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Drug InfoNet Doctors' Answers to Frequently Asked Questions - Alzheimer's Disease

Doctors' Answers to "Frequently Asked Questions" - Alzheimer's Disease


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Related Info: Alzheimer Disease Sites

Alzheimer's Disease [posted 1/14/99]
Question: My sister who is 75 years old has been diagnosed with Alzheimer's. Would Aricept be of any benefit to her? She is really in a bad state.

Answer: I'd try Aricept since its toxicity is minimal and any improvement would be welcome. Alzheimer's is very individual with some having rapid decline and others very slow, hard to know at this stage.

Alzheimer's Disease [posted 10/19/98]
Question: My mother died of Alzheimers in 1984 at the age of 59. I know that there are numerous studies being undertaken with families of Alzheimers patients and I'd like to participate so that I can be a recipient of any supplements, vitamins or compounds which might possibly prevent the onset of this disease. Can you give me a contact (either email, phone or address) where I can apply for such a study? Thanks so much.

Answer: I'd contact the Alzheimers Society.

Alzheimer's Disease [posted 8/4/98]
Question: My 86 year old mother was taken to a doctor by my sister and the doctor said that my mother was in the early stages of Alzheimer's Disease. I spoke with him on the phone and he said that he based his diagnosis on the results of a Mini-Mental Exam that he did on my mother. He did not explain this exam very well to me. Could you please tell me about this exam and any drugs that are commonly used in the treatment of this disease.

Answer: The mmpi is a long test to address different intellectual and emotional factors. It can help to differentiate between depression and dementia. However, it in itself is insufficient to diagnose Alzheimer's Disease. Alzheimer's is a clinical diagnosis formed after a neurological exam, exclusion of other factors (depression, Vitamin B 12 deficiency, hypothyroidism, etc.). There are several medications that are being used to slow the progression of Alzheimer's. Cognex was the first and helps some with some liver, etc., toxicity to watch for. I wasn't very impressed with its effects, although some of the geriatric colleagues had spotty success. It takes a long time to achieve the 40 mg a day (slow build up is required) and is expensive. A newer alternative is Aricept and is a little easier to use and seems to be a better drug. Both of these drugs work by inhibiting acetylcholinesterase. Acetylcholinesterase is an enzyme that breaks down acetylcholine. It seems that higher levels will improve functioning in some patients with Alzheimer's. It does not seem to arrest the progression of the disease, merely keep the functioning better when the degradation continues.

Alzheimer’s and Vitamin E
Question: If Vitamin E is now recommended for Alzheimer's victims, but can be dangerous, what about the other bioflavinoids such as grape seed or pine bark extract? Would these have the same effect as Vitamin E?

Answer: There is no known toxic dose of Vitamin E. I know of no risk with Vitamin E.

Medications and Alzheimer’s
Question: My father is taking 3 medications because of Alzheimer’s. They are Paxil 30 mg, Cognex 30 mg, and Trazadone 100 mg. He is suffering from Alzheimer’s and he seems very concerned about death. Everything he thinks and talks about is regarding death. Could any of these medications be the cause of this?

Answer: Paxil is an antidepressant from the class of drugs called SRI drugs. This stands for serotonin reuptake inhibitor drugs. They are generally well tolerated, but some patients experience difficulty sleeping, dry mouth and constipation. Cognex is a relatively new drug, especially for the treatment of Alzheimer’s Dementia. Side effects are mainly liver and white cell depression. Trazadone is an antidepressant which is in a class of its own. It also works primarily through serotonin. I would be very reluctant to combine Paxil and Trazadone since they both work through similar mechanisms. The only way to determine if the problem is his dementia or the drugs is to systematically stop one drug at a time. I'd start with the Trazadone.

Alzheimer’s Disease and medications
Question: My father is taking 3 medications because of Alzheimer’s. They are Paxil 30 mg, Cognex 30 mg, and Trazodone 100 mg. He is suffering from Alzheimer’s and he seems very concerned about death. Everything he thinks and talks about is death. He believes there are bodies buried behind houses and that people are asking him to make a count on the dead that were in Vietnam. This is very disturbing. He also threatened to kill my mother and her baby (this is my father I'm talking about), but my parents only have 2 kids we are both grown and out of the house. This scared her and my mother. Could any of the medications be the cause of this? Do you have any suggestions?

Answer: Alzheimer's Disease rarely has delusional thinking or hallucinations. So, I doubt this is due to his dementia. Did he have these thoughts before the medications? I'd discuss this with his physician and see a neurologist if he hasn't already. Confusion is common with Alzheimer's, but delusions are not.

Alzheimer’s Disease
Question: Is there anything to help a 69 year old person with the early stages of Alzheimer’s Disease.

Answer: The first thing to do when Alzheimer’s Disease is suspected is to ensure that it really is Alzheimer’s and not some other (hopefully preventable) cause of dementia. Thyroid and B12 are two that are treatable If it is Alzheimer’s, Cogentin should be tried if there are no contraindications. There will be an additional drug available this summer to try.

Estrogen and Alzheimer’s Disease
Question: Is there any relationship between taking estrogen and fending off Alzheimer’s?

Answer: There has been one recent study which showed a decrease in dementia in patients taking estrogen. This is interesting and exciting. I have started several demented patients on estrogen who have failed other treatment. Further research is needed, but this appears to be real and an exciting advance. Whether it will prevent dementia is also not researched, but is a logical possible conclusion.

Alzheimer's Disease
Question: What are some most current drugs given to patients to improve memory functions?

Answer: At this time there is only one FDA drug approved specifically for Alzheimer's and that drug is Cognix. Cognex or Tacrine has been FDA approved in the treatment Alzheimer's patients for several years now. It is taken in hopes of building up just one of the chemicals known to be deficit in these patients - namely acetylcholine. It has very modest claims stating that about 50-60 % of patients may improve on this medication. If a patient shows a plateuing of symptoms, this is claimed by the manufacturer to represent an improvement. There is, as of yet, no cure for this condition. Cognex must be taken 4 times a day to avoid side effects like nausea. Also, to because of concern about the chance for liver problems, patients must have weekly blood work for the first 24 weeks of therapy as the dosage is escalated. The FDA will soon be approving a new medication said to be similar in claims to the Cognex, but with fewer side effects and without the need for frequent blood testing. There is also a product out on the market called Hydergine, which has been around for many years. It has not enjoyed much recent popularity because it's exact mechanism of action is not known and it has been given to patients with dementia, which encompasses many other conditions above and beyond the condition that we call Alzheimer's. You are not likely to find much enthusiasm for this drug from the neurlogists. in your area.

Alzheimer's Disease - Stages
Question: Please explain the different stages of Alzheimer's Disease. I am inquiring concerning a patient which was staged a 6c. How many different stages are there and what are the major differences between them?

Answer: There are many different Dementia Scales published in the literature. There is some controversy about which is the 'best' one and much of this is related to the fact that various scales will measure different features and also the nature of Alzheimer's Disease itself which has some variability in it's course. The staging that you refer to comes from "The Global Deterioration Scale for Assessment of Primary Degenerative Dementia", Amer. Journal of Psychiatry, vol. 139, pp1136-39:

  1. No Cognitive decline
  2. Very Mild decline
  3. Mild decline
  4. Moderate decline
  5. Moderate to Severe decline
  6. Severe decline
  7. End Stage


Risperidone

Question: Is there any information available on the use of this drug in people with restlessness and agitation from Alzheimers?

Answer: Risperidone is a fairly new drug which is used in agitated patients for sedation. Consequently, it is commonly used in Alzheimers patients when there is agitation. It is also used for any patient with agitation - usually demented or psychotic patients. Indeed, it is listed as an anti-psychotic drug. Like other drugs of its class, it may have fairly severe side effects. These include the neuroleptic malignant syndrome(a potentially fatal side effect involving rigidity, fever, and altered mental status), tardive dyskinesia(involuntary movements of the facial muscles-sometimes irreversible) as well as lowered blood pressure, seizures, and elevated prolactin levels. This drug has less sedative effects than some of its predecessors like Thorazine, but similar side effects.

Cognex
Question: Do you have any information on Cognex, a drug for Altzheimers patients? When should labs be drawn after a patient starts on Cognex?

Answer: Cognex or Tacrine has been FDA approved in the treatment Alzheimer's patients for several years now. It is taken in hopes of building up just one of the chemicals known to be deficit in these patients - namely acetylcholine. It has very modest claims stating that about 50-60 % of patients may improve on this medication. If a patient shows a plateuing of symptoms, this is claimed by the manufacturer to represent an improvement. There is, as of yet, no cure for this condition. Cognex must be taken 4 times a day to avoid side effects like nausea. Also, to because of concern about the chance for liver problems, patients must have weekly blood work for the first 24 weeks of therapy as the dosage is escalated. The FDA will soon be approving a new medication said to be similar in claims to the Cognex, but with fewer side effects and without the need for frequent blood testing.

Cognex
Question: Is this considerd a safe drug for dementia problem which they claim is AD? Is there a better product for such a problem?

Answer: Cognex(tacrine hydrochloride) is a relatively new drug for the treatment of Alzheimer's Dementia. It is not approved nor should be used for other forms of dementia. Unfortunately, to date there is no specific test for Alzheimerws Dementia. As a result, it is often used for dementias which seem to be Alzheimer's in clinical presentation. Cognex is of a class of drugs called cholinesterase inhibitors. This can produce a slow heart rate(bradycardia), increased gastro-intestinal motility and diarrhea, and ulcers. Patients with a previous history of ulcers should use this medication with great care. Other potential risks include liver toxicity and low white blood cell counts. There have been fatalities involving liver damage with this drug. The drug should be started at small doses and increased gradually with constant and regular monitoring of blood counts and liver function. Currently, there is no other medical treatment for Alzheimer's Dementia-the reason that clinicians are willing to take the above risks. In my own experience, I have seen occasional improvement with Cognex and it is definitely worth trying considering the discouraging course of most dementias.

Hydrazine
Question: is there a drug called hydrazine(not the rocket fuel)ha! or hydragene used for memory enhancement? Is it prescription? I believe it is used in alzheimers cases. What about coline? Are there any other memory enhancement drugs? Thanks for you time. Ben

Answer: Hydergine (ergoloid mesylate) is a drug which has been used for years in patients with dementia and early dementia. Most studies demonstrate that patients improve in functional status. For some reason, this isn't a very popular drug and tends not to be used. I reviewed the literature on this several years ago to present to medical residents. I was surprised to find as many positive studies as I did and few to any negative studies. It is a drug which should be tried if there are no other reversible causes of dementia. Don't expect major improvements. Side effects are remarkably rare and is basically a previous reaction to the drug. Other treatments for general dementia are lacking; choline gets a lot of attention in health food stores. However, controlled studies have not demonstrated effectiveness.

Haldol
Question:My mother has recently been diagnosed with alzheimers, and has been placed in a 24-hour care facility. She had to change locations (and physicians), and was prescribed 2 mg/daily of Haldol...supposedly to reduce her agitation and anxiety. I am concerned that this medication is "overkill" in that she seems a bit more disoriented than before...and displays some extrapyramidal symptoms (hand tremors). I am curious if other trials with less powerful drugs to reduce her anxiety and agitation might be indicated (as deseryl, buspar, xanax)? My understanding is that Haldol is frequently effective with AD when significant halluncinatory/delusionary cognitions are prominent. Any particular protocols that MD's are advised to utilize in evaluating and prescribing for AD patients? Ben

Answer: Alzheimers Dementia is commonly associated with levels of agitation and disorientation. Many studies have demonstrated that a closely supportive environment which maximized sensory input and one on one caretaking will reduce this agitation and disorientation significantly. However, most nursing facilites lack the financial and personal resources necessary to provide and maintain this level of care. Unfortunately, the level of funding by insurance and government does not allow these facilites to render this type of care. Also, it takes a dedicated and focused care group to continue this type of care. Consequently, as a practical matter physicians and nursing facilities sedate excessively agitated patients. The tremor is probably entirely due to the haldol.

Symptoms
Question:What can I expect from a patient with Alzheimer's when they have very short memory and stumble. What will happen next in the progression of the disease?

Answer: If this patient does indeed have Alzheimer's Dementia, the progression is usually progressive with mental and then physical decline. The rate at which this happens is unpredictable-but, will always progress. About the only "expected" thing is that things will get worse.

Lithium & Alzheimer's
Question:My father has Alzheimer’s and is currently in a nursing home. In the last few months the nursing staff have stated that he has been having some aggression fits where he will try and hit someone (always a male). The residing physician has put my father on Lithium (600mg a day). Since my father has been on the drug he is very sluggish and his coordination is extremely bad also he is always sleeping in a chair in the reception room when we arrive. The other day when we went to visit one nurse told us that he had been vomiting. All these symptoms sound like his toxicity is too high. I am worried. My father was a very active man and could still function quite well on his own a few weeks ago, now since he has been on the drug he is now acting like a 95 year old person and he is very pale and looks tired. My father is only 66. Please let me know what you think and what me and my family should do.

Answer: I have never used lithium as a sedative. I would be very leery of this use. Ask the director of the home if blood levels and serum sodium levels are being checked. Also, occasional thyroid levels will be necessary. One option is to have his previous physician call the nursing home physician and inquire to his thoughts. This bypasses any confrontation with you and allows the previous personal physician to keep involved-which will increase the quality of care.

Paranoia
Question:My Mother has Alzheimer’s Disease and refuses to think anything is wrong with her. She is currently taking Elavil and has become paranoid and thinks things are real when they are not. Is there any new drug therapy for this disease? Could the Elavil be causing some of her paranoia? She was given it for nausea and weight loss. I would appreciate any help that you could give me so that I could better approach the subject with her doctor.

Answer: Paranoia is not a major part of most patients with Alzheimer’s Disease. Neither is nausea. Weight loss occurs but, usually later in the disease. In short, although your mother may have Alzheimer’s some of the features that you describe are somewhat atypical. Has she seen a dementia specialist, or a neurologist? You can usually ask for a second opinion without offending her personnel MD.




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