Q1. Can consumption of alcohol influence the progression of Alzheimer’s in an individual?

Alcohol can make the symptoms of Alzheimer’s worse (memory and behavior problems, for example), but it is not likely to accelerate the progression of the illness unless the consumption is very heavy. In general, I recommend that patients with Alzheimer’s limit their intake of alcohol to no more than one drink a day (1 beer, 4 ounces of wine, 1 ounce of liquor in a mixed drink). But if one drink is enough to cause a noticeable impairment, then even that much is probably too much for a patient with Alzheimer’s.

Of note, many years of very heavy alcohol use can cause dementia, but this is not the same as Alzheimer’s disease.

Q2. Can occasional recreational use of cocaine (twice a month) increase your risk for developing Alzheimer’s?

Cocaine use is not a known risk factor for Alzheimer's disease, as far as I know. However, cocaine use can lead to long-term cognitive problems, including decreased ability for abstract thinking, problem solving and multitasking, as well as decreased working memory (for example, the memory required to hold a phone number in your head long enough to go write it down).

Q3. What can I do to help my mom, who has Alzheimer's, stop being hungry all the time? We fix regular meals, but she tells us she hasn't eaten in days and my dad goes back in and fixes another meal. She is not satisfied with a snack; she wants meat, potatoes, veggies, etc., and she is gaining so much weight. I think my dad still sees her as his wife and not the child she has become. Can anything be done medically or otherwise to help her?

— Sharon, North Carolina

The central problem in patients with Alzheimer's disease is memory impairment. Perhaps not surprisingly, some patients forget they have already eaten and request, or even demand, to eat again. This can become a significant problem in families. How do you control this? There is no simple solution other than absolute restriction to three regular modest meals per day with mid-morning and mid-afternoon snacks. All must be calorically controlled. To help offset the continuing clamor for food, try giving her carrots, celery, cucumbers, and other low-fat foods. It is also important that your mother's blood sugar is tested to make sure she does not have diabetes.

The other aspect in the situation with your mom relates to your dad's desire to please her. He must understand that it is not in her best interest to gain excess weight. He probably understands this but is finding it very difficult to deal with the loss of his wife's personality and her present status. It may be in his best interest to seek counseling during this difficult adjustment period.

Q4. My mother is almost 86 and has been diagnosed with Alzheimer's/dementia. She is taking both Aricept (donepezil) and Namenda (memantine). Most of the time, she is very lucid and "together." She knows who we are and can carry on a conversation. Occasionally she says things that are very strange and obviously not based in reality. We know that sometimes these hallucinations or delusions have been caused by a urinary tract infection or dehydration. Is this the progression of the disease? A mental health professional has suggested that at these times, Mom may be suffering from delirium. We want to understand what is going on with Mom, so we can be as helpful and supportive as possible. Can you help us with this? Also, what is the best way for us to interact with Mom when she is in this place in her head? Thanks!

Hallucinations and delusions may be a symptom of the Alzheimer's dementia or they could represent delirium. Delirium is generally caused by an illness (such as urinary infection or pneumonia), electrolyte disturbance, medication or some other significant change in health status.

Any new changes in behavior need to be evaluated by a physician, particularly hallucinations and delusions, or changes in level of consciousness (if the person is really hard to wake up or not sleeping for days). The cause(s) of delirium need to be found and treated. Stable or occasional, isolated events are probably not delirium. So, if there is a change in behavior or level of consciousness, take her to a doctor.

If it is not a change, I would deal with the departures from reality in the most kind and compassionate way you can, which is usually to go along with it and not argue or try to convince her that her belief or perception is wrong. Arguing will usually just make everyone upset.

Q5. My mother has recently been diagnosed with Pick's disease. Can you explain the difference between that and Alzheimer's? And can you give me some suggestions on how to go about finding someone who can help my dad care for her?

Pick's disease causes a slow shrinking of brain cells due to an excess protein buildup. This leads to a focal atrophy (loss of tissue) of the frontal lobe of the brain, causing deterioration in mental function and particularly affecting personality, behavior, and thinking; unfortunately, you can also expect a decline in your mother's ability to speak coherently. In contrast, Alzheimer's disease is more diffuse in the brain and typically affects memory.

My advice is to take your mother to a neurologist, psychiatrist, or geriatrician who specializes in treating patients with Pick's disease and who can help your family develop a plan for treatment and caregiving. If there are other family members who can help with the day-to-day care, it's important to work out a schedule to relieve your father or he will become both physically and emotionally exhausted. If there are no family members who can help, you might consider paid home health aides to give your father breaks (admittedly, the costs add up). To find a competent aide, ask your doctor for a recommendation or call upon a certified home health agency, such as a visiting nurse service. You can also find support online, from sites like the Pick's Disease Support Group.

Learn more in the Everyday Health Alzheimer's Disease Center.