Alzheimer Disease (cont.)

Medical Treatment

Even though Alzheimer disease is not reversible, treatment can slow the progression of symptoms in some people. Relieving symptoms can improve function significantly. Some of the important treatment strategies in dementia are described here.
 
Nondrug treatments

Behavior disorders such as agitation and aggression may improve with various interventions. Some interventions focus on helping the individual adjust or control his or her behavior. Others focus on helping caregivers and other family members change the person's behavior. These approaches sometimes work better when combined with drug treatment.
 
Drug treatment

The symptoms of Alzheimer disease can sometimes be relieved, at least temporarily, by medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are the cholinesterase inhibitors.

• Cholinesterase is an enzyme that breaks down a chemical in the brain called acetylcholine. Acetylcholine acts as an important messaging system in the brain. Brain acetylcholine level is low in most people with Alzheimer disease.
  
  
• Cholinesterase inhibitors, by stopping the breakdown of this neurotransmitter, increase the amount of acetylcholine in the brain and improve brain function.
  
  
• These drugs not only improve or stabilize cognitive functions, they may also have positive effects on behavior and activities of daily living.
  
  
• They are not a cure, but they do slow down the rate of decline in some people. In many people the effect is modest, and in others, the effect is not noticeable.
  
  
• The effects are temporary, since these drugs do not change the underlying cause of the dementia.

Another drug, memantine, is showing promise in Alzheimer disease. This new drug works by blocking brain damage caused by another brain chemical called glutamate.
 
Certain drugs are being used on a trial basis in people with Alzheimer disease. Experts think these drugs might help based on what we know from research about Alzheimer disease. None of these drugs have yet achieved widespread acceptance as treatment for the disease.

• Anti-inflammatory drugs are being tried on the premise that inflammation is one cause of senile plaques and neurofibrillary tangles.
  
  
• The antioxidant tocopherol (vitamin E) is believed by some to counteract damage in brain cells, which may have a role in causing Alzheimer disease or its progression.
  
  
• Hormone replacement therapy has been given to some women who have been through menopause and have Alzheimer disease, but this approach has been questioned by many experts. The rationale is that the loss of estrogen at menopause takes away one line of protection from the disease.

Other drugs are used to treat specific symptoms or behavior changes.

• Mood swings and emotional outbursts may improve with antidepressant or mood stabilizing drugs.
  
  
• Agitation, anger, and disruptive or psychotic behavior are often relieved by antipsychotic medication or mood stabilizers.

Medications

The cholinesterase inhibitors and memantine have been approved by the US Food and Drug Administration (FDA) specifically for Alzheimer disease. The drugs listed here are some of the most frequently prescribed from each class. For more information, see Understanding Alzheimer Disease Medications.

• Cholinesterase inhibitors - Donepezil (Aricept), rivastigmine (Exelon), and galantamine (galanthamine, Reminyl). These drugs have largely replaced an older drug called tacrine (Cognex).
  
  
• Glutamate receptor inhibitors - Memantine (Namenda)
  
  
• Antidepressants/anxiolytics - Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), olanzapine (Zyprexa)
  
  
• Mood stabilizers - Lithium (Eskalith, Lithobid), valproic acid (Depakote)
  
  
• Antipsychotics - Haloperidol (Haldol), risperidone (Risperdal), quetiapine (Seroquel)
  
  
• Anticonvulsants - Valproic acid (Depakote), gabapentin (Neurontin), lamotrigine (Lamictal)

All drugs cause side effects. The aim in prescribing a drug is that the benefits of the drug outweigh the side effects. Seniors are especially likely to experience drug side effects. People with dementia who are taking any of these drugs must be checked often to make sure that if side effects occur, they are tolerated and do not cause serious problems.
 
These drugs may interact with each other or with other drugs. This is important in seniors, who often take several different drugs for various medical disorders. Side effects may be due not to one specific drug, but to combinations of drugs.

Next Steps

Follow-up

After Alzheimer disease has been diagnosed and treatment begun, the individual requires regular checkups with his or her health care provider.

• These checkups allow the health care provider to see how well treatment is working and make adjustments as necessary.
  
  
• They allow detection of new medical and behavior problems that could benefit from treatment.
  
  
• These visits also give the family caregiver(s) an opportunity to discuss problems in the individual's care.

Eventually the person with AD will become unable to care for himself or herself, or even to make decisions about his or her care.

• It is best for the person to discuss future care arrangements with family members as early as possible, so that his or her wishes can be clarified and documented for the future.
  
  
• Your health care provider can advise you about legal arrangements that should be made to ensure that these wishes are observed.

Prevention

There is no known way to prevent Alzheimer disease. Being alert for symptoms and signs may allow earlier diagnosis and treatment. Appropriate treatment can slow or relieve symptoms and behavior problems in some people.
 
Some experts think that education and other forms of intellectual challenge may have a protective effect against the disease. Individuals with low levels of education and mental/intellectual activity are said to be at a higher risk for the disease and to be more likely to have more severe disease, but this has not been proven conclusively. 

Outlook

Alzheimer disease starts slowly but finally results in severe brain damage. People with the disease gradually lose cognitive functions, ability to carry out activities of daily living, and ability to respond appropriately to their surroundings. They eventually become completely dependent on others for care. These losses are inevitable, but the speed with which they occur varies from person to person and may be slowed down by treatment.

Alzheimer disease is considered to be a terminal disease. The actual cause of death usually is a physical illness such as pneumonia. Such illnesses can be debilitating in a person who is already weakened by the effects of aging and the disease. On average, a person with Alzheimer disease will live 8-10 years after the disease is diagnosed. Some people live for as long as 20 years with good nursing care.

Support Groups and Counseling

If you are a caregiver for a person with Alzheimer disease, you know that the disease tends to be more stressful for the family members than for the affected person. Caring for a person with Alzheimer disease can be very difficult. It affects every aspect of your life, including family relationships, work, financial status, social life, and physical and mental health. You may feel unable to cope with the demands of caring for a dependent, difficult relative. Besides the sadness of seeing the effects of your loved one's disease, you may feel frustrated, overwhelmed, resentful, and angry. These feelings may in turn leave you feeling guilty, ashamed, and anxious. Depression is not uncommon but usually gets better with treatment.
 
Caregivers have different thresholds for tolerating these challenges. For many caregivers, just "venting" or talking about the frustrations of caregiving can be enormously helpful. Others need more, but may feel uneasy about asking for the help they need. One thing is certain, though: if the caregiver is given no relief, he or she can burn out, develop his or her own mental and physical problems, and become unable to care for the person with Alzheimer disease.
 
This is why support groups were invented. Support groups are groups of people who have lived through the same difficult experiences and want to help themselves and others by sharing coping strategies. Mental health professionals strongly recommend that family caregivers take part in support groups. Support groups serve a number of different purposes for a person living with the extreme stress of being a caregiver for a person with Alzheimer disease:

• The group allows the person to express his or her true feelings in an accepting, nonjudgmental atmosphere.
  
• The group's shared experiences allow the caregiver to feel less alone and isolated.
  
  
• The group can offer fresh ideas for coping with specific problems.
  
  
• The group can introduce the caregiver to resources that may be able to provide some relief.
  
  
• The group can give the caregiver the strength he or she needs to ask for help.

Support groups meet in person, on the telephone, or on the Internet. To find a support group that works for you, contact the following organizations. You can also ask your health care provider or behavior therapist, or go on the Internet. If you do not have access to the Internet, go to the public library.
 
For more information about support groups, contact these agencies:

• Family Caregiver Alliance, National Center on Caregiving - (800) 445-8106
  
  
• Alzheimer's Association - (800) 272-3900
  
  
• National Alliance for Caregiving
  
  
• Eldercare Locator Service - (800) 677-1116

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