Table of Contents
- Case Study – Did Mrs. Santos’ have Alzheimer’s disease?
- Important Concepts Regarding Medications and Procedures for the Treatment of Alzheimer’s
- Enhancing the Mind – There is No Magic Pill for Alzheimer’s
- Natural Dietary Supplements and Home Remedies
- Mind Medications versus Holistic Remedies
- When to Consider Mind-Altering Drugs
- Treating the Symptoms of Alzheimer’s Disease
- Alzheimer’s and Aggressive Behavior
- Alzheimer’s – Illusions, Hallucinations, and Psychosis
- Alzheimer’s – Bowel and Bladder Incontinence
- Alzheimer’s – Insomnia and Wandering
- Alzheimer’s Medications
- Acetylcholinesterace Inhibitors
- Antidepressant Medications
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Some Commonly Prescribed Antidepressants in Alzheimer’s Disease
- Other Medications Used with Alzheimer’s Disease
- Medications Used to Treat Insomnia
- Sleep Medicines That are Purported to be Non-Habit Forming
- Future Treatment: What’s in the Pipeline for Alzheimer’s Disease
- Alzheimer’s Vaccine
- Growth Factor
- Monoclonal Antibody Treatment
- Beta-Amyloid Immunotherapy
- Secretase Inhibitor Research
- Stem Cells
- Prevention is the Only Reasonable Alternative
- Prepare Now for Your Future
- And The Greatest of These is Hope
Case Study – Did Mrs. Santos’ have Alzheimer’s disease?
The high-pitched screams echoed like a siren off the cold, white tiles covering the emergency room walls. As I entered the small examining room, Mrs. Santos, a petite Hispanic woman in her late 60s, strained and struggled, and tried feverishly to bite at the restraints on the gurney. Her pupils dilated with a frenzied stare, she ignored the pleas of her three daughters who begged her to calm down, to relax.
The oldest daughter spoke first and told me there had been a dramatic change in their mother’s personality and behaviors over a six-month period. “Her personality changed just after surgery for breast cancer,” the daughter said. “She refused radiation and other treatment. And the doctor said that probably no other treatment was needed.”
“Then, Mother began complaining of numbness in her arms and legs,” her daughter continued, “and shortly after this, she started to act peculiar, very paranoid and suspicious and she even hallucinated once.”
The daughter told me that Mrs. Santos’ primary care doctor had done an MRI of her brain a week ago, and it was negative. Then a few nights later, their father had called, as Mrs. Santos was irrational and alarmed. “Our father thought Mother might have had a seizure,” one woman said.
In spite of Mrs. Santos’ combativeness, I did a brief neurological exam. Then holding her small hands in mine, I noticed her unpolished nail beds and the fine white lines stretched across them as if they had been painted on, but they were not. I immediately ordered an analysis of her nails, hair, and urine and started safe and effective treatment. Had I not taken her symptoms seriously and searched for other clues in the examination, she may have been given strong mind medications (pharmaceuticals) that may have masked the symptoms without treating the toxicity.
I tell my medical students at USC there are three things a doctor must be certain of before starting treatment: a probable diagnosis, a proper diagnosis and a treatable diagnosis.
You may wonder what this has to do with the medical treatment of Alzheimer’s disease. Remember, the commencement of medical treatment is always dependent on the diagnosis. Did Mrs. Santos’ have Alzheimer’s disease? Was it another type of dementia or mental illness? Why would I analyze her nails and hair?
Turns out, Mrs. Santos suffered from delirium because of arsenic poisoning. Arsenic causes white lines in the nail beds, which I noticed when I held her hands during the examination. Was someone trying to poison Mrs. Santos? Not at all. Her daughter said that relatives in Mexico had sent the woman a case of jam made from apricots and apricot pits to help prevent the spread of her cancer. In addition, the jam had high levels of arsenic-that I determined when noticing the common signs of white lines in her nail beds called Mees lines. It makes sense, in that apricot pits contain traces of arsenic. Evidently, by eating the apricot jam, enough arsenic built up in Mrs. Santos’ system, to cause symptoms that mimicked a brain disorder or Alzheimer’s disease.
In my clinical experience both men and women are generally brought to see an Alzheimer’s specialist by their children. I have seen, as have my colleagues, a tremendous amount of denial in marriages, that there is something “potentially destructive” going on in their spouse’s brain. The healthy spouse does not want to admit that the “love of their life” has a problem. When I asked Mrs. Santos’ husband about her mental state and memory loss, he said he didn’t notice his wife’s severe mental problems, saying, “Well, she her bad moments, but I think she’ll snap right back, doctor.”
Usually, the wives, in general, tend to be more realistic. Much has to do with their level of sophistication and experience about Alzheimer’s disease, perhaps from knowing someone with Alzheimer’s or caregiving to a family member with the same.
Still, adult children are the ones most sensitive to change-as you noted with Mrs. Santos being brought to the ER by her two daughters. Spouses seem to miss the gradual deterioration of their partner’s mind. Most commonly, a calamity or potential crisis is the cause of a brain evaluation. This may stem from a car accident, nighttime confusion and the patient is found wandering throughout the neighborhood at 3am, or other precipitating event.
Important Concepts Regarding Medications and Procedures for the Treatment of Alzheimer’s
In doing so, I will answer the following questions:
- When is medication necessary for Alzheimer’s disease?
- When is medication considered to be a drug as compared to a natural dietary supplement?
- How can medications help and harm you?
- What’s the honest truth about the efficacy of Alzheimer’s medications versus the financially driven hype?
- What other medications are used in the treatment of symptoms of Alzheimer’s disease?
- What new treatments are in the pipeline…for the future?
Enhancing the Mind – There is No Magic Pill for Alzheimer’s
The past century has brought myriad false promises within the arena of mind-enhancing products. As an example, at the turn of the last century, heroin and cocaine were commonplace–both given as treatment to ill patients and even taken by prominent physicians such as German psychiatrist Sigmund Freud. In the 1960’s, the hallucinogen LSD–promoted by such notables as Harvard psychiatrist Dr. Timothy Leary – was thought to be the new mind – enhancing wonder-drug, until numerous psychoses including suicides occurred that were directly related to this psychedelic drug.
Later, biofeedback caught the headlines, touted as “the answer to mind-over-matter.” One demonstration of biofeedback showed a Lionel train running on energy generated by the brain. This brain booster could indeed enlist the vagal nervous system that controlled heart rate, blood pressure, skin temperature, and alpha waves of the brain. In truth, however, the hype of biofeedback outweighed the reality; the effects of biofeedback were shorter-lived than those who could afford the $100 an hour sessions to develop the skill. Yes, as with many highly touted miracle-cures, the therapists’ financial benefit far exceeded their patients’ improvement. Like LSD and the miracle drugs before, biofeedback went down a one-way track to failure.
Sure, we all want a cure for Alzheimer’s disease. The more we see Alzheimer’s rob our family and friends of their minds and memories, the more passionate we become in seeking effective treatment. To that end, there will always be some manic Medicine Men with their wagons ready to separate your wallet from your good common sense – from what you know to be true, that is, there is no magic pill to cure Alzheimer’s.
If you or a loved one has Alzheimer’s, it’s important to realize that while there are a few proven medications that can give temporary relief of this devastating illness, no medication is proven (yet) to fully manage this brain disease effectively. Also keep in mind that a well-known pharmaceutical company in one of its recent newsletters stated the truth: “All the treatments so far (including anticholinesterase inhibitors such as Aricept) have not reduced patients from being placed in nursing homes by even one day.”
The American Academy of Neurology (AAN) notes that by the time the average patient is diagnosed with Alzheimer’s disease, they still live another 8.5 years. On the average, they are admitted to a nursing home within two and a half years of the diagnosis. This means that if you get Alzheimer’s, you might spend the last six years of your life without the company of your family or even the house that you called “home.”
As we try to understand medical research, I believe it’s vital that we remember four key points:
- Scientific results that appear to be a gain in animal experiments may not translate into long-term help for the human mind.
- Scientific trials must be controlled and then evaluated and retested over time to see if the signs and symptoms of Alzheimer’s disease improve.
- The time from concept of animal studies to an effective, safe, and proven drug is 5 to 10 years at best
- The benefit of any pharmaceutical treatment must far outweigh the burden.
Natural Dietary Supplements and Home Remedies
The use of herbal or natural pharmacology as “home remedies” is increasingly commonplace as the cost of medicine soars. Yet, before you ingest any natural dietary supplements from your grocer’s shelf, it’s important to know the effects, side effects, and how some of these “natural therapies” may have drug-like consequences when taken with other prescribed medicines. As an example, the natural herbs gingko biloba and passionflower increase bleeding. When these herbs are taken with aspirin or warfarin, an prescribed anti-coagulant, the chances for bleeding are even greater. In addition, when the botanical evening primrose oil, available for just dollars at most groceries, is taken with the antidepressant Prozac, it can increase the likelihood of seizures.
Even though natural dietary supplements, including herbs, are not governed by the FDA and are distributed as “food products,” they still have powerful, drug-like influences on the body. Read about the potential effects they can have if you mix them with common medications. Talk to your doctor about your medications and supplements and see what changes need to be made.
Mind Medications versus Holistic Remedies
Mind medicines are man-made drugs (pharmaceuticals) that affect the brain. Holistic remedies are naturally occurring substances in nature such as ginkgo biloba. When mind medications are ingested with some natural dietary supplements, they vie for the same transporter systems. Each medication and supplement has specific actions, interactions, and side effects. Caffeinated tea is one example of the good and bad found in holistic therapies. While green and black tea are proven to be excellent antioxidants that can fight free-radicals in the body, the additional caffeine may produce anxiety and sleeplessness, and also interact with psychotropic medications. Caffeine, an addictive “drug,” is often responsible for insomnia, as well as withdrawal headaches and irritability.
When to Consider Mind-Altering Drugs
You may wonder at what point you should consider taking a mind-altering drug-whether a prescribed medication or holistic botanical or natural dietary supplement. With the risks involved, it makes sense to talk to your doctor before self-medicating with any medication or supplement that may alter your mind. Here are some guiding recommendations:
Mind medications: If you have experienced memory problems consistently for three months, then your primary care doctor may consider prescribing a mind medication (pharmaceuticals). Nevertheless, before you panic and think you have Alzheimer’s disease, make sure your physician has ruled out other treatable causes of memory loss such as thyroid disease, depression, vitamin B-12 deficiency, and recent gastric bypass surgery.
Also, I emphatically advise you to consult with a specialist (a board certified neurologist), especially if the medication is to be continued for more than two months. Most mind-enhancing drugs are proven ineffective. In addition, mind-enhancing drugs are extremely costly and even dangerous. On the side, if you’ve read the latest media recommendations to reverse Alzheimer’s disease, along with the primetime advertising by major pharmaceutical companies, you’d come up with a curious concoction of ginkgo biloba, Hydergine, Prozac, and Aricept. The problem is that not one of these natural dietary supplements and mind medications has been scientifically proven to increase the longevity of brain function.
Holistic or natural supplements: Holistic supplements are over-the-counter natural dietary supplements such as ginkgo biloba, kava, St. John’s wort, and valerian, among others. Consultation with your health care professional is always advised before taking a holistic drug. Medications such as aspirin interact with these non-FDA approved natural dietary supplements, and just because they are sold at the corner supermarket does not mean they are safe-or effective. Complications occur frequently in older adults who mix various medications with supplements.
Treating the Symptoms of Alzheimer’s Disease
In treating Alzheimer’s disease today, the best we can do is treat the symptoms-as there is no cure, nothing to halt and reverse the disease once it begins. According to the American Academy of Neurology, the major complications of Alzheimer’s disease that are most concerning to the family or caretaker include the following signs and symptoms:
- Aggressive behavior
- Illusions, hallucinations, and psychosis
- Bowel and bladder incontinence
- Insomnia and wandering
Alzheimer’s and Aggressive Behavior
Aggressive behavior is found in 65 percent of all patients with Alzheimer’s disease. This aggression is most commonly at night and occurs frequently during the transition from mild to moderate Alzheimer’s. Medications that are best to deal with it are the neuroleptics such as Seroquel, Zyprexa, and Geodon that have low side effect profiles. Other antipsychotics such as Haldol, Thorazine, and Risperdal cause Parkinsonian symptoms such as rigidity and sedation and increase the chance of falls and injury.
These medications, according to recent advice from the New England Journal of Medicine, must be closely monitored. It is advised that a specialist monitor these medications, as long-term treatment often is not necessary. That is, once a patient is aggressive, it does not mean that they will continue to be so.
Alzheimer’s – Illusions, Hallucinations, and Psychosis
Hallucinations, illusions, and psychosis are behavior symptoms that often cause great distress to the family, especially to the spouse or a child. During this time, the Alzheimer’s patient begins to develop paranoid behavior. Since they cannot remember or grasp what is happening and become overwhelmed easily, they begin to imagine things. A similar experience occurs when people first lose their hearing. They begin to think people are whispering about them, believing that others are trying to keep secrets from them (paranoia).
In Alzheimer’s disease, patients cannot remember where they placed their wallet, keys, or cell phone. Therefore, they begin to believe that people around them are plotting against them, taking these items and deliberately hiding them.
The Alzheimer’s patient may then become accusatory, most often to those they loved and trusted the most. This can then lead to more aggressive behavior.
Alzheimer’s patients often get illusions first. This illusion is the misidentification of a real object. They might see a coat hanging up on a coat rack and believe it’s a person-that an intruder is in the house. An Alzheimer’s patient might see an old photograph of their mother and then tell other family members the next morning that their mother had come to visit them during the nighttime. Yet when the photo is removed, the illusions go away. They’ll even tell you stories about someone who came and told them to do a task or make a move.
Delusions and psychosis, fixed false beliefs that are persistent in nature, are uncommon in Alzheimer’s disease. The hallmark of psychosis is that it is a false, fabricated reality – but a reality the patient believes is true and nothing can change his or her mind. For example, one of my patients shared his story that a plane flew overhead to x-ray his house to determine if the patient was doing something wrong. Each time I saw the elderly man, he’d relay the same story with greater detail than before. Despite being told that there were no airports or overflying airplanes, nor was there any reason for someone to spy on him, he persisted in his belief and only became angry and accused his own wife of being part of the conspiracy. In Alzheimer’s disease, such fixed, false beliefs are uncommon. If there is a delusion in Alzheimer’s, it is often random. This particular patient had a long history of schizophrenia.
Delusions must be distinguished from confabulations. A confabulation is a “fill in the gap” response. It’s what neurologists used to call the “string sign,” or when a person with limited comprehension abilities makes up a plausible story. For instance, let’s say a physician raises both hands and asks, “What color string am I holding?” A normal individual would realize that there wasn’t any string in the doctor’s hands. However, a person that confabulates will go on to describe the color, size, and length of the string. If a bill goes unpaid, the person that confabulates says that it was sent to the wrong address. Or looking at milk spilled on the floor, this person would say the cat did it by opening the refrigerator and pushing it over. Or, the person might say there’s a leak in the pavement, and it just “looks” like milk. Sometimes the confabulation can be quite inventive.
Here’s some advice: never, ever confront the patient who confabulates; never call them liars, because it causes agitation and resistance. Instead, listen attentively. If they have not endangered themselves such as leaving the stove unit on high, simply clean up the problem (the spilled milk) and say that it’s okay to spill milk. It just needs to be wiped up.
The same medications used to treat aggression can be used for these patients, especially if the behavior, hallucinations, or illusions are frightening and cause distress to the patient. A simple treatment may also include a nightlight and placing familiar objects in the room.
Patients who experience hallucinations or illusions need 24-hour supervision and should not be left home alone, especially if they demonstrate activities that might be a danger to themselves or to others such as cutting electrical wires or leaving the stove on. Try to maintain a stable, predictable environment with assistants who are familiar to the patient’s cultural background if possible.
Alzheimer’s – Bowel and Bladder Incontinence
In the early- and mid-stages of Alzheimer’s disease, bowel and bladder incontinence is usually not a problem. But as the disease progresses to the mid- to late-stages, bowel and bladder incontinence can occur. Management of this problem includes:
- Scheduling bathroom visits
- Wearing pads
- Using bladder inhibitors for urinary incontinence (these are often dangerous as they can cause urinary retention)
Alzheimer’s – Insomnia and Wandering
The Alzheimer’s patients’ biorhythms are easily disturbed. These rhythms are worsened when they are allowed to sleep during the day, and their sleep-wake cycles become more disturbed than normal.
In 30 percent of Alzheimer’s patients, sleep disturbance is a major reason they’re placed in nursing homes, as the caregiver becomes exhausted. Sleeplessness at night is often associated with wandering about 20 percent of the time. With wandering, the patient leaves the home and walks the streets of their neighborhoods. In their home or in a nursing home, they might get into the rooms or beds of other people living with them. It’s completely common for an Alzheimer’s patient to be found snoozing in a bed across the hall from her room or in another wing of the nursing home’s Alzheimer’s Unit. You can imagine the havoc this causes to both the patient and to the recipient!
Treatment involves managing sleep patterns by keeping the patient active during the day and having a fixed schedule. Sleep onset drugs such as Ambien are a last resort as are the antipsychotics.
When someone has Alzheimer’s disease, nerve cells and vital chemicals in the brain are lost over time. This occurs in parts of the brain that are vital to memory and other mental processes. Let’s look at several of the most common medications approved by the FDA for treatment of the symptoms associated with Alzheimer’s disease. These medications work in specific ways to boost memory or slow down the progression of Alzheimer’s.
Acetylcholinesterace inhibitors, including Aricept, Exelon, and Razadyne/ER, reduce the destruction of acetylcholine after it’s been excreted, thereby leaving it around for longer periods of time. The rationale behind the use of acetylcholinesterase inhibitors is that it has been noticed in Alzheimer’s disease that there was a decrease in acetylcholine at the receptor site. Therefore, anything that would increase the amount of acetylcholine would improve memory.
While acetylcholinesterase inhibitors may temporarily improve the patient’s symptoms, these medications do absolutely nothing to rectify the disease process. While definitely not a cure, there’s some inclination that acetylcholinesterase inhibitors may delay the disease process.
How It Works: Aricept is a cholinesterase inhibitor that stops the breakdown of acetylcholine, a chemical in the brain used for memory and other mental functions. In Alzheimer’s disease, there is a deficiency in acetlycholine in some areas of the brain, which accounts for some symptoms of the disease. Cholinesterase inhibitors also help increase the levels of acetylcholine in the brain. By increasing the amount of acetylcholine, it’s thought that communication between cells should improve and thus increase memory.
The problem is that Alzheimer’s causes a loss of the communication wires and neuron cells. Adding more transmitters (acetylcholine) will only provide temporary help. It does not fix the problem.
Possible Side Effects: Aricept has the least side effects of all the anticholinergic drugs. About 5 to 10 percent of patients may have mild side effects such as nausea, vomiting, and diarrhea. Some patients experience weight loss and insomnia.
How It Works: Exelon is thought to maximally decrease the progression of Alzheimer’s disease, by blocking acetylcholine and butyrocholinesterase. Of all the medications for Alzheimer’s disease so far, Exelon seems to be the only one that works in this way. This medication also affects butyrocholine, which is another type of cholinergic transmitter in the brain.
Possible Side Effects: With Exelon, side effects might include muscarinic effects such as sweating, diarrhea, and nausea. Other less common side effects include seizures and arrhythmias.
How It Works: Razadyne blocks acetylcholine but not butryocholinesterase. Razadyne also binds to nicotine receptors, which increases neurotransmitters for brain activity. Razadyne may also block cell death in Alzheimer’s disease, which might slow the progression of Alzheimer’s more than Exelon. However, no recent study has shown that any of these combinations actually reduce a patient from going to a nursing home by even a single day.
Possible Side Effects: Side effects with Razadyne include upset stomach, vomiting, diarrhea, and urinary tract infections (UTI). Other problems include arrhythmias and seizures.
Memantine HCL (Namenda)
How It Works: Namenda is approved by the FDA for treating moderate and severe Alzheimer’s disease. Namenda works by blocking n-methyl D-aspartate (NMDA) receptors to reduce the entry of calcium into the neurons, which may protect it from damage. The NMDA receptor binds the neurotransmitter glutamate, thus increasing its charge and making it more widely to transmit its message to the next neuron. Namenda may also block programmed cell death. I have seen Namenda improve speech, learning, and recent memory in Alzheimer’s patients, and I highly recommend this one.
Possible Side Effects: Some side effects associated with Namenda include dizziness, headache, confusion, Stevens-Johnson syndrome (a life-threatening allergic reaction) and seizures.
Depression is seen in over 70 percent of Alzheimer’s patients and complicates the disease by interfering with sleep and energy. Antidepressants are commonly prescribed to alleviate the signs and symptoms of depression and, thus, improve the quality of the person’s life in spite of the Alzheimer’s disease.
Antidepressants are effective in the early stages of Alzheimer’s when patients recognize their cognitive loss and the loss of their mental abilities cause stress with consequent increase in cortisol levels that eventually produces a decrease in serotonin, dopamine, and even adrenaline. Patient’s first symptoms include difficulty with sleep, early morning awakening, increased fatigue, severe anxiety, and finally weight loss and anhedonia (a complete loss of pleasure). The patient can get to the point where they are immobile and appear to be severely demented. Severe depression can mask as Alzheimer’s. I have had at least one hundred cases where severe endogenous depression was the primary cause of memory loss. Antidepressants, of which there are tricyclics, SSRIs, SNRIs, are the primary antidepressants used. There’s also another category of antidepressants that contains bupropian (Wellbutrin), trazedone (Desyrel), and duloxetine (Cymbalta).
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Nortriptyline (Pamelor)
The tricyclics were the first generation of antidepressants, including amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor). These are drugs that reuptake serotonin, increasing the amount available for use. Serotonin is the calmative neurotransmitter that also enhances dopamine production (the feel good transmitter). Initially, these drugs were to be used as antihistamines for allergies until it was found that people who took the tricyclics received a great antidepressant effect. Their sleeping habits improved, their energy levels increased, as did their appetite. Today, the tricyclics are used as both antidepressants and pain relieving modulators. In particular, amitriptyline is used for general neuropathic pain, migraines, arthralgias, and myalgias.
Selective Serotonin Reuptake Inhibitors (SSRIs)
In the mid to late 1980s, the second generation of antidepressants, the selective serotonin reuptake inhibitors or SSRIs was formulated. These started with Prozac and then moved to sertraline (Zoloft), paroxetine (Paxil), and fluvoxamine maleate (Luvox). Other antidepressants with different mechanisms of action from the SSRIs were also developed during that same time, including bupropion (Wellbutrin), venlafaxine (Effexor), and mirtazapine (Remeron).
Antidepressants launched in the 1990s have completely different biochemical effects from the drugs of the past. This is important because we have made progress in diagnosing new subtypes of depression and have also arrived at new genetic findings, leading to the new field of pharmacogenetics where a given drug’s metabolism and clinical effects may be genetically determined. Most of the new antidepressants, such as SSRIs, can be used with no dietary restrictions. They are safe even for cardiovascular patients, including those with cardiac arrhyth-mias and blood pressure changes.
I believe that the selective serotonin reupdate inhibitors (SSRIs) may decrease the chance of Alzheimer’s as they elevate serotonin levels in the brain while also suppressing dopaminergic pathways. Many patients who take antidepressants report more refreshing sleep and clarity of mind. Because they feel relaxed, in control, and rested, they can make healthy lifestyle choices and deal with life’s challenges in a much healthier manner.
Some Commonly Prescribed Antidepressants in Alzheimer’s Disease
|Generic Name||Brand Name||Common Usage|
Neuroleptics, such as Haloperidol (Haldol)
In Alzheimer’s patients, the neuroleptics are given to control serious psychological behavior as combativeness, illusions, hallucinations and delusions. Ideas of reference, such as when a patient believes that someone is out to get them, are also treated with neuroleptics.
How They Work: Haldol is a commonly used neuroleptic. Haldol is considered to be particularly effective in the management of hyperactivity, agitation, and mania and is used to treat acute and chronic psychosis, including schizophrenia and manic states. Haldol is also used in the management of aggressive and agitated behavior.
Possible Side Effects: Haldol can cause insomnia, headaches, cerebral seizures, and tardive dyskinesia or involuntary movements of the lips, tongue, face, trunk and extremities.
Atypical Neuroleptics such as Quetiapine (Seroquel)
How They Work: The atypical neuroleptics are prescribed for psychosis, severe anxiety, and wandering, While Seroquel is not indicated for the treatment of dementia-related psychosis, it is used at low doses to offset behavioral/psychosis problems with Alzheimer’s.
Possible Side Effects: Side effects of Seroquel include headache, somnolence, hypertriglyceridemia (high levels of triglycerides), severe hypotension, tardive dykenesia, neuroleptic malignant syndrome (NMS), a life-threatening, neurological disorder often caused by an adverse reaction to a neuroleptic or antipsychotic medication. (This is rare at low doses).
Other Medications Used with Alzheimer’s Disease
How It Works: Olanzapine is a selective monoaminergic antagonist that’s normally prescribed for schizophrenia, or manic episodes of bipolar disorder. It helps in controlling symptoms such as hallucinations and delusions, as well as social withdrawal and apathy.
Possible Side Effects: Some possible side effects of Zyprexa include dizziness, daytime sleepiness, weight gain, neuroleptic malignant syndrome, diabetes mellitus, and extrapyramidal symptoms such as tremors, rigidity, drooping, rolling eyes, and a masked- like expression.
- Alprazolam (Xanax)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
- Temazepam (Restroil)
- Triazolam (Halcion)
How They Work: The benzodiazepines belong to a group of medications called central nervous system (CNS) depressants. These medications act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders. These drugs are all habit-forming or addictive.
With Alzheimer’s disease, I avoid the use of benzodiazepines to ameliorate symptoms, even anxiety and agitation. I advise this for the following reasons:
- Patients can develop a tolerance to daily use of benzodiazepines within a month.
- Patients become addicted so when the drug is withdrawn, they will have increased agitation.
- Increased doses of benzodiazepines are required to have the same effect. With an increased dosage, the patient may have increased confusion and a deterioration of both recent and past memory. Functional MRIs have shown that the use of benzodiazepines show an overall decrease in brain activity.
Possible Side Effects: Side effects of benzodiazepines may include memory impairment, psychomotor retardation, toxicity, depression and emotional blunting. These drugs may also give rise to physiologic and physiologic dependence.
Medications Used to Treat Insomnia
Initially, I may prescribe eszopicione (Lunesta), zaleplon (Sonata), zolpidem (Ambien), or ramelteon (Rozerem) for minor sleep disturbance. If these don’t work, I often recommend an antidepressant such as sinequan, trazadone, and amitriptyline. Amitriptyline, due to its arrhythmic effects, is not advised in patients with coronary artery disease or over 60 years of age.
Medications to induce sleep should be monitored and discontinued when feasible. Unfortunately, in many nursing homes that I attend, the patients with dementias such as Alzheimer’s often take many sedatives, antidepressants, and antipsychotic medications-without one doctor reviewing this list. As an example, one elderly man was on 17 medications because of his wandering, aggressiveness, and psychotic behaviors. The medications had accumulated in his system, causing liver failure and death. Make sure one doctor sees all the medications you take to avoid serious complications or toxicity.
Sleep Medicines That are Purported to be Non-Habit Forming
|Generic Name||Brand Name|
|mirtazapine||Remeron (atypical antipsychotic)|
|quetiapine fumarate||Serequel (atypical antipsychotic)|
Future Treatment: What’s in the Pipeline for Alzheimer’s Disease
The studies are ongoing in a desperate search for the Alzheimer’s cure. Some studies are focusing strictly on the hope of an Alzheimer’s vaccine, an immunization that can finally rid us of this horrific disease. Others are looking at nerve growth factors, monoclonal antibodies, and stem cells-hoping for a modern miracle. Still others are focusing on the beta amyloid hypothesis, as some believe that by blocking the generation of beta amyloid in the brain or enhancing the clearance of beta amyloid, they can successfully treat those with Alzheimer’s disease. Let’s look at some of the more promising theories in the search for an Alzheimer’s cure.
In 1999, it was announced to the medical community that injecting beta-amyloid into mice genetically predisposed to form amyloid plaque, and Alzheimer’s disease, actually prevented the amyloid from being produced. In the young mice that were injected, no plaque was found after their maturation. However, in the older mice that already had plaque formed, no change was noted. The conclusion of this study? The young mice produced antibodies against beta-amyloid thereby preventing the disease. In the human trials, this study has been abandoned because of the death of six human participants from encephalitis.
The concept of growth factor is simple, logical and obvious. We know that growth factors influence stem cells. These growth factors are like sentinels, watching their territory of the brain and making certain it works in harmony with the rest of the cells. While growth factors can influence all the cells in their domain, scientists are still determining how to manufacture growth factor, similar to the way we manufacture insulin to treat diabetes.
Monoclonal Antibody Treatment
Elan Pharmaceuticals is now approaching the treatment of Alzheimer’s focusing on the beta-amyloid hypothesis. It is believed that by blocking the generation of beta-amyloid or enhancing the clearance, it will result in the successful treatment of Alzheimer’s patients, again a logical hypothesis. Beta-amyloid is involved in the formation of plaque that causes difficulty in thinking and learning. The fundamental idea is that the clearance of beta-amyloid may lead to improved function in Alzheimer’s patients. Beta-amyloid, also known as ABETA, is actually a small part of a larger protein called amyloid precursor protein or APP. Beta-amyloid is formed when certain enzymes called secretases cleave the APP.
Beta-amyloid immunotherapy treats amyloid disease by enhancing the body’s immune response. Active immunization much like that in the polio vaccine stimulates the body’s own immune system to produce anti-beta-amyloid antibodies that may attach to the beta-amyloid and clear it from the brain.
So far, this treatment has reduced tau protein, which is a known marker that’s elevated in the CSF. Also, brain volume was lowered in anti-beta-amyloid responders as measured by MRI. It has not yet proven to be effective in humans.
Secretase Inhibitor Research
Beta-secretase is believed to initiate the first step in beta-amyloid formation, the precursor to plaque development in the brain. Gamma-secretase is a multi-protein complex thought to play a significant role in the formation of beta-amyloid. Gamma-secretase inhibitors appear to reduce beta-amyloid levels in the brain.
Recent results have shown the trials in humans have failed to reduce the rate of Alzheimer’s disease in men and women who participated in the studies. There is no medical treatment in the near future and anyone who says otherwise is giving false hope.
The most recently purported miracle cure for Alzheimer’s disease (and many other nervous system diseases) is said to be the “stem cell”. Stem cells are immature cells that could be matured into brain cells. One way stem cells could be used is to replace dead brain cells such as those cells that are lost because of Alzheimer’s disease. Indeed, some stem cells have been used to cure diseases of the blood for more than thirty years, so this is an exciting concept. And although this is possible in theory, if a person has lost his memories because of Alzheimer’s disease, and we use stem cells to give him or her back the capacity to remember, that person will not regain those old memories and will be a different person from then on.
Prevention is the Only Reasonable Alternative
This is the reason that prevention of Alzheimer’s disease is so extremely important – we cannot regain memories; they are forever erased from our brains once Alzheimer’s disease takes hold in the brain.
I am a firm proponent of using stem cells to treat the appropriate types of diseases. The medical community has been using them to cure blood diseases such as leukemia for decades. Before that, the diagnosis of leukemia was a diagnosis of death. So we have come an astonishing distance – because of stem cells. But even after thirty or more years of actual clinical application of this type of stem cell therapy (and after all the basic science and animal experiments that preceded this), we can still only treat about 70 percent of the patients and much of the time severe rejection problems occur. We still have a long way to go with the one form of stem cell therapy that we are already using. It’s going to be a long time before new therapies, particularly those for the brain, come into widespread clinical practice.
Prepare Now for Your Future
Consider the following sage advice with the FIVE method:
F – Have a strong social and spiritual network that includes Family, Friends, and Faith. A recent study by AARP notes 94 percent of baby boomers believe there is a God yet statistics show only 33 percent actively practice this belief in a faith community; 30 percent have no nearby family or close friends.
I – Insurance-Take care of your future financial needs with elder care Insurance.
V -Vest in a retirement community that has step-down care. Baby boomers are searching for retirement homes in remote areas in the mountains, valleys, and the far west, even in foreign countries. Many of these foreign countries do not have the money or the inclination to treat people over age 60 especially if they’re foreigners.
E -Evaluate who will be on your health care team if and when you do have Alzheimer’s disease. Prepare a team including a physician in geriatric care young enough to be around where you will need this healthcare expert. Have a hospital with a good reputation that is within 30 minutes of where you live. Be certain that there is a rehabilitation unit that takes your insurance so you are not relegated to a nursing home.
And The Greatest of These is Hope
Though science has made significant gains in the struggle with Alzheimer’s, there’s still no sure-cure for this disease. However, medical studies have clearly indicated that there is hope through prevention. We must all remember that the greatest resource that God has given us is our body, mind, and soul. Through the 4 step D.E.A.R. program I explain how to maximize brain health and, more importantly, how to maintain your motivation through balancing your hormonal symphony, putting you in concert with the natural means at your disposal to mitigate the aging process and mental deterioration.
Longevity with continued independence is completely possible today. All it takes is a decision to act right now. A cure for Alzheimer’s disease may come tomorrow or next year. However, prevention must start today.