I recently read that there is a new drug called angiotensin receptor blocker (ARB) that fights Alzheimer's disease. Please tell me more about this drug. Is it available in prescription form? [ 07/14/11 ]
Angiotensin receptor blockers (ARBs) have been in common use for the treatment of hypertension for some years. The most familiar of these are losartan (Cozaar), irbesartan (Avapro), olmesartan (Benicar), candesartan (Atacand), valsartan (Diovan), and telmisartan (Micardis). They all are thought to work by blocking the activation of angiotensin II AT1 receptors, which results in vasodilation, reduced vasopressin secretion, reduced production and secretion of aldosterone, and other effects. Some studies, but not all, have found decreased rates for development and progression of Alzheimer's disease in people taking ARBs for high blood pressure. Its effect on Alzheimer's prevention or delay might be independent of its effect on blood pressure, since its use has also been shown to lower beta amyloid, among other effects.
Why is it better to give Alzheimer’s disease patients medications to delay the disease? [ 07/05/11 ]
Now that we recognize Alzheimer's disease to include a prolonged pre-symptomatic phase during which a destructive disease process is progressing silently, it's very clear that we should attempt to delay the course of the disease during the early stages and prolong the experience of a healthy life. In the late stages of Alzheimer's disease, however, the question of whether to delay progression becomes a profound and complex consideration. In advanced dementia, designated health care representatives are called upon to interpret and implement the presumed wishes of an affected person who may no longer be living what many of us would consider a life of acceptable quality. In my clinical practice, however, I have frequently known mildly, moderately, and even some severely demented adults to enjoy a seemingly good quality of life, highly dependent upon others for basic everyday functions but capable of mutually rewarding social interactions and pleasure. The decision to prolong life despite significant and likely progressive medical compromise is a complicated process that should be anticipated by each of us and, if possible, made clear in advance to those who will be designated as future health care representatives and tasked with making difficult decisions on behalf of us when we are unable.
How safe is aspartame? Can it cause memory loss, brain poisoning, or Alzheimer’s disease? [ 07/05/11 ]
The use of aspartame is a topic of great controversy, with strong proponents of its benefits as a low-calorie sweetener bumping heads with nutrition-oriented critics concerned about potential toxic metabolites and other alleged toxic effects. Although a link between aspartame use and memory loss, brain poisoning, or Alzheimer's disease has been suggested by some, at this point there is no convincing evidence that moderate and appropriate use is linked with these adverse outcomes.
During the last few weeks, an 85-year-old Alzheimer’s patient has been opening and closing a case that contains her deceased husband's jewelry and a box of her rings. She does this for hours. One night, she repeated this behavior for five hours. I unplugged the light by the nightstand where she keeps the jewelry, but she now uses another light. I've tried keeping her up during the day, but it doesn't work. Do you have any suggestions? [ 06/27/11 ]
A repetitive behavior such as this may reflect a variety of causes, and it's tough to figure out which are most relevant without a more detailed analysis. I wonder if this repetitive behavior reflects feelings about her husband's absence. Also, have you've tried to sit down with her and reminisce about her late husband by looking at pictures and sharing fond recollections? Perhaps that would be a way of giving her some relief from the need to interact in this way with his possessions. Other possible explanations for her behavior might include anxiety (her deceased husband's jewelry may provide a comforting effect), a manic reaction (accounting for the sleep disturbance), or just lack of other activities that might occupy her (such as a jigsaw puzzle to work on) if she experiences disrupted sleep and wants to get up during the night.
My mother, who is 89 years old, is suffering from Alzheimer disease. Her doctor prescribed risperidone or haloperidol for her irritability. I did not have these prescriptions filled because of the following FDA warning: Risperidone and haloperidol are not for use in psychotic conditions that are related to dementia. They have caused fatal heart attack and stroke in older adults with dementia-related conditions. Based on this data, what drug can my mother take for her irritability instead of these medications? [ 06/24/11 ]
The antipsychotic medications all carry a warning on their prescribing information for increased risk of various medical complications, including an increased risk for death, yet they continue to be used because there are few alternative drugs from which to choose. The antipsychotics can often be helpful to a limited degree, but patients taking them must be monitored carefully for adverse effects and prescribers should be using the lowest effective dosage for the shortest amount of time needed. Though I can't comment on your mother's specific needs, there are certainly other medications used to treat irritability in Alzheimer's disease patients. Citalopram has been suggested as an alternative, base on some evidence, and other options that are less well evidence-supported include trazodone, divalproex, and gabapentin. Please consult your mother's prescribing clinician for more details on the risks and benefits applicable in her specific case.
My stepfather is 84 years old and has Alzheimer’s disease. He is currently using the Exelon patch. He does not think that it helps, and his doctor just shrugs his shoulder and tells him to do whatever he wants. He has a host of other medical problems, including several aortic aneurisms. Should we stop using the patch? [ 06/23/11 ]
The Exelon patch (rivastigmine transdermal) is helpful in a modest way for symptoms of cognitive impairment and for overall level of functioning, but it's quite difficult to be sure any of the cognitive enhancing medications are “working” when patients continue to get worse. Unfortunately, gradual worsening is a characteristic of Alzheimer's disease and the medicines indicated for treatment do not indefinitely prevent the disease from worsening. Though I can't advise about this decision for your stepfather, consultation with his prescribing clinician may clarify the pros and cons of such a decision.
Does any of the research on Alzheimer’s disease also apply to primary progressive aphasia (PPA)? Would the new oral slow-release medication that has been shown to have a positive effect on mice engineered to show features of Alzheimer’s and Huntington's diseases also help with PPA? I never see specific research on PPA, so I'm always hoping that Alzheimer’s research might also apply to this neurological condition. [ 06/22/11 ]
Primary progressive aphasia is a neurodegenerative disorder characterized by increasing difficulty with finding words. Ultimately there can be a profound disturbance of language function, often accompanied by other cognitive difficulties. There is no cure and there continues to be controversy about PPA's appropriate classification. It is most commonly considered a form of frontotemporal dementia; however, autopsy studies identify a significant number of individuals diagnosed during their lives with PPA who actually had Alzheimer's disease. Typically, PPA is treated with supportive medications to manage anxiety, depression, or insomnia, if these occur, and the central language deficit is addressed with speech therapy. The treatments for Alzheimer's disease might be worth trying in some cases, on the assumption that a subset of people diagnosed with PPA might actually have Alzheimer's disease that has presented in an atypical way. Most cases of PPA, however, are believed to represent a different disease process and therefore might not be responsive to current or experimental Alzheimer's treatments.
Can you please comment on what peer-reviewed studies indicate concerning homocysteine, Alzheimer’s disease, and general brain health? [ 06/01/11 ]
For several decades, there has been interest in whether homocysteine plays a role in various medical disorders, and evidence has been identified to connect elevated homocysteine levels with conditions including coronary artery disease, stroke, silent white matter infarcts, Alzheimer's disease, and possibly Parkinson's disease. A genetic disorder associated with elevated homocysteine levels includes, among other damaging symptoms, a heightened risk for mental retardation. Peer-reviewed, influential findings from the Framingham Study linked elevated homocysteine levels with an increased risk for development of Alzheimer's disease, and subsequent research suggested that homocysteine makes hippocampal neurons more vulnerable to the toxic effects of beta amyloid, which is produced in this neurological disease. Efforts to reduce the symptoms of Alzheimer's disease through dietary supplementation with B12 and folic acid, however, have produced inconsistent results and have not supported initial hopes that dementia symptoms could be reduced by lowering elevated homocysteine levels. Although the information above provides evidence of a connection between homocysteine and a number of medical conditions, there is no conclusive evidence in humans linking diet to incidence of Alzheimer's disease.