7.30.2016 Mary Yamin-Garone, More About Treating Alzheimer’s Symptons
Good afternoon. Welcome to Demystifying Alzheimer’s. I’m your hostess Mary Yamin-Garone.
In Monday’s podcast, I talked about treating Alzheimer’s symptoms. I’ll talk more about that today.
Depression and anxiety are extremely common among Alzheimer’s sufferers and doctors frequently prescribe medication to treat the symptoms of those conditions. Research shows, however, that drug therapy for psychological problems usually works best when combined with nondrug treatments, like counseling, stress reduction and behavior modifications.
Most anti-depressants currently prescribed are tricyclic antidepressants or selective serotonin reuptake inhibitors, known as SSRIs.
First prescribed in the 1950s, tricyclics were the preferred pharmacological approach to treating depression for many years. While the drugs are still considered effective, tricyclics may take weeks to show their effects and can cause irritating side effects, such as weight gain, dry mouth, irregular heartbeat and, in some individuals, impaired vision.
Most physicians today prefer SSRIs, a newer generation of drugs designed to increase serotonin levels—a neurotransmitter that influences mood, emotion, appetite and sleep—in the brain. SSRIs, believed to be generally safe and effective in treating depression in older adults and Alzheimer’s sufferers, seem to cause relatively few side effects in most people. They can, however, increase anxiety and agitation in those already suffering from those symptoms.
Medications frequently prescribed for Alzheimer’s patients suffering from depression, apathy and irritability include:
- Zoloft and
If anxiety interferes with your loved one’s overall ability to function (for example, nervousness discourages them from leaving the house), their doctor might prescribe one from among a family of drugs known as benzodiazpines. Ativan, Serax, Buspar and Ambien are the most popular.
Benzodiazepines are considered effective sedatives and can help combat agitation and sleeplessness, which are common complaints among Alzheimer’s sufferers. They are, however, addicting and their effectiveness tends to decrease the longer a person takes them. Experts advise using them with caution for short intervals.
Many doctors are reluctant to prescribe sleep aids for older adults with Alzheimer’s because they’re particularly susceptible to the serious side effects those medications can cause, like agitation and problems with balance and incontinence. They also urge Alzheimer’s patients to avoid over-the-counter sleep remedies. The active ingredient in many of them, the antihistamine diphenhydramine (Benadryl), is particularly problematic for those with AD because it can slow down brain cell messenger chemicals that are already impeded by Alzheimer’s.
Effective treatment of one symptom sometimes helps relieve others. Anti-anxiety medications and some antidepressants make some people sleepy and might be helpful in treating insomnia patients.
Treating Behavioral Problems
Antipsychotic medications are used to quell some of the more disruptive and disturbing symptoms of mid- to late-stage Alzheimer’s. They include hallucinations, delusions, aggression, agitation, hostility and uncooperativeness.
The drugs are extremely potent and are associated with serious side effects, such as weight gains of thirty pounds or more in many individuals. The Alzheimer’s Association warns that they should be used with extreme caution in people with dementia who are susceptible to serious side effects, including stroke and an increased risk of death from antipsychotic medications.
No drug is FDA-approved to treat behavioral and psychiatric Alzheimer’s symptoms. Those used most often—Abilify, Clozaril, Haldol, Zeprexa, Seroquel, Risperdal and Geodon—are prescribed for symptoms other than those for which they were tested and approved.
If you and your doctor are considering using antipsychotic drugs to treat your loved one’s AD symptoms, you should ask these questions.
- What problems does this drug treat and how effective is it?
- What improvements might we expect?
- How will it interact—or interfere—with treatments for other conditions?
- What are the most common side effects? Which ones should we be on the lookout for?
- How long will it take for the drug to show benefits?
- How is the drug’s effectiveness evaluated?
- How will you evaluate whether and when to stop using it?
A comprehensive study published in 2006 showed that these medications may be less effective than previously thought for treating Alzheimer’s symptoms. That year, the FDA issued a blackbox warning about a slight—but statistically significant—increased risk in individuals with dementia who are taking antipsychotic medications. An FDA review of 17 studies of off-label use of these drugs in treating Alzheimer’s suggests that while certain antipsychotics are useful in reducing aggression and/or psychosis, they shouldn’t be used routinely with Alzheimer’s sufferers unless they’re in severe distress and won’t respond to other treatments.
Many AD sufferers are older and may take several medications at once. Here are some suggestions, adapted from the Mayo Clinic, to help keep track of your loved one’s daily medication needs.
- Write and regularly update a list of medications, dosages and the time of day all vitamins and pills should be taken. Post it inside a kitchen cabinet door.
- Make a list of common side effects and other information about all medications.
- Use a weekly pillbox to sort medications and keep track of whether they’ve been taken.
- Use alarms and reminders, such as phone calls, to help keep your loved one on schedule.
- Post their doctor’s emergency phone number and the number of the local poison control center near all phones in case of an accidental overdose.
It’s also helpful to keep the following precautions in mind when considering prescription medications.
- Be sure medications are taken under a physician’s care who is experienced in treating and monitoring patients taking AD drugs.
- Understand the specific symptoms the medication is prescribed to treat, such as confusion or memory problems.
- Ask why your doctor prescribed a particular drug rather than another.
- Ask how effective they expect the medication will be in treating symptoms and how they’ll measure its effectiveness.
- Make the doctor aware of all prescription medications, herbal supplements or over-the-counter medications your loved one is taking. Some over-the-counter allergy medications, like Benadryl, and herbal supplements, like St. John’s Wort, may interfere with Alzheimer’s medications.
- Begin with the lowest effective dose of any drug and increase it gradually, if needed.
- Don’t stop giving your loved one the drugs if you don’t see a noticeable improvement in their symptoms.
- Call your doctor immediately if the medication causes severe side effects. Continuing the medication could cause serious health issues.
According to Consumer Reports, the price of most Alzheimer’s drugs is between $148 and $195 per month. Fortunately, your loved one may be eligible to get help paying for the medications their doctor recommends.
Your doctor or research center may give you free samples of drugs they take and nearly all pharmaceutical manufacturers have patient-assistance programs that provide or point you to sources of free or low-cost medications.
You may want to begin by visiting the BenefitsCh eckup website. This service of the National Council on Aging can help you determine which drug programs your loved one may be eligible for and provide information on the enrollment process.
All Medicare beneficiaries are eligible for prescription drug coverage. For details about drug benefit for those with Alzheimer’s, visit the Medicare Prescription Drug Plan finder on the agency’s website.
Partnership for Prescription Awareness is a one-stop online information source that offers a single point of access to more than 475 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. Call 888-477-2669 to see which programs your loved one may be eligible for.
That’s all for today. Thanks for listening. I hope this information was helpful.
Join me next time for more about Demystifying Alzheimer’s.