Marilyn had been watching her dadís memory deteriorate for two years. Now she was in my office asking about placement options. I wondered why he hadnít been started on any medication.
ďI asked the doctor if Dad should be on an Alzheimerís drug. He said they don't help.Ē
I am so grateful for the medications I have in my arsenal in the fight against Alzheimer'í disease and other dementias.
Having dementia is like being in a car thatís rolling downhill. These drugs put the brakes on and slow the process. You may not see an improvement, but the patient stays functional and independent longer, which relieves some of the stress on the caregiver.
How do they work?
In the early 1980s, researchers found that Alzheimerís patients are low on a brain chemical called acetylcholine.
Try as they might, the scientists couldnít synthesize an acetylcholine pill. All they could do was develop a compound that would keep the remaining acetylcholine from breaking down.
They call those drugs acetylcholinesterase inhibitors.
I call them the three sisters: Aricept (donepezil), Exelon (rivastigmine) and Razadyne (galantamine).
The most common side effect of all three is stomach upset, diarrhea and weight loss. Rarely will heart rhythm disturbance and seizures be reported.
Aricept also causes leg cramps.
Which is my favorite? I use all three, depending on the patientís needs. Some prefer a patch instead of a pill; others have insurance formulary limitations.
Namenda (memantine) is in a separate class.
It is thought that some of the nerve cells in Alzheimerís patientís brains are hypersensitive; bombarded with stimulation and unable to block out the excess. It's like being in a restaurant with TVs blaring, music playing, glasses clinking and people talking while you are trying to hear the waitress.
Namenda filters the excess stimulation so the important information can be processed. It seems to help patients focus and concentrate more. I've also found it to be useful in calming patients who are agitated and paranoid.
The most common side effects seem to be drowsiness, headache and constipation. It is often used along with one of the three sisters. The combination seems to work well and boost the effectiveness of both classes of drugs.
The new kid on the block is Axona. Its effectiveness rests on the theory that since glucose is not metabolized well in Alzheimerís patientsí brains, they need an alternative nutritional source.
Axona is a type of triglyceride that is broken down into ketone bodies to feed the brain.
This prescription-only powder is mixed with water or other liquids and given daily after a meal. To minimize stomach upset, it is started at a low dose.
Iíve used the other medications with success in patients of all ages with various types of dementia. I usually reserve Axona for younger patients (50 to 70) with true Alzheimerís dementia.
As far as alternative treatments, Iím growing fond of coconut oil. This is sold in health food stores and drugstores. About four teaspoons a day seems to be the effective dose. We have to be cautious in patients with diabetes or high triglyceride levels.
Over the years, Iíve seen other supplements used with varying degrees of success. These include ginkgo biloba, vinpocetine, huperzine and lecithin.
I recommend that you look at all your treatment options for this deadly disease, and work with your doctor to start the right medications as early as possible.