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Getting Sick Means Double Trouble For Caregivers And Patients

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By: Matt Kwong

If you're caring for Alzheimer's or dementia patients, care for yourself first, doctors warn; especially at this time of year, when the shift from summer to fall tends to give way to seasonal sniffles.

Everyday infections such as the common cold, a stomach bug, upper respiratory infection or urinary tract infection have been shown to hasten cognitive decline among people with dementia. You don't want to pass along a bug to your loved one, to bring on these afflictions.

"A caregiver needs to realize, if [their] health is impaired, it's likely to have a consequence on the person you're caring for," James Galvin, a professor of neurology at New York University's Langone Medical Centre said.

Be vigilant around your patients, he advised. Wash your hands, wear a mask, get your flu shots, live a healthy lifestyle.

"If you're sick, you shouldn't be caring for somebody who's sick," he said.

Why colds are more dangerous

Inflammation is part of the body's protective immune response in otherwise healthy people, marked by symptoms such as a runny nose or congestion for a person with a cold.

A runny nose, for example, indicates a swelling of mucous membranes in the nose as the body expels fluids. In much the same way, coughing indicates an inflamed throat that is flushing bacteria out of a sick person's system.

But the stress of inflammation in the brain can be a risk factor for Alzheimer's, explained Daniel Lackland, a professor of epidemiology at the Medical University of South Carolina.

Lackland said that changes in organs seemingly unrelated to the brain -- lungs, stomach, the mouth, the kidneys -- will actually speed up memory decline.

"The brain is doing the same thing you see in other parts of the body when there's an infection," he said. But when "[inflammation] affects the cerebral vascular system and makes it less functional, it accelerates the disease process."

Physicians have long noticed a link between Alzheimer's patients in hospital who develop chest or urine infections and an accelerated rate of memory loss.

Galvin says brains already weakened by neurodegenerative disease are less able to handle the new stressor, he said.

"Think about your brain as having this reserve, this backup," Galvin said. Take a healthy individual and give them an infection, and it might affect their ability to function, but they have enough reserve so they don't show any cognitive decline.

"People with a brain disease tend to lose their reserve just by nature of having this degenerative process," he said.

"Now if you take somebody with a brain disease and give them the same exact infection, they do much worse because their brain can't tolerate the infection because there is no reserve to tap into," he said.

The cause and effect

Physicians have long noticed a link between Alzheimer's patients in hospital who develop chest or urine infections and an accelerated rate of memory loss.

"The hypothesis is these inflammatory responses are causing some damage. While inflammation is good to fight an infection, giving you your chills and achy muscles, it's not good for all the cells around it," Galvin said.

When University of Southampton researchers studied mice models, they found that immune cells in the brain that normally defend against a neurodegenerative disease behaved very differently when an infection was introduced.

"Rather than defending the brain against the developing disease, brain immune cells were 'primed' by the ongoing neurodegeneration and ramped up levels of inflammation," Hugh Perry, who led the study, concluded in the March 2014 study.

This, in turn, caused even more damage in the brains of the mice, exacerbating dementia symptoms and causing memory to worsen.

Despite all best efforts your mom, dad or spouse gets sick. What do you do?

Over-the-counter medications such as antihistamines, normally used to treat hay fever or the common cold, should be "avoided at all costs," according to James Mastrianni, associate director of the Alzheimer Disease Center at NYU's Langone School of Medicine.

"These drugs have anticholinergic effects, which blocks the major brain system affected in Alzheimer's disease, the cholinergic system," he said.

The cholinergic system is essential for memory and learning, and Mastrianni said the primary drugs used to treat Alzheimer's disease are designed to stimulate this system.

If the usual things don't help -- rest, plenty of fluids -- then, as always, consult your primary care physician.

For more OTC warnings, read Be careful with over-the-counter cold pills.

The Alzheimer's Foundation of America offers these further tips:

  • Monitor the amount of food and fluids the person you are caring for consumes.
  • Wear a mask and try to keep a mask on the person with dementia if either of you get ill.
  • Wash your hands often and avoid spreading the infection as best as possible.
  • Monitor how often the person with dementia drinks fluid and urinates to avoid dehydration. Remind the individual with dementia to drink fluid on a schedule to assure adequate oral fluid intake.
  • Use Tylenol or aspirin if cleared by your doctor. Remember that the person you are caring for may forget to ask for the medication.

This story was published on Alzlive.com, a website for caregivers of people with Alzheimer's and dementia. For more tips and support, visit the site here.

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