A Practical Approach To Dementia Medications
Its easy to get a bit lost in the weeds, when it comes to medications to treat the cognitive decline of Alzheimers and other dementias.
Overall, these are medications that seem to offer only a little if any benefit to most people.
They are indeed widely prescribed, because patients are usually anxious to do everything possible to preserve their mental abilities, and because doctors want to be able to offer *something*. And most of the time, they dont seem to harm patients or cause significant side-effects.
I think its reasonable for people to take or try these medications, as long as they are aware of the evidence regarding the usually modest benefit.
So what should you do about medications, if you or your older relative has been diagnosed with Alzheimers or another dementia?
If you have already been on dementia medications for a while:
If you arent experiencing side-effects, you may want to continue on the medications indefinitely.
But if you are concerned about medication expenses and pill burden, consider a trial of stopping the medication.
After all, the overall benefit of these medications is small. And you can always restart dementia medications if you think the dementia symptoms got worse off the medication.
If you are just starting the dementia journey:
If you are debating whether to start medications for dementia, keep in mind the following points:
Can Dementia Get Worse Suddenly
Dementia occurs due to physical changes in the brain and is a progressive disease, meaning it gets worse over time. For some people, dementia progresses rapidly, while it takes years to reach an advanced stage for others. The progression of dementia depends greatly on the underlying cause of the dementia.
What Class Of Drug Is Namenda
. Furthermore, what class of drug is memantine?
Memantine is in a class of medications called NMDA receptor antagonists. It works by decreasing abnormal activity in the brain. Memantine may improve the ability to think and remember or may slow the loss of these abilities in people who have AD.
Similarly, is memantine an antipsychotic? One of these drugs, memantine, slows the progression of some symptoms in people with moderate to severe Alzheimer’s disease. There is some evidence that memantine also helps with aggression, agitation and delusions for people in this group.
Similarly one may ask, what kind of drug is Namenda?
Namenda is the brand name of the prescription drug memantine, which is used to treat symptoms of Alzheimer’s disease and severe dementia. The medicine works by decreasing abnormal activity in the brain. It’s in a class of drugs known as NMDA receptor antagonists.
Is Namenda the same as memantine?
Aricept and Namenda are used to reduce symptoms of mild to moderate dementia like that found in patients with Alzheimer’s disease. Aricept is a cholinesterase inhibitor and Namenda is an orally active NMDA receptor antagonist.
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Visual Hallucinations And Agitation In Alzheimer’s Disease Due To Memantine: Report Of Three Cases
Roberto MonasteroCecilia CamardaCarmela PipiaRosolino Camarda
Memantine, a noncompetitive NmethylDaspartate receptor antagonist, is currently the only drug proposed for the treatment of moderate to severe Alzheimer’s disease. It has been shown to have neuroprotective effects by inhibiting the excitotoxic effect of NMDA glutamate receptors. Memantine has a tolerability profile similar to placebo. However, the worsening of psychotic symptoms in patients with Lewy body dementia treated with memantine has been recently reported. We describe three patients with probable Alzheimer’s disease who developed worsening or de novo visual hallucinations and agitation after memantine treatment.
What Do We Mean By ‘dementia Drugs’
Dementia is the broad term used to describe a number of different conditions affecting the brain.
There is currently no cure for the diseases that cause dementia.
However, some drugs can help to relieve or control symptoms for people living with Alzheimers disease, dementia with Lewy bodies or Parkinsons disease dementia.
Unfortunately, there are currently no drugs that can improve the cognitive symptoms of vascular dementia or frontotemporal dementia.
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Which Is Better Namenda Or Aricept
Aricept works for all stages of Alzheimers, and most forms of it are available in generic. Slows progression of Alzheimers disease. Namenda can slow the progression of symptoms in moderate and severe Alzheimers disease, but cannot cure it.
Frequently Asked Questions About Memantine
How quickly does memantine work?
Most people start to notice some improvement within the first few weeks they are taking memantine , but it can take a few months for the full effects to be felt. The less severe your symptoms are, the sooner you will see improvement.
Can memantine be used in people with obsessive compulsive disorder ?
Studies have shown that memantine can help some people with OCD that have not had success with other medications. This would be considered an “off-label” use of this medication, as it’s not FDA-approved to treat OCD. If your provider has prescribed memantine to you for this reason, the dose might be different from what’s listed on this page. Be sure to follow your provider’s instructions very carefully.
Does memantine improve your memory?
Yes, memantine has been shown to improve memory. Unfortunately, it is not a cure for Alzheimer’s disease, so it is possible your symptoms might get worse again over time.
Can you drink alcohol while taking memantine ?
This is not a good idea. Drinking alcohol while taking memantine can raise your risk of side effects, especially dizziness. It can also worsen the symptoms of Alzheimer’s disease.
Does memantine make you sleepy?
It can. Drowsiness is a possible side effect of memantine , but it’s not common. Usually, this side effect will get better or go away after you’ve been taking the medication for a few weeks. If you find this side effect to be bothersome, let your provider know.
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Medication That Can Make Dementia Worse
Some medicines used to improve dementia seek to increase choline levels in the brain. This is a chemical that the brain cells use to communicate with each other.
Some types of pharmaceutical drugs are âanti-cholinergicâ which means that they decrease choline levels.
They may also cause difficulties while urinating, constipation, and a dry mouth.
Examples of such medication include:
- Benadryl: This is mostly found in over-the-counter sleeping and allergy pills as well as cough syrups.
- Tropsium/Sanctura: these aid persons who need to urinate frequently but they can also cause agitation and confusion.
- Bladder pills like Detrol/Tolterodine.
- Atropine/AtroPen: Caution needs to be exercised when using eye drops in dementia.
- Glycopyrrolate/Robinul: it dries secretions and also causes agitation and confusion
- Diphenoxylate and Lomotil/atropine: it is often prescribed for persons who have diarrhea. It may be okay when used one or two times. Frequent use, however, may cause problems for persons who have dementia.
- Amitriptyline: In the past, this was used to treat depression. Today, it is prescribed to treat irritable bowel conditions and neuropathy.
- Steroids: medicines that are often used to reduce various types of inflammation can cause pose health problems for individuals with dementia. An example is Prednisone that which can cause insomnia, agitation, and confusion.
How Medication For Dementia Works
Pharmaceutical drugs given to persons living with dementia normally work by increasing the levels of various chemicals in the brain.
Medications like rivastigmine, donepezil, and galantamine increase the levels of a chemical known as acetylcholine.
This chemical is usually low in persons who have dementia and the medicine can treat some of the symptoms that affect memory and thinking in some people with the neurodegenerative illness.
NICE recommends that the 3 medications are more suitable for persons who have mild or moderate dementia.
Common side effects of these medications may include muscle cramps, feeling sick, diarrhea, headache, and tiredness.
Memantine is another pharmaceutical drug that doctors prescribe for persons with dementia. It helps to reduce the amount of glutamate.
Experts believe that it slows down damage to brain cells affected by dementia.
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How To Take Medications For Dementia
Dementia doctors normally recommend that a person starts taking medication in small doses before increasing it after some time to target the required dose.
This is very important when it comes to answering the question can dementia make dementia worse.
Depending on how an individual reacts to the medication, a doctor can either stop the medication entirely or go ahead with the treatment option.
Keep in mind that many people will develop some side effects when they start taking dementia medication.
For most, these usually go away after some time.
While most people can take dementia medicine without a problem, itâs necessary to observe individuals who have a history of medical problems.
For instance, persons with severe kidney or liver issues may not be in a position to take the medicines or if they are helpful may need to take lower doses.
Management Of Cognitive Symptoms
Medicines may be used as an adjunct to non-pharmacological treatment. When medicines are used they should be initiated in consultation with a specialist team experienced in the management of dementia. Treatment should be reassessed on a regular basis and continued only when considered to be having a worthwhile effect on symptoms. Donepezil hydrochloride, galantamine, and rivastigmine are recommended for the treatment of cognitive symptoms of mild-to-moderate dementia due to Alzheimers disease. Memantine hydrochloride is a suitable alternative for patients with moderate-to-severe Alzheimers disease when acetylcholinesterase inhibitors are contraindicated or are not tolerated. A trial of an acetylcholinesterase inhibitor may be considered for managing cognitive symptoms in Lewy body dementia. Pharmacological treatments are not recommended for the treatment of cognitive symptoms in cases of vascular dementia, unless there are elements of mixed dementia which may respond to treatment.Acetylcholinesterase inhibitors can cause unwanted dose-related cholinergic effects . They should be started at a low dose and increased according to tolerability. Choice of agent is generally determined by cost, mode of delivery and risk of adverse effects there is no evidence that one acetylcholinesterase inhibitor is more effective than the others.
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What Drugs Are Available To Treat The Cognitive Symptoms Of Dementia
The main drugs used to treat cognitive symptoms of dementia are called cholinesterase inhibitors.
Cholinesterase inhibitors include donepezil, rivastigmine and galantamine. There is also a drug called memantine, which works slightly differently.
These drugs dont work for everyone, and the average effect is fairly small. But, for most people, theyre still well worth trying.
Tips For Taking Medicines For Dementia
The person with dementia may need support to manage their medications. You may find it helpful to do the following:
- Develop a routine for giving the medication: ask the pharmacist if medications should be taken at a certain time of day or with our without food. Then create a daily ritual. This might involve taking medications with breakfast or right before bed.
- Pill boxes or blister packs: ask your pharmacist about aids to help you to give medication as prescribed, eg, using pill boxes or blister packs. Read more about remembering to take your medicine.
- Swallowing difficulties: if swallowing is a problem, talk to your pharmacist or doctor. Read more about difficulty swallowing medicines.
- Side effects: ask your doctor or pharmacist about what side effects might occur with the medication and what you should do if you get them. Some dementia medicines may make the symptoms worse, so it’s important to be aware of this and let your doctor know. Read more about medicines and side effects.
- Get the treatment reviewed regularly: a medicine which is useful may not continue to be effective indefinitely because of the progressive changes to the brain caused by dementia.
- Keep a record of all medications, including over-the-counter medicines such as pain relievers, cold medicines and antacids. Also include creams or eye ointments, vitamins, herbal supplements and complementary medicines. Take this record to medical appointments.
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Support And Other Therapies
There are also several therapies and practical measures that can help make everyday living easier for someone with dementia.
- occupational therapy to identify problems in everyday life, such as getting dressed, and find practical solutions
- speech and language therapy to help improve communication problems
- physiotherapy to help with movement difficulties
- psychological therapies, such as cognitive stimulation
- relaxation techniques, such as massage, music or dance therapy
- social interaction, leisure activities and other dementia activities, such as memory cafes
- making changes to your home, such as removing loose carpet and potential trip hazards, making sure the home is well lit, and adding grab bars and handrails
How Does Peanut Butter Detect Alzheimers
The peanut butter test is a diagnostic test which aims to detect Alzheimer’s disease by measuring subjects’ ability to smell peanut butter through each nostril. The researchers believe that people with Alzheimer’s were not able to smell the peanut butter as well through their left nostril as their right one.
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Can Memantine Cause Aggression
4,5 Con- versely, memantine has been shown to cause agitation and other psychotic manifestations. A total of 11 cases of AD,6,7 Lewy body disease,810 and Parkinsons disease11 have been reported who developed agitation, hallucinations, delusions, and intense dreaming after a few doses and recovered at drug withdrawal.
How Well Does Memantine Work
In people with moderate to severe Alzheimers, memantine seems to provide some benefits, in terms of slowing the deterioration of Alzheimers. But again, the benefit overall seems to be fairly modest.
Its not at all clear that people with mild to moderate Alzheimers benefit from memantine a 2011 review concluded that the scientific evidence doesnt support this claim.
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Namenda Only Works For Severe Alzheimers Disease And Dementia
Namenda was approved by the FDA in 2003 for use in people with moderate to severe Alzheimers disease or other types of dementia. The FDA rejected the manufacturers application to expand approval to include mild Alzheimers or dementia. However, the drug is often prescribed off-label for patients with mild Alzheimers or dementia even though there is little evidence of its benefit at this stage of disease and other drugs, such as Aricept and Razadyne, are more effective. Off- label means that the use is not on the FDA-approved label for the drug, because of lack of proof that it is safe and effective for that use.
Although Alzheimers disease is the more common diagnosis, Alzheimers disease is just one type of dementia. It is currently impossible to be sure if the type of dementia is caused by Alzheimers disease until there is an autopsy. Doctors can make a probable diagnosis through additional lab tests. These tests cannot diagnose Alzheimers disease, but rule out other causes for dementia symptoms, some of which should be treated differently. These tests are expensive and can be very time consuming. For that reason, studies of Alzheimers disease are usually studies of people with multiple types of dementia, so we use the terms interchangeably in this article.
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
Do Any Vitamins Help Treat Dementia
Vitamin E which works as an anti-oxidant in the body has been studied for the treatment of Alzheimers, and may be beneficial.
In 2014, a large study of patients with moderate-to-severe Alzheimers disease found that daily treatment with 2000 IU/day of Vitamin E resulted in less functional decline than treatment with placebo, memantine, or a combination of memantine and vitamin E.
Of note, since the study was conducted in the VA health system, most participants were men. And again, the benefit seen was modest.
It is not clear that vitamin E helps for milder Alzheimers, or mild cognitive impairment. Always talk to a doctor before trying vitamin E for brain health, as vitamin E can increase bleeding risk in some people.
No other vitamins have been shown to slow cognitive decline in Alzheimers or other dementias. In particular, although low vitamin D levels have been associated with a risk of developing dementia, no clinical research has shown that treatment with vitamin D helps people maintain cognitive function.
A study of vitamin B supplementation in the treatment of people with mild to moderate Alzheimers disease did not show any benefit. Note that participants in this study had normal vitamin B12 levels at baseline the very common problem of vitamin B12 deficiency in older adults can cause or worsen cognitive problems.
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Important Information About All Medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
If you buy any medicines, always check with a pharmacist that they are safe to take with your other medicines.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Why Discontinue Medications
Consider discontinuing medications when one or both of the following two factors arise:
- Side Effects: If there are too many side effects or they diminish the quality of life for the person, strong consideration should be given towards discontinuing the medication.
- No Benefit: If the patient or loved one has been on the medication for quite some time and now her dementia has progressed to the late stages, physicians and pharmacists will sometimes recommend discontinuing the medication if there is no observed benefit. This decision may, at times, be made when a person elects hospice care, but at other times it is considered as an option simply if the perceived benefit is little or none.
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