In each issue of our Johns Hopkins Memory Bulletin, leading neurologists answer readers' questions about Alzheimer's disease, memory, and dementia. Here are two recent examples.
Alzheimer's Disease Question 1: My wife Elisa is 82 and has been taking Aricept for four months. She complains of having nightmares and says that the Aricept is the cause. I went to the Aricept website and I didn't read about nightmares as a side effect of the drug.
When I mentioned Elisa's complaint at my Alzheimer's disease support group meeting, no one there had any experience with nightmares caused by Aricept. What has been your experience with Aricept and nightmares? Cleveland, OH
Answer: Vivid dreams and nightmares can be side effects of all the cholinesterase inhibitors, the drug class in which Aricept, Razadyne, and Exelon reside. They can also be side effects of most antidepressant medications, especially those in the selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) classes. Talk with the physician who prescribed the Aricept for your wife; I have found that lowering the dosage sometimes helps.
Alzheimer's Disease Question 2: What do you recommend that I do for my grandfather with Alzheimer's, who doesn't realize that he is actually home? Some background: Gramps worked for the railroad for 48 years and did a lot of traveling during his career. Now that he is 90 and was diagnosed with Alzheimer's disease a year ago, he suddenly says that someone should pick him up, along with his luggage, and help him get home. I live with him and tell him repeatedly that he is already home. He gets this blank look on his face and then repeats that he wants to go home. This has been going on for a month, and I don't know how I can convince him and ease his concerns that he is already safe at home. Westport, CT
Answer: You are describing what doctors refer to as an agnosia, an inability to recognize a familiar object, person, or place despite intact eye function. This symptom can be seen in other brain diseases that affect the parietal lobes of the brain, so it is not only a symptom of Alzheimer's disease but does become common in Alzheimer's disease as the illness progresses.
This is not merely "forgetting" where one lives; many individuals with this problem can accurately describe the home they live it. Rather, it is an inability of the brain to merge the memory of a place with the perception the person is seeing at that time. In my experience, there is no benefit and sometimes harm in repeatedly trying to convince the patient that "this is your house." I think it would be best to distract him by changing the subject, reminiscing about his home, or empathizing with his distress. On occasion, it is ethically permissible to lie to someone with Alzheimer's disease if that decreases his or her distress (for example, telling him, "We'll be going to the house tomorrow").
