Why Such ‘precision Medicine’ May Matter
As theyre based on a specific at-risk population, the teams findings lend support to a treatment approach called precision medicine, which has grown increasingly popular in Alzheimers research. It veers from a one-size-fits-all model and considers individual differences in environment, lifestyle and genetics in drug development and treatment decisions.
The traditional drug development approach for Alzheimers disease has been focusing on one protein, one gene or one cellular pathway, Huang says. The assumption for many years has been that we may find a magic bullet that will fit every Alzheimer’s disease patient.
Now, experts increasingly say the answer to ending Alzheimers probably doesnt lie in a single drug or therapy. Tackling the disease will likely require specific types of treatments, perhaps multiple therapies, including some that may target an individuals unique genetic and disease characteristics much like cancer treatments that are available today, Jean Yuan, M.D., a program director in the NIAs Division of Neuroscience, said in a statement.
A major reason: The disease cant be pinned to one cause, at least in most people. Experts say it’s likely due to a combination of age-related changes in the brain, along with genetic, environmental and lifestyle factors.
Common Over The Counter Medications Linked To Dementia
Peter Forster Best Practices, Insomnia Treatment
Common over-the-counter medications may increase your risk for dementia. That is the startling finding of a recently published journal article which used a number of approaches to examine the possible risk of using medications that have anticholinergic effects.
This includes many psychiatric medications as well as many common over the counter antihistamine medications, medications for sleep, and for GI problems: Benadryl , Sominex , Tylenol PM , Bonine , and many other medications, are some examples.
The study was extremely well designed and is likely to remain the definitive work on the subject. Using brain imaging techniques, the researchers found lower metabolism and reduced brain sizes among study participants taking the drugs known to have an anticholinergic effect. They also found an increased incidence of new cases of dementia among those receiving anticholinergic medications, and lower scores on a number of tests of memory and brain function.
These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia, said Shannon Risacher, Ph.D., assistant professor of radiology and imaging sciences, first author of the paper, Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults.
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Bring Down Blood Pressure Now
While more research investigates the brain benefits of blood pressure meds, you can play it smart by taking healthy lifestyle steps to keep blood pressure in a healthy range. Here are some of the best strategies.
Eat real.
That means nixing processed foodseven canned vegetables, which are oftenhigh in sodium. Among the most successful blood-pressure-lowering diets area Mediterranean diet or DASH .Both diets are high in fruits, vegetables,whole grains, low-fat dairy, poultry, fish and nuts, but low in harmful fats, red meat,sweets and sugary drinks. The effects can be quick, with blood pressurereductions in just two weeks.
Shed extra weight.
In one analysis of 25 clinical trials, losing an average of 11 poundsshaved 4.4 points offsystolic blood pressure and 3.6 points offdiastolic. Other studies have found that modest weight loss canprevent hypertension in overweight people, even if they dont reduce theamount of sodium in their diet.
Check blood pressure at home.
Monitoring your blood pressure at home can improve blood pressuremanagement more than just seeing your doctor. You can purchase automaticblood pressure cuffs for as little as $35 ask your doctor for arecommendation. Many pharmacies and drugstores also offer free bloodpressure readings.
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Side Effects Of Drugs Used To Treat Low Mood And Irritability
These medications, which are antidepressants, are prescribed to help improve mood and decrease irritability.
- Celexa : Headache, constipation, nausea, diarrhea, dizziness, drowsiness
- Paxil : Constipation, dizziness, headache, drowsiness, nausea, loss of appetite
- Prozac : Diarrhea, indigestion, nausea, loss of appetite, dizziness, insomnia, drowsiness
- Zoloft : Dizziness, headache, constipation, nausea, indigestion, reduced libido
- Desyrel : Constipation, diarrhea, nausea, vomiting, dizziness, backache
Substitues For Anticholinergic Drugs
If you have decided to forego taking anticholinergic drugs, first off, talk to your physician before suddenly stopping. There are some substitutes as well as natural remedies that are effective. But, you should discuss these with your physician before making the switch-particularly if you are on a prescription drug with anticholinergic effects.
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Preventing And Dealing With Medication Refusal
People living with dementia sometimes forget that they need to take medication and can get agitated when asked to do so. The experts at the Alzheimers Association suggest these steps to help prevent medication refusal.
Create a routine around taking medication. In addition to giving medication at the same time every day, establish a routine where the person sits in the same chair, uses the same cup to swallow water, and engages in other repeatable events. Routines may lend a sense of safety and security to prevent medication refusal.
Explain the need for the medication clearly and quickly. People living with dementia can forget what their medication is for or how to take it. No one would want to take medication without knowing why. So make a simple statement before handing over the pill. For example, This is a pill that will help you sleep better. You take it twice a day. Put it in your mouth, then drink a bit of water.
If the person refuses to take the medication, try again another time. People with dementia can be agreeable one minute and resistant the next. Someone who refuses medication may be perfectly happy to take it 30 minutes later.
If swallowing becomes a problem, ask their provider or pharmacist if there is a liquid option. Difficulty swallowing can be a problem for people living with dementia, and it can also be a side effect of certain drugs. If a person seems to be physically unable to take their medication, contact their provider right away.
Research Shows How Low Should You Go
Lower is not necessarily better when it comes to blood pressure. A 2013 study published in the journal JAMA Neurology found that people with heart disease or stroke who had lower-than-normal blood pressure were more likely to show changes in the brain that can affect cognition and memory. National guidelines recommend people with hypertension who are 60 and older aim for a goal of less than 150/90 mm Hg, while those ages 30 through 59 aim for a diastolic goal of less than 90 mm Hg. Younger people should aim for a goal of less than 140/90 mm Hg. Consult with your doctor about the best target for you.
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Do Medicines For Dementia Work
Alzheimer’s disease: medicines can’t cure Alzheimer’s disease, but they may slow it down for a while and make it easier to live with.
- Cholinesterase inhibitors may be used in people with mild to moderate Alzheimers disease or mixed dementia. These may give temporary help with memory, motivation, concentration and daily tasks.
- Memantine may be useful in the moderate or severe stages of Alzheimers disease, to help with attention and daily tasks, and possibly ease distressing or challenging behaviours.
Some Otc Meds Tied To Higher Risk For Dementia
Understanding Alzheimers DiseaseAlzheimer disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks, according to the National Institute on Aging. In most people with Alzheimers, symptoms first
HealthDay News Long-term and/or high-dose use of a class of medications used for hay fever, depression and other ills has been linked in a new study to a higher risk of dementia.
The drugs called anticholinergics include nonprescription diphenhydramine and tricyclic antidepressants like doxepin . This class of medications also includes older antihistamines like chlorpheniramine and antimuscarinic drugs for bladder control, such as oxybutynin .
However, the study, published in JAMA Internal Medicine, could only point to an association between long-term or high-dose use of these drugs and a higher risk of dementia, it could not prove cause-and-effect.
The new study was led by Shelly Gray, PharmD, of the Group Health Research Institute-University of Washington. Her team explained that the anticholinergic class of medications work by blocking a neurochemical called acetylcholine, in both the brain and body.
However, no one should stop taking any therapy without consulting their health care provider, said Gray, director of the geriatric pharmacy program at the University of Washingtons School of Pharmacy.
Read Also: Where Does Dementia Come From
Medications For Alzheimers: Insomnia
Alzheimers often causes changes in sleep patterns, resulting in insomnia.
Chronic insomnia can significantly decrease quality of life for both the person with Alzheimers and their families.
Belsomra is currently FDA-approved to treat insomnia in mild to moderate Alzheimers disease.
Side effects include impaired alertness and coordination, worsening of depression or suicidal thinking, complex sleep behaviors, sleep paralysis, or compromised respiratory function.
Side Effects Of Drugs Used To Treat Cognitive Symptoms
These medications, which are classified as cholinesterase inhibitors, glutamate regulators, or a combination of both types of drugs, are prescribed to help boost memory and thinking.
- Aricept : Diarrhea, loss of appetite, muscle cramps, nausea, sleep changes
- Belsomra : Sleepiness or unusual drowsiness, headache
- Exelon : Nausea, vomiting, diarrhea, decrease in appetite
- Namenda : Constipation, diarrhea, vomiting, confusion, dizziness, headache
- Namzaric : Headache, diarrhea, dizziness, insomnia, loss of appetite
- Razadyne : Dizziness, headache, diarrhea, nausea, vomiting, decrease in appetite
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Treating The Accompanying Symptoms Of Dementia
Dementia often causes a number of behavioural and psychological symptoms which can be very distressing.
These may include depression, anxiety, sleeplessness, hallucinations, ideas of persecution, misidentification of relatives or places, agitation and aggressive behaviour. These symptoms may respond to reassurance, a change in the environment or removal of the source of any distress such as pain. However, sometimes medication may be required for relief.
Major tranquillisers
Major tranquillisers, also known as neuroleptics or anti-psychotics, are used to control agitation, aggression, delusions and hallucinations. Haloperidol is one commonly used drug. In modest doses this drug tends to cause symptoms similar to Parkinsons disease such as stiffness, shuffling gait and shakiness, and older people are very prone to these side effects. Some are unable to tolerate even low doses of Haloperidol.
Newer tranquillisers such as Risperidone have fewer Parkinsons like side effects and have been studied more intensively in people with dementia than Haloperidol has. Risperidone appears to be helpful for the treatment of aggression and psychosis, but may be associated with a slight increase in risk of stroke.
Olanzapine and Quetiapine are sometimes used, but have been less comprehensively studied in the treatment of dementia, and there is some evidence that Olanzapine may also be associated with increased risk of stroke.
Drugs for treating depression
Drugs for treating anxiety
What Are Cholinesterase Inhibitors
If your loved one has Alzheimerâs disease that isnât too severe yet, their doctor might prescribe them a cholinesterase inhibitor. If they have another type of dementia, their doctor may consider it, too.
What they do: Scientists think these help prevent a âmessenger chemicalâ in our brains called acetylcholine from breaking down. Acetylcholine is important in learning, memory, and mood. Cholinesterase inhibitors also appear to delay the worsening of Alzheimerâs symptoms.
These medicines include:
What to expect: Most people with Alzheimerâs who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.
But the improvements donât seem to last long — about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.
All three medicines work similarly, but one might work better for your loved one than it does for someone else.
Side effects: Most people donât have side effects when they take cholinesterase inhibitors, but some do have:
- Nausea
- Insomnia
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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.
Medicines To Treat Challenging Behaviour
In the later stages of dementia, a significant number of people will develop what’s known as behavioural and psychological symptoms of dementia .
The symptoms of BPSD can include:
- increased agitation
- aggression
- delusions and hallucinations
These changes in behaviour can be very distressing for both the person with Alzheimer’s disease and their carer.
If coping strategies do not work, a consultant psychiatrist can prescribe risperidone or haloperidol, antipsychotic medicines, for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer’s disease where there’s a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol should only be used if other treatments have not helped.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.
Sometimes other medications may be recommended to treat specific symptoms in BPSD, but these will be prescribed “off-label” .
It’s acceptable for a doctor to do this, but they must provide a reason for using these medications in these circumstances.
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Medications For Alzheimers: Moderate To Severe Stages
In the moderate to severe stages of Alzheimers, Namenda is the primary drug prescribed.
It can improve memory, attention, reason, language, and the ability to perform simple tasks.
Namenda can be used alone or with other Alzheimers disease treatments.
People with moderate to severe Alzheimers might also benefit from taking both Namenda and a cholinesterase inhibitor .
3 commonly prescribed drugs at this stage:
- Namenda is approved for moderate to severe Alzheimers
- Aricept is approved for all stages of Alzheimers
- Namzaric
Namenda regulates the activity of glutamate, a chemical involved in information processing, storage, and retrieval.
It can cause side effects including headache, constipation, confusion, and dizziness
Timed Or Automatic Pill Dispenser
Automatic pill dispensers provide a compelling combination of secure storage and timely reminders.
The pills are preloaded into the dispenser and programmed to be delivered at the correct time. When the pill is dispensed, an alarm sounds.
Automatic pill dispensers for home use can be purchased for less than $100. The drawback of the automatic dispenser is that someone must invest the time to fill and program the machine.
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Medications For Alzheimers: Early To Moderate Stages
In the early to moderate stages of Alzheimers, a class of drugs called cholinesterase inhibitors are used.
These drugs treat symptoms related to memory, thinking, language, judgment, and other cognitive processes.
They might also help delay symptoms or slow them from worsening and may help control some behavioral symptoms. However, they dont always work for everyone.
3 commonly prescribed cholinesterase inhibitors:
- Aricept is approved for all stages of Alzheimers
- Exelon is approved for mild to moderate Alzheimers
- Razadyne is approved for mild to moderate Alzheimers
Side effects include nausea, vomiting, loss of appetite, and increased frequency of bowel movements.
Cholinesterase inhibitors work by affecting certain chemicals that carry messages among the brains nerve cells. As the disease progresses, less of that chemical is produced.
Thats why these medications become less effective over time.
Drugs To Treat The Cognitive Symptoms Of Dementia
A number of drugs are currently available in Australia for use by people with dementia. These drugs fall into two categories, cholinergic treatments and Memantine.
Cholinergic
Cholinergic treatments offer some relief from the symptoms of Alzheimers disease for some people for a limited time. Drugs known as acetylcholinesterase inhibitors work by blocking the actions of an enzyme called acetylcholinesterase which destroys an important neurotransmitter for memory called acetylcholine.
Current cholinergic treatments are approved for use for people with mild to moderate Alzheimers disease. A number of the acetylcholinesterase inhibitors are available as subsidised medicines under the Australian Pharmaceutical Benefits Scheme.
People may receive these drugs at nominal cost if a physician or psychiatrist has found them to have a diagnosis of Alzheimers disease.
They must show improvement on a commonly used test of mental function in the first six months of treatment in order to receive further supplies of subsidised medication.
Memantine
Memantine targets a neurotransmitter called glutamate that is present in high levels when someone has Alzheimers disease. Memantine blocks glutamate and prevents too much calcium moving into the brain cells causing damage. It is the first in a new class of therapies and acts quite differently to the acetylcholinesterase inhibitors that are currently approved for treatment in Australia.
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