Alzheimer's Disease

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Treatment

There is no cure for Alzheimer's disease. The U.S. Food and Drug Administration (FDA) has approved donepezil (Aricept®), galantamine (Razadyne® ER, formerly branded as Reminyl®), and rivastigmine (Exelon®) for treatment of mild-to-moderate Alzheimer's disease.

The Exelon® Patch (rivastigimine transdermal system) is also approved for mild-to-moderate dementia associated with Alzheimer's. This patch is applied to the skin (usually on the back, chest, or upper arm) and delivers medication continuously for 24 hours.

In October of 2006, Aricept® was approved for treatment of severe dementia in patients who have advanced disease.

These medications help increase the level of acetylcholine (ACh) in the brain by inhibiting the enzyme that breaks it down. They may help patients with early or moderate Alzheimer's disease maintain function longer and may slow progression of the disease for a few months to a few years.

Side effects include the following:

• Diarrhea
• Dizziness
• Drowsiness
• Fatigue
• Nausea
• Vomiting

Patients with liver disease, peptic ulcer disease, chronic obstructive pulmonary disease (COPD), and slow heartrate (bradycardia) should not take these drugs.

Memantine (Namenda®) is the only medication approved by the FDA to treat moderate-to-severe symptoms of Alzheimer's disease. It can be used alone or in combination with other medications (e.g., donepezil).

Memantine helps protect nerve cells in the brain from excess glutamate, which is a neurotransmitter that plays a role in neurodegenerative diseases. Clinical studies have shown that it can improve memory and function and prolong the ability of Alzheimer's patients to perform some tasks independently. Side effects include headache, constipation, confusion, and dizziness.

Neurobehavioral symptoms associated with Alzheimer's disease interfere with normal daily activities and sleeping. Depression that occurs during the early stages are commonly treated with antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs) and the tricyclics. Benadryl is used to help relieve insomnia. These medications produce side effects including drowsiness, dry mouth, and constipation.

Agitation and belligerence are sometimes treated with antipsychotic medication, such as haloperidol, risperidone (Risperdal®), benzodiazepines, and newer antipsychotic drugs (e.g., olanzapine [Zyprexa®], quetiapine [Seroquel®], ziprasadone [Zeldox®, Geodon®]). Antipsychotics are not FDA-approved to treat symptoms of Alzheimer's disease and may increase the risk for death in elderly dementia patients. Side effects include sedation, confusion, and increased muscle tone.

Safety and Quality of Life
Memory aids such as notepads and reminders posted in specific locations are helpful. A careful evaluation of the home is essential for safety, especially the kitchen, bathroom, and bedroom. Some therapists and social service workers are trained to perform this service. People with Alzheimer's are often afraid to be alone or fear they'll be forced to leave their homes.

Loss of independence and changes in their environment, such as being placed in a nursing home, can cause distress, anger, confusion, and agitation. Patients need well-managed orientation to a new environment and constant reassurance. Family involvement and support services help patients and their caregivers cope.

Prognosis
Patients may survive 8 to 10 years with Alzheimer's disease. Some have been known to live 25 years with the disease. Death usually occurs due to secondary infections, heart disease, or malnutrition.

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