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

I follow this group on Facebook and have downloaded their brochure as follows:

If you or a loved one suffers from Alzheimer’s, Early Onset Alzheimer’s, or another Dementia related disease, if you are an advocate, or want to know more about these diseases, we invite you to join us. Memory People™ is a Facebook group founded by Rick Phelps who was diagnosed with Early Onset Alzheimer’s Disease June of 2010. Rick saw the need for real time interaction for all those touched by these diseases. At Memory People™ you will find care and support in a comfortable and safe environment where patients, caregivers, and all involved come together to share our stories, support each other, and bring awareness to these diseases. First, you will need to have a Facebook account to join us. From your Facebook home page type Memory People into the search bar. Then click on Memory People, and you will be taken to our home page where you can read about our group. Then, just click on the “Join Group” button and one of our Administrators will add you. If you or a loved one have been touched by Alzheimer’s or another Dementia related disease we encourage you to join us at Memory People™.
bringing Awareness, one person at a time
Rick Phelps
Founder, Memory People
Cell 740-294-2456
phelps2645@gmail.com
Leeanne Chames
Personal Assistant to Rick Phelps
Executive Director, Memory People
leeannechames@gmail.com

The Area Agency on Aging is pleased to announce its new dedicated Alzheimer’s helpline.  It provides free, trusted, unbiased information about services available in Mobile, Baldwin and Escambia Counties for individuals and families affected by Alzheimer’s disease and related dementias.  The phone is answered Monday through Friday from 8 a.m. to 5 p.m. on normal business days.  The service is provided in partnership with the Alzheimer’s &  Dementia Coalition of South Alabama.

As my mother’s abilities have declined, I’ve become creative in solving the daily challenges of personal hygiene.  Standing in front of the bathroom sink to brush her teeth became very difficult as my mother’s stamina weakened.  The day I had her sit in her recliner to carry out the task was a relief to us both.  I have a small table that I can place all the implements I need close by.  I lay a towel over my mother’s chest to keep her dry.  I begin the process by first using a brush pick to

Tools used to brush teeth

clean out the excess food stuck between her teeth or pocketed in her jaw. I wipe what I dig out on a paper towel.    I then put toothpaste on a soft bristle child size toothbrush.  All the while, I compliment my mom on what a good job she’s doing, that her dentist would be proud, and what we are doing next.  On most days, she will open her mouth willingly and allow me to gently brush. Next, I give her a small cup of water to swish around in her mouth, then hold up a small bowl for her to spit the contents of her mouth into.  Sometimes I have to show what I want her to do – swishing the water in my mouth and spitting it into the bowl.  I inspect our progress, then may need to use the brushpick again or brush again, and rinse.  Once satisfied that we have thoroughly cleaned everything, I give her a capful of mouthwash.  I remind her not to swallow the mouthwash but show the swishing motion with my mouth and have the bowl close by to empty her mouth.  I wipe her mouth off with the towel on her chest, then finish by applying some chapstick to moisten her lips.  She will agree that she feels better now.

If she is not willing to open her mouth at the beginning of the process, I usually move on to her hands, wiping her hands with a damp towel, cleaning her fingernails with the tool attachment to her fingernail clippers, and applying lotion to her arms and hands.  This will distract and relax her and she will usually agree to open her mouth.  Most times, I follow the teeth cleaning with the hand washing.  I also play easy listening music while we do both activities.

What once was a problematic situation such as bad breath, food stuck in her front teeth and agitation in trying to remedy that has turned into a daily intimate ritual that is satisfying to us both.

Published: Wednesday, November 07, 2012, 2:53 PM     Updated: Thursday, November 08, 2012, 5:45 AM

By Press-Register Editorial Board
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Beth Reinert with her mother.

By Beth Reinert

Guest Columnist

My mother was diagnosed with Alzheimer’s disease in 2008. Preparing for her long-term care, meeting her financial requirements and offering meaningful activities have dominated my life. In addition to caring for all of her needs, I’ve spent hours doing research on the Internet, reading books and making phone calls for just one reason: So I could provide her with the best care possible.The number of unpaid caregivers for Alzheimer’s patients in the United States totals over 10 million, yet the job is often lonely and unrecognized. Most of us aren’t prepared to take on such care of a loved one, but once the commitment is made, we have so much to learn.

While overcoming one challenge after another, I have come to realize how vital caregivers are. We are the ones who make the decisions that determine quality of life, medical care and safety. Even with help from my sister, I finally realized that a team of people is necessary to provide 24/7 care. But where do I go for help?

Finding a support group was a good place to start. The first time I sat down with families living with Alzheimer’s disease, I felt so relieved that I wanted to cry. Here were my comrades, the ones who knew what I was going through. I found good referrals, creative suggestions and listening ears from the group participants.

I also received help from the E.A. Roberts Center, from family members, from my church, from home health care, from hospice, from the staff at the assisted living facility where she lives and from the private sitters scheduled to keep her company.

I found resources through the South Alabama Regional Planning Commission and the Area Agency on Aging and became involved with them as a volunteer. They put on an annual Caregiver Conference that I attended for the first time last year. I still benefit from what I learned at the conference. Where else can you acquire facts on bladder and bowel health, hear about the latest products for incontinence and learn how to qualify for Medicaid when the time comes?

Information about these topics helped me overcome problems that seemed insurmountable at first. Now I face these issues and many others with confidence.

I’ve heard that the new optimism is solutions. Well, solutions can be found at the Caregiver Conference on November 14, 2012 at the Daphne Civic Center. It’s free to attend and they offer adult day care or in-home sitters at no cost to make it possible for you to attend. If you are a caregiver—unpaid or professional—I urge you to continue to educate yourself by attending this conference. Your job will become easier and the care you are giving will improve. You can even earn CEUs if you need them.

I want all caregivers to be able to easily access services from our local community. In my association with Area Agency on Aging, they have listened to my concerns about the needs of caregivers and dementia patients. As a result, the Alzheimer’s Disease and Dementia Association Helpline was developed and is ready to be launched on November 15. By calling 251-706-4680, local information and resources for family members or clients with Alzheimer’s or dementia can be found.

As my mother’s disease progresses, I know that we will embrace what each day brings. With continued faith and asking for help when we need it, I trust my mother will continue to have the care and love that she deserves.

For those interested in attending this year’s Caregiver Conference the final day to RSVP is Tuesday, Nov. 13. You can do so by calling 251-433-6541.

Beth Reinert has a master’s degree in education and serves on the South Alabama Alzheimer’s and Dementia Coalition. She can be reached at pittman1212@comcast.net.

Beth Reinert lives with Alzheimer’s Disease in many ways.  She worked as the  Recreation Director on a Special Care Unit for Alzheimer’s patients  for two years before her children were born.  Having a BS and MEd  from the University of South Alabama that specializes in Therapeutic Recreation prepared her for implementing appropriate activities and interaction.  Both her maternal and fraternal grandmothers died with the disease and she is the primary caregiver for her mother who is well advanced in the disease.  Beth is an avid writer and advocate for the elderly, particularly for those with dementia.  She is especially passionate for the plight of the caregiver who is walking the journey with a loved one living with Alzheimer’s disease.