A: We know that a single stroke can cause memory deficits but the more usual cause of memory loss due to stroke is multiple strokes. A previous history of stroke can be a ‘red herring’ and indeed other causes of memory loss can co-exist. The history of the events and time line are very important. MRI scanning of the brain in this situation can be very helpful. I think in this situation detailed evaluation of the memory function would be important and that this should then be monitored to see if the memory function is stable or declining. It sounds to me that you are witnessing a gradual decline in memory function and this would not be my expectation in a patient who had a small stroke a number of years ago unless there was evidence on the MRI scan of brain of significant vascular abnormalities.
A: Thank you for your questions. There is unfortunately a link between Down's syndrome and the development of Alzheimer's disease. This is not fully understood but we know that people who have Down's syndrome can develop the plaques and tangles in the brain that are found in Alzheimer's disease. Your detailed knowledge of this person will be very helpful in highlighting the changes that have occurred in this person. One of the great difficulties especially in the early stages of Alzheimer's is identifying the changes that have occurred. I note that tests are currently being conducted and that you are waiting for a formal diagnosis. My understanding of the treatments that are currently licensed for Alzheimer's disease is just that. They are licensed for people who have been given a diagnosis of Alzheimer's disease. If a person is deemed suitable for any treatment the potential benefits and risks have to be considered and this is a discussion to have with the local clinician. You are correct that there is a patch available for the treatment of Alzheimer's disease. It is an Exelon patch and this contains the medicine Rivastigmine which is similar to Aricept (Donepezil). The most widely used licensed treatment for Alzheimer's disease in the U.K. and probably globally is Aricept.
A: Good diabetic control is very important for a wide range of health issues so this should be carefully evaluated. In addition it sounds as though memory testing is indicated and this should be discussed with the family doctor.
A: As far as I am aware there are no specific treatments for this particular condition. The symptoms you describe however can be closely evaluated. It is well recognised that head trauma can lead to these problems. You do not say how extensive the memory problems are or if they are having a significant impact on daily function. It is quite possible to have memory loss and yet function at a good level. The anxiety and mood swings are important symptoms that should be carefully evaluated. I think in this situation you would wish the memory function to be measured and monitored. There are also assessment scales that allow anxiety symptoms to be monitored. Depression must be considered in this situation. Anyone who has been a boxer has been used to being fit and active. There are now good antidepressant treatments available and the appropriateness of such a treatment would be worth discussing with your fathers' doctor.
A: This is an interesting issue that you raise. Age related Macular Degeneration is not in my experience a condition that I immediately associate with Alzheimer's disease. In fact in my experience over the 20 years that I have been involved with assessing patients with Alzheimer's disease it occurs infrequently in the Alzheimer population that I have seen. That is of course not to say that there is not an association and it is quite feasible, and certainly worthy of further investigation whether in some cases there is a link. Please see a link below to a recent article highlighting the genetics of AMD http://www.dnaindia.com/health/report_additional-genes-linked-to-age-related-macular-degeneration-identified_1370978 Whilst it is commonly said that Alzheimer's disease is not genetically inherited, our understanding of the condition continues to evolve. It is of increasing interest to test the genetic profile of an individual presenting with probable Alzheimer's disease, the APOE4 gene being one in particular. We know in certain cases there is a strong family history of Alzheimer's. You may already have had sight of the article below that links AMD and Alzheimer's thought the APOE4 gene http://linkinghub.elsevier.com/retrieve/pii/S0002929707607411 I would encourage you therefore to continue to take an interest in this area. Your mother’s ophthalmologist may have some thoughts on this. Visual disturbance in Alzheimer's disease is well documented and you may be familiar with the recently highlighted variant of Alzheimer's disease PCA (Posterior Cortical Atrophy) suffered by author Terry Pratchett. Of course the presence of significant visual disturbance does make the diagnosis of Alzheimer's disease more challenging, but I have seen patients, registered blind who are able to read the words and copy the various diagrams often presented in the course of memory testing used in the diagnostic process. The falls and blows to the head are of course very important in the history of this case. It would be very difficult to attribute the degree of cognitive impairment if any due to these episodes. I think offering a trial of treatment with donepezil seems very reasonable and I hope this is beneficial. I am not aware of current studies looking specifically at the link between AMD and Alzheimer's.
A: The scenario you describe is possibly not that uncommon and highlights a number of issues. The Mini Mental State Examination is a test that is designed to give an indication of cognitive function. An MMSE score of 23 out of 30 is within the mild dementia range. You may wonder if this score was in fact due to the deficiency of Vitamin B12. Many elderly people have low Vitamin B12 levels and it is usually said that the level has to be very low for it to have an impact on memory function. However if the level is low then appropriate replacement therapy is usually given. The memory may not improve with the initiation of B12 therapy but other complications such as anaemia should be avoided. Recurrent urinary infection is common in elderly females and it is good that this problem now appears to have been dealt with. My understanding is that now your mother is on no memory enhancing medication. You wonder if vitamins may be beneficial. A good diet, exercise, fresh air, interacting with others are all important. The actual benefits of taking vitamin supplements (unless for a confirmed deficiency such as the B12 that your mother is taking) in this situation are not really known. It is important to remember that dementia is common in the over 80's and monitoring the memory function even though no treatment is being prescribed may be worthwhile.