brain, spinal cord, and nerve disorders
Alzheimer Disease
Treatment of Alzheimer Disease
Safety and supportive measures Medications that may improve mental function Treatment of Alzheimer disease involves general measures to provide safety and support, as for all dementias. Also, certain medications can help for a while. The person with Alzheimer disease, family members, other caregivers, and the health care practitioners involved should discuss and decide on the best strategy for that person. Pain and any other disorders or health problems (such as a urinary tract infection or constipation) are treated. Such treatment may help maintain function in people with dementia. Creating a safe and supportive environment can be very helpful. Generally, the environment should be bright, cheerful, safe, stable, and designed to help with orientation. Some stimulation, such as a radio or television, is helpful, but excessive stimulation should be avoided. Structure and routine help people with Alzheimer disease stay oriented and give them a sense of security and stability. Any change in surroundings, routines, or caregivers should be explained to people clearly and simply. Following a daily routine for tasks such as bathing, eating, and sleeping helps people with Alzheimer disease remember. Following a regular routine at bedtime may help them sleep better. Activities scheduled on a regular basis can help people feel independent and needed by focusing their attention on pleasurable or useful tasks. Such activities should include physical and mental activities. Activities should be broken down in small parts or simplified as the dementia worsens. People with dementia can benefit from an environment that is the following: Safe:Extra safety measures are usually needed. For example, large signs can be posted as safety reminders (such as “remember to turn the stove off”), or timers can be installed on stoves or electrical equipment. Hiding car keys may help prevent accidents and placing detectors on doors may help prevent wandering. If wandering is a problem, an identification bracelet or necklace is helpful. Familiar:People with dementia usually function best in familiar surroundings. Moving to a new home or city, rearranging furniture, or even repainting can be disruptive. Stable:Establishing a regular routine for bathing, eating, sleeping, and other activities can give people with dementia a sense of stability. Regular contact with the same people can also help. Planned to help with orientation:A large daily calendar, a clock with large numbers, a radio, well-lit rooms, and a night-light can help with orientation. Also, family members or caregivers can make frequent comments that remind people with dementia of where they are and what is going on. Thecholinesterase inhibitorsdonepezil,galantamine, andrivastigmineincrease the level of acetylcholine in the brain. (Acetylcholine is a neurotransmitter that helps with memory, learning, and concentration.) This level may be low in people with Alzheimer disease. These medications may temporarily improve mental function, including memory, but they do not slow the progression of the disease. Only some of the people who have Alzheimer disease benefit from these medications. For these people, the medications may effectively turn the clock back 6 to 9 months. These medications are most effective in people with mild to moderate disease. The most common side effects include nausea, vomiting, weight loss, and abdominal pain or cramps. Memantineappears to help relieve symptoms of moderate to severe Alzheimer disease.Memantinecan be used with a cholinesterase inhibitor. Aducanumabis a newer medication that may be used to treat Alzheimer disease. It is injected under the skin once a month.Aducanumabis a monoclonal antibody designed to target beta-amyloid (an abnormal protein), which accumulates in the brain of people with Alzheimer disease. Studies showed thataducanumabcan reduce the number of beta-amyloid plaques in the brain. Thus, some experts predict thataducanumabmay eventually be shown to slow the progression of Alzheimer disease. However, according to others, more evidence is needed to show thataducanumabreduces the symptoms and slows the progression of Alzheimer disease. In addition,aducanumabhas side effects. It can cause swelling and bleeding in the brain, detected by magnetic resonance imaging (MRI). In most people, these abnormalities are small and do not cause symptoms, but a few people have severe symptoms, including confusion, disorientation, difficulty walking, loss of balance, blurred vision, headaches, nausea, and falls. Researchers continue to studyother medicationsthat may prevent or slow the progression of Alzheimer disease. Estrogen therapy for women, nonsteroidal anti-inflammatory drugs (NSAIDs, such asibuprofenornaproxen), andginkgobiloba have been studied. But none has consistently proved to be effective. Moreover, estrogen appears to do more harm than good. Vitamin Eis an antioxidant that theoretically might help protect nerve cells from damage or help them function better. Whethervitamin Eis useful is unclear. Before people take any dietary supplement, they should discuss the risks and benefits with their doctor. Caring for people with Alzheimer disease is stressful and demanding, and caregivers may become depressed and exhausted, often neglecting their own mental and physical health. The following measures can help caregivers: Learning about how to effectively meet the needs of people with Alzheimer disease and what to expect from them:Caregivers can get this information from nurses, social workers, organizations, and published and online materials. Seeking help when it is needed:Caregivers can talk to social workers (including those in the local community hospital) about appropriate sources of help, such as day-care programs, visits by home nurses, part-time or full-time housekeeping assistance, and live-in assistance. Counseling and support groups can also help. Caring for self:Caregivers need to remember to take care of themselves. They should not give up their friends, hobbies, and activities. Caring for people with dementia is stressful and demanding, and caregivers may become depressed and exhausted, often neglecting their own mental and physical health. The following measures can help caregivers: Learning about how to effectively meet the needs of people with dementia and what to expect from them:For example, caregivers need to know that scolding about making mistakes or not remembering may only make behaviors worse. Such knowledge helps prevent unnecessary distress. Caregivers can also learn how to respond to disruptive behavior and thus calm the person more quickly and sometimes prevent disruptive behavior. Information about what to do on a daily basis may be obtained from nurses, social workers, and organizations, as well as from published and online materials. Seeking help when it is needed:Relief from the burdens of around-the-clock care of a person with dementia is often available, depending on the specific behavior and capabilities of the person and on family and community resources. Social agencies, including the social service department of the local community hospital, can help locate appropriate sources of help. Options include day-care programs, visits by home nurses, part-time or full-time housekeeping assistance, and live-in assistance. Transportation and meal services may be available. Full-time care can be very expensive, but many insurance plans cover some of the cost. Caregivers may benefit from counseling and support groups. Caring for self:Caregivers need to remember to take care of themselves. For example, engaging in physical activity can improve mood as well as health. Friends, hobbies, and activities should not be abandoned. Supportive measures is essential because Alzheimer disease is progressive. Long before a person with Alzheimer disease needs to be moved to a more supportive and structured environment, family members should plan for this move and evaluate the options for long-term care. Such planning usually involves the efforts of a doctor, a social worker, nurses, and a lawyer, but most of the responsibility falls on family members. Decisions about moving a person with Alzheimer disease to a more supportive environment involve balancing the desire to keep the person safe with the desire to maintain the person’s sense of independence as long as possible. Some long-term care facilities specialize in caring for people with Alzheimer disease. Staff members are trained to understand how people with Alzheimer disease think and act and how to respond to them. These facilities have routines that make the residents feel secure and provide appropriate activities that help them feel productive and involved in life. Most facilities have appropriate safety features. Finding a facility that has the appropriate safety features is important. Before people with Alzheimer disease become too incapacitated, decisions should be made about medical care, and financial and legal arrangements should be made. These arrangements are called Advance Directives . People should appoint a person who is legally authorized to make treatment decisions on their behalf (a health care proxy). They should discuss their As Alzheimer disease worsens, treatment tends to be directed at maintaining the person’s comfort rather than at attempting to prolong life. 