AD for AD: Advance Directives and Alzheimer’s Disease

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The abbreviation AD commonly signifies time, as in AD 400. But two other ADs are equally critical. When it comes to both Advance Directives and Alzheimer’s Disease, time is indeed of the essence: proactive choices could save someone’s life, or make their passing more peaceful.

Is Their Paperwork Correct? 

Everyone knows an advance directive is a smart step to ensure their wishes will be carried out if they become incapacitated and unable to express themselves. Elder law advisors will likely discuss this topic with clients in detail.

But given our collective aversion to facing our own demise, or any form of incapacity, only about a third of adults have completed an advance directive, according to the National Institutes of Health. People feel, often rightly so, that there is yet time.

Until Alzheimer’s rears its disorienting head.

Without an advance directive (AD) — or even with one — someone is unlikely to be appropriately covered in the event they develop dementia.

That’s why a few organizations have developed Dementia Directives focused specifically on the type(s) of care choices someone would want if they were diagnosed with Alzheimer’s or another form of cognitive decline.

An Alzheimer’s AD from the University of Washington can be downloaded here.

End of Life Choices New York offers a similar Alzheimer’s AD, here.

The point of a dementia AD, as with all advance directives, is avoiding unnecessary suffering. It must be completed well ahead of needing to be enacted because, as one geriatrician notes, “With dementia, by the time you get to the point of having to decide what you want done, you’ve largely lost the capacity to do so.”


Is It Actually Alzheimer’s?

Of course, since we already know how prevalent Alzheimer’s and other forms of dementia are (Alzheimer’s is the fifth leading cause of death among those 65+), it behooves families and caregivers to play detective and insist on extensive testing.

It may not be Alzheimer’s at all, as one financial entrepreneur found out to his shock and relief — three years after his father’s sudden and rapid decline.

One day he shared his dad’s symptoms with a neurosurgeon he met at a fundraiser, and was shocked when the doctor said, “Your father doesn’t have Alzheimer’s.”

An MRI diagnosed hydrocephalus (fluid accumulation in the brain that can mimic brain damage). After a shunt drained the excess fluid, his father asked, “Brad, how are the markets?”

The product Brad Kotansky created to help families collaborate about finances is a welcome idea for all ages and life stages, and may be useful for reverse mortgage professionals to explore.

Disrupting Dementia

Beyond Alzheimer’s imposters, the herpes virus may play a causal role. We’ve explored the role of tau proteins acting like an infection in the brain. Now, new research has detected two common herpes viruses in the brain tissue of people with Alzheimer’s — which may mean antiviral drugs could slow or even prevent the disease, as well as help scientists find ways to boost cell immunity.

This discovery does not mean herpes causes Alzheimer’s, cautions the director of the National Institute on Aging. But it does show evidence that viral infections can influence the course of the disease.

People with Down syndrome may also help unlock the mystery of Alzheimer’s: they’re more susceptible to it than the general population, and affected earlier: half develop symptoms by age 50.

The extra copy of chromosome 21 is the culprit. It both causes Down syndrome and leads to a buildup of plaque in the brain, a marker for Alzheimer’s. A two-year clinical trial testing a new vaccine is currently underway at Massachusetts General Hospital.

Would it Help to Be Vegetarian?

While maintaining a healthy weight, regular exercise, and sufficient sleep are advisable for anyone wishing to stave off disease, there is evidence to support a vegan model (no meat, no dairy) in reducing the risk of Alzheimer’s, because eliminating consumption of saturated fats lowers the risk of obesity, diabetes, and cardiovascular disease, all of which “may contribute considerably to the pathogenesis of Alzheimer’s disease.”

However, a strict vegetarian diet has also been found to reduce cognitive abilities in at least one study, which advocates eating fish. Strict vegetarians may also suffer from a Vitamin B12 deficiency, which can lead to pernicious anemia — and the elderly are especially at risk.

So moderation is key. As is keeping one’s brain as active and engaged as possible. One creative solution: a puzzle book designed for elders with memory issues, in a large enough font, and much simpler to use than conventional crosswords.

On the research frontier, AARP has kicked off a new “Disrupt Dementia” campaign with a $60 million investment, the first and largest venture fund focused on discovering and developing effective new drugs for treating dementia. And a number of other dementia breakthroughs are likewise gaining ground.


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