Caregiver Connections
Adapted from WebMD:
Dementia is a condition of mental decline that causes progressive memory impairment and problems with learning, judgement, communication and quality of life. Alzheimer's disease is the most common form of dementia, accounting for 60%-80% of all cases. Alzheimer's disease causes a decline in mental function and personality changes, which may include agitation, depressions and hallucinations.
While there is no cure for Alzheimer's disease and no proven treatment to slow its progressions, there are a number of medicines available that may help improve the mental function of people with Alzheimer's disease. If these drugs are given early enough in the course of the disease, they may enable people to carry out daily activitites and prolong the time they can be managed at home. There are also medicines to help manage troubling symptoms of Alzheimer's disease, including depression and behavioral problems such as agitation and aggression.
Planning and medical/social management can help ease the burden on patients and family members. Exercise, good nutrition, activities and social interaction are important. A calm, structured environment may be helpful.
Your doctor will determine the best treatment for the patient based on various factors, including the patient's age, overall health and medical history. Other factors are the extent of the disease, the patient's tolerance for specific medicines and therapies, and the opinion or preference of the patient and caregiver.
ARICEPT, a cholinesterase inhibitor, is the most widely used drug for Alzheimer's disease. In Alzheimer's disease there is a deficiency in acetylcholine, a chemical used for memory and other mental functions, in some areas of the brain. Aricept slows down the breakdown of acetylcholine. In some patients it can improve memory and daily living.
EXELON and RAZADYNE (formerly Reminyl) are newer drugs that also work by inhibiting the breakdown of acetylcholine. They are most effective when given in the earlier stages of the disease.
Side effects for Aricept, Exelon and Razadyne are generally mild and may include diarrhea, nausea, fatigue, insomnia and weight loss. Other cholinesterase inhibitors, such as Donepezil, Rivastigmine and Galantamine, may result in slowing the heart rate so that the body may not have enough oxygenated blood to function properly.
Research at the Veteran Affairs Healthcare System in Boston, Massachusetts found that use of other cholinesterase inhibitors such as Donepezil, Rivastigmine and Galantamine may result in brachycardia - lowering of the heart rate to less than 60 beats per minute.
A slower than normal heart rate means that the body may not have enough oxygenated blood to function properly, which may require the use of a pacemaker. Care plans of elders with dementia treated with cholinesterase inhibitors should include regular, thorough heart check-ups.
   NAMENDA is the first drug to be approved for treatment of moderate to severe Alzheimer's disease. Namenda works by a different mechanism than other Alzheimer's treatments; it is thought to play a protective role by regulating a chemical in the brain called glutamate.
Glutamate plays a role in learning and memory by acting as a "gatekeeper", regulating the amounts of other chemicals in the brain, such as calcium, which is required for information storage.
   Namenda keeps glutamate in check, which can improve the brain's ability to process information and retrieve memories. Namenda may have increased benefit when used with Aricept, Exelon, Razadyne or Cognex. Side effects may include tiredness, dizziness, confusion and headache.
COGNEX, another cholinesterase inhibitor, also slows the breakdown of acetylcholine. Cognex may cause liver damage, so your doctor will need to monitor liver function regularly.
In addition to the medicines already mentioned, the American Academy of Neurology has stated that Vitamin E supplements are likely to delay the time to clinical worsening in patients with Alzheimer's disease.
It is important to know that new research findings are giving reason for hope. Several drugs are now being studied in clinical trials to determine if they can slow the progress of the disease or imporive memory or other symptoms for a period of time.
 An Alzheimer's vaccine is also being studied. However, because of unwanted side effects the initial clinical trial was stopped. Continued studyes are under way to modify the vaccine for improved safety.