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Thursday, December 12, 2013
Medication and Alzheimer's Disease
A family member has been extensively evaluated by a neurologist for memory problems, the current diagnosis is dementia, she is 59 years of age. She was on Aricept but was taken off the drug because when the dose was increased she became exretemly confused. Her current medication is 50mg of Zoloft for depression like symptopm. My questions are: Should all/most patients where Alzheimer`s is suspected be on Aricept or some like drug.
Also, she appears like the textbook definition of an early stage Alzheimer`s patient...she has been having memory problems for the last five years....how exactly does a patient move from stage 1 to stage 2, is it more of a gradual transition or are their specific markers to look for and does this transition from stage 1 to 2 happen at defined time periods or does it like all else vary with each individual.
It appears that, on average, most patients with mild or moderate Alzheimer`s disease benefit from drugs like donepezil (Aricept). Agitation can occur as an effect of this kind of treatment, or it may be a coincidence. If the agitation was linked to a dose increase, restarting at the last tolerated dose is often useful. Dose increases should not occur before 3-4 weeks at the earliest because of the risk for side effects with more rapid dose increases.
Stages are an artificial construct used as a shorthand to help communicate an individual`s condition. The pathology of Alzheimer`s disease follows a linear course of brain cell death and does not obey stages. With these things in mind, the transition between clinical stages is gradual and sometimes fuzzy.
Like the onset of AD, I like to think of the transitions between stages like waves on a beach: some are higher and some are lower on the shore. No one wave tells you whether the tide is coming in or going out, but over the course of time the average water level has indeed risen higher on the shore. Similarly, no one day can tell you whether a stage transition has occurred.
Jon Stuckey, PhD
Case Western Reserve University