Alzheimer Disease (cont.)

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

After Alzheimer's 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.

There is no known way to prevent Alzheimer's 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.

Alzheimer's 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's 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's disease will live 8-10 years after the disease is diagnosed. Some people live for as long as 20 years with good nursing care.

If you are a caregiver for a person with Alzheimer's 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's 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's 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's 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