What medication options are best for a patient with Alzheimer’s disease who is anxious every day? She tried Lexapro, but it was not effective to deal with the anxiety, and caused suicidal ideation. We don't want her to sleep all of the time, but her husband needs a break and some rest. In the evenings she is unable to enjoy TV or relax, and ‘sundowning’ sometimes lasts all day. She may express an understanding that her bed is right there, but she still begs to "go home to her original city.” Bedtime is difficult to keep at a regular time as she tends to nap in the chair waiting for her time to go to sleep. She did not tolerate Ambien very well, and the effectiveness of Tylenol PM has worn off. She does not even take Aricept or Namenda any longer because they did help with her cognition. We prefer not to overmedicate her, but would like to know if there are anti-anxiety medication options that might help. [ 02/05/11 ]
Treatment of anxiety symptoms in Alzheimer's disease patients can be truly challenging because there are so many different causes of anxiety. Before trying an anti-anxiety medication, it's important to consider some of these causes and how they might be addressed behaviorally. Consider whether she may be in pain from constipation, a urinary tract infection, sores, joint pains, or other sources. Is she bored or feeling under-stimulated?
Even if she's unable to understand and enjoy television she may be able still to get pleasure from taking a little walk, listening to her favorite music, doing a very simple puzzle (for example with 25 pieces or fewer), watching a video tape of loved family members reminiscing, or enjoying a massage of her hands with lavender oil or lemon balm. Scheduling enjoyable activities at the times when she might otherwise tend to nap could improve her ability to sleep at night, though sleep continuity is typically impaired in patients with Alzheimer's disease and both daytime napping and nighttime wakefulness are common.
Concerning medications, many patients discontinue Namenda once it appears to no longer help with cognition, but some evidence supports its benefits in reducing agitation nonetheless. Tylenol PM includes components that may help some individuals increase sedation or even confusion, so its use must be evaluated individually. A geriatric psychiatrist can help you consider the potential value of other anti-anxiety medications such as buspirone, trazodone, an antipsychotic medication, or an anti-seizure medication; however, each of these medication categories has potential side effects that may accompany their possible benefits.
I am 64 years old, and the youngest in a family of eight. I have two sisters diagnosed with Alzheimer’s disease, and would like to know if there is anything I can do to avoid getting this brain disorder? I presently have an active gym program and I’m involved with book keeping. Also, does taking a daily aspirin help decrease the risk of developing this brain disorder? [ 02/03/11 ]
Alzheimer's disease is a complex disorder, for which there is currently no known prevention or cure. Some research has generated hope that one day it might be possible to slow the progression of Alzheimer's disease, delay its symptoms or even prevent it from occurring at all. Although there is preliminary data to support the benefit of some interventions, such as physical activity and cardiovascular risk reduction, nothing at this time has definitively been shown to prevent Alzheimer's disease or other dementias.
At this point, the advice for maintaining healthy physical and cognitive health is essentially the same as the advice given for the promotion of healthy aging in general. You should keep up your gym program, book keeping, and pay attention to diet and other lifestyle factors as well. Studies on the effects of physical exercise indicate that it is beneficial for cognitive as well as physical health. Aerobic exercise is excellent and resistance training also useful. A Mediterranean-type diet that is high in fiber, vegetables, and healthy oils; and low in saturated fats and simple sugars also has been associated with healthier cognitive aging. Other data support the importance of adequate sleep, stress reduction, cognitive stimulation, and maintaining a sense of social connection and purpose.
A daily aspirin, while likely beneficial in prevention of some other disorders, has unfortunately not been shown helpful in preventing Alzheimer's disease.
Is consuming sugar a problem if you have Alzheimer’s? [ 02/02/11 ]
A diet high in carbohydrates with a high glycemic index* is thought by some experts to contribute to the risk for Alzheimer's disease. The arguments for this position include the following considerations:
- Most simply, a high sugar diet may increase the risk of obesity, and obesity is associated with harmful metabolic changes that increase the likelihood of Alzheimer's disease.
- High sugar intake can increase the risk for developing diabetes mellitus, a disease associated with increased risk for Alzheimer's disease.
- Even individuals without diabetes have been shown to develop altered sensitivity to insulin with high sugar intake, and one theory about Alzheimer's disease suggests that resistance to insulin's effects and lower levels of insulin-like growth factors in the brain may contribute to the development of this neurological condition.
Studies on animals have lent further support to the connection between sugar and Alzheimer's disease. Mice bred to be at high risk for brain changes resembling Alzheimer's disease showed memory impairment and higher levels of amyloid beta deposition in their brains when their water was sweetened with 10% sucrose. Evidence in human subjects suggests that a high sugar diet can interfere with cognition as well. Although the possible link between sugar and Alzheimer's disease might someday lead to development of a new treatment, it is already sensible for Alzheimer's disease patients (and truly for the rest of us as well) to monitor sugar intake and limit this to reasonable levels. Diets high in fiber, vegetables, nuts, and beans help regulate blood sugar and support health in a variety of ways. Further research will help to clarify the relationship between a diet high in carbohydrates that have a high glycemic index and Alzheimer's disease risk.
* High glycemic index means that the carbohydrates are broken down rapidly into glucose or blood sugar. They provide quick energy but contain few nutrients and little fiber, and in large amounts they may damage cells.
Is Singulair a safe drug to give someone who has dementia? [ 01/26/11 ]
Singulair is the brand name for montelukast, a leukotriene receptor antagonist used for maintenance treatment of asthma and for relief of seasonal allergy symptoms. By diminishing inflammation, montelukast helps asthma by reducing constriction of the airways. Its side effect profile includes a warning of increased risk for bleeding, and this might increase the risk for gastrointestinal bleeding that is rarely associated with cholinesterase inhibitors, which are used in the treatment of some dementias. Otherwise, montelukast's side effect profile and list of adverse reactions does not appear worrisome with respect to treating dementia patients.
My husband is in the middle stage of Alzheimer’s disease. His doctor has suggested adding lithium to his treatment plan, which currently includes Namenda and Aricept. Is lithium a new treatment for Alzheimer’s disease? [ 01/25/11 ]
Experiments reported in 2002 and 2003 showed that lithium inhibits an enzyme, glycogen synthase kinase. Researchers hypothesized that this action of lithium might reduce accumulation of beta amyloid and also block formation of neurofibrillary tangles by tau protein. Consistent with this hypothesis, experiments in cultured brain cells and in special transgenic mice have demonstrated that lithium reduces amyloid beta production in these experimental models of Alzheimer's Disease. Whether this property of lithium could translate into functional improvement in human victims of Alzheimer's Disease remains uncertain, but a 2007 transgenic mouse study (Caccamo et al. Am J Pathol 2007;170:1669-75) found lithium to reduce tau phosphorylation but not A beta or working memory deficits, and a single blind human study reported byHampel and colleagues in the Journal of Clinical Psychiatry (2009;70:922-31) found no treatment effect of lithium (at target blood levels from 0.5 - 0.8 meq/l during the 10 week trial) on global cognitive performance (measured by ADAS-Cog), depressive symptoms, GSK-3 activity, or CSF biomarker concentrations. At this time, lithium remains an agent of interesting possibilities but unproven human clinical benefit in the treatment of Alzheimer's disease.
Is losing the sense of smell a symptom of Alzheimer’s disease? If so, during which stage of the disease does this symptom occur? [ 01/21/11 ]
For several decades, researchers have recognized that impaired sense of smell is an early characteristic of Alzheimer's disease. The olfactory bulb and tract show degenerative changes early in the course of the illness, so investigators have developed "scratch and sniff" odor recognition tests in hopes of increasing early identification of Alzheimer's disease. These tests look for changes in the detection, identification, discrimination, and memory of odors. Since baseline olfactory measures are rarely available when such a test is administered to someone with a possible illness, it can be difficult to be sure that impaired ability to smell was not present all along. Furthermore, sometimes impaired sense of smell is the result of mechanical problems in the nasal cavity such as polyps or a deviated septum. The false positives (identification of people with impaired sense of smell but who do NOT have Alzheimer's disease) in smell tests have made this approach less popular than some more reliable diagnostic tests.
My mother was diagnosed with vascular dementia 4 years ago. Last September, she was moved from her older nursing home to a newer one that has a dedicated dementia unit, because the original home could not handle her anymore (she kept going outside and was disruptive with other patients). I have noticed a rapid decline since her move to this new nursing home, and I am wondering if this is just the progression of the disease or if the changes are related to her medications. I noticed changes immediately after she was prescribed Depakote, as she no longer made sense when she spoke. She is also on a very small dose of Seroquel. She has lost about 20 pounds in the past year, but she has been maintaining her current weight for about 4 or 5 months now. I would appreciate any information that you give me. [ 01/11/11 ]
The "non-cognitive behavioral symptoms" or NCBS of dementia often create more day to day difficulty than mere memory loss, as your mother's condition illustrates. She may need the attention of a skilled geriatric psychiatrist to sort out which of the many causes of disruptive behavior is most important in her particular case. Just as you point out, her disruptive behavior could reflect the progression of her dementia, the occurrence of a separate medical problem such as a stroke or a urinary tract infection, the development of a separate psychiatric problem such as depression (which is very common in this situation), the move to a new nursing home, the adverse effects of divalproex (Depakote) or quetiapine (Seroquel), or anxiety. With all of these choices, each of which would suggest a different course of action, some careful analysis must go into diagnosing your mother's condition. Her disease may make it impossible for her to rely on memory and new learning to improve her behavior, but a successful dementia unit often can apply behavioral methods to reduce disruptive behavior. If these fail, one or more of the available medications may be helpful. I hope this information will help you work with your mother's nursing home staff and a good consultant to improve her behavior and the quality of life for her and her caregivers.
I live in rural India, and my father was admitted to a hospital for an angioplasty. Subsequently, a blood clot developed, traveled to his brain and then dissolved. After that, he has exhibited classical signs of Alzheimer’s . After lunch, I give him .25 milligrams of alprazolam so that he can sleep, but this often does not help. After dinner, I give him .50 milligrams of the same medication, and this does seem to help him sleep through the night. He often has high levels of anxiety for approximately three hours before dinner and we don’t know how to manage it. The medicines prescribed to him by psychiatrists and neurologists increased his anxiety and prevented him from sleeping. He requires assistance in walking and changing. Should I increase his sedation? We tried giving him 1 milligram of lorazepam at night but it only disoriented him and kept him awake. [ 01/10/11 ]
I am sorry for your father's and your family's misfortune. His behavior may suggest Alzheimer's disease, but the occurrence of these symptoms after angioplasty and a clot to his brain suggests the possibility of vascular dementia as an alternative. Either way, the treatment of his anxiety appears to be the primary concern. Although I cannot give specific advice about the best medications for your father without knowing many more details of his health, I will suggest that you speak with his doctors to find a better approach than the use of alprazolam. This benzodiazepine sedative, like lorazepam, often reduces anxiety but at the same time interferes with aspects of mental functioning such as concentration and memory. Furthermore, a rebound anxiety may occur as one dose wears off and the next has not yet been given. Although behavioral approaches are considered the safest for addressing anxiety and agitation, many clinicians now also use antidepressants such as citalopram, antipsychotics such as quetiapine (though metabolic concerns may limit appropriateness of this choice), or anti-seizure medications to treat the symptoms you are describing.