Oct 21, 2008 7:00 AM CST

ALZHEIMER’S MEDICATIONS

BY LEONARD HOCK, MD– MEDICAL DIRECTOR COVENANT HOSPICE

Alzheimer’s is the cruel thief. It steals away memories—first of all short term memories then memories from further and further in the past. It steals away the hopes and plans of senior citizens during what should be their golden years. It can steal away finances because of the expense for the care required. That expense isn’t just for the patient or their family, it’s an expense for the whole country. With more and more patients diagnosed with Alzheimer’s disease, very nearly five million Alzheimer’s patients are now in this country, the expense for health care, nursing home care, physicians care, home care is increasing every month. There is also the expense for medications for Alzheimer’s disease. How about these medications? Do they cure the disease and reverse Alzheimer’s? Do they improve the memory, the social skills, and the quality of life for Alzheimer’s patients?

Alzheimer’s is a complex disease and physicians and researchers are not even sure about the variable causes of Alzheimer’s. We know that some people are at greater risk of developing Alzheimer’s than others—people who have had head trauma or serious injuries, people who smoke, and even though Alzheimer’s is not considered to be a hereditary disease we know that it does seem to cluster in some families, but we don’t know why. Patients with Alzheimer’s have common symptoms---memory loss, difficulty with language and judgment. Sometimes they have behavior problems. Finally as the disease progresses they have physical problems. They become very debilitated with no appetite, often no control over their bowels and bladders in the advanced stages. There are also medical similarities. We know that the brains of Alzheimer’s patients often shrink. The circulation is frequently diminished. The nerves in the brain become tangled and many times there is gummy protein substance that seems to cause the nerves to function improperly or not at all. Researchers understand that chemicals in the brain, like choline and acetolcholine and glutamine seem to affect Alzheimer’s disease.

There have been many attempts and great hopes placed on the medication treatment of Alzheimer’s. Vitamins have been given, sometimes in mega doses. Female hormones—estrogen has been administered. Non-steroidal anti-inflammatories like arthritis medications have been given. None of these have shown significant, scientifically researched improvement in Alzheimer’s disease. The first specific memory drug used in Alzheimer’s was Cognex. Unfortunately, after years of use no great benefit was seen with this medication.

Now days several specific Alzheimer’s medications are available. Aricept, Exelon, Razadyne, and Namenda are all being prescribed every day. But none of them are a cure. Listen to the advertisements on television about Alzheimer’s medications. None of them use the word cure. In a couple of research studies, combinations of medications have shown very slight and temporary improvement in cognition. That does not mean a reversal of memory loss or a great improvement that an ordinary person would even notice. The Alzheimer’s medications are intended and used by physicians to slow the progression of the disease. When doctors are able to diagnose Alzheimer’s disease very early these medications can allow the patient to enjoy more quality time at home with their family holding on to whatever memories or thought processes they have had left. At least holding on to them a bit longer. Eventually, though, all Alzheimer’s will progress with medications or without. In fact, while some patients may benefit by having significant slowing of the progression of their disease with medications, others may not. There really is no way to predict which patient will benefit and which patient will not. When we look at all patients with Alzheimer’s disease on these specific medicines there is very little evidence that their life was prolonged. So the medicines aren’t used to cure the disease or even reverse it. They are not used to make Alzheimer’s patients live longer. The medicines are used to slow the progression of the disease so that for a while a patient and their family can preserve or hold onto a quality of life.

This brings up many questions for doctors, patients, and families about the use of Alzheimer’s medications. Should these medicines be prescribed for every Alzheimer’s patient? When is the best time to start these medications? Is there a time as the disease progresses when these medications should be stopped? How can we tell if the medication is really helping?

Most experts in this area would say not every Alzheimer’s patient should be started on medications. Patients who have the diagnosis and enjoy a comfortable quality of life may have the disease slowed a bit with these medications so they would be good candidates to benefit for the medications for a period of time. But probably not in the very later stages of their life. Patients with very advanced Alzheimer’s and those who are not enjoying a high quality of life—they can’t recognize their family, their friends, their surroundings, they seem uncomfortable, sad, or even non-communicating—they would probably not benefit from these medications. Just as every individual is unique and different, every individual with Alzheimer’s is also unique and the disease process is not exactly the same in all Alzheimer’s patients. That’s why if someone you love has Alzheimer’s you need to discuss the disease, it’s progression, and medications with the doctor.