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Detection of Alzheimer's
By Kristine Dwyer, Staff Writer
Page 2

Treatments and Medication Benefits:

Although there is no cure for AD, new and improved treatments are on the horizon and offer hope. Most health professionals feel that the best plan of treatment includes a combination of medication, changes in lifestyle and support, along with a goal of managing symptoms that affect memory, thinking and behavior. The regional director of the Alzheimerís Association of Minnesota-North Dakota points out that there is a growing interest in the use of non-medical interventions that may be effective on their own or used in combination with medications.  These interventions may include memory and communication aids, speech therapy, behavioral therapies, memory stimulation therapy, exercise, adequate sleep and  education. The environment also strongly influences the health and capabilities of persons with AD; thus, it is important for caregivers to pay attention to safety factors, reduce stimuli and adjust the surroundings to accommodate the disease.   

AD changes the brain in many ways, which results in a decrease of acetylcholine levels. It is believed that acetylcholine is a chemical messenger that is important for memory, thought and judgment. The US Food and Drug Administration currently approves five prescription drugs, yet only three are actively marketed for the treatment of mild to moderate AD. According to Mayo Clinic, these medications are referred to as cholinesterase (ko-lin-ES-tur-ase) inhibitors and seem to improve the effectiveness of acetylcholine either by increasing the amount in the brain or strengthening the way nerve cells respond to it. The top three cholinesterase inhibitors are Aricept, Razadyne and Exelon. They have all been effective treatment options in clinical trials. The other two medications are: Cognex, which has been on the market since 1993 but is rarely prescribed, and Namenda, which is the first drug approved by the FDA to treat moderate to severe dementia and may be co-prescribed with cholinesterase inhibitors. Treatment with medications has revealed delays in nursing home placements and improvements in cognition and functional abilities in many patients with AD.

Doctors usually start patients on a low dosage of medication and then gradually increase the dosage based on the tolerance level of the patient.  According to a journal of the American Academy of Family Physicians, the above named medications have a low incidence of serious reactions but they do have common side effects that can occur such as nausea, vomiting, diarrhea or weight loss.  Tolerance to these medications often develops over time. Cholinesterase inhibitors must be taken regularly and in a sufficient dosage to benefit the patient. Interruptions of the drug treatment over time will result in sustained or irreversible cognitive decline. If a patient is unlikely to follow a drug regimen or has an illness that could interrupt the drug regimen, benefits will decrease and patients may face greater side effects.  The healthcare provider should consult with the patient and the family to decide together on the best plan of treatment. Pharmacists are also a valuable resource for medication information.

It is important to understand that medication alone cannot stop the disease and medications do not work for everyone. For those who are helped, the effects may be only modest or temporary. Treatment with medication may help prevent symptoms such as depression, sleeplessness or wandering from becoming worse for a period of time and can help keep behavioral symptoms under control. Periodic monitoring and testing of a patientís functional and cognitive abilities is also recommended.  These results may offer encouragement to the patientís family and can serve as a guide for doctors, patients and families in planning for the future.

Clinical Trials:

The best evidence of progress in AD research lies in the growth of clinical testing of treatments, prevention of the disease and diagnosis. This alone gives patients and families a reason to hope. Advances in our knowledge and understanding of AD have also led to the development of many new drugs, diagnostic tests and treatment plans. Scientists now recognize the need for earlier detection of AD and are devising new brain imaging techniques and lab tests that could improve diagnosis. One landmark trial that began in 2005 is the Alzheimerís Disease Neuroimaging Initiative. The goal of this trial is to determine whether standardized brain images combined with laboratory and psychological tests may offer a better way to identify those at risk for Alzheimerís, track disease progression and monitor treatment effects.

Clinical trials are the final testing ground for new treatments that are currently under investigation. Each trial represents the results of years of scientific thought, observation, and data analysis and is only possible through the participation of patients and their family members. Clinical trials are the principal way that researchers can discover whether a treatment is safe and effective for patients, especially for those in the early stages of the disease. Trials take place at private research facilities, specialized AD research centers, teaching hospitals and even at physiciansí offices. Taking part in a clinical trial can be a big step for both the patient and the family so itís necessary to discuss the expectations and pros and cons of participation with the clinical trials staff.

There are two kinds of drug trials available:

  • Treatment trials with existing drugs that assess whether an already approved drug may be useful for other purposes. For example, an arthritis treatment may help in the prevention of AD.

  • Treatment trials with experimental drugs or approaches to discover whether a new drug or treatment approach may help improve memory function, decrease symptoms, slow the progression of AD or prevent it altogether. Each one of these clinical trials includes up to three phases. Once these phases are complete and investigators are satisfied that the treatment is safe and effective, the research team can submit its results to the Food and Drug Administration (FDA) for review.

When a person signs up for a clinical trial, they are asked to sign an informed consent form to ensure that they are protected and well cared for during the study. If a participant is unable to provide informed consent because of memory loss, it is still possible for an authorized representative (usually a member of the family) to give permission. Next, patients go through a process of screening to see if they qualify and can safely participate before they proceed with the study. Although clinical trials may not produce miraculous results, many participants believe that even if the benefit to them is small, they are making a valuable contribution toward future research.  Family members have also found that the best benefit of participating in a clinical trial is the regular contact with the research team.  The team can be a link to education, provide advice on the emotional and physical aspects of AD, and offer supportive and helpful information.

The amount and variety of clinical trials underway are a sign of the intensity of research to seek solutions for a disease that robs the mind and takes away the essence of a personís life. Current clinical trials are available on the Internet under or by contacting the Alzheimerís Association or the Alzheimerís Disease Education and Referral Center (ADEAR) at 1-800-438-4380 (a service of the National Institute on Aging).

Caring for a person with AD can be likened to driving on an unfamiliar road, riding a roller coaster or even walking on a tightrope. It can be an incredibly stressful ride, yet rewards can also be visible. The key is to balance your own needs against those of the person you are caring for day to day. Many caregivers find that they are stronger than they ever thought possible and that they feel rewarded knowing they have stayed committed to helping a loved one during the difficult years.

Caregiving can produce a great deal of stress that can lead to physical decline and emotional exhaustion. The health of caregivers is at risk, yet they often become the Ďhidden patientsí while focusing all of their attention on the person with AD. Caregivers need to keep their own health in check and visit their doctor on a regular basis. Support systems must also be alert to signs of caregiver burnout or depression and plans must be made to provide respite to the caregiver. No one can do it all alone. It is heartbreaking to watch a loved one go through the stages of Alzheimerís disease and caring for them requires an abundance of courage and strength.  Asking for help and taking care of yourself cannot be overemphasized. 

The Alzheimerís Association assistance is available nationwide and offers a wide variety of programs, educational materials and support services to persons with AD and their caregivers. Many communities have a local or regional chapter and offer regular education and support group meetings. The Alzheimerís Association also provides:

  • A 24-hour, tollfree (multilingual) Information Helpline (800) 272-3900 that links callers to information about AD, treatments, caregiving strategies and local programs.

  • The nationís largest Alzheimerís library including books, journals, cassettes, videos and CDs that can be obtained through interlibrary loans at your local library.

  • Internet support at, including online chat rooms, research updates, brain health tips, the new CareFinder program that assists caregivers in planning care and finding support and the Safe Return program, which helps families locate a loved one who has wandered off or gotten lost.  This Internet site is set up to help families and caregivers make informed decisions.

  • Care Consultationó one of the core services of the Alzheimerís Association (available in most states) that assists the person with AD or related dementias and their family in planning for, and dealing with, all aspects of the illness experience.

In addition to contacting the Alzheimerís Association, consider care options such as in-home respite care, adult day programs, home care services, delivered meals programs, or chore services. Keep a personal journal of your journey or a medical journal to record helpful information for yourself and the physician. Continue with activities that are enjoyed. Maintain a network of support and communicate your needs to family members, friends, volunteers, and organizations to avoid isolation. Join a caregiver support group to find hope, gain valuable information from people who understand your position and learn new ways to cope with the challenges you face.

Alzheimerís disease impacts the whole family. Like a pebble thrown into the water, the ripples of the disease touch the lives of everyone. The signs and symptoms of AD canít be ignored! Early detection and current treatments can help maintain or even improve memory, thinking and behavior problems plus support the quality of life for persons with AD and their caregivers.


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