Alzheimer's Disease

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Alzheimer's Disease Treatment

AD cannot be cured and the impaired functions cannot be restored. Currently, the progression can be slowed but not stopped.

Treatment focuses on attempting to slow the progression; managing the behavior problems, confusion, and agitation; modifying the home environment; and most importantly, supporting the family. As the disease progresses, it may take a greater toll on the family than the patient.

DRUG TREATMENT

There are currently three drugs available to try to slow the progression of the disease and possibly improve cognitive function. These three are tacrine (Cognex), donepezil (Aricept), and rivastigmine (Exelon).

All three affect the level of acetylcholine (a neurotransmitter) in the brain. All three have potential side effects, such as nausea and vomiting.

Tacrine, the first drug of this type approved, also causes an elevation in liver enzymes and must be taken four times a day. It is now seldom used.

Of the two other drugs, Aricept has been available longer. It is taken once a day and has been reported to improve or stabilize cognitive functioning and is well tolerated. Exelon, a new drug, shows a similar effectiveness like Aricept and is taken twice a day. New drugs are scheduled for release in the near future.

To improve cognitive function, it may be necessary to stop medications that worsen confusion or that are not essential to the care of the person. This may include medications (such as anticholinergics, analgesics, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and other medications).

BEHAVIORAL PROBLEMS

Underlying disorders that contribute to confusion should be identified and treated. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions (such as depression). The correction of these medical and psychiatric disorders often greatly improves the patient's mental function.

Medications may be required to control aggressive, agitated or dangerous behaviors. These are usually given in very low doses, with adjustment as required.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).

MODIFYING THE HOME ENVIRONMENT

The person with AD will need support in the home as the disease worsens. Family members or other caregivers can help by understanding how the person with AD perceives his or her world. Provide structured activities that promote the remaining abilities and reduce the effects of the compromised abilities.

Simplify the patient's surroundings, and give frequent reminders, notes, lists of routine tasks, or directions for daily activities. Give the person with AD a chance to talk about their challenges and to participate in their own care.

OTHER PRACTICAL STEPS

The sensory functions of the person with AD should be evaluated. If deficits are found, the patient should be assisted by hearing aids, glasses, and cataract surgery as appropriate. General nutrition and health maintenance is important, but special diets or nutritional supplements are usually unnecessary. Exercise is important and should be encouraged.

Eventually, 24-hour monitoring and assistance may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs. This may include in-home care, nursing homes, adult day care, or convalescent homes.