Grechel wrote:...
Since I learned about my status I have been worried about my parents/grantparents without telling them about indirect genetic info I have about them. They have been ok so far but my 87 years old grantfather is not as sharp as he used to be lately -maybe very early stage AD. Last few weeks he has been anxious about some obsessive ideas and not sleeping. I am wondering whether an SSRI or any other anxiety meds would be helpful or would harm an old potential ApoE4 person. I know research is blurry but wanted to reach out to this wonderful community if any of you know anything about managing this kind of obsessive anxious behaviour.
Thank you! I am happy to finally post instead of lurking.
Welcome, Grechel, from an ApoE 4/4 woman who is old enough to be your mom and still enjoys browsing Google Scholar, Pub Med and serving on groups with smart people like you! Your parents and grandparents must be thrilled to have a woman in the family showing that women continue to advance frontiers of science!
I'm sorry that your grandfather is showing some signs of early dementia in his obsessive behavior and sleep difficulty. As you know, advanced old age is itself a risk factor for dementia, although it may well be that he has some neuropathological features of both vascular and mixed dementia, which tends to be seen more in those who begin to show symptoms in their late 80's. A 2019 article on a study in Finland of the "oldest old" found that ApoE 4 status predicted amyloid and tau pathology and cerebral macroinfarcts, found in about 30% of ApoE 4 carriers, but did NOT predict a diagnosis of dementia, which appeared highly multifactorial in this group of hardy individuals.
Prediction models for dementia and neuropathology in the oldest old: the Vantaa 85+ cohort study
It may be helpful to think of your grandfather as both cognitively resilient and resistant to have arrived at age 87 and only now show some early signs of difficulty. As a former special educator, I always encouraged staff and families to look at a strengths-based assessment: what is working well and how can we extend or scaffold that in situations that are more difficult? One way to start is to look at Environment, Immediate Antecedents, Frequency, Intensity and Duration of problem behaviors, and Competing Alternative Behaviors.
His environment may be causing some visual spatial confusion, or not enough cues to help his circadian rhythm. If his obsessions are that people have moved his things, it may be helpful to label furniture, or to reduce some of the clutter that some find comforting until it's overwhelming. If he's agitated in the early evening or not tired, it may be helpful to try to get him into a senior center for some physical and social stimulation during the day, or even to a regular "coffee hour" with friends his age early in the day. Just like most of us, having natural light, exercise and social activity help our mood and tire us out. Here's an excerpt from a RCT about positive, well-tolerated lighting interventions that increased daily activity, helped mood and improved sleep.
The present results demonstrate that exposures tailored to maximally entrain the circadian system, especially when carefully delivered and measured in the field, can significantly improve sleep quality, depressive symptoms, and agitation behavior in patients with ADRD. The light was also well tolerated by the participants, which is crucial for the effective delivery of a lighting intervention in real-world applications.
Effects of a Tailored Lighting Intervention on Sleep Quality, Rest–Activity, Mood, and Behavior in Older Adults With Alzheimer Disease and Related Dementias: A Randomized Clinical Trial
Immediate Antecedents may mean someone spending some time figuring out what happens just before an obsessive period. Are there questions asked of him? Is there a transition from one activity to another? Do the obsessive thoughts bother him or just represent some forgetfulness (like asking why he's going somewhere every 30 seconds)? My husband had a 93 year-old aunt who was obsessively paranoid after a right hemisphere stroke resulted in lack of insight and sudden cognitive changes. She responded much better to my mother-in-law saying "I'll talk with the doctors about that in the morning" and then asking about dinner, or playing bingo, rather than trying to explain why she was wrong in her thinking. Some researchers have found that use of music or visual reminiscences to calm and redirect obsessive thinking helps. Here's an excerpt about that:
Our proposal is based on two foundational concepts—reminiscence therapy and Dr. Oliver Sack’s music research. Reminiscence therapy is used to recall past memorable events using prompts such as photos and music... Irrespective of their stage in AD, all people are able to respond and react to musical stimulation in improving cognition, behavior, and mood in AD [18]. Research has shown individualized music therapy is the most effective [19]...
A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer’s
As Julie G also mentioned, small doses of melatonin have been helpful to some, although it can also cause diarrhea. Here's a recent post from a 70 year old user who has found a transdermal patch helps his sleep:
https://www.apoe4.info/forums/viewtopic ... nin#p76697 As for other medications, you may want to talk to your parents about seeking out a knowledgeable geriatrician who has experience in balancing the risks and benefits of medications in someone your grandfather's age and who can look at all the medications he is currently taking to see what effects they may be having on his recent changes. It might also be helpful to rule out causes of general anxiety such as palpitations from heart arrhythmias with an easy ECG--my mother was diagnosed with that at age 80 and successfully treated with a beta blocker.
Good luck to you and your family! The journey you are starting with your grandfather may be uncertain, and yet bring deep closeness and love.
