A: Alzheimer’s disease is currently the most common cause of Dementia. The word Dementia comes from the latin ‘demes’ which literally means loss of the mind. Therefore there are many conditions that can cause Dementia. The second most common cause of dementia is Cerebrovasular disease (hardening of the arteries). What this means is a person can have Dementia due to a cause other than Alzheimer’s disease. If a person has been told they have Dementia the question to ask is what is the cause?. Is the Dementia due to Alzheimer’s disease or another cause.
A: Yes. Many studies are specifically designed to allow individuals to participate who have Alzheimer's disease and who are currently receiving Alzheimer's therapy e.g. Aricept (Donepezil), Exelon (Rivastigmine), Reminyl (Galantamine), Ebixa (Memantine). Participation in a study allows access to potential new treatments in addition to standard Alzheimer's therapy.
A: You raise an important issue. Yes, he could potentially take part in an Alzheimer's trial but we would have to see your husband and evaluate him carefully. Treatments work in different ways. Given that your husband has known Alzheimer's disease but is on no current treatment an Alzheimer's trial of a potential new medications would be well worth considering.
A: Thank you for this question. The scenario you describe is not uncommon. Aricept is a symptomatic treatment for Alzheimer's disease. That is it can improve some of the symptoms for varying degrees of time. The recent strokes of course may have had an impact on the memory function. It is important that any risk factors for stroke are identified and appropriately treated. Depression must be watched for and can be treated effectively. In terms of other specific treatments for Alzheimer's disease Aricept and the class of drug it belongs to (the acetylcholinesterase inhibitors) remain the mainstay of Alzheimer's therapy. There are several avenues of research ongoing but the recent strokes may preclude entry into a research programme but having said that this is an avenue certainly worth exploring.
A: Alzheimer's disease is the commonest form of dementia and you say your brother has been diagnosed with Early Onset Alzheimer's disease and Vascular dementia which of course is quite possible. Many patients with Alzheimer's disease have findings on brain scanning that indicate some underlying vascular pathology. This does not necessarily mean they actually have vascular dementia as well. There are actual criteria that can be applied to an MRI scan of the brain that describe the changes and allow a conclusion to be reached as to whether or not the changes are significant enough to meet the diagnostic criteria for vascular dementia. Your brother is receiving treatment with Aricept which is licensed for the treatment of Alzheimer's disease and this is a positive outcome. Some patients with vascular changes on a brain scan may simply be labelled as vascular dementia when in fact the changes may be minor and they in fact have underlying Alzheimer's disease. The importance of this is that they may then receive no treatment. Vascular risk factors are of course important to identify and treat. In terms of potential stem cell treatment for Alzheimer's disease this is an area that we have no experience of. Of more relevance possibly is the potential to participate in a vaccine programme. Such programmes are currently designed for those with Alzheimer's disease who may or may not currently be receiving treatment for the condition. The degree of vascular change would have to be assessed because if it were too great then an individual is likely to be ineligible to participate.
A: I understand the great difficulties and problems this can cause. Alzheimer's disease affects the cortex, the outer layer of the human brain and it is well documented that Alzheimer's disease causes a major disturbance of language. In some patients the word finding problems remain mild for lenghty periods. In others the loss of language is rapid and this is very upsetting. An important thing to remember is that comprehension is often much better than you might imagine. We see this often in research. A person who is still functioning well yet who has a very low memory score because they cannot say the words to answer the questions. Sadly this means that many people are excluded from research studies because their memory scores are too low. You do not say if your wife is currently receiving any treatment or what recent memory scores have been. There are new treatments such as vaccines being studied but to know if your wife would be eligible to participate she would have to be properly evaluated.
A: The scenario you describe is sadly not uncommon. We know that about 50%-60% of patients prescribed an acetylcholinesterase inhibitor, and donepezil (Aricept) is a drug within this class, will show evidence of response to treatment. The remainder for reasons not fully understood do not respond. For some doctors response is taken as evidence of stability or no deterioration. Some individuals do positively respond to treatment and this response can be maintained for varying periods of time. It appears from what you say in your mother-in-law's case that she is not responding to treatment. You do not say what her age is, the current dose of donepezil or mention the result of the memory test that is often done. I am referring to the Mini-Mental State Examination test (MMSE). This is scored out of 30 points. The mild dementia range or early stage you refer to would normally include those individuals with score in the 20-26 range. Once the MMSE score starts to fall below 20 out of 30 then this is more in keeping with moderate dementia. I think from a practical point of view a discussion with those involved with her medical care might be helpful. It would be helpful to know what the current memory score is and how it has changed. Is there any room to increase the dose of donepezil? She may already be at the maximum daily dose of 10mg. You also highlight episodes of aggression and this should be discussed and monitored as we know behavioural disturbance occurs not infrequently in this condition and may be amenable to additional treatment.
A: There are many causes of an irregular heartbeat. Often this can be diagnosed from a simple ECG tracing, sometimes more prolonged recording of the heart beat is required. You mention that your wife has quite advanced Alzheimer's disease. If you feel that she would be able to visit the clinic for assessment then we could potentially arrange to see you both. The method of contact would be for you to telephone the clinic during working hours and explain the reason for your call. A member of the research team will ask you some questions to try and ensure your wife might be potentially suitable. There will be questions about her medical history and current medications. It is possible that a research study might be available that your wife could participate in even though she has been deemed not suitable for prescription medication for her Alzheimer's disease.