Three New Insights About Alzheimer's Disease
Studies show what we think we know about dementia may not always be accurate.
Delusions Often Stem From Real Concerns
Delusions are one of the most disturbing symptoms of Alzheimer’s disease. A delusion is a false belief that the person insists is true. The patient may insist that someone is spying on them or wants to harm them. They may believe that a relative is someone else.
Delusions and other dementia-related behaviors are often treated with medications. But Prof. Jiska Cohen-Mansfield of Tel Aviv University suggests medications can do more harm than good. Her research focuses on the understanding that many delusions in fact have a rational basis.
Cohen-Mansfield’s team studied 74 nursing home patients whose caregivers reported on the delusions the patients were expressing, including fears of abandonment, suspicions that possessions were being stolen, and feelings of not being "at home." Cohen-Mansfield points out, "If you begin to think about these delusions from the point of view of the dementia patient, you begin to understand that their delusions are explainable reflections of the reality they live in. For example, for patients who felt that they were not at home, the nursing home did not satisfy their definition of home. Anxiety often accompanied separation from the outside environment or from their loved ones—a rational response." She explains that delusions also may stem from the patient reexperiencing earlier traumatic events.
The research team says that instead of giving these patients antipsychotic medications, caretakers should use methods that promote empathy and understanding of the underlying cause of delusions.
Stressful Test Conditions Can Lower Scores on Memory Tests
To assess a senior patient’s memory fitness, doctors often administer a series of simple memory and thinking tests in the office. The patient might be asked to remember a series of words, to perform simple arithmetic problems, and so forth. When a patient scores poorly on this test, the doctor may conclude that the patient is in the earliest stages of dementia—a devastating conclusion for patient and family.
A new study from the Université de Montreal suggests that some seniors score poorly on these tests due to stressful conditions associated with the doctor visit. The researchers describe a typical scenario: "To get to her appointment, your mother, who is no longer used to driving in town, took her car, looked for a parking space for 15 minutes, got lost in a labyrinth of one-way streets, had never used those new electronic parking meters before and is convinced that the machine stole her credit card number. Out of breath, she walked 20 minutes looking for the doctor’s office and finally arrived late for her appointment, even though at this advanced hour of the afternoon she usually has a nap."
Most of us are familiar with "going blank" under stressful conditions. It is why the most knowledgeable "Jeopardy" contestants don’t necessarily win, even though they might clear the board while lounging in front of the TV at home. The study’s lead author Shireen Sindi says, "When a situation is new, unpredictable, uncontrollable or threatening to the ego, it leads to the production of stress hormones." The action of these hormones on the brain can generate acute memory disorders, especially in older adults.
The research team, from the university’s Centre for Studies on Human Stress, suggests that more accurate results are obtained when senior patients take these tests under more relaxed conditions.
A Sense of Purpose May Delay the Symptoms of Alzheimer’s Disease
Chicago’s Rush University Medical Center has conducted a number of intriguing and groundbreaking studies on the brain-protective qualities of socialization and other "people-related" lifestyle choices. The most recent of these studies, reported on in the Archives of General Psychiatry, confirmed that having a sense of purpose in life can preserve our cognitive abilities—even if our brains already contain the harmful plaques and tangles that typify Alzheimer’s disease. "Purpose in life" means that we engage in activities that are meaningful to us. It means that we feel we have a reason to live, and that the things we do have an impact on the world.
While Alzheimer’s research today seeks to prevent the development of plaques and tangles that damage the brain, Rush researcher Dr. Patricia A. Boyle notes that understanding how to minimize the impact of the brain changes is also important. "Our study showed that people who reported greater purpose in life exhibited better cognition than those with less purpose in life even as plaques and tangles accumulated in their brains," said Boyle. "These findings suggest that purpose in life protects against the harmful effects of plaques and tangles on memory and other thinking abilities. This is encouraging and suggests that engaging in meaningful and purposeful activities promotes cognitive health in old age."
The U.S. government has just debuted the new Alzheimers.gov website, a one-stop clearinghouse of information about dementia, including local resources that can help patients and families deal with cognitive impairment.
Read an in-depth interview with Rush University’s Dr. Patricia A. Boyle concerning the connection between cognitive health and a sense of purpose in the May 2012 issue of The Atlantic.
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