Dear Dr. Cynthia:

My mother has had Alzheimer's disease for the past eight years and last year I had to move her into a nursing home. She mostly still knows who I am, although at times she forgets my name or thinks that I am my father or one of her brothers (all of whom are deceased). She frequently does not recognize my sister.

Each year, my wife and I bring her to our house for Christmas dinner. We don't do anything fancy, but we like to show her the tree, give her a few presents and share the meal.

For the past two or three years, however, she has become agitated with the visit. She doesn't want to get in or out of the car and has trouble relaxing in our house. Last year it took me almost an hour to get her back into the car when it was time to take her home.

I don't mind the time, but we were both upset and exhausted by the time we got back to her room. My young niece and nephew were also very upset when they saw how agitated grandma seemed to be.

My wife is telling me that this year we should not bring her home. I hate to think of her sitting in the nursing home on Christmas day, but I don't think anyone wants to repeat what happened last year. What do you think?

Patrick

Dear Patrick:

The hallmark of Alzheimer's disease is memory loss. In the early stages of the disease, this loss is usually confined to short-term memories -- what a person ate for breakfast, what they did earlier in the day. As the disease progresses, the memory loss expands to include older memories, such as remembering how many children or grandchildren the person has and what the children's names are. Eventually, even the ability to recognize loved ones can be lost.

Not being able to remember what you just did means that you cannot learn new things. Getting into a car at 2 p.m. does not mean that you will recognize the same car a few hours later. And a room full of strangers can be very anxiety-provoking for anyone -- especially if the "strangers" all seem to know you!

It sounds to me as if your mother has reached the stage in her disease progression where she has a very limited capacity to process new information. This causes her great distress in situations that are "new" -- and that would include anything that deviates from her daily routine.

I would suggest that you consider not taking her out of her home, which is now the nursing home. A quiet visit and gift to her on her own turf are more likely to be satisfying to everyone. You will not be doing her a disservice. You will be giving her a gift.

Dear Dr. Cynthia:

I am 78 and in reasonably good health. I have just been told that I have a neuropathy in the bottoms of my feet and some swelling -- mostly very mild -- in my right ankle. I have also been having weird episodes on and off for about five years. When I am sitting, I will suddenly feel extremely hot from the waist down and very weak. The episodes don't last more than a minute, but they worry me.

I have had a stress test that is perfectly fine and my blood work shows no deficiencies. A doctor friend suggested my symptoms could come from a disc. I have no real pain, but the muscle spasm can be very painful in my thighs and feet.

My primary-care physician says not to worry and to just ignore the symptoms. But I would like to rule out anything that could get progressively worse. Should I see a neurologist or an orthopedic doctor? Since I live alone, I want to stay as well as I can for as long as I can.

Anonymous in Pittsburgh

Dear Anonymous:

Let me get straight to the point. Although your doctor may have been well-intentioned, advice to "ignore the symptoms," is not sufficient. If you are going to be informed and be able to age well, you need to know whether your symptoms need further attention. In any case, I am wondering how it would even be possible to ignore symptoms that include feelings of weakness and painful muscle spasms.

The list of what can cause a neuropathy, or disease of the nervous system, is long and complicated. Possible causes can include everything from a simple viral illness to a tumor, nerve compression (as from a herniated disc), vitamin deficiency, toxins and diabetes. Medical textbooks are filled with conditions that can be associated with neuropathies.

In addition, you did not say which symptoms led to the diagnosis of a neuropathy. For example, do you have any symptoms of burning or tingling in your feet? Do you have any signs of muscle weakness as well as muscle spasms? How did your symptoms begin and what triggers them? And when you have the episodes of warmth and weakness, do you also have any additional symptoms such as increased perspiration or heart palpitations? You also did not say whether or not you had any other conditions (such as high blood pressure) or were on any medications.

I would strongly recommend that you seek further medical attention.

A good place to start would be with a neurologist who might want to add a few tests to your evaluation. Nerve conduction studies can give highly specific information regarding the functioning of different nerves. In addition, electromyography will tell your doctor whether or not your muscles also are affected.

Your symptoms could be due to more than one problem, and a definite diagnosis might remain elusive. But, at a minimum, you deserve the following: 1) an explanation of the possible causes of your symptoms; 2) a sufficient work-up to rule out any serious or progressive problem; and 3) a general prognosis and treatment plan -- at least for the symptoms if not for the underlying cause.

In the end, after an adequate evaluation, you may again be told "not to worry." If the advice is based on the results of a thorough work-up, it will be good news indeed.