Alzheimers Patch

May 6th, 10 / 0 Comments







The Alzheimers patch is one way to deliver the medication Exelon to those suffering from mild Alzheimers disease. It is an effective Alzheimers medication and here
are some of the things you want to know.

Exelon – What It Is

Exelon is the marketing name for the drug Rivastigmine and this is an cholinesterase inhibitor type of medication (acetycholine is a chemical helping nerve transmissions and this class of medications help prevent it from being destroyed).

Preventing the destruction of nerve pathways helps prevent the progression of the Alzheimers Disease. There is also research pointing out that this kind of medication also enhances the functioning of the nerve connections in the brain.

The Alzheimer’s Patch: Does It Work?

Research trials indicate there is an improvement in functioning using this product.

For example, in one study done in 2002, the long term safety and effectiveness of Exelon was done – dose 1.5 mg/3 times a day. The effectiveness of the drug was tested by using the Mini-Mental State Examination and some items on the Alzheimer’s Disease Assessment Scale while the progression of the disease was monitored using the Global Deterioration Scale.

After 26 weeks, patients showed no deterioration (but no improvement either which is to be expected as Alzheimers damage is permanent). 11% of patients had to be withdrawn off the trial because of adverse effects of the medication.

Bottom line – it worked well if a regular dose was kept up for the full treatment regime on mild to moderate cases.

(Bilikiewicz A, Opala G, Podemski R, Puzyski J, et al. Med Sci Monit 2002; 8:PI9-15.)

Can You Combine the Alzheimers Patch With Other Medications

Yes. In a word, a combination of medications sometimes (and I emphasize the word sometimes) seems to have an effect greater than the individual medications themselves. While this is reported in the literature, there are also cautions that this can’t be standardized or counted on. There are too many individual differences between patients to say they’ll get XX or YY amount of improvement by combining medications.

And sometimes there isn’t any.

So the bottom line is that it can be done, isn’t something to overly worry about if it is done and it may help some patients.

Can You Switch to the Patch?

There is no problem switching to the patch from other medications or from oral Exelon.

The results of a trial on brain functioning done by Shua-Haim, Celeste Yap, Aleksey Kretov, and Paul Lee found that caregivers reported 20% of patients improved cognitive functioning with the patch over oral medications while 17% of patients were reported as having declined.

Things to Discuss With Your Physician

Side effects. There appear to be fewer side effects from the Alzheimers patch than taking Exelon orally. But abdominal pain, anxiety, aggression, confusion, constipation, depression, diarrhea, fatigue, headache, gas, insomnia, night sweats, loss of appetite, vomiting and weight loss are associated side-effects from Exelon.

Combinations with Other Medications. While nothing appears in the literature I could find at the time of writing, it is clearly important to discuss with your family physician for up-to-date information.

The length of time it takes to work. There is some literature that points out that patients need to be on this medication for several months for it to start working.

How often the patch needs changing. Currently, the patch needs changing every 24 hours.

Who is the Alzheimers patch good for? Mild to moderate cases seem to respond while more severe cases do not.







medications, treatment

Alzheimers Medicine for Early Stages

May 6th, 10 / 0 Comments








When it comes to Alzheimers medicine for dementia treatment, there are several different drugs registered and used by physicians. Understand that none of these will cure the problem but will slow the progression or mask the symptoms of the problem.

The other kind of treatment often prescribed has to do with alleviating the symptoms associated with the disease, so we’ll see prescriptions for things like sleeplessness, anxiety or depression.

Cholinesterase Inhibitors

If I go way back to my college physiology classes, I remember that acetylcholine is the chemical in the body that makes the nerves connect and work better.

Cholinesterase is an enzyme that breaks down the acetylcholine (summarizing about three months of lectures).

We want a normal supply of acetylcholine because this makes our nerves run properly. And when we get Alzheimers the cholinesterase is breaking too much of the good stuff down. So we want to stop this from happening.

The cholinesterase inhibitors that are registered (at the time of this writing) were donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) The chemical is the first name and the drug name or trademarked name you purchase it by is the second name.

Donepezil (Aricept) – seems to work best (according to the FDA if I’m reading the data correctly) for mild cognitive problems and will delay the onset of Alzheimer’s for about a year. It is however registered for mild, moderate and severe cases.

Effectiveness

According to the research I saw, about 50% of people get a benefit from this kind of Alzheimers medicine. (which means the other 50% do not see any improvement)

There are also side effects that include diarrhea, nausea and vomiting and this causes some patients to stop taking the pills as well.

I’ve written about the other kinds of Alzheimers medicine and you can see them in the related articles.

One article that you might want to check out is this one on medication aimed at the later stages of Alzheimer’s.







medications, treatment

Antipsychotic Drugs can kill Alzheimers Patients

May 6th, 10 / 0 Comments







Here’s a troubling bit of new research. Researchers at Kings College in London UK, have shown that Alzheimer’s patients treated with anti-psychotic medications were 10% more likely to die than those untreated or treated with placebos – after one year of the test. After 3 years, the anti-psychotic drug patients were twice as likely to die than untreated patients.

So the practice of treating with anti-psychotics in a bid to more effectively manage behavior problems in some Alzheimer’s patients is effectively killing them faster.

The problem is that some Alzheimer’s patients tend to hallucinate or become aggressive as the disease progresses and this leads to management issues from the caregiver point of view.

It’s a tough call for sure and the answer to this depends on which side of the issue you find yourself. Saying glibly that it has to be done on a patient by patient basis is obvious but doesn’t deal with the realities of overstrained facilities and the fact that health care providers are human beings with all the stress and strain as the rest of us. So it’s a problem – no question about it. And there’s no easy answer here.

To illustrate, in a hospital I used to work, an 80-year old man (a former middle-weight boxer) cold-cocked an unsuspecting staff member. It came out of nowhere and the staff member never saw it coming – went straight to the floor out cold. It was one formidable right hook to the jaw. The patient wandered away afterward – blithely unaware of what he had done. Luckily, the staff member recovered fully except for the ongoing jibes at coffee break.

Bottom Line

So if you have a family member is this situation, you have to understand both sides of the issue and you have to make an informed decision with the medical people. Simply understand there may be a price to pay for both you, the staff and the patient.







medications, research

Alzheimers Disease Care

May 6th, 10 / 0 Comments







Alzheimers disease care involves using medications for the later stages (registered at time of writing) of this dementia involve treating with the chemical memantine (sold as Namenda).

Let me emphasize again that this is not an Alzheimer’s cure but rather something that masks the symptoms of the disease.

How it Works

Again, from basic physiology, let me summarize for you. Glutamate is a moderator of some chemical/electrical processes in the brain and we need it in small amounts.

What seems to happen with Alzheimers (and other dementia causes) is that too much glutamte is produced when brain cells die. The excess of glutamate speeds up the remaining brain cells – wearing them out – and this in turn causes them to die.

An excess of glutamate increases the wearing out and death of brain cells.

So memantine (Namenda) treats the symptoms of the problem by slowing down or regulating the glutamate. It actually does this at the cell membrane level and is only effective when there is excess glutamate – otherwise, it does nothing.

Combination

There is some thought that combining the shorter term Alzheimers medications with the longer term ones will improve the effectiveness of treatment.

Effects

This form of Alzheimers disease care does not repair the effects of Alzheimer’s but rather allows patients to continue on at the same level of functioning for a longer period of
time.

The easiest way to think of this is that it is a quality of life issue. The patient is going to be able to maintain themselves in a retirement facility longer (not get lost, be able to use the bathroom etc) rather than having to go into a nursing care home.








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medications, treatment

Causes of Dementia

May 5th, 10 / 0 Comments








There are different causes of dementia (Alzherimers is only one) and one of the main difficulties lay-people have is sorting out the differences.

For example, a quick list includes: infections, small strokes, head injuries, drug interactions or drugs by themselves and even some nutritional deficiencies. And of course, Alzheimer’s disease is included in there.

The bottom line is that anything that can influence the operation of the brain can give you symptoms of dementia. The good news is that some of these difficulties can be reversed (i.e. stop the medication or fix the nutritional deficiency) so jumping to conclusions that the dementia is permanent before the underlying cause is known
isn’t a smart thing to do (but entirely common and human given our public understanding of this disease).

A Short Summary of Causes of Dementia

Causes of Dementia You Can’t Reverse

Alzheimer ‘s Disease. This is indeed the most common cause of dementia – it is estimated that it creates 50% of the conditions. The good news is that there ‘s another 50% out there that isn’t Alzheimer ‘s. Alzheimer ‘s can be treated and slowed but is irreversible and damage is permanent.

Vascular Dementia This is the second most common cause of dementia and it is estimated to hit 30-40% of dementia patients. This is the common “hardening of the arteries” thatwe hear about so much. Deposits of fat, dead tissue etc form on the inside of our arteries and block off the blood flow to the brain. This in turn creates many mini-strokes and brain damage. There are several different forms of this dementia (all are related to blood restriction however). Treatments can (like Alzheimer ‘s) slow the progression but once a brain function is lost, it can ‘t be recovered.

Other Diseases that create or mimic dementia include:

Parkinson ‘s Disease may create some symptoms but is not the same nor will everyone who gets Parkinson ‘s develop dementia.

Lewy body dementia is caused by microscopic bits of protein which destroy nerve cells.

Huntington ‘s Disease is an inherited problem where certain kinds of brain cells waste away. Again, it ‘s not guaranteed that all those with Huntington ‘s will develop symptoms of dementia but it ‘s fairly common.

Creutzfedt-Jakob disease is a disease created by small”agents”called prions that invade and kill off brain cells. This problem develops quickly and is fatal – it tends to attack younger or middle-aged individuals.

The important thing to understand is that treatment is different for each of these problems and trying to do this yourself is next to impossible. Do see a physician for assistance

Treatable Causes of Dementia

Head Injury. Brain damage and repair has come a huge way in over the last few years. The brain will often”remap”itself if given the proper rehabilitation processes. Injuries that occur over a long time (thinking boxing or head-beating sports) may not be treatable and can lead to dementia.

Infections of the brain (meningitis, encephalitis) can be primarycauses of dementia. Treat these and the problems diminish. Other infections such as HIV/Aids and syphilis can directly influence the brain in their latter stages because of brain cell inflammation.

Brain tumors can mimic dementia. The swell and interfere with normal glandular operations so they can mimic the symptoms of dementia.

Exposure to toxins. Working around heavy metals (mercury, lead) without protection can be hazardous to your health and this is one way the problem presents itself.

Hormone problems (thyroid, pituitary) can lead to hormone imbalances and this can mimic dementia symptoms and lead to permanent damage if not treated.

Hydrocephalus or swelling of the brain (the brain”floats”in clear cerebrospinal fluid) created by an excess fluid and the resulting pressure on the inside of the head – directly influencing how the brain functions. There are several forms of this problem and all
are causes of dementia but can be reversed with the appropriate timely treatment.

Metabolic disorder of the liver, pancreas and kidneys can disrupt salt balances in the body and this in turn can (quite quickly) create conditions that mimic Alzheimers. If this persists, brain cells may die but if treated on time a full recovery is possible.

Hypoxia (lack of oxygen in the blood) is one of the treatable causes of dementia. The lack of oxygen in the blood starves the brain and can kill brain cells. Pneumonia or Emphysema are two primary causes of this problem. This is one reason why it is thought that cigarette smoking that creates

Emphysema is also related to Alzheimer ‘s.

Congestive heart problems are also related to hypoxia.

Drug reactions. I ‘m told (off the record) that this is more common that we ‘d like to know about and with the drug mixes that many seniors are on for a variety of conditions, it is impossible to track all the possible outcomes. Individual drugs – such as those for sedation can create these symptoms as can those that create symptoms such as”dry mouth”or”constipation”

This is not to mention illegal drugs such as cocaine or heroin may cause dementia symptoms if taken in high enough doses, for long times, or taken by elderly people Drug withdrawal usually removes the reaction in most cases.

Nutritional deficiencies. The B vitamins are particularly associated with symptoms that resemble dementia.

Alcoholism - chronic drinking creates liver problems and this in turn is one of the above causes of dementia

Bottom Line

When it comes to any of these causes of dementia, the rule of thumb is to work with a doctor to get a reliable diagnosis. That diagnosis is the basis for treatment and lay people simply can’t make this kind of distinction.


causes, symptoms

Early Signs of Alzheimers

May 5th, 10 / 0 Comments








Some of the early signs of Alzheimers include the following points.

Please understand that some of these behaviors are quite normal in limited quantity. But, if you’re like me, you’re always wondering is this normal or is this a problem.This might give you a sense of being able to tell the difference.

Memory Loss

We all know this one as one of the primary stages of Alzheimer’s but we all forget names and appointments on occasion (don’t forget the better half’s birthday or anniversary – if you’re a guy – tattoo that one on the insides of your eyelids).

The difference is that the symptom of Alzheimer’s means we’re forgetting things we just learned. Not things we’ve known for some time.And the person is unable to remember that data because it’s simply lost.

Familiar Tasks

I don’t know about you but I do wander into a room and ask myself, ‘Why did I come down here?’ This is normal.You’re focussing on several items at the same time and you decide to do something but on the way there your brain is processing other information as well. You “forget” why you went into the room and then a few minutes later – you remember and feel pretty stupid about it.This is normal.

What isn’t normal is when you’re focussing on the task at hand and forget the steps involved in doing them.You forget how to dial a telephone or play a game.Those are things to worry about.

Language Problems

I write for a living and I wish I had a quarter for every time I’ve sat and stared the word processor saying: I know that word – where is it? I can’t remember the darn thing.This is normal.

What isn’t normal is when you forget a simple word or substitute an unusual word (or one that doesn’t quite make sense) into a written or spoken sentence so that sentence doesn’t quite make sense.Sometimes substituting phrases for the word in question (that describe the word) is also used so you wind up with extremely convoluted sentence structure.Mind you, if you’ve been doing this all your life (as a friend of mine has) then you shouldn’t worry.

Forgetting Time

It’s not uncommon for normal folks to be driving along and forget where we’re going.Or forget one stop in the sequence of shopping stops.It’s also not uncommon for normal folks to lose track of time in the day.

One of the early signs of Alzheimers though is getting lost in your neighborhood and not being able to find your way home. Patients forget their normal routes and how to return home.Getting lost is hard on both the individual and the family because it signals a serious level of problem. At the beginning of the disease, there are compensations a person can take – such as calling a cab – but as Alzheimer’s progresses, this kind of coping skill disappears as well.

Judgment Calls

This is a tough one to pin down.We all make decisions that, in hindsight, we wouldn’t do again. And we’ll keep on doing this because we’re human.

So this makes it a really tough call about an early sign of Alzheimers because there’s a line that gets crossed and it’s a hard one to identify.

Small decisions don’t make a lot of sense in individual circumstances.It’s not the big decisions that count here, it’s all the little ones – like wearing inappropriate clothes for the weather, cleaning out the house and giving things to strangers.

I had to remove the valuable jewelry from my mom’s cabinet when she started giving things away to other people out of the family.We did it by suggesting the grandchildren would like these pieces now rather than after she was dead.Mom liked that suggestion – I took the jewelry and she never missed or mentioned it all again.







diagnosis, symptoms

Signs of Alzheimers

May 5th, 10 / 0 Comments








When it comes to more distinct signs of Alzheimers Disease, the following scale may be of assistance.

Health care folks use this sliding scale in their decision making (it’s called the Global Deterioration Scale or Reisberg Scale.

This scale divides the progression into seven alzheimers stages.

Stage One

There is no cognitive decline – the patient has normal function and nobody knows the disease is working.

Stage Two

Very mild cognitive decline. The difficulty is understanding the severity of this sign of Alzheimers, deciding if it’s “normal” or whether it is Alzheimer’s.

Typical symptoms would include: memory lapses, forgetting familiar names and locations, normally found objects. Generally, the patient notices these things but othere do not. The difficulty is that it is a sliding scale. We all lose stuff – where’s the deciding line between normal and Alzheimers. At this point however, the patient is likely getting concerned.

Stage Three

This is where the family begins to see some cognitive decline and clear signs of Alzheimers. In some individuals, the disease can be diagnosed (but not in all patients at this early stage)

You’ll see mild forgetfulness, difficulty learning new things but still possible to do so, difficulty concentrating or a lowered attention span, some difficulty with geography and a tendency to get temporarily lost.

This Alzheimers stage produces the first communication difficulties with finding the right word and misplacing valuables. Problem solving tends to become more difficult and if working, this may become noticeable faster. Friends, co-workers and family know there is an issue now.

Stage Four

We enter the world of moderate cognitive decline and the ability to diagnose the early stage of Alzheimer’s Disease.

Typical signs of Alzheimers at this stage include the loss of memory of the patient’s personal history, an increasing inability to handle complex tasks such as finances or travel arrangements. Multi-stage tasks become increasingly difficult. Patients tend to have a decreased knowledge of current events. There will be a deterioration in complex mathematical abilities (such as backward counting in multiples or multiplying numbers together – things that require some thinking in symbols)

Stage Five

This is moderate to mid-stage Alzheimers disease and here the person starts to require help with day-to-day tasks.

Typical symptoms would include major gaps in memories, forgetting often-used telephone numbers or the names of close friends (or even family). A loss of awareness or remembering recent events in their lives is now very evident.

Stage Six

Moderately to Severe (mid-stage) Alzheimers and the signs of Alzheimers are becoming more severe.

Symptoms would include starting to forget the name of the primary caregiver of close family members (often temporarily). Recent events are forgotten fairly quickly (within a few minutes).

Some assistance may be needed with daily living and help get dressed or bathed may be in order. Greater difficulty counting or with any math processing is evident.

At this stage we start to see some very evident emotional changes such as anxiety or confusion. There may be agitation, anxiety, hostility or the exact reverse. This often comes a a great surprise to the family – to see a formerly loved, happy person become anxious and hostile.

There may be obsessive or repetitive behavior of simple activities and sleep problems will be reported. Incontinence rears its head.

Stage Seven

When it comes to a sign of Alzheimers, this coincides with severe or late-stages.

Symptoms include: increasingly severe cognitive decline and most complex thinking activities are lost. Vocabulary continues to shrink and disappears at this stage. The ability to walk independently and sit without support disappears. Assistance is needed with all activities of personal hygiene and the patient is usually incontinent.

Summary

These are the “typical” symptoms and progression. There is no one-size fits all here – each individual will be different and the movement between stages isn’t clear nor is it consistent. These signs of Alzheimers should be treated as guldeposts rather than a distinct road-map.

You do your best.







diagnosis, symptoms

Alzheimers Symptoms

May 5th, 10 / 0 Comments








Alzheimers symptoms generally fall into several areas but it is first important to understand that *everyone has occasional memory problems*

At least I do.

So it’s a fairly normal part of being alive to “forget” something (like birthdays but hopefully not anniversaries). And forgetting something doesn’t mean you have Alzheimer’s.

I look at it as being in the moment. And the length of that moment simply shortens as the diseease progresses. So while healthy folks have very long moments – years in fact – those with Alzheimer’s or early Alzheimers symptoms have progressively shorter moments till they become measured in minutes or seconds.

Here are some of the Alzheimer’s symptoms.


Increasing the number of times you forget something and the persistence of this.

So you tend to forget recent things, you forget more of them and this doesn’t get better with time. Note that sometimes medications can cause symptoms of forgetfullness or
confusion. I routinely forget the names of people I’ve met but the Alzheimer’s patient forgets names of people they’ve known well. This progresses until even family members can’t be recognized.

Abstract thinking becomes more difficult.

For example, if you’ve always had trouble balancing the checkbook, then you don’t have Alzheimer’s. But if you start having trouble and can’t seem to get it right over time – then this is an example of abstract thinking degrading. Numbers are one thing that seems to be a target and obvious symptom for many folks. The ability to deal with things that contain numbers is abstract thinking.

Ever have trouble finding the right word.

As a writer, this is a feature of my everyday life but when it starts becoming worse, then it’s a symptom. The use of language degrades and eventually even writing or reading become difficult.

Disorientation in time and date.

This has been one of the marked Alzheimers symptoms in my family and it progressively gets worse as the disease progresses. Knowing what date or even day of the week it is disappears.

There’s a loss of the ability to plan or make judgements about situations.

So it is entirely possible to plan to make dinner but forget to take the burning pot off the burner. Or to think you’ve eaten dinner when you haven’t.

Again, this starts with small things and progresses.

Burning pots and the associated fire risks are often one of the signals that families use to obtain care for their loved one. A friend told me she hadn’t known how bad the problem was with her mother until she found multiple sets of old pots/pans cardboard packing boxes in the basement.

Cooking or other sequential tasks become harder to do as one part of the sequence is forgotten.

If you see a sequence changing, then you might want to pay attention. In my grandfather’s case, he always went to work on the same streetcar, same route, same
time but one day he forgot where the streetcar stopped. That was his last day of work.

Mood swings or personality changes might occur.

Stubborness, distrust, anger or the opposite – complete goodwill towards all mankind might emerge. One friend’s mother, who was quite the harridan while we were growing up became all light, love and good cheer as the disease progressed.

Restlessness or increased anxiety and inappropriate behavior might occur.

Most Frightening Thing

One of the most frightening things is that individuals with this disease know it is happening to them.

And they hide it, keeping the problems to themselves for as long as possible.

Even family doctors are not told. So when we do finally recognize some of the extreme behaviors, we also recognize the smaller signs that had been present for some time. My mother developed excellent coping skills and her actiing ability was such that not even close friends knew she had no idea who they were during their conversations.

These are the basic early Alzheimers symptoms in plain language and I hope they help you understand a bit better.

As with all things, a little bit of these things may be normal but it’s the pattern of them that add up to the diagnosis.

Bottom line

One of the first questions I asked our family physician was how long this was going to last – how long did my formerly extremely-bright mother have to live with this problem – her own version of hell?

The answer was a little surprising. Once Alzheimers symptoms are confirmed and the diagnosis is made, the average lifespan is 8 years.

The first three years are the best in terms of performance but survival and problems increase dramatically after that.

So the pattern of Alzheimers symptoms we saw are simply getting worse month by month.







diagnosis, symptoms

Alzheimers Disease Stages

Feb 15th, 10 / 0 Comments







The progression of Alzheimer’s Disease stages is fairly well known but the movement between the stages (figuring out which one a patient is in) and the speed of movement is quite an individual matter. There is no one-size fits all in this progression or length of time in each stage.

Some Things to Consider

The symptoms, the order in which they appear and the severity of those symptoms will be different for each patient (as will the effect on their lives and that of their family’s)

Stages overlap so there is no clear progression between stages. And there is often a plateau – where relatively rapid decline is followed by a longer period of seemingly lack of change.

The movement from stage to stage (because of the overlapping) can be quite subtle just as the initial diagnosis may have been difficult, so too is clearly defining the individual stages.

We’re looking at a (rough) estimate of 7-10 years for the disease to progress (although there are variations out of the average).

From a family point of view, the patient is losing ability but all care providers emphasize it is important for the family to support the patient by focussing attention on the abilities the patient is left with rather than emphasizing what has been lost.

The Stages

Early Stage

Mild impairment including (but not limited to) forgetfulness, problems expressing themselves, changes in mood or behavior. At this early stage, the patient requires minimal care and assistance. They likely have some sense of what’s happening and can discuss the problem and help with directing care plans.

Middle Stage

This second of Alzheimers disease stages is where serious decline begins, memory declines and other cognitive abilities continue to deteriorate. At this stage, the person may still retain the knowledge of the problem but clearly requires help in daily living.

Later Stages

The disease progresses, the patient loses knowledge of their memory loss, increasing amounts of care are required for daily living, generally a 24/7 level of care is required to handle an increasing level of tasks the patient can no longer accomplish. Some physical symptoms begin e.g. incontinence and communication abilities deteriorate. The patient loses a sense of location, getting lost easily.

End of Life

At this stage, the person increasingly stops functioning in the world and nursing care is increasingly required for feeding and personal care. The person stops walking and continues to physically decline. The focus on care at this point is quality of life and comfort.

There is a Global Deterioration Scale that you may find useful because it tends to pinpoint in greater accuracy this deterioration and can be used for discussions with physicians.

But the above are the main Alzheimers disease stages that are commonly used by support people to discuss the patient’s needs.







diagnosis