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    How Caregivers for Dementia Patients Manage Mood and Personality Changes

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    Shifts in behavior can be challenging to manage. Experts have five strategies that can help.Susan Hirsch was visiting her father in the hospital where he was recuperating after a fall and was shocked to find him — long devoted to her mother — flirting with a nurse as if he were “17 and in the Navy again,” she said.Ms. Hirsch, a 67-year-old memory care educator from Palmyra, Pa., scolded her father. But the admonishment only enraged the 93-year-old man; she recalled him saying, “in not nice words,” to get out of his room as she scuttled away.More than 11 million adults in the United States are caring for people diagnosed with Alzheimer’s and other forms of dementia. In addition to memory loss, most people with dementia will experience mood and behavior changes including aggression, apathy, disorientation, depression, wandering, impulsivity and delusions.Many caregivers describe mood and personality changes as the most upsetting symptoms. While antipsychotic and sedative medications are often used to manage dementia-related mood issues, they have limited efficacy.To get on top of — and feel less toppled by — mood changes, it’s helpful for caregivers to remember that those shifts are caused by changes in the brain, said Dr. Nathaniel Chin, a geriatrician and associate professor in the department of medicine at the University of Wisconsin-Madison.“They’re no one’s fault,” he said, and recognizing this can help you “feel less upset at your loved one.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Francisco Lopera, the ‘Country Doctor’ Who Upended Our Understanding of Dementia

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      Francisco Lopera defied rebels, cartels and vampire bats to become a pioneering researcher of Alzheimer’s disease.In 1978, Dr. Francisco Lopera did what recent medical school graduates in Colombia and much of Latin America have long done: He set out for an obligatory year of work in a remote part of the country, where an inexperienced médico rural might be the only physician for miles. Dr. Lopera, who was born in the Andean region of Antioquia and knew mostly mountains and farm life before medical school, carried out his service in the Darién Gap, on the Caribbean coast near Panama.There Dr. Lopera, a groundbreaking Colombian Alzheimer’s researcher who died this week at age 73, treated stabbings, snakebites, complicated births, burns and fevers in a hospital that had electricity for only half the day. On one occasion, he was kidnapped by Marxist guerrillas. Another time, he had to flee gunshots.When I met Dr. Lopera in 2017, to start research on a book about the families with Alzheimer’s that became his life’s work, he told me a story about two young brothers who had died one after the other in his hospital, of unknown causes. Lopera traveled to the family home in a remote jungle clearing, where he discovered that the boys’ surviving siblings had bites on their fingers from vampire bats. He sent the bodies to a pathology lab hours away by boat, and the pathologists confirmed rabies. When the government brought in a rabies expert to investigate, Dr. Lopera joined him.He left that experience — long nights in the rainforest, searching for hidden roosts, engrossed in the natural history of rabies and bats — wanting to become a rabies epidemiologist. But that was not to be. His interests were eclectic and quick to change, and a few years later he became a neurology resident in Medellín.In 1984, Dr. Lopera examined a farmer in his 40s who appeared to have dementia. Dr. Lopera took again the unusual step of traveling to the family home, in a mountain hamlet like the one where he had been born. Not just the farmer had symptoms of dementia, he saw — a brother also appeared to be affected. Dr. Lopera had discovered what would turn out to be the world’s largest family with early-onset Alzheimer’s disease. The family shared a genetic mutation, later nicknamed the paisa mutation, that was unique to their region of Colombia. Dr. Lopera spent the next four decades studying the family’s 6,000 members.Dr. Francisco Lopera, second from right, in Yarumal, Colombia, in 2010, with Oderis Villegas, center, who was showing signs of Alzheimer’s disease at age 50. A sister, María Elsy, left, had a more advanced case.Todd Heisler/The New York TimesWe are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      A Blood Test Accurately Diagnosed Alzheimer’s 90% of the Time, Study Finds

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      It was much more accurate than primary care doctors using cognitive tests and CT scans. The findings could speed the quest for an affordable and accessible way to diagnose patients with memory problems.Scientists have made another major stride toward the long-sought goal of diagnosing Alzheimer’s disease with a simple blood test. On Sunday, a team of researchers reported that a blood test was significantly more accurate than doctors’ interpretation of cognitive tests and CT scans in signaling the condition.The study, published Sunday in the journal JAMA, found that about 90 percent of the time the blood test correctly identified whether patients with memory problems had Alzheimer’s. Dementia specialists using standard methods that did not include expensive PET scans or invasive spinal taps were accurate 73 percent of the time, while primary care doctors using those methods got it right only 61 percent of the time.“Not too long ago measuring pathology in the brain of a living human was considered just impossible,” said Dr. Jason Karlawish, a co-director of the Penn Memory Center at the University of Pennsylvania who was not involved in the research. “This study adds to the revolution that has occurred in our ability to measure what’s going on in the brain of living humans.”The results, presented Sunday at the Alzheimer’s Association International Conference in Philadelphia, are the latest milestone in the search for affordable and accessible ways to diagnose Alzheimer’s, a disease that afflicts nearly seven million Americans and over 32 million people worldwide. Medical experts say the findings bring the field closer to a day when people might receive routine blood tests for cognitive impairment as part of primary care checkups, similar to the way they receive cholesterol tests.“Now, we screen people with mammograms and PSA or prostate exams and other things to look for very early signs of cancer,” said Dr. Adam Boxer, a neurologist at the University of California, San Francisco, who was not involved in the study. “And I think we’re going to be doing the same thing for Alzheimer’s disease and hopefully other forms of neurodegeneration.”In recent years, several blood tests have been developed for Alzheimer’s. They are currently used mostly to screen participants in clinical trials and by some specialists like Dr. Boxer to help pinpoint if a patient’s dementia is caused by Alzheimer’s or another condition.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Gena Rowlands Has Alzheimer’s Decades After ‘The Notebook’

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      Rowlands, 94, played an older woman with dementia in the 2004 movie directed by her son, Nick Cassavetes.Gena Rowlands has Alzheimer’s disease, a late-life challenge for the Oscar-nominated actor who captivated Hollywood in the 1970s with her performance in “A Woman Under the Influence” and later portrayed a character with dementia in “The Notebook.”Rowlands’s son, Nick Cassavetes, the director of “The Notebook,” revealed the diagnosis in a recent interview with Entertainment Weekly, telling the magazine that she had been living with the disease for five years.“She’s in full dementia,” he said. “And it’s so crazy — we lived it, she acted it, and now it’s on us.”A former theater and television actress, Rowlands, 94, made 10 films across four decades with John Cassavetes, the independent film pioneer who was also her husband. She was nominated for the Academy Award for best actress for two of them: “A Woman Under the Influence” (1974), in which she plays a wife and mother who cracks under the burden of domestic harmony, and “Gloria” (1980), about a woman who helps a young boy escape the mob.When Rowlands received an honorary lifetime achievement Oscar in 2015, Laura Linney praised her as an actor who “smashed and destroyed the female stereotype of her time.”“Her work declares: You want to see a modern woman? Here is a modern woman,” Linney said.In 2004, a new generation of filmgoers came to know Rowlands for her portrayal of the older version of Allie in the romance drama “The Notebook.” (Rachel McAdams played the character in her younger years.)Rowlands’s tearful performance in a pivotal scene moved audiences and critics alike. Jessica Winter of The Village Voice credited Rowlands with “locating the terror and desolation wrought by the cruel betrayals of a failing mind.”In an interview with O magazine published the year “The Notebook” was released, Rowlands said her own mother had experienced Alzheimer’s.“I went through that with my mother, and if Nick hadn’t directed the film, I don’t think I would have gone for it — it’s just too hard,” she said.After “The Notebook,” Rowlands made several more appearances in films and television shows, including in “The Skeleton Key” and the detective series “Monk.” Her last appearance in a feature film was in 2014, when she played a retiree who befriends her gay dance instructor in “Six Dance Lessons in Six Weeks.” More

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      Alzheimer’s Takes a Financial Toll Long Before Diagnosis, Study Finds

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      New research shows that people who develop dementia often begin falling behind on bills years earlier.Long before people develop dementia, they often begin falling behind on mortgage payments, credit card bills and other financial obligations, new research shows.A team of economists and medical experts at the Federal Reserve Bank of New York and Georgetown University combined Medicare records with data from Equifax, the credit bureau, to study how people’s borrowing behavior changed in the years before and after a diagnosis of Alzheimer’s or a similar disorder.What they found was striking: Credit scores among people who later develop dementia begin falling sharply long before their disease is formally identified. A year before diagnosis, these people were 17.2 percent more likely to be delinquent on their mortgage payments than before the onset of the disease, and 34.3 percent more likely to be delinquent on their credit card bills. The issues start even earlier: The study finds evidence of people falling behind on their debts five years before diagnosis.“The results are striking in both their clarity and their consistency,” said Carole Roan Gresenz, a Georgetown University economist who was one of the study’s authors. Credit scores and delinquencies, she said, “consistently worsen over time as diagnosis approaches, and so it literally mirrors the changes in cognitive decline that we’re observing.”The research adds to a growing body of work documenting what many Alzheimer’s patients and their families already know: Decision-making, including on financial matters, can begin to deteriorate long before a diagnosis is made or even suspected. People who are starting to experience cognitive decline may miss payments, make impulsive purchases or put money into risky investments they would not have considered before the disease.“There’s not just getting forgetful, but our risk tolerance changes,” said Lauren Hersch Nicholas, a professor at the University of Colorado School of Medicine who has studied dementia’s impact on people’s finances. “It might seem suddenly like a good move to move a diversified financial portfolio into some stock that someone recommended.”Tell us about your family’s challenges with money management and Alzheimer’s. More

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      My Father, Ronald Reagan, Would Weep for America

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      The night before my father died, Ronald Reagan, I listened to his breathing — ragged, thin. Nothing like that of the athletic man who rode horses, built fences at the ranch, constructed jumps from old phone poles, cut back shrubs along riding trails. Or of the man who lifted his voice to the overcast sky and said, “Mr. Gorbachev, tear down this wall.”Time and history folded over themselves inside me, distant memories somersaulting with more recent realities — the 10 years of his journey into the murky world of Alzheimer’s and my determination to abandon the well-worn trail of childhood complaints and forge a new path. To be blunt, I had resolved to grow the hell up.I can still remember how it felt to be his child, though, and how the attention he paid to America and its issues made me jealous.Long before my father ran for office, politics sat between us at the dinner table. The conversations were predictable: Big government was the problem, the demon, the thing America had to be wary of. I hated those conversations. I wanted to talk about the boy who bullied me on the school bus, not government overreach.In time I came to resent this country for claiming so much of him. Yet today, it’s his love for America that I miss most. His eyes often welled with tears when “America the Beautiful” was played, but it wasn’t just sentiment. He knew how fragile democracy is, how easily it can be destroyed. He used to tell me about how Germany slid into dictatorship, the biggest form of government of all.I wish so deeply that I could ask him about the edge we are teetering on now, and how America might move out of its quagmire of anger, its explosions of hatred. How do we break the cycle of violence, both actual and verbal? How do we cross the muddy divides that separate us, overcome the partisan rancor that drives elected officials to heckle the president in his State of the Union address? When my father was shot, Tip O’Neill, then speaker of the House and always one of his most devoted political opponents, came into his hospital room and knelt down to pray with him, reciting the 23rd Psalm. Today a gesture like that seems impossible.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Adele Springsteen, Bruce Springsteen’s Mother, Dies at 98

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      Bruce Springsteen has long said that his mother was among his greatest influences and credited her with encouraging his musical ambitions.Adele Springsteen, who nurtured the budding musical talent of her son, the pioneering rock star Bruce Springsteen, died on Wednesday. She was 98.Mr. Springsteen announced his mother’s death in an Instagram post on Thursday. No cause was given, but Ms. Springsteen had struggled for more than a decade with Alzheimer’s disease.Her son has been outspoken about his relationship with his mother and her influence on him.Ms. Springsteen rented him his first guitar when he was 7, he said in 2021 during his Broadway show, “Bruce on Broadway,” which ran for more than two months as the city began to emerge from pandemic-related closures. The show had wide-ranging reflections, including thoughts about his mother.It was also Ms. Springsteen, he told the brimming Broadway audiences, at the St. James Theater, who danced to 1940s swing music and impressed in him the joys of bop-inspiring tunes, according to the NBC program “Today.”He also spoke of his mother’s ability to persist in her vivacious spirit even as aging and a punishing disease took their toll.“She’s 10 years into Alzheimer’s,” he said. “She’s 95. But the need to dance, that need to dance is something that hasn’t left her. She can’t speak. She can’t stand. But when she sees me, there’s a smile.”Ms. Springsteen was born Adele Zerilli on May 4, 1925, in Brooklyn. She married Douglas Springsteen, with whom she had her son in 1949 and later two daughters, Virginia and Pamela.She worked as a legal secretary and raised a young working-class family in Freehold, N.J., while her husband often struggled to find steady work and grappled with mental illness. He died in 1998.“She willed we would be a family and we were,” Mr. Springsteen wrote in “Born To Run,” his memoir. “She willed we would not disintegrate and we did not.”Ms. Springsteen’s high-spirited ethos, ever-present, seemed to be the through line in her life, and one that buoyed the lives of the people around her.“My mother is the great energy — she’s the energy of the show,” Mr. Springsteen told The Miami Herald in 1987. “The consistency, the steadiness, day after day — that’s her.” He added that “it was she who created the sense of stability in the family, so that we never felt threatened through all the hard times.”In the Instagram post on Thursday announcing his mother’s death, Mr. Springsteen shared a video of his mother, in old age, dancing to “In the Mood” by Glenn Miller, captioned with an excerpt from his own 1998 song about her, “The Wish.”“I’m older but you’ll know me in a glance,” it read. “We’ll find us a little rock ’n’ roll bar and we’ll go out and dance.”Aimee Ortiz More

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      I Clerked for Justice O’Connor. She Was My Hero, but I Worry About Her Legacy.

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      When I learned that Justice Sandra Day O’Connor had died, I felt not just the loss of a world historical figure but also the loss of someone who formed a part of my identity.As a young woman, I was in awe of Justice O’Connor. Her presence on the Supreme Court offered an answer to any doubts I had that I belonged in the law. As a young lawyer, I was lucky enough to work for a year as her law clerk.While clerking for her, I came to understand and appreciate not only her place in history but also her vision of the law. She refused opportunities to issue sweeping opinions that would substitute her ideals for the democratic process. This made it all the more tragic that toward the end of her career, she joined in a decision — Bush v. Gore — that represented a rejection of her cautious approach in favor of a starkly political one.For me, she stands as a shining example of how women — everyone, really — can approach life and work. I witnessed her warmth, humor and humanity while experiencing the gift of learning and seeing the law through her eyes. Those personal and legal impressions have left an enduring mark on me as a person and as a lawyer.At the time Justice O’Connor became a lawyer, women in that role were rare. As has now become familiar lore, after she graduated near the top of her class from Stanford Law School in 1952, she was unable to find work as a lawyer. As a justice, she made sure that opportunities denied to her were available to others. Shortly after I graduated from law school, I joined two other women and one man in her chambers, making a rare majority-woman chamber when just over a third of the clerks for Supreme Court justices were women.I always found it remarkable that I never heard Justice O’Connor talk with any bitterness of the barriers she faced pursuing her career. Instead, she worked hard and without drama to overcome them. Remarkably, that experience did not harden her.She had a wicked sense of humor. The door to our clerks’ office held a photocopied image of her hand with the words “For a pat on the back, lean here.” Her face transformed in an almost girlish way when she laughed, which she did often.When she met with the clerks on Saturday to discuss upcoming cases, she brought us a home-cooked lunch — often something inspired by her Western roots. (One memorable example was tortillas and a cheesy chicken filling, to make a kind of cross between a burrito and a chicken quesadilla. It was a bit of a mess to eat but delicious.) She insisted that we get out of the courthouse and walk with her to see the cherry blossoms, and she took us to one of her favorite museums; once we visited the National Arboretum and lingered at the bonsai exhibit. She believed firmly in the benefits of exercise, and she invited us to join daily aerobics sessions with a group of her friends early in the morning in the basketball court above the Supreme Court chamber, which she delighted in calling the “highest court in the land.”She was also a hopeless romantic, and she was well known for trying to find partners for her single clerks. She met her husband, John, in law school, and they married shortly after graduation. He had received an Alzheimer’s diagnosis when I clerked for her, though that knowledge was not yet public. He often came by her chambers as she worked to maintain a sense of normalcy. She retired in 2006 largely because of his progressing dementia. In a powerful lesson of what it is to love, she was happy for him when he struck up a romance with a fellow Alzheimer’s patient. It was devastating to learn that she was subsequently diagnosed with dementia herself.When I clerked for her in 1998 and ’99, she was at the height of her powers. She was the unquestioned swing justice, and some called her the most powerful woman in the world.But she approached the role with humility. Considered a minimalist, she worked to devise opinions that decided the case and usually little more. She was sometimes criticized for that approach. Justice Antonin Scalia made no secret of his frustration. When she refused to overturn Roe v. Wade, in the 1992 case Planned Parenthood v. Casey, he snarlingly referred to the opinion as a “jurisprudence of confusion.” She was criticized by many academics for failing to articulate a grand vision of the law.What they missed was that this was her grand vision of the law — or at least of the Supreme Court. She had spent the formative part of her career before she entered the court as a member of the Arizona State Legislature, where she rose to become the first female majority leader of a State Senate.She believed that the most important decisions about how to govern the country belonged to the political branches and to state legislatures, not to a court sitting in Washington. Seeing the law through her eyes during the year I worked for her, I realized that she was not looking for a sweeping theory that would change the face of the law. She wanted to decide the case before her and provide a bit of guidance to the lower courts as necessary but leave the rest to the democratic process.In December 2000, this made reading the opinion she joined in Bush v. Gore all the more heartbreaking. Her vote made a 5-to-4 majority for the decision to halt the recount in Florida rather than allow that process to play out, throwing the election to George W. Bush, who became the first president since 1888 to be elected without winning the popular vote. The decision, widely criticized for its shoddy reasoning, was the opposite of the careful, modest decisions she had spent her career crafting. It disenfranchised voters whose ballots had been rejected by ballot-counting machines in the interests of finality — in the process substituting the judgment of the court for the expressed will of the people.The court showed that it could — and would — behave in nakedly political ways. It had given into the temptation to engage in ends-driven reasoning that was utterly unpersuasive to those who did not already share its view of the right result. In doing so, the court might have opened the door to what has now become something of a habit.Justice O’Connor retired just over five years later, and she was replaced by Samuel Alito. It has been painful to watch as, in decision after decision, he has voted to undo much of the legacy she so carefully constructed. The blunt politics of Bush v. Gore now look less like an embarrassing outlier and more like a turning point toward a court that has cast aside Justice O’Connor’s cautious minimalism for a robustly unapologetic political view of the law. Unsurprisingly, public opinion of the court has fallen to a near historic low.Justice O’Connor remains a transformative figure in the law, a woman who charted a path that I and so many others have followed. If the court is to regain the public trust, it should look, once again, to her shining example, which embodied a powerful ideal: the court is not a body meant to enact the justices’ vision of what the law should be. Its role is, instead, to encourage our imperfect democracy to find its way forward on its own.Oona A. Hathaway is a professor of law and political science at Yale University and a nonresident scholar at the Carnegie Endowment for Peace.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow the New York Times Opinion section on Facebook, Instagram, TikTok, X and Threads. More