David Shenk Answers Your Questions About Alzheimer's

David Shenk is the author of "The Forgetting: Alzheimer's, Portrait of an Epidemic."

You submitted your questions about Alzheimer's disease. Read Shenk's answers below:

Question: I still don't understand the difference between dementia and Alzheimer's. Also, I have read that you should not argue with an Alzheimer's patient, but when my mother is confused, I feel that it sometimes seems to help when I "correct" her version of reality. Can I do anything to keep her grounded in reality?

-- Judy, Gadsden, AL

Shenk: Very important question. "Dementia" and "senile dementia" are generic terms that describe a set of symptoms - memory loss, confusion, aphasia, and so on. Every case of dementia is caused by one or another disease. Alzheimer's is one of those diseases, and is by far the most common cause of dementia. There are other diseases that cause dementia - multi-infarct dementia, fronto-temporal dementia, and others. But the important point here is that it is no longer acceptable for a doctor to leave a diagnosis at "just dementia." It's important to find a doctor who will work to find out which disease is causing the dementia.

This has to be handled on a case-by-case basis, but every caregiver I've spoken with about this has found that the easiest and most comforting thing to do is to let the patient be comfortable in his/her own reality. As you've suggested, you're never going to bring your mom back to your reality. She has a progressive brain disease and is now living through her own very different reality. If correcting her gently makes her happy, that might make sense some of the time. But generally, you want to be showing an understanding of what they are saying, and gently steering them to a conversation that they find comforting.

Question: Is there such a disease as pre-Alzheimer's? What medicines, nutritional changes or aggressive clinical trials are available to help patients keep their memory and ability to function longer? Does loneliness or depression precipitate dementia or Alzheimer's?

-- Alicia, Clayton, NC

Shenk: There are a few medications that help some people to stabilize their symptoms, or perhaps improve a little, for as long as a year or two. These drugs do not actually stop the disease. You should speak to your doctor about which drugs might be appropriate for your loved one. [Disclosure: A number of pharmaceutical companies have funded conferences at which I have paid to speak.]

Depression does not cause Alzheimer's or any other disease related to senile dementia. It is possible, even common, for people to have depression and Alzheimer's at the same time, and the depression can and should be treated. It's also very common for caregivers to develop depression - and it's important to watch for that and to treat it aggressively.

Question: How do I deal with a family member who accuses me of lying and stealing from her?

-- Karen, Sherwood, OR

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