Help for dementia?

[concerneddaughter]

Is there any help or hope for dementia? My mother is 76 and has seen so many doctors, including neurologists, an endo, gastroenterologists, rheumatologists, and others. No one seems to help beyond prescribing medications with serious side effects (Namenda and Lamictal) where you wonder if the side effects are worse then the original symptom.

She was placed on thyroid medication 54 years ago to lose weight after a pregnancy, and has been on it ever since, even though she has been underweight for a long time now.

In her early 40s, after a hysterectomy, she developed symptoms of fibromyalgia, and despite years trying various medications, has suffered constant and continuing pain, insomnia, brain fog, fatigue, and memory problems. She was finally taken off HRT about two years ago, at the age of 74.

She has had chronic constipation, and been diagnosed with anxiety, depression, inability to concentrate, muscle cramping, low blood pressure, and now dementia. She frequently has trouble swallowing, and has had her throat stretched several times.

In recent years, she has had tingling and numbness on one side of her body, recurrent twitching and shaking, seizures (some doctors have called them TIAs, others say no), and frequent bladder infections. Two years ago, she fainted and hit her head and was hospitalized for a subdural hematoma and received rehabilitation.

She has become very unbalanced and suffers from weakness and frequent falls. Now her speech is becoming affected.
My research of her symptoms made he wonder if she had celiac, but recent blood tests say no. I still wonder if a GF diet might help.

Can anything be done to improve her condition?

[DrMariano2]

@concerneddaughter 738 wrote:

Is there any help or hope for dementia? My mother is 76 and has seen so many doctors, including neurologists, an endo, gastroenterologists, rheumatologists, and others. No one seems to help beyond prescribing medications with serious side effects (Namenda and Lamictal) where you wonder if the side effects are worse then the original symptom.

She was placed on thyroid medication 54 years ago to lose weight after a pregnancy, and has been on it ever since, even though she has been underweight for a long time now.

In her early 40s, after a hysterectomy, she developed symptoms of fibromyalgia, and despite years trying various medications, has suffered constant and continuing pain, insomnia, brain fog, fatigue, and memory problems. She was finally taken off HRT about two years ago, at the age of 74.

She has had chronic constipation, and been diagnosed with anxiety, depression, inability to concentrate, muscle cramping, low blood pressure, and now dementia. She frequently has trouble swallowing, and has had her throat stretched several times.

In recent years, she has had tingling and numbness on one side of her body, recurrent twitching and shaking, seizures (some doctors have called them TIAs, others say no), and frequent bladder infections. Two years ago, she fainted and hit her head and was hospitalized for a subdural hematoma and received rehabilitation.

She has become very unbalanced and suffers from weakness and frequent falls. Now her speech is becoming affected.
My research of her symptoms made he wonder if she had celiac, but recent blood tests say no. I still wonder if a GF diet might help.

Can anything be done to improve her condition?

To answer your first question:

When someone has dementia, two questions need to be asked:
1. What level of improvement in mental function is possible.
2. What level of mental function is best.

For example, one of my patients had Alzheimer’s Disease. It was severe. He needed 24-hour care since he could no longer perform activities of daily living. He had severe memory problems. He had no desire to do things. He would primarily sit in his seat. He could converse with his family. But he was very very forgetful. He had severe irritability and anger problems – which interfered with his family’s ability to care for him.

When I treated him, he would improve significantly. His memory improved. He could walk around. He wanted to do things around the house. Although this looked on the surface better, it was actually not. His memory and judgment were improved but not fully. This was actually a very dangerous for him. For example, he wanted to drive – even though he had lost his license years ago. So he got hold of his keys and drove his car … into a tree. He wanted to take walks. He would go out of the house and wander around, getting lost in the neighborhood. He wanted to help wash the dishes. But the dishes would be only half clean. He wanted to fix things in the home. But his projects would be half done – resulting in progressive damage to his home. His “improved” condition stressed his family so much, his wife became very anxious and depressed. He needed more and closer supervision than before treatment. And at times he could not be supervised because he was stubborn about what he wanted to do. He was a large and mobile man.

His family did not want him in a nursing home, where he would be among strangers. They wanted to take care of him in his home until his passed.

To answer question 1: Because his brain damage was so extensive, the best that treatment could accomplish is akin to having a glass that is half-full. His glass could never be full. But this level of functioning was not best for him. It was actually worse for him and his family.

To answer question 2: Thus, the level of mental function that is best for him is actually that with no treatment at all of dementia. Focus, instead, was on palliative treatment – treatment to improve the quality of his life but not to prolong it. By quality of life, this meant reducing suffering, rather than attempting to improve cognitive function.

With consultation with his family, I stopped his dementia treatment. Instead, I focused solely on stabilizing mood – to reduce irritability and anger problems which impaired his family’s ability to care for him and caused them much stress.

He became stable in mood, cooperative. He was generally cheerful, talkative, calm and happy. He did not suffer. Despite limited activities, he enjoyed his life. Whenever he visited me, he was cheerful. He liked to talk about his previous line of work – though he lost specifics and the skills for his work. When I gave him his tools, he did not know what to do with them. He could not remember anything new. He was cooperative with treatment. He lived the rest off his life in peace as did his family, in the warmth of his home, not with strangers in a nursing home.

—

After asking and addressing the two questions about dementia, the most important area to focus upon is suffering.

Curing disease is actually not a physician’s primary job according to the Hippocratic oath. Reducing suffering is. Reducing suffering is a lot easier to accomplish.

For example, fibromyalgia related pain, insomnia, anxiety, depression, muscle cramps, seizures, low blood pressure are some conditions that can be improved significantly to reduce suffering. Addressing these would greatly improve one’s quality of life.

To address these, what is important is to identify the pathophysiology of each condition – not just label them with a diagnosis. Once the pathophysiology (cause) of a condition is determined – and there can be many of them for any given condition – then targets of treatment are identified and treated. Addressing pathophysiology would then be expected to improve a person’s condition better than by trial and error treatment.

To answer your second question: yes, there are things that can be done to improve your mother’s condition.

[chaos]

Dr. M,

My maternal grandmother also suffered from dementia. My mother is 67 and in good shape, but has also lived through a lot of stress.

I am concerned about dementia.

What things can be done to help prevent dementia?

I would also add that she had a complete hysterectomy when she was about 40, and was never given HRT. Interestingly, she apparently never needed it. She has always been fine emotionally, etc…

Some have suggested pregnenolone.

[DrMariano2]

@chaos 749 wrote:

Dr. M,

My maternal grandmother also suffered from dementia. My mother is 67 and in good shape, but has also lived through a lot of stress.

I am concerned about dementia.

What things can be done to help prevent dementia?

I would also add that she had a complete hysterectomy when she was about 40, and was never given HRT. Interestingly, she apparently never needed it. She has always been fine emotionally, etc…

Some have suggested pregnenolone.

Some causes of dementia – such as some forms of Alzheimer’s Disease – are inherited and cannot be stopped at this time since we have no effective treatment. At best, they can be slowed in progression.

Some causes of dementia are preventable – e.g. vascular dementia. And it is possible to reduce the risk of developing dementia.

Off the top of my head, it boils down to:

1. Optimizing intercellular signaling systems and reducing the risk of structural damage.
2. Optimizing cellular metabolism and nutrition.
3. Optimizing behavior

Optimizing signaling systems and reducing the risk of structural damage includes:
1. Reducing insulin resistance.
2. Improving Thyroid Function (e.g. in Alzheimer’s disease, the central nervous system may be hypothyroid even if the rest of the body is euthyroid).
3. Optimizing Hypothalamic-Pituitary-Adrenal Axis regulation. This improves one’s ability to adapt to stress and to provide the brain with glucose. This includes optimizing Progesterone – whose metabolites help protect neurons.
4. Optimizing Testosterone or Estrogens. In women, this is particularly important since Estrogen promotes neuron growth and connections. Many women diagnosed with dementia may respond to estrogen treatment.
5. Reducing excessive Norepinephrine signaling. This includes controlling blood pressure since stroke is a common cause of dementia
6. Reducing Excessive Inflammation and Proinflammatory Cytokine signaling (some pro-inflammatory signaling is needed, thus it should not be shut down, rather a balance is necessary)
7. Protecting Dopamine neurons. Dopamine is one of the signals for memory.
8. Optimizing Acetylcholine signaling. Acetylcholine is a trophic factor for glia, without which, they automatically die, taking their neurons along with them.
9. Reducing atherosclerotic blood vessel changes. This involves reducing excessive cholesterol and reducing excessive inflammation.
10. Blood pressure control – this involves numerous signaling systems including the sympathetic nervous system-renin-angiotensin-aldosterone system.
11. etc. etc.

Optimizing Cellular Metabolism and Nutrition includes:
1. Optimizing B12. Low B12 is one cause of reversible and irreversible dementia.
2. Optimizing Iron.
3. Optimizing other fat soluble vitamins – A, D, E, K
4. Optimizing Animal Protein, Saturated Fat, and Cholesterol intake. Realize that 1/2 of the brain is cholesterol (dry weight). And people who live the longest tend to have the highest intake of these nutrients.
5. Optimizing water intake
6. Optimizing Lithium. Physiologic lithium from natural sources help promote neuronal growth and mood stability. This is not a medicinal level of Lithium use. The doses are generally around 4.8 to 10 mg of elemental Lithium a day. This doesn’t impair thyroid function, per Jonathan Wright MD’s measurements.
7. Optimizing Omega-3, Omega-6 fatty acid intake
8. Optimizing anti-oxidant intake – which helps improve anti-inflammatory signaling.
9. etc. etc.

Optimizing Behavior includes:
1. Using the brain – such as learning new subjects, challenging the brain in solving problems, continuing to work rather than retiring especially if activities are enjoyable, etc. Activities which use language areas in the brain particularly are important. Use it or lose it, as one saying goes. Continuous lifelong learning is important.
2. Exercise – walking, for example, stimulates neuron growth and activity. Elderly who walk can solve puzzles better than those who are sedentary.
3. etc. etc.

Pregnenolone is made from cholesterol. So long as brain cholesterol production and hypothalamic-pituitary-adrenal axis function are intact, then pregnenolone may not be necessary. Sometimes this may be needed.

[misseschris]

This is such an interesting thread, as I have never heard of anyone, but myself, in favor of discontinuing treatment for dementia.

My poor mother suffered from dementia and was given Aricept. I noticed that the drug kept her at a level where she was aware of her illness and it caused her great distress. She knew what was happening to her and suffered great anxiety and fear because of it. I requested that she be taken off the medication and let the disease progress, which it did. She soon got to the point where she was no longer aware of her predicament. She became much calmer, less combative and more at peace. This was better for her and for us as now we could have her with us much more, and she could enjoy just being with her family- and was now oblivious to what was happening- which was a blessing.

I, during that very stressful time, felt guilty for requesting that her ‘treatment’ be stopped, but it seemed so inhumane to keep her ‘functional’ enough so that she was aware of her terrible situation.

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