Alzheimer’s disease (AD) is the most common form of dementia – a disease that affects adults older than 65 and causes the death of nerve cells in the brain. A person with AD loses memory and the ability to complete everyday tasks. As the number of older American grows, so does the prevalence of the disease. Currently, there are 5 million people living with AD in the United States. By 2050, that number is expected to triple.

People caring for AD patients may have several challenges, including:

• Communicating and coping with changes in the patient’s personality
• Other conditions that affect the elderly such as slip-and-fall injuries that may require hip replacement surgery
• Heart troubles
• Diabetes

On top of this, these are several medications for treating AD that have varying levels of effectiveness and safety. Symptoms like depression, psychosis and apathy may be treated with additional drugs that also carry a host of side effects and may interact with AD medications.

Caregivers should know what to look out for when it comes to these medications because some can cause serious harm.

Types of Medications Used to Treat Alzheimer’s

In the United States, there are two classes of U.S. Food and Drug Administration (FDA)-approved drugs for the treatment of AD: cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists. These drugs are fairly expensive and have not been found to be very effective.

Cholinesterase inhibitors work by preventing the breakdown of a chemical responsible for thought, learning and memory called acetylcholine. These drugs are recommended for mild to moderate cases of AD.

Some drugs in this category are:

• Aricept
• Exelon
• Razadyne

Aricept in particular has come under fire from consumer advocate groups like Public Citizen because of its lack of effectiveness and severe side effects at higher doses, including dizziness, agitation and gastrointestinal problems. Vomiting is also a severe side effect and can lead to pneumonia, bleeding and even death.

The only N-methyl-D-aspartate (NDMA) receptor antagonist that is FDA approved is Namenda, which treats moderate to severe AD. This drug works by blocking NDMA receptors, preventing the release of amino acids that kill nerve cells. It can also be prescribed in combination with Aricept.

Common side effects of these drugs are dizziness, drowsiness and fainting – conditions that may heighten the risk of injuries from falls. If more than one of these drugs is prescribed, side effects could be worse.

Other Drugs Prescribed to AD Patients

There are a number of other symptoms AD patients may suffer from, such as depression, apathy and psychosis. These symptoms may be treated with additional drugs, including:

• SSRIs. For depression, doctors typically prescribe antidepressants known as selective serotonin reuptake inhibitors (SSRIs). While SSRIs like Zoloft are linked to birth defects when taken during pregnancy, older patients with AD may experience nausea, weight loss or gain, dizziness or agitation.
• Stimulants. Apathy is another common symptom of AD. To treat this, doctors may prescribe a stimulant such as Ritalin. This drug can cause high blood pressure, severe insomnia and psychotic symptoms. It is also addictive. This medication is especially risky for adults older than 65, and a caregiver may wish to inquire about an alternative.
• Antipsychotics. Some AD patients suffer from hallucinations or aggressive behavior, and antipsychotics are used to treat these symptoms. A study published in the May 2009 issue of Lancet Neurology revealed that these drugs are not much more effective at controlling these episodes than placebo, however. Also, they may double the risk of death, and serious side effects such as Parkinsonian-like symptoms can also develop. Before prescribing antipsychotic medications, many doctors recommend behavioral treatments such as controlling the patient’s environment and routine.

Non-Pharmaceutical Options

There is no cure for AD, but there are a few alternatives to medications for easing some symptoms:

• Keep a routine and avoid unfamiliar places.
• Always be aware of tone and body language when communicating with an AD patient, and try to use gentle touch to communicate if verbal communication is not working.
• Use distractions such as music, dancing or singing to stop disruptive behaviors.
• Take time out for yourself if you are getting frustrated.
• Always let the patient know he or she is safe.
• Keep extra sets of things patients may lose, such as glasses or keys.
• Try not to argue with the patient.

As always, when making any decision about a patient’s care or medications, work hand-in-hand with the patient’s physician.

Bio: Michelle Y. Llamas is a writer and researcher for Drugwatch.com and the host of Drugwatch Radio. She has written for medical journals and been a guest on podcasts focused on health

Sources:

National Institutes of Health. (2013). Methylphenidate. Retrieved from www.nlm.nih.gov/medlineplus/druginfo/meds/a682188.html

New York Times. (2012). Alzheimer’s disease medications. New York Times. Retrieved from http://health.nytimes.com/health/guides/disease/alzheimers-disease/medications.html

Consumers Union of United States. (2013, January 7). Alzheimer’s drugs are expensive, and they don’t work very well for most people. Washington Post. Retrieved from http://articles.washingtonpost.com/2013-01-07/national/36188995_1_drugs-generics-seroquel

National Institute on Aging. (2012). Caring for a person with Alzheimer’s disease. Retrieved from http://www.nia.nih.gov/alzheimers/publication/caring-person-ad/understanding-how-ad-changes-people-challenges-and-coping

An Explanation of the Rights of Nursing Facility Residents

It is the goal of Alabama’s nursing facilities to promote and protect the rights of each of their residents. According to the Older American’s Act, a federal law which was initially passed in 1965, each nursing facility resident has a right to a dignified existence, self-determination, and communications with and/or access to persons and services both inside and outside of the nursing home. Also included is the right to the individual’s freedom of choice, the right to privacy and the right to voice grievances. Some of these resident rights include:

• the right to be treated with dignity, privacy, respect, and to live in a safe, clean, comfortable, and homelike environment
• the right to exercise their rights as citizens of the United States and of the State of Alabama, including the right to vote
• the right to be fully informed in writing of all facility services and charges for those services
• the right to be informed of their health status and the right to participate in the planning of their own care and treatment, the right to refuse medical treatment, including experimental research, and the right to formulate an advance directive
• the right to have their money and property protected
• the right to manage their financial affairs
• the right to know if they are eligible for Medicaid or Medicare and how to apply for coverage
• the right of freedom of choice to make their own decisions
• the right to privacy including accommodations, medical treatment, written and telephone communications, personal care, and meetings of family and resident groups, but this does not require the facility to provide a private room
• the right to retain and use personal possessions, as space permits
• the right to privacy and confidentiality of their medical and clinical records
• the right to an accessible grievance procedure that is easy to use
• the right to refuse to perform services for the facility unless they desire to do so and it is documented in the plan of care
• the right to choose the groups and activities in which they wish to participate
• the right to have guests visit and other personal communications
• the right to basic procedural safeguards on admission, transfer and discharge
• the right to get advance notice about a change in room or roommate, and to be told why such a change is needed
• the right to be informed in writing of the bed-hold policy for temporary absences from the facility
• the right to be free from physical restraints or psychoactive drugs administered for discipline or convenience, or not required to treat their medical symptoms
• the right to be free of verbal, mental, sexual, or physical abuse and involuntary seclusion
• the right to refuse a transfer to another room within the facility under certain circumstances
• the right to self-administer drugs if the interdisciplinary team has determined that this practice is safe
• the right to examine the results of the most recent Federal or State survey of the facility
• the right to be free of interference, coercion, discrimination, or reprisal from the facility in exercising these rights
• the right to be informed both orally and in writing of their rights and all the rules and regulations governing their conduct and responsibilities during their stay in the facility
• If you feel your rights are being violated, give your local Ombudsman a call.  In Mobile, Escambia, and Baldwin Counties, call Ivy Walker at 251-433-6541 or 1-800-243-5463.

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