Dementia Solutions – Caregiving Advice, February 2015 Update

Dementia expert, Karen Tyrell, offers answers to visitors for their situation-specific questions. Karen is a dementia consultant who can point you in the right direction, giving quick insight and personalized answers to help you with dementia care challenges.

Do you have a specific question relating to dementia that you need answered? Please submit your questions by email to: [email protected]

February, 2015 Update

1. Dementia and Dental Care – Why Was My Mother’s Medication Changed?


“I reside with my mum in BC and recently noticed a change in the medication she was taking for her Alzheimer’s. The pill appeared different from what she had previously been using. When I asked the pharmacist about this, he responded that the new medication was being given because it was more cost-effective. I am shocked that they did not inform us of the change. I am also noticing differences in my mum’s behaviour and wonder whether this is due to the new medication. What should I do?”

 ~ Unsettled in BC


Information is power, and it’s important that patients always feel informed and empowered when it comes to their health. It is therefore understandably frustrating to be left in the dark about this change, and I am sorry that both you and your mother were not informed.

The reason for the altered medication is because in April 2014 three main brand-name drugs (known as Cholinestrease inhibitors) that have been used to support those diagnosed with dementia, including Alzheimer’s, had their patents expire. With the expiry, the stage was set for generic drugs to enter the scene and act as replacements here in BC. Despite being chemically identical to the main brand-name drugs, generic drugs cost less to produce and for that reason were adopted. Your mother is essentially taking the same medication she always did, but at a lower cost.

Since generic medications are designed to be identical to the original medications, they are not likely to be linked to the changes noticed in your mother’s behaviours however, if you feel you would prefer the generic type again, contact your mother’s doctor. In some cases, it could be the progression of Alzheimer’s that is causing the shifts. To allay your concerns, it is best to share your observations with your mother’s doctor. It may be time for another physical check-up and for implementing some new strategies to cope with her changed behaviours. Though medication cannot stop or slow the progression of Alzheimer’s, there are creative non-drug approaches that can have very positive effects. This will help both you and your mother navigate the changes that accompany Alzheimer’s.

2. Blocking EP2, Blocking Alzheimer’s- Is There A Drug That Does This?


“A close family member of mine has Alzheimer’s, which is why I often go online to read about new research regarding the disease. I recently came across a fascinating study that found that blocking the action of a molecule in the brain, known as EP2, could be linked to reversing or preventing memory loss, brain inflammation and other features of Alzheimer’s. Is this research being conducted in Canada and is there any available medication that can block EP2?”

 ~Inquiring Mind


Alzheimer’s affects countless families such as yours, which highlights the importance of finding ways to prevent and treat the disease. Researchers all over the world have been on the mission for several years now, studying changes and functions in the brain and how they relate to Alzheimer’s. It is wonderful that you are taking interest in reading about the exciting new findings.

Here in BC, Canada, brain researcher Brian MacVicar from the University of British Columbia published his work on microglia that relates closely to the study you refer to. Microglia are the foot-soldiers on the frontline that keep our brain healthy. These cells act as the first and primary form of active immune defence in our central nervous system. MacVicar’s work showed how microglia moved to areas of injury in the brain to repair damage. His studies also provided insight into how inflammation and hypoxia (reduced oxygen levels in the brain) activates microglia in a way that weakens the connection between neurons and results in cognitive impairment. This in turn leads to Alzheimer’s disease.

The study about blocking EP2 that you mentioned was published in December 2014 by Stanford University. The research focused on the EP2 molecule on the surface of microglia that can lead to deterioration in microglial function. If microglia cannot do its job of warding off damage to the brain, this results in brain degeneration. Therefore blocking the EP2 molecule could shield the brain from memory loss, inflammation and other features of Alzheimer’s.

I am not aware of any current studies in Canada on creating medications to block EP2. However, there has been research in Canada that follows a parallel path, such as the example I provided of the study in BC, and other similar work may soon be ready for public release. I will be sure to keep my eye out for the latest and hope you continue to do the same. Keep taking the initiative in being informed and inquisitive!

3. Dementia Patient in a Respite Care Facility-To Visit or Not To Visit?


“My mother-in-law went on a much-needed vacation, while my father-in-law who has dementia stayed in a respite care facility while she was away. We were worried that he would feel abandoned during his stay, but when I visited him he appeared to simply be confused and didn’t recognize me right away. He didn’t mention any feelings of abandonment but did keep saying that he wanted to return home. He returned back home, but yet continues to mention wanting to get back home no matter where he is. My wife and I are not sure whether visiting him while he is in respite is a good idea or not. Should we not visit him next time?”

~ Confused Son-in-Law


The fact that your father-in-law was not upset by feelings of abandonment is a good sign. His constant longing to return home, even when he is home, is a common behaviour among those with dementia. Impaired cognitive functioning makes the familiar appear unfamiliar, which leads to feelings of disorientation. The added effects of memory loss also mean that he may not remember how many times you visit or even if you visit at all.

The next time your father-in-law is in respite care, call before visiting to check in on how he is doing. If the staff mentions that he is asking for family members and having trouble adjusting, you could visit to provide reassurance or even try a new approach by speaking to him over the phone. Know, however, that your father-in-law is also receiving support from staff at the facility, who are often very well trained in dealing with dementia-related behaviours, such as the desire to go home. They likely have several effective strategies up their sleeves for keeping him preoccupied and assured that he will be going home soon.

Respite facilities offer a much-needed break for family caregivers, such as your mother-in-law, your wife and yourself. It sounds like the transition to a new environment did not cause your father-in-law too much stress. His feelings of disorientation, whether at the facility or at home, are a part of his condition that can surface anywhere and at any time.

When a family member has dementia, it can sometimes feel as if guilt and uncertainty is attached to every decision made. The best way to manage these feelings is to remember that you are all doing your best and to treat each new situation as an opportunity to make tweaks and adjustments for a better outcome.

Do you have a specific question relating to dementia that you need answered? Please submit your questions by email to: [email protected]

Karen Tyrell CDP, CPCA is a Dementia Consultant & Educator for Personalized Dementia Solutions ( and the author of the book “Cracking the Dementia Code – Creative Solutions to Cope with Changed Behaviours.” She offers her expertise on dementia care through speaking engagements, workshops and by working one-on-one with families and caregivers.