Dear Mary,

I find your column very informative and your answers compassionate and well thought out. Both of my parents are entering their 80s and I'd like to ask your advice for my situation.

There are several new and emerging medical therapies for Alzheimer's disease and I wonder if you would address if and how the course of the disease may seemingly be rewritten. From what I gather the medications are not viewed as a cure, but can slow the progression of the disease. Is it possible that years of quality life may be added, and individuals may ultimately die of other causes attributed to aging?

My interest stems from trying to educate family members and myself about my mother's illness. At my urging my father took her to a neurologist who concluded she is in the early stages of Alzheimer's and put her on Aricept. Prior to the medication her speech and memory were failing but now they seem essentially restored. Various family members seem relieved she is improved and want to forget about her diagnosis and move on.

She just turned 81 and my dad is 79 and otherwise they seem in good health. They still live in the large house they've owned for 30 years, and none of their children live close by. They are not ready to downsize but have talked about it and I have tried to support their tentative interest in moving closer to me. As the only daughter, and the closest in distance, I am certain that caregiving responsibilities will fall on me. I'd like to do what I can to minimize future problems. What should I expect for my parents regarding social and lifestyle changes?

Thanks for your advice.

Dear Reader,

Thank you for taking the time to write and express your feelings. The issue of Alzheimer's disease is viewed as a chronic disease. Affected persons are living longer and functioning for longer periods of time than even five years ago. And yes, some are dying of other causes. This trend will continue until prevention, arresting the disease, or possibly a cure is found. Cognitive enhancers such as Aricept first came on the market in 1993 with the introduction of Cognex. Today there are three most frequently prescribed for early and middle dementia: Aricept, Exelon, and Reminyl. It is important to understand that none of them stops the progression of the disease. By treating the symptoms they help the person maintain function, or even function at a higher level, for a longer period of time. Eventually they become less effective as the disease progresses.

In September 2003 the FDA approved memantine for use in the later stages. It is manufactured under the brand name Namenda by Forest Laboratories. Studies showed there was slower cognitive decline in the treated group than in the placebo group.

In the near future I expect a drug will be found that would actually stop the progression of the disease. When the cause is found - which I expect will be more that one – prevention and even a cure may be possible. The Alzheimer's Association has good information about current treatment and research studies.

Regarding your mother, family members should understand that she still has cognitive limitations and her short-term memory, concentration, judgment, and ability to do things in order may be affected. This means she still needs guidance and safety management. As the disease progresses she will become more self-isolating, forgetful, unable to follow or carry on a conversation, and make decisions. Physical function will also decline and eventually she will become totally dependent for all her needs.

As your father ages you can expect normal changes - slower memory recall, impaired balance, diminished vision and hearing, and slower reaction time making driving difficult. With advancing age he too will become frail and more dependent on others for help with activities of daily living.

Continue to encourage them to downsize while they are still able to enjoy a new adventure. The longer they remain in the big house, the harder it will be for them to move. Consider housing, such as that in a continuing care community, which can meet their future needs without forcing them to make another move.

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Dear Mary,

My husband has had Alzheimer's disease for a while and recently took a rapid decline. He started having hallucinations, was constantly accusing me of things, and restraining me physically. A drug was added to calm him down, but a couple of weeks ago he had to be hospitalized. I became aware that I could no longer care for him at home and was forced to move him into an Alzheimer's care unit. All the "professionals" said it would be the best thing for him, and for me.

I am having trouble dealing with all aspects of this. I think more than anything I feel terribly guilty that I am not able to take care of him, and I know placement is not what he would have wanted. If you could recommend some help I would appreciate it.

Dear Reader,

Guilt is a normal caregiver emotion but it is important to understand that what occurred was out of your control. It is not your fault that he has Alzheimer's disease and you are not to blame for the events that have transpired. You did what you had to do for his and your own safety. You are still his caregiver but now traveling on a different path.

All of this is taking a great toll on your health. I encourage you to talk to a mental health professional and join a support group. You need the support and encouragement of others to see this through. Please take care of yourself with the same passion that you take care of your husband.

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