Doctor's Diary
Many families describe repetitive questioning as one of the most distressing aspects of Alzheimer's disease Alzheimer's disease
A neurological disease that affects memory and behaviour. It is characterized by beta-amyloid plaques and neurofibrillary tangles in the brain. There is no known cause but genetics and lifestyle are thought to play a role.. Having to answer the same question over and over and over saps morale like few other aspects of the illness.
One common misunderstanding about the nature of repetitive questioning is that it is a request for information. Some very detailed studies carried out in the Geriatric Medicine Research Unit at Dalhousie University by Dr. France Cloutier, supported by an Alzheimer Society of Canada Post-Doctoral Research Fellowship, showed that more often, the 'purpose' of repetitive questioning is not to seek information as much as it is to seek reassurance. Thus, one way to respond to the request, is to supplement Supplement
A quantity added to what is already naturally present in order to compensate for a deficiency. E.g. taking a supplement vitamin if enough vitamins are not ingested through ones diet.
the informative part of the answer with some support and reassurance. (For example, for the person who repeatedly asks 'When are we going to the doctor?' the answer might be not just 'We are going to the doctor tomorrow', but with emotional support added 'we are going to the doctor tomorrow, and I know that you are nervous - I am a little nervous too - but I think that they will tell us that things are getting better.')
Understanding the illness in this way - at the level of the experience of people who are going through it - is known as phenomenology. It has played a surprisingly small role in Alzheimer's disease research, but an excellent example of how it can help us get to grips with Alzheimer's disease is in the excellent book by Steven R. Sabat. The Experience of Alzheimer's Disease. Life Through a Tangled Veil. (Oxford: Blackwell, 2001).
We have also come to understand that the repetitive questions are not just a problem with memory Memory
The ability to process information that requires attention, storage, and retrieval. (people do forget that they have asked the question before) but also a problem with planning. This likely is why repetitive questioning often has to do with questions about upcoming events, like a doctor's appointment, or the visit of a friend, or going on a trip.
Our most recent work on repetitive questioning was done as part of a controlled clinical trial Clinical trial
Organized studies that test the value of various treatments, such as drugs or surgery, in human beings. of galantamine (Reminyly, Razadyne) in treating people with mild-moderate Alzheimer's disease. We found that most patients in this trial who set a goal for improvement in verbal repetition met that goal (about 60%) and only a few got worse (less than 10%). By contrast less than a third of people on placebo got better, and more of them showed worsening of their verbal repetition. The full study on repetitive questioning is published in Neurology Neurology
Scientific study of the nervous system in respect to its function and abnormailities. , 2007;68:1116-1121. The main report from the clinical trial was published in the Canadian Medical Association Journal (CMAJ 2006;174:1099-1105) and is available free on-line at www.cmaj.ca.
