Q: My mother was diagnosed with moderately severe Alzheimer’s disease. She forgets entire conversations and repeats the same questions over and over.
She loses things, forgets to go to appointments and to pay bills. She recently took a walk and couldn’t find her way home. She seems depressed.
How can Alzheimer’s be treated?
A: This is a difficult question because the incidence of Alzheimer’s disease is on the rise, and there is no cure.
There are lifestyle modifications and medications that may reduce the rate of physical, cognitive and functional decline to some extent.
First of all, there is more than one kind of dementia.
Alzheimer’s disease is the most common kind, followed by vascular dementia (multiple “mini-strokes”), a combination of these two, then dementia from Parkinson’s disease.
There are other less common forms of dementia, and some are treated differently than others.
The following treatments refer to Alzheimer’s disease.
Alzheimer’s disease causes progressive brain cell degeneration with an associated decline in mental, physical, social, and functional abilities.
The aim of treatment is to slow the rate of decline, and to retain the ability to function independently for as long as possible.
Some patients can have mild cognitive impairment for years without developing Alzheimer’s. Others develop full blown Alzheimer’s, declining rapidly and becoming debilitated. The rate of decline and severity is variable.
The severity of dementia ranges from mild to severe, and is determined by taking a medical history and doing standardized testing. Testing includes evaluating memory as well as inquiries about the ability to use a phone, pay bills, shop, prepare meals, take medications correctly, or even everyday tasks like bathing and dressing.
Treatment varies depending on severity.
There are medications that may modestly slow the rate of decline temporarily. Results vary from patient to patient.
There are two classes of prescription medications, the cholinesterase inhibitors (for mild to moderate dementia) or memantine (for moderate to severe dementia). A combination of the two classes may be used for moderate to severe dementia.
Cholinesterase inhibitors include Aricept, Razadyne, and Exelon, all of which have been shown to produce (minor) clinical improvements. Memantine (Namenda) shows some (minor) benefits with moderate to severe dementia.
A combination of both classes of drugs may be used in the moderate to severe group. Taking Vitamin E 2000iu per day also demonstrates some decrease in the rate of deterioration, whether taken alone or to enhance the prescription medications.
If your mother has clinical depression, her cognitive symptoms may improve with treatment of her depression.
It may be necessary to control agitation also when dementia progresses. It’s important to keep blood pressure, blood sugar, cholesterol and chronic medical problems under control for best results. Studies have not shown Omega-3 fatty acids, aspirin, gingko biloba or statins to reduce the rate of decline in Alzheimer’s.
On the bright side, exercise has been shown to reduce physical and functional decline and reduce the risk of depression in Alzheimer’s patients.
Exercise programs should be prescribed as tolerated for Alzheimer’s patients at any stage.
Leisure activities, particularly ones that are mentally stimulating, also improve quality of life, decrease depression, and help slow memory loss.
Many Alzheimer’s patients can read, dance, do crafts, enjoy listening to music or sing songs.
Their remote memory remains intact longer than recent memory, and reminiscing and telling stories about the past is good for their well being.
Ask your doctor about any medications she may be taking that can cause worsening of memory and other symptoms of dementia.