their ability to function properly. By the time Alzheimer’s reaches its final stage, damage is widespread and brain tissue has significantly atrophied.

There are four FDA medications approved for the treatment of Alzheimer’s. In no particular order and for a mild to moderate disorder are rivastigmine (Exelon), galantamine (Razadyne) and donepezil (Aricept). The heavy hitter for advanced cases is memantine (Namenda). All four regulate the chemicals that transmit messages between neurons within the brain. Their purpose is to help memory and speech and assist with behavioral problems. The big issue is that they don’t modify the underlying disease process, nor do results last more than a few years.

While it’s not what you really want to hear and I wish I could be more helpful, research has been phenomenal over the past few years and important advances have been made. Scientists and physicians are working together for a better understanding of the disease. Every effort brings us a step closer to the time when we will be able to better manage this horrible condition. While the last trial was a failure, perhaps another one is on the horizon that might make all the difference in the world for you. I suggest you contact the Alzheimer’s Disease Education Center at (800) 438-4380 or online at www.nia.nih.gov/Alzheimers.

DEAR READER: Sundowner’s, or sundowning, is confusion that generally occurs late in the day, although it has been known to occur during early-morning hours as well. The cause appears elusive and is often misunderstood.

The disorder is commonly seen in hospital or nursing-home settings where an older individual may be forced to adjust to a different setting. Or, in some cases, it can manifest following illness or surgery. Sundowner’s may be temporary for some but prolonged in other instances. It is seen primarily in Alzheimer’s patients, in those with Parkinson’s and with other forms of dementia. As a matter of fact, up to 25 percent of all diagnosed Alzheimer’s patients have been found to exhibit sundowner’s as well.

As the day progresses, a patient becomes fatigued and less able to deal with stress. In the case of hospital or nursing-home placement, it is likely all visitors have gone home for the day and there is less to occupy a person’s mind. Perhaps medications have been administered prior to sleep. The patient who was stimulated earlier in the day has nothing to occupy his or her mind and appears increasingly forgetful and agitated. Memory loss seems greater. Blood-pressure readings may be lower. Patients may see things that aren’t there or perceive things to be other than what they actually are. These visions can be extremely frightening.

Treatment might include establishing a repetitive routine that a patient can rely on. Continuity is good. Noise from the radio and television during evening hours may exacerbate agitation in some but help others. Allow the patient’s sleeping area to remain lit during the night such as with a nightlight. Review all medications to be assured they don’t have insomnia or disrupted sleep patterns as a side effect. Ask the doctor about the use of over-the-counter melatonin or St. John’s wort as a possible sleep aid. Avoid giving food items later in the day that contain caffeine, such as coffee and chocolate. Monitor the patient’s diet to determine whether any specific foods trigger agitation.

While not always possible to accomplish, family members or caregivers who can spend nighttime hours with a patient in a nursing home or hospital setting will provide a comforting sense of familiarity that may avoid symptoms. Keep in mind that with those patients able to ultimately return home to familiar surroundings, sundowner’s can disappear completely, making the process of providing appropriate care easier. The fact that the condition may appear out of the blue is no reflection on the quality or capabilities of a facility where a patient may be placed. Family members need not be overly concerned by perceived wrongdoing after hours but should express their thoughts regarding the possibility of a misunderstood disorder that affects their loved ones.

Most of all, remember that anyone with sundowner’s is unaware of the havoc that he or she may impose on family members and caregivers. The condition is not fatal but can be extremely difficult to deal with.