1. Are there any bad side effects from Alzheimer’s drugs?
The drugs aducanumab-avwa (Aduhelm) and lecanemab-irmb (Leqembi) are relatively new drugs that target the fundamental pathophysiology of Alzheimer's disease by reducing amyloid beta plaques in the brain. They are for use in those with early stages of Alzheimer’s and with confirmed presence of amyloid pathology. They may also cause swelling or bleeding (called ARIAS) in the brain.
A person with Alzheimer's may be taking medicines to treat their symptoms and other health problems they have. But when they take many medications at once, there’s a higher chance they’ll have a bad reaction to them. The problems can include confusion, agitation, sleepiness or sleeplessness, mood swings, memory problems, and upset stomach.
Some people who have severe symptoms of Alzheimer's disease -- such as aggressive behavior or hallucinations (seeing, feeling, or hearing things that aren’t there) – may need stronger medicine to keep their problems under control. But some of these drugs can make their other Alzheimer’s symptoms worse. For example:
- Some drugs such as benzodiazepines (tranquilizers) can cause confusion, memory trouble, and slowed reactions, which can lead to falls.
- Some medicines that treat depression can cause sedation and other side effects.
- These drugs may react with medicines that treat Alzheimer's disease, including donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), and rivastigmine (Exelon).
- Some medicines that treat hallucinations can cause sedation, confusion, and drops in blood pressure.
Ask your doctor about the pros and cons of these options. Also, some over-the-counter drugs, including cough and cold remedies and sleep medicines, can have side effects, too. They may also react with other Alzheimer’s meds. A doctor can let you know which ones are safe to take.
2. I'm thinking about taking a trip with my father, who has Alzheimer's. How can I make it easier for both of us?
Plan ahead. Think about their needs so you'll be ready for any changes or problems. You can try taking a short trip first to see how they reacts to traveling. A few other tips:
- Give them simple, relaxing things to do when you’re traveling. They could read a magazine, play with a deck of cards, or listen to music, for examples.
- Never leave a person with dementia alone in a car. When moving, keep their seat belt buckled and the doors locked.
- Plan regular rest stops.
- If they get agitated during the trip, stop at the first place you can. Don't try to calm them while you’re driving.
- Think about going on vacation somewhere that’s familiar to them -- like at a lake cabin they have visited in the past, for example.
- If they get flustered easily, it may be wise to avoid places that are crowded. You may also want to skip fast-paced sightseeing trips.
- If they have never been on a plane, it may be a good idea to drive instead, if possible.
- Alert the airlines and hotel staff that you’re traveling with a relative who is memory-impaired. Make sure they carry or wear some sort of identification.
- Enjoy your time with your dad, but try to find time to relax, too. It may help to bring someone along who can help you with caregiving tasks.
3. I'm having trouble getting my loved one to eat. What can I do?
Their Alzheimer’s symptoms can make it harder for them to get enough to eat. They might have trouble knowing when they are hungry or thirsty, have problems eating or swallowing, have a hard time using silverware, or feel depressed. Try some of these tips:
- Talk to your loved one's doctor. They may be able to help if your loved one is not eating because of a treatable problem, like depression.
- Don't force them to eat. If they are not interested in food, try to find out why.
- Focus on serving more nutritious choices, like protein, fruits, vegetables, and healthy fats, and less salt and sugar.
- Try giving them shakes with nutrition added to maximize the calories they get.
- Offer smaller meals more often instead of three large ones.
- Encourage them to walk, garden, or do other things that get them moving to boost their appetite.
- Serve finger foods that are easier for them to handle and eat.
- Prepare meals that offer different textures, colors, and temperatures.
- Make eating fun, not a chore. For example, liven up your meals with colorful place settings, or play background music.
- Try not to let your loved one eat alone. If you can’t eat with them, invite a guest.
4. My mother has Alzheimer's disease, and I've noticed she’s getting more confused. How can I help her?
- Keep their surroundings and routine the same. If you have to make changes, do it gradually.
- Make things simple, and avoid situations where they has to make decisions.
- Describe the events for the day to them. Remind them of the date, day, time, place, etc. And repeat the names of the people they see often.
- Put large labels (with words or pictures) on drawers and shelves so they’ll know what’s in or on them.
- If they don't seem to understand something you’ve said, use simpler words or sentences.
- Make sure they takes their medicines on schedule.
- Be patient and supportive.
5. Is there anything I can do to help my mother preserve what memory they have left?
Losing cherished memories is one of the hardest parts of Alzheimer's disease. Some medicines may help slow down symptoms. There are also some ways to help them hold on to the things they do remember.
- Use notes, lists, and memos to remind them of their daily tasks.
- Keep photos of family members and friends where they can see them. Label them with names if you need to. Get them to talk about the people or the hobbies they used to enjoy.
- Make sure they get enough sleep.
- Encourage them to read, do puzzles, write, or do other things that keep their mind active. But if they get frustrated, don’t push them to keep going.
6. Can ginkgo biloba cure Alzheimer's?
For many years, people thought this extract from the ginkgo tree might be a memory booster. But there’s no evidence that it works in treating or preventing Alzheimer's. In fact, it may be harmful. One large study showed that taking it every day may cause dangerous side effects, such as too much bleeding, and that ginkgo does not slow the decline of cognition.
7. Is exercise good for someone with Alzheimer's disease?
Yes. Exercise improves strength and endurance and keeps the heart healthy. It can also give your loved one more energy and improve their mood and sleep. Physical activity also helps people with Alzheimer's disease keep up their motor skills and balance, which can help them avoid serious injuries from falls. It can make the brain work better, too.
The type of exercise that’s right for your loved one depends on how much the disease affects them. Someone in the early stages of the disease may enjoy walking, bowling, dancing, golf, and swimming. As the disease gets worse, they may need more supervision. Talk to their doctor before they start any exercise program.
8. Do the symptoms of Alzheimer’s disease vary by the time of day?
Many people with the disease get confused, anxious, and agitated at dusk and into the evening hours. It’s called sundown syndrome, or sundowning. The problems may last a few hours or throughout the night.
Doctors don’t know exactly what causes sundowning, but they think a lot of different things play a role. Those could include physical and mental exhaustion (after a long day), and a shift in the body’s internal clock that happens with the change from daylight to dark. Some people with Alzheimer's have trouble sleeping at night, which may also make confusion worse. Some medications can add to the problem, too.
Some ways for you and your loved one to handle sundowning:
- Schedule harder tasks early in the day when they are less likely to get agitated.
- Watch their diet and eating habits. Offer sweets and drinks with caffeine only in the morning hours. Serve them a late afternoon snack or early dinner.
- Offer them decaffeinated herbal tea or warm milk. They might help them relax.
- Keep the house or room well-lit. Close the drapes before the sun goes down so they don't watch it get dark outside.
- If they fall asleep on the sofa or in a chair, let them stay there. Don't wake them to go to bed.
- Distract them with things they enjoy. Soothing music or a favorite video may help.
- Encourage them to be physically active during the day. It may help them to sleep better at night.
9. Are people in the early stages of the disease still interested in sex?
No one has studied sexuality in Alzheimer's. But many people with the disease also have a mood disorder, such as depression, or other medical problem, which can lead to sexual problems. Medications that treat these conditions can also affect someone’s sex life. People with dementia often feel less interested in many areas of their lives, like their appearance, clothes, and friends. That may affect their sex drive, too.
If your partner has Alzheimer’s and you’re concerned about their sexuality, try the following:
- Ask your loved one's doctor if they might have a mood disorder.
- Make sure they are getting treatment for any medical problems that may make them feel worse, like pain from arthritis.
- Ask their doctor how their medications might affect their sexuality.