Caregivers report that one of their greatest needs is for emotional support, second only to the need for time off. Many have no one to talk to about the problems they face in caring for a demented family member. The guilt, loss, and grief are especially difficult to express. Caregivers frequently feel that others do not truly understand the extent of care required. Visits from other family members greatly ease the sense of bur­den. Family members and friends are by far the most common sources of emotional support, although support groups and professionals may assist in relieving feelings of isolation.Perhaps the most important and valuable coping strategy is the arrangement of an adequate amount of time off to run errands and to engage in recreational and social activities. The research is quite clear that individuals who do not obtain a sufficient amount of time away from the responsibilities of caregiving feel a much greater sense of burden and have less success managing their emotional and physical health. Respite care and day care are valuable in this regard. Although community respite day care have been difficult to find in the past, many cities now have excellent day care programs specifically designed to meet the special need of Alzheimer patients. If your community does not offer such services, perhaps your local Alzheimer support group can help to develop special day programs

In the early stages of Alzheimer’s disease, the person is able to both perform self-care activities and function socially. Initially, changes in behavior may be subtle and infrequent. During this stage the person may deny the presence of any abnormality and may try to cover up his behavior with excuses. These changes are often attributed to other physical or mental problems. As time progresses the signs and symptoms become more frequent and are noticed by family and friends. The once quiet and friendly person may exhibit swings in mood and outbursts of anger. Tasks that were simple, such as cooking, playing cards, and driving a car, become difficult. There is difficulty concentrating, making decisions, and maintaining coordination.

As the disease advances, the person’s attempts to cover up for the behavior become more difficult. Sleep may be interrupted and the person may experience hallucinations. In addition, safety becomes a concern because of restlessness and tendencies to wander off, especially at night.

The lack of ability to function independently is characteristic of the final stages of the disease. Profound weight loss, related to impaired intake of food and fluids, is sometimes noted. The activities of daily living, such as hygiene and elimination, can no longer be controlled. In addition, the inability to recognize self, family, and friends may contribute to feelings of anger and frustration.

Three kinds of treatments are currently in practice -

1. Behavior management
2. Drug therapy
3. Emotional support for the patient’s caregiver.

The last has been the most successful to date thanks to the untiring work of individuals and to the support provided by organizations such as the Alzheimer’s Association. Behavior therapy holds no cures but it offers great improvement in the day-to-day management of patients with Alzheimer’s disease and other dementia symptoms. For instance, Veronique Breuil and her colleagues at Hopital Broca in Paris have reported some behavioral benefits following a “cognitive stimulation program.”

Research on drugs that might enhance Alzheimer patients’ performance on memory and language tasks is moving at a rapid pace. A computerized search restricted to a psychology database revealed 262 studies involving drugs and Alzheimer’s disease just in the last ten years. A lot of work is being done with cholinesterase inhibitors (e.g., aminoacridines such as tacrine and velnacrine). These can prevent the rapid degrading of acetylcholine, an important neurotransmitter that Alzheimer patients typically have in reduced amounts. The logic is that a patient’s limited supply of acetylcholine would have a better chance of doing its job if it can be kept from depleting so rapidly. There is also a lot of encouraging research on the memory benefits of glucose, and some promising work on delayed onset of symptoms with anti-intammatories. With the number of new drugs being developed, the need is even stronger for better tests to positively identify Alzheimer’s disease.

As Dr. Hutton discussed in his treatment of the medical aspects of dementia there presently is no single known cause or any associations of lifetime events that lead to the specific type of dementia known as Alzheimer’s disease. There are only theories suggesting cause­and-effect relationships, which provide some direction for future research. Since we are what we eat, a legitimate question is, “Does diet alone, in any way, contribute to the onset of Alzheimer’s disease?” The answer to this question is most certainly no. It is possible, however, that some dietary components of food, over which we have no control, may participate in the disease once it has begun.

The most studied dietary component observed to be associated with Alzheimer’s disease is aluminum. It seems clear that aluminum does not cause Alzheimer’s disease. After all, many people use aluminum cook ware, and we store foods in aluminum containers. Aluminum is a major component of numerous antacids and deodorants, and many foods naturally contain aluminum. The mineral is also abundant in the soil, normally nontoxic, and has no known nutrition function. Aluminum accumulates in the brain plaques of Alzheimer patients as the disease progresses. The concentration of two other minerals, silicon and calcium, have also been observed to be concentrated in the brain plaques. Bromine and nickel, two more nonessential dietary components, have been found to be elevated in the blood and spinal fluid of a small sampling of Alzheimer patients. While the source of these minerals is probably dietary, at this time the evidence is insufficient to conclude that common dietary practices contribute to the onset of Alzheimer’s disease.