Medications and Alzheimer's Disease
Sexual Health Network : Life with Alzheimer's Disease
The main group of medications that may slow down the progression of symptoms are called cholinesterase inhibitors, and for early-stage patients Aricept, Exelon and Reminyl are three approved products in common use.
Alzheimer's Disease Reading Alzheimer's Patients' Behavior: It Takes a Detective
Sexual Health Network - Alzheimer's Disease
Wise advice: "Alan Dengiz, MD, director of geriatric medicine at St. Joseph Mercy Hospital in Ann Arbor, Michigan, offers another common challenging scenario and possible solution. 'One of the things that happens, especially as the day progresses, is that the individual with Alzheimer's disease will say, 'I want to go home' when they're in their home. What they're thinking about oftentimes is a home from their past because that's what's still alive in their brain, whereas the current home is not as familiar to them because they've lost the more recent memories.'
'What I recommend is that you go along with that rather than trying to correct them and getting them angry,' Dr. Dengiz continues. 'You can say, 'Well, let's go home later on, but why don't we go into the kitchen and have a nice cup of tea and just sit down and relax?' Sometimes that's enough to do it.' "
Most especially, always remember: "One of the important things for caregivers to understand is that frustrating or challenging behavior is a result of the disease and brain cells dying, and it's not reflective of the person," O'Brien says. "If families recognize that, it's easier to find a way to manage."
Articles for Alzheimer's Caregivers
Easy to read and insightful....
Sexual Health Network - Alzheimer's Disease
"Learn about alzheimer's disease symptoms such as memory loss and senile dementia. Find out about the treatments and causes, as well as the stages of alzheimer's disease and dementia."
Sexual Health Network
"The father of television personality Linda Dano experienced years of mental deterioration before he was diagnosed with Alzheimer's disease. Hear Linda describe how her family coped. "
Alzheimers research articles
Psychiatrysource.com
Information on Alzheimer's
www.therubins.com
US info site for senior citizens has usefull section of articles about Alzheimer.
Recent developments in pain in dementia -- Scherder et al.
BMJ
How to assess and treat pain when dementia causes problems with perception and communication of pain.
"Epidemiological studies show that, worldwide, the number of people aged over 65 will increase substantially in the next decades and that a considerable proportion of this population will develop dementia.1 Ample evidence shows that ageing is associated with a high rate of painful conditions, irrespective of cognitive status.2 The number of patients with dementia who will experience painful conditions is therefore likely to increase. A key question relates to whether and how patients with dementia perceive pain. Patients with dementia may express their pain in ways that are quite different from those of elderly people without dementia.3 Particularly in the more severe stages of dementia, therefore, the complexity and consequent (frequent) inadequacy of pain assessment leads to the undertreatment of pain."
Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study -- Gill et al. 330 (7489): 445 -- BMJ
BMJ article asks if certain antipsychotic drugs prescribed to contol psychotic* symptoms in older patients with dementia increase the odds of having a stroke. I find the mention of "non-pharmacological harm reduction strategies" especially interesting. Non have been offered for dad by either medical professionals nor the extra care accommodation which lacks funding for activities.
"In this population based cohort, older adults with behavioural and psychological symptoms of dementia (BPSD) who received atypical antipsychotic drugs seem to have a similar risk of admission to hospital for ischaemic stroke as those receiving typical antipsychotic drugs. These findings are important because of the frequency with which atypical antipsychotics are used to manage BPSD.6 Our results may help to inform drug prescribing for this group of patients.
What is already known on this topic
Atypical antipsychotics are commonly used to manage behavioural and psychological symptoms of dementia (BPSD)
Recent evidence from clinical trials suggests an association between atypical antipsychotic use and cerebrovascular events (including stroke) among older adults with BPSD
These data prompted the UK Committee on Safety of Medicines to recommend against the prescribing of atypical antipsychotics to patients with BPSD
What this study adds
Use of atypical antipsychotics by patients with dementia is not associated with a greater risk of stroke is than use of typical antipsychotics
Findings were consistent for a series of subgroup analyses including ones for patients at high baseline risk of stroke
The choice of atypical or typical antipsychotics to manage BPSD should not be based on concerns about the risk of stroke"
What do these results mean for clinical practice?
Clinicians managing patients with dementia who develop behavioural disturbances should initially rule out underlying medical illnesses or drugs that might predispose to delirium.33 If BPSD is diagnosed,
clinicians should initially consider non-pharmacological harm reduction strategies such as education of family members, ABC charting, and music therapy.3 If pharmacotherapy is considered necessary, it should be tailored to the individual. Our data show that the risk of ischaemic stroke is similar for patients receiving atypical antipsychotics and those receiving typical antipsychotics. Other potential risks of antipsychotics (for example, extrapyramidal symptoms, tardive dyskinesia) should also be weighed against the benefits. A working group of psychiatrists, general practitioners, and geriatricians in the United Kingdom has developed guidelines for the management of BPSD in people with a history of stroke or transient ischaemic attack.34 Unfortunately, many of the alternatives to atypical antipsychotics for managing BPSD have received only limited evaluation and have their own important adverse event profiles.4 The US National Institute of Mental Health is currently sponsoring the clinical antipsychotic trials of intervention effectiveness (CATIE) Alzheimer's disease trial, which is a 36 week study comparing three atypical antipsychotics, a selective serotonin reuptake inhibitor, and placebo to treat BPSD. Results are due in 2006.35 This study and others36 should shed light on the optimal management of BPSD and the risk of stroke in this patient population.
*
Dementia.com Glossary
"
Psychosis
A mental disorder causing the individual to lose contact with reality. Characterized by impairment in reality testing, which manifests as delusions, hallucinations, incoherent speech, and disorganized and agitated behavior."
ZEN - Buddhism Glossary
Mokurai's Temple defines Zen as:
"Zen: Japanese; Ch'an (Chinese); a branch of Mahayana Buddhism which developed in China during the sixth and seventh centuries after Bodhidharma arrived; it later divided into the Soto and Rinzai schools; Zen stresses the importance of the enlightenment experience and the futility of rational thought, intellectual study and religious ritual in attaining this; a central element of Zen is zazen, a meditative practice which seeks to free the mind of all thought and conceptualization."
What has this to do with Alzheimer's? Well, I like to think of Dad as nearing a state of Zen in many ways. His favourite TV is the adverts which he engages with totally with little or no critical thought about the content, intent, self awareness or indeed any manipulation of his behaviour - he doesnt do shopping and I reckon the "need to" rarely if ever crosses his mind.
For mum's funeral he repeatedly asked "what do the ladies drink?" and attempted to make a list. That was over a year ago. Fair, enough all his daily needs are taken care of between the family and the staff at the "extra care accommodation" but I have to assume from being with him that the concept of needs and pro-actively tending to them oneself does not impinge on his being.
The first awareness to go after one stroke was hunger, he just does not feel it and so has to always be prompted to eat. As a large part of human activity still has the aim of fulfilling hunger plus other basic needs before the desires induced by western capitalist culture this alone frees him from thought about what needs to be done. As he also forgets almost immediatly that he has eaten (and almost everything else) he is also freed from much of the noise of memory.
I see this emptiness as far from the void of nihilism but to mix my metaphors as more akin to a state of grace. Medicalisation of "going ga-ga" carries very negative connotations but sometimes I really envy him for his seeming to exist right here right now without complication...
Worry Accelerates Your Risk of Alzheimer's 2/23/05
Mercola
Early Detection of Alzheimer's Made Possible With New Test 2/19/05
Early Detection of Alzheimer's Made Possible With New Test 2/19/05: "A team of researchers developed a highly effective new test to locate the disease in its early stages, when the patient is still alive and can be treated. The test is called a bio-barcode assay; it detects small amounts of proteins in spinal fluid and is up to 1 million times more sensitive than other available tests. "
Mercola recommends: The Notebook on DVD for a sensitive film about Alzheimers.
Mercola also writes that "The number of people with Alzheimer's disease is expected to triple, as the greatest known risk factor of Alzheimer's is age. About 4.5 million people are affected today and the prevalence doubles every five years after the age of 65. In fact, if current population trends continue, it is estimated some 13.5 million Americans will have Alzheimer's disease by 2050.
But what's important for you to understand is that Alzheimer's disease is not a normal part of aging and there are a number of natural and safe ways to prevent and treat it."
He recommends:
1) increase the amount of fresh vegetables, which are high in folate, in your diet and restrict grains and sugars
2) consuming high-quality fish or cod liver oil
3) Exercise
4) Avoid and remove mercury from your body
5) Avoid aluminum
6) Seek mental stimulation
Brain scans reveal possible indicator of risk of developing Alzheimer's disease,
Health News Article | Reuters.com
"NEW YORK (Reuters Health) - Mental tasks take an extra effort for healthy non-demented older adults with a genetic variation called APOE-e4, which has been linked to an increased risk of developing Alzheimer's disease, research shows.
On tests of learning and memory, brain scans show that people with APOE-e4 apparently have to work harder to achieve scores comparable to those reached by people with the APOE-e3 "
This remains just a possible indicator of increased risk of developing dementia not a treatable cause.
