Posted on 10/12/2006 2:28:56 AM PDT by John Carey
The drugs most commonly used to soothe agitation and aggression in people with Alzheimer’s disease are no more effective than placebos for most patients, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms, researchers are reporting today.
The report, based on a large government comparison of the drugs’ effectiveness, challenges current practice so sharply that it could quickly alter prescribing habits, some experts said. About 4.5 million Americans suffer from the progressive dementia of Alzheimer’s disease, and most patients with the advanced disease exhibit agitation or delusions at some point.
The drugs tested in the study — Zyprexa from Eli Lilly; Seroquel from AstraZeneca; and Risperdal from Janssen Pharmaceutical — belong to a class of medications known as atypical antipsychotics. The drugs are used to treat schizophrenia and other psychoses, and are commonly prescribed for elderly patients in long-term care facilities.
(Excerpt) Read more at nytimes.com ...
I would look into the alternative therapys to pharmacutical treatment. Primarily to the fungal link to Altzhimers. Balance the body ph, make sure she has proper nutrition and throw in natural foods that are hard on fungus.
my bet is she will will get much better.
Our experience with Alzheimer's medication was that Aricept gave him very little benefit, and indeed gave him severe diarrhea. Delusions and hallucinations were a significant problem. They frightened Dad, and interfered with toileting and many aspects of his daily care. At the recommendation of his nursing home physician, we temporarily placed Dad in a geriatric psych unit in order to stabilize him with anti-psychotic medications.
From the time Dad entered the psych unit, he deteriorated rapidly. He was prescribed Zyprexa and some other medications. The first day, he fell out of his wheelchair and ended up in the ER. He was so "out of it" that he slumped over and tipped the chair over onto himself. As the doctors adjusted his dosages he became slightly more alert, but he was never again as alert as the day he entered the unit.
After about 3 weeks, Dad returned to his nursing home. He had entered the psych unit wobbly, but still capable of walking. Once he was on Zyprexa he became non-ambulatory. He was very lethargic, confused, largely uncommunicative, and had more trouble swallowing. He had to be moved from Assisted Living to full time nursing care. In addition, we hired a nurse's aide to stay with him during his waking hours, because he was at such risk of falling. He was in a fine nursing home, but even the best of homes can't provide full-time individual supervision for residents who keep falling out of their chairs.
Sadly, Dad died of pneumonia within 2 months of starting psych meds. The last 2 weeks of his life, we were reducing the levels of his meds, and he was becoming more alert again. Sadly, he developed aspiration pneumonia and died just after Christmas.
We acted on the best advice of his medical team at the time, hoping to help him with his frightening delusions. Unfortunately, the side effects were ultimately far worse than we could have anticipated, and the benefits very slim or nonexistent. This is a great dilemma in caring for loved ones with dementia. We want to help them in some way and to improve their quality of life, but the options are very limited and often unproven. I can't fault the nursing home or his regular doctors. I truly believe their options were limited and they did their best for him. Whether the psych unit could have done better, we'll never know. Sadly, this is an area of medicine sorely in need of breakthroughs.
My mother in law was on Aricept. We had hopes. It did nothing at all as far as we could tell. We were able to keep her in her home with 24/7 care. I do hope they can find a cure. She was a bright Swarthmore grad with a beautiful personality and mind. It all faded before our eyes. She really died long before her heart stopped.
The doctor put my grandmother on Aricept when he diagnosed her Alzheimers a couple years ago through a battery of memorization tests. It did slow down the symptoms, but I think it was one of those cases where you didn't know what would happen next and alzheimers has 7 stages and each person doesn't enter into the same stage, some advance quickly through them, while others progress through them slowly. Aricept does slow down the progression, but only in some cases.
My mother in law weighs 76 lbs as well with Parkinson's related dimentia.
I managed to get her a lower dose, like mine to 5 mg. of ARicept.
Yes, they do forget that with me as well. I'm not a Giant.
American In Israel, may have a point, with the fungal thing. Both her and my FIL have had the Fungal Infected toes for as long as I can remember and refused to treat them.
Interesting.
Yeahk, docs do better with most MSers with the addition of Namenda, but I cannot have that with the steroids on board. Oh well.
Good enough for now.
Another little item - Dad's dementia was primarily vascular in origin, apparently mixed with Alzheimer's. We found that hydration was very important. When he pushed Dad to drink more fluids, my husband was usually able to improve his cognitive function somewhat.
Correct as I understand it.
May be related to when treatment begins.
I'm going to look into it further.
Diet is a problem. At 69 pounds my mother needs calories but she is also on a low salt diet because of heart related problems. She has become a very picky eater. I wonder if some of her meds affect her taste. We'll be eating the same thing and I'll think it's fine and she'll complain it has no taste or tastes terrible.
Yes, how sad.
At that point, it may be harder for the family than the patient.
As Ronald Reagan said as his disease progressed "Every day I meat new people".
Still funny even in the throws of personal tragedy.
The thinking is that - to stem their temper and aggravation outbursts, and let them remain at home without driving the caregivers zonkers - a shrink is more "expert" in the various drugs to calm things down.
It'll undoubtedly be a couple of interesting hours.
Oh, Agreed!
Dementia is related to vascular issues, whatever the cause. Saw a link to Diabetes the other day.
Again, hosting a live thread elsewhere, gotta go.
And fluids also help her. When she has an IV for whatever reason she definately improves. But it's hard getting her to take more fluids. She is so tiny and her stomach is so shrunken that a few sips of anything fills her.
That's the way my grandmother was toward the end of the home caregiving I gave her. She was an entirely different person. Mean, vicious in a verbally demeaning way, vulgar, and since I lived with her, I was her only outlet for her obscenities and outbursts that come out of nowhere. Most of those outbursts came and gone in spurts of varying length from a few minutes to all afternoon. Her eating habits changed to the point she was putting sour cream on jello, stuff like that. I never was critical because I knew that would be a jumping off point for another one of her outbursts. I just took everything in stride. As long as she wasn't putting poison on her food, I wasn't trying to step in and correct her.
My dad put his foot down when she wandered off the farm for a third time this past summer. That was this past July.
The only thing I can tell you is try to make the best of your situation, and don't sweat the moments when your loved one starts calling you names you've never heard come out of her sweet mouth before. I have to say, I had moments where I flew off the handle. My mother corrected my ways by telling me it only makes matters worse for all of us. Those heated outburts from a loved one is just one of the symptoms of alzheimers, most often caused by frustration and confusion and in some cases paranoid of simple things like tepid shallow bath water.
Could be the fungal infection that is affecting her tasting.
MIL is what Italians call "A parsley picker". Turns her nose up at everything. Always did.
There is now an oral antifungal that works very well. What does she have to loose.
True. It's quite possible it didn't even help my grandmother. The doctor diagnosed it two years ago, and my folks and I sat down one time and thought back and we think it might have started long before that and we just didn't notice it because we're all forgetful at one time or another regardless of age, and we probably just thought it was one of those moments.
I wish you luck with the psychiatrist, and hope you have better success than we did with my father-in-law. Reactions to these drugs are very individual. Keep a close eye on medication levels, especially if they are to take their meds unsupervised. It's easy to over-medicate elderly folks. I'm experiencing this with my own father just now. He's been taking Xanax for anxiety following a heart attack and some legal problems. He's been taking it too liberally, and my brother and I are fighting him tooth and nail to reduce his dose. He's a hazard to himself (wobbly on his feet, impaired judgement) and we don't want him to put himself in a wheelchair or worse.
If there is a Hospice in your area I urge you to contact them.
My Mother recently passed (at home) from Alzheimer's and they were FANTASTIC. They can get a nurse to help or just provide someone to sit with your Mom while you get a break. PLEASE contact them you will not be sorry.
My major frustration is that neither parent has a clue that they indeed require help....my mother is in her little dream world, thinking that she could take care of everything, and my father's memory is so bad that he thinks he gets himself up to go to the bathroom (8 or 10 times a night, by the way) and insists that he showers himself - which, of course he doesn't....he can't take three unassisted steps without taking a header.
So, every few days both of 'em gang up on the caregivers ("firing" them, etc.) and it's at the point where they'll drive them away, leaving us no option than "the home".
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