What are the treatments for Alzheimer’s disease?
Two classes of medication are approved for Alzheimer’s disease. The first class, cholinesterase inhibitors, is represented by three drugs: donepezil (Aricept®), galantamine (Razadyne®), and rivastigmine (Exelon®) They are believed to work by replenishing a chemical in the brain that is important for memory. Cholinesterase inhibitors are indicated for mild, moderate, and severe Alzheimer’s disease.
Another drug, memantine (Namenda®), which works in a different way, is used in moderate to severe Alzheimer’s, often in combination with one of the cholinesterase inhibitor drugs. These drugs cannot cure or reverse Alzheimer’s disease. However, many patients and family members notice moderate improvement or stabilization of symptoms for variable periods of time. There is clear evidence that people who take these medications do better in the long run than those who do not.
Some Alzheimer’s patients develop depression, which may be treated by an antidepressant medication, counseling, or both. A small percentage of patients may become agitated or see and hear things that are not really there (auditory and visual hallucinations). Most of the time hallucinatory symptoms can be addressed without medications. Occasionally, small doses of antipsychotic medications such as risperidone or quetiapine may be necessary for limited periods.
It is important for patients with Alzheimer’s to maintain optimal general health. Anything that worsens a patient’s medical condition can make the dementia worse. Maintaining physical and intellectual activity is also important. However, a patient should not be stressed beyond their capacities.
Cognitive and physical rehabilitation
At some institutions, investigators are looking at ways to train Alzheimer’s patients to improve their memories. The value of this kind of treatment remains to be proven. In the advanced stages of Alzheimer’s disease, some patients develop problems with walking, balance, and muscle tone. These symptoms can be helped by physical therapy.
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What are some of the challenges in dealing with Alzheimer’s disease?
At Barrow, our goal is to maximize independence for those with Alzheimer’s while minimizing the risk of physical harm. Depending on circumstances and the severity of symptoms, potentially dangerous activities include:
- operating machinery
- having a highly responsible occupation
If you are caring for a person with Alzheimer’s disease, you must periodically assess potential risks to safety and act to reduce them.
Driving is often the most sensitive issue. It is hard to be without a car, and many Alzheimer’s patients resist losing their driving privileges. Sometimes failing a driving test convinces the patient to stop driving. Other times, it may be necessary to take away the keys.
Emotion and behavior
A common emotional symptom of Alzheimer’s disease is apathy. Patients with Alzheimer’s sometimes become less interested and engaged in activities that used to be important to them.
Apathy is not the same thing as depression, but some Alzheimer’s patients also show the typical symptoms of depression. These include:
- trouble sleeping
- poor appetite
- decreased energy
Depression is commonly treated by medication.
Some patients with Alzheimer’s easily become agitated. Their agitation can either be mental (for example, obsessively focusing on a particular symptom) or physical (for example, pacing), or both. Some also may have false beliefs (for example, someone is stealing from them) or see and hear things that are not there (for example, an intruder). In most cases, these symptoms are fleeting, and a tactful approach can defuse them. In more severe cases, medications can be used.
People with Alzheimer’s have a tendency to lose weight even though their appetite is still good. Increasing caloric intake and the appeal of food often are enough to control weight loss.
Bladder and bowel
Incontinence (lack of control) of bladder function, especially at night, is sometimes a feature of late-stage Alzheimer’s disease. Incontinence of bowel is much less common. You can keep this symptom under control by adjusting the person’s diet, scheduling times to use the toilet, and using adult diapers.
Legal and financial issues
Patients with moderate to severe Alzheimer’s disease are usually not competent to handle their own legal and financial affairs. Before a patient reaches this stage, it is important for families to agree who will make these important decisions when the patient cannot.
Almost everybody who cares for a loved one with Alzheimer’s disease suffers from some degree of stress. Signs of caregiver stress include:
- difficulty concentrating
- increases in your own health problems
It is important for caregivers to recognize and accept that this is an inevitable part of being a caregiver. Education and resources are available to help. Above all, caregivers must remember to take care of themselves. Too much stress can negatively affect a person’s caregiving abilities.
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