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Doctors' Answers to "Frequently Asked Questions" - Alzheimer's Disease
Related Info: Alzheimer Disease Sites
Alzheimer's Disease [posted
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
Answer: I'd contact the Alzheimers Society.
Alzheimer's Disease [posted
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.
Alzheimers and Vitamin E
Answer: There is no known toxic dose of Vitamin E. I know of no risk with Vitamin E.
Medications and Alzheimers
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 Alzheimers 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.
Alzheimers Disease and
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.
Answer: The first thing to do when Alzheimers Disease is suspected is to ensure that it really is Alzheimers and not some other (hopefully preventable) cause of dementia. Thyroid and B12 are two that are treatable If it is Alzheimers, Cogentin should be tried if there are no contraindications. There will be an additional drug available this summer to try.
Estrogen and Alzheimers Disease
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.
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
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:
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.
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.
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.
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.
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.
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
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.
Answer: Paranoia is not a major part of most patients with Alzheimers Disease. Neither is nausea. Weight loss occurs but, usually later in the disease. In short, although your mother may have Alzheimers 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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