Alzheimer's Disease - Treatment
There is currently no cure and virtually no medical treatment for Alzheimer's disease. Steps can be taken, however, to make an AD patient more comfortable and to protect him or her from potential dangers posed by the disease. Both physical and emotional support can be provided for the patients who are able to do less and less for themselves.
Caregivers also need assistance. Looking after a person with AD can be discouraging and exhausting. The caregiver needs support to prevent anger, despair, and burnout. Provisions also need to be made for the financial and legal problems that arise as an AD patient is less able to think and plan clearly.
Drugs
The two drugs currently approved for use with AD patients are tacrine (pronounced tak-REEN, trade name Cognex) and donepezil (pronounced do-NEP-uh-zil) hydrochloride (trade name Aricept). Both are neurotransmitters, which increase the ability of brain cells to communicate with each other. In this way, they provide some help in improving a person's ability to think and to perform normal daily activities.
Tacrine has limited effects on patients in the early stages of AD. While it may delay their admission to a nursing homes by a few months, it is quite expensive and has side effects such as nausea, vomiting, diarrhea, stomach pain, indigestion, and skin rash. Donepezil has two advantages over tacrine: it has fewer side effects and has to be taken only once a day rather than three times a day.
Doctors sometimes prescribe other drugs for AD patients. Several preliminary studies have been made on older women who take the hormone estrogen, which is used to prevent osteoporosis (pronounced OSS-tee-o-puh-ROS-sis; see osteoporosis entry), or weakening of the bones. These studies show that women who take estrogen have lower rates of AD, and that those who do develop AD have slower disease progression and less severe symptoms.
Other early studies show promise in delaying the onset and even the risk of developing AD. The regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of developing AD. Two antioxidants, selegiline and vitamin E, are also thought to delay the onset (beginning) of AD in some people.
Care and Safety of Individuals with Alzheimer's
As the course of AD develops, individuals require more and more care. At first, the problems are relatively simple. Perhaps they lose the ability to select appropriate clothing or comb their hair. Gradually, however, they may not be able to eat, wash, or otherwise take care of themselves.
Ensuring that people with AD eat properly is one problem. Sometimes they may simply not feel hungry or forget how to prepare foods for themselves. In advanced stages of the disease, they may have difficulty in swallowing, which means they ultimately will require the use of a feeding tube.
Eventually, many people with AD become incontinent, that is, they lose control of their bowels and bladder. Problems with incontinence are among the most difficult for family members to deal with, often convincing the family to have the AD patient moved to a nursing home where regular, professional care is available.
If a person with AD remains in the home, they should be provided with a calm, non-threatening environment. Regular exercise is also important. Professional help may be necessary to deal with emotional problems, such as anxiety, depression, and hallucinations.
AD patients must also be protected from a variety of physical hazards. They usually can no longer take long walks by themselves or drive a car. Safety devices such as grab bars in the bathroom, bed rails on the bed, and wider door openings may be needed. Electrical appliances may have to be unplugged when not in use, and the hot water heater thermostat adjusted to prevent the individual from being burned.
Care for the Caregiver
Family members and others who care for a person with AD have a difficult and stressful job that becomes even harder over time. It is not unusual for caregivers to develop feelings of anger, resentment, guilt, and hopelessness. Depression is a common problem among caregivers.
For many caregivers, the most helpful way of dealing with these feelings is a support group. Support groups consist of other AD caregivers and professional counselors. Caregivers have an opportunity to discuss their thoughts and feelings with others in the same situation. Contact numbers of AD support groups can be obtained from the Alzheimer's Association and from local social service agencies, the patient's physician, or drug companies that supply medications used to treat AD.
Outside Help, Nursing Homes, and Government Assistance
The problems of caring for an AD patient often become too much for family members. In such cases, a variety of outside care is usually available. For example, some local community agencies will bring a hot meal to the patient's home each day. Some adult day-care businesses exist where the patient can spend the day under professional supervision.
Eventually, temporary outside help may not be enough. In such cases, the family may decide to move the patient to a nursing home. This decision is usually extremely hard for both the patient and the family. It can also be very expensive. In addition, the most suitable home for the patient may be located at some distance from the family home, making regular visits difficult.
Several federal governmental programs can help with the cost of care for an AD patient. These include Social Security Disability, Medicare, and Supplemental Security income. These programs do not pay for long-term nursing home stays, but they may help with the cost of care, medication, and other expenses. Information about these programs can be obtained from local Social Security and Medicare offices.
Nursing home care can also be paid for through a variety of private insurance programs. In general, these programs tend to be expensive and are not available to many people with limited incomes.
Alternative Treatment
Ginkgo extract has been suggested as a possible treatment for AD patients. Some people think the herb may help relieve the symptoms of dementia. A natural product called acetylcarnitine (pronounced uh-setl-KAR-nuh-teen) has also been proposed as a method for improving the function of brain cells. At present, there is little scientific evidence for the effectiveness of either product. Other nutritional supplements, such as vitamin B 12 , and folic acid have been recommended for the maintenance of good mental health.
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