By
Kristine Dwyer, Staff Writer
Page 2
Treatments and Medication Benefits:
Although there is no cure
for AD, new and improved treatments are on the horizon and offer
hope. Most health professionals feel that the best plan of
treatment includes a combination of medication, changes in
lifestyle and support, along with a goal of managing symptoms
that affect memory, thinking and behavior. The regional director
of the Alzheimer’s Association of Minnesota-North Dakota points
out that there is a growing interest in the use of non-medical
interventions that may be effective on their own or used in
combination with medications. These interventions may include
memory and communication aids, speech therapy, behavioral
therapies, memory stimulation therapy, exercise, adequate sleep
and education. The environment also strongly influences the
health and capabilities of persons with AD; thus, it is
important for caregivers to pay attention to safety factors,
reduce stimuli and adjust the surroundings to accommodate the
disease.
AD changes the brain in many ways, which results in a decrease
of acetylcholine levels. It is believed that acetylcholine is a
chemical messenger that is important for memory, thought and
judgment. The US Food and Drug Administration currently approves
five prescription drugs, yet only three are actively marketed
for the treatment of mild to moderate AD. According to Mayo
Clinic, these medications are referred to as cholinesterase (ko-lin-ES-tur-ase)
inhibitors and seem to improve the effectiveness of
acetylcholine either by increasing the amount in the brain or
strengthening the way nerve cells respond to it. The top three
cholinesterase inhibitors are Aricept, Razadyne and Exelon. They
have all been effective treatment options in clinical trials.
The other two medications are: Cognex, which has been on the
market since 1993 but is rarely prescribed, and Namenda, which
is the first drug approved by the FDA to treat moderate to
severe dementia and may be co-prescribed with cholinesterase
inhibitors. Treatment with medications has revealed delays in
nursing home placements and improvements in cognition and
functional abilities in many patients with AD.
Doctors usually start patients on a low dosage of medication and
then gradually increase the dosage based on the tolerance level
of the patient. According to a journal of the American Academy
of Family Physicians, the above named medications have a low
incidence of serious reactions but they do have common side
effects that can occur such as nausea, vomiting, diarrhea or
weight loss. Tolerance to these medications often develops over
time. Cholinesterase inhibitors must be taken regularly and in a
sufficient dosage to benefit the patient. Interruptions of the
drug treatment over time will result in sustained or
irreversible cognitive decline. If a patient is unlikely to
follow a drug regimen or has an illness that could interrupt the
drug regimen, benefits will decrease and patients may face
greater side effects. The healthcare provider should consult
with the patient and the family to decide together on the best
plan of treatment. Pharmacists are also a valuable resource for
medication information.
It is important to understand that medication alone cannot stop
the disease and medications do not work for everyone. For those
who are helped, the effects may be only modest or temporary.
Treatment with medication may help prevent symptoms such as
depression, sleeplessness or wandering from becoming worse for a
period of time and can help keep behavioral symptoms under
control. Periodic monitoring and testing of a patient’s
functional and cognitive abilities is also recommended. These
results may offer encouragement to the patient’s family and can
serve as a guide for doctors, patients and families in planning
for the future.
Clinical Trials:
The best evidence of progress in AD research lies in the growth
of clinical testing of treatments, prevention of the disease and
diagnosis. This alone gives patients and families a reason to
hope. Advances in our knowledge and understanding of AD have
also led to the development of many new drugs, diagnostic tests
and treatment plans. Scientists now recognize the need for
earlier detection of AD and are devising new brain imaging
techniques and lab tests that could improve diagnosis. One
landmark trial that began in 2005 is the Alzheimer’s Disease
Neuroimaging Initiative. The goal of this trial is to determine
whether standardized brain images combined with laboratory and
psychological tests may offer a better way to identify those at
risk for Alzheimer’s, track disease progression and monitor
treatment effects.
Clinical trials are the final testing ground for new treatments
that are currently under investigation. Each trial represents
the results of years of scientific thought, observation, and
data analysis and is only possible through the participation of
patients and their family members. Clinical trials are the
principal way that researchers can discover whether a treatment
is safe and effective for patients, especially for those in the
early stages of the disease. Trials take place at private
research facilities, specialized AD research centers, teaching
hospitals and even at physicians’ offices. Taking part in a
clinical trial can be a big step for both the patient and the
family so it’s necessary to discuss the expectations and pros
and cons of participation with the clinical trials staff.
There are two kinds of drug trials available:
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Treatment trials with existing drugs that assess whether an
already approved drug may be useful for other purposes. For
example, an arthritis treatment may help in the prevention
of AD.
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Treatment trials with experimental drugs or approaches to
discover whether a new drug or treatment approach may help
improve memory function, decrease symptoms, slow the
progression of AD or prevent it altogether. Each one of
these clinical trials includes up to three phases. Once
these phases are complete and investigators are satisfied
that the treatment is safe and effective, the research team
can submit its results to the Food and Drug Administration
(FDA) for review.
When a person signs up for a clinical trial, they are asked to
sign an informed consent form to ensure that they are protected
and well cared for during the study. If a participant is unable
to provide informed consent because of memory loss, it is still
possible for an authorized representative (usually a member of
the family) to give permission. Next, patients go through a
process of screening to see if they qualify and can safely
participate before they proceed with the study. Although
clinical trials may not produce miraculous results, many
participants believe that even if the benefit to them is small,
they are making a valuable contribution toward future research.
Family members have also found that the best benefit of
participating in a clinical trial is the regular contact with
the research team. The team can be a link to education, provide
advice on the emotional and physical aspects of AD, and offer
supportive and helpful information.
The amount and variety of clinical trials underway are a sign of
the intensity of research to seek solutions for a disease that
robs the mind and takes away the essence of a person’s life.
Current clinical trials are available on the Internet under
www.alz.org or by contacting the Alzheimer’s Association or the
Alzheimer’s Disease Education and Referral Center (ADEAR) at
1-800-438-4380 (a service of the National Institute on Aging).
Caring for a person with AD can be likened to driving on an
unfamiliar road, riding a roller coaster or even walking on a
tightrope. It can be an incredibly stressful ride, yet rewards
can also be visible. The key is to balance your own needs
against those of the person you are caring for day to day. Many
caregivers find that they are stronger than they ever thought
possible and that they feel rewarded knowing they have stayed
committed to helping a loved one during the difficult years.
Caregiving can produce a great deal of stress that can lead to
physical decline and emotional exhaustion. The health of
caregivers is at risk, yet they often become the ‘hidden
patients’ while focusing all of their attention on the person
with AD. Caregivers need to keep their own health in check and
visit their doctor on a regular basis. Support systems must also
be alert to signs of caregiver burnout or depression and plans
must be made to provide respite to the caregiver. No one can do
it all alone. It is heartbreaking to watch a loved one go
through the stages of Alzheimer’s disease and caring for them
requires an abundance of courage and strength. Asking for help
and taking care of yourself cannot be overemphasized.
The Alzheimer’s Association assistance is available nationwide
and offers a wide variety of programs, educational materials and
support services to persons with AD and their caregivers. Many
communities have a local or regional chapter and offer regular
education and support group meetings. The Alzheimer’s
Association also provides:
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A 24-hour, tollfree (multilingual) Information Helpline
(800) 272-3900 that links callers to information about AD,
treatments, caregiving strategies and local programs.
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The nation’s largest Alzheimer’s library including books,
journals, cassettes, videos and CDs that can be obtained
through interlibrary loans at your local library.
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Internet support at www.alz.org, including online chat
rooms, research updates, brain health tips, the new
CareFinder program that assists caregivers in planning care
and finding support and the Safe Return program, which helps
families locate a loved one who has wandered off or gotten
lost. This Internet site is set up to help families and
caregivers make informed decisions.
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Care Consultation— one of the core services of the
Alzheimer’s Association (available in most states) that
assists the person with AD or related dementias and their
family in planning for, and dealing with, all aspects of the
illness experience.
In addition to contacting the Alzheimer’s Association, consider
care options such as in-home respite care, adult day programs,
home care services, delivered meals programs, or chore services.
Keep a personal journal of your journey or a medical journal to
record helpful information for yourself and the physician.
Continue with activities that are enjoyed. Maintain a network of
support and communicate your needs to family members, friends,
volunteers, and organizations to avoid isolation. Join a
caregiver support group to find hope, gain valuable information
from people who understand your position and learn new ways to
cope with the challenges you face.
Alzheimer’s disease impacts the whole family. Like a pebble
thrown into the water, the ripples of the disease touch the
lives of everyone. The signs and symptoms of AD can’t be
ignored! Early detection and current treatments can help
maintain or even improve memory, thinking and behavior problems
plus support the quality of life for persons with AD and their
caregivers.
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