Expert: Mary Gordon - 7/8/2010

Question
Please list the medications used and any supplements

Answer
Hi Marla,

First off, it's really important that the person have an accurate diagnosis, done by a geriatric psychiatrist or neurologist with a specialty in dementias. There are many, many causes of dementia. Drugs that help one kind that can actually make other kinds worse. It is also common for older people to have more than one illness causing dementia at the same time. For example, many people have Alzheimer's and are also having mini-strokes. If only a general practitioner has put the label of Alzheimer's on a person, you will want to ask to be referred to a specialist to confirm that is exactly what is going on, so you can be sure that the person is getting appropriate medications. Lewy Body dementia is a common cause of dementia, and people with this illness can be made very ill by some of the common medications used for Alzheimer's.

There is no evidence that dietary supplements can help people with the common progressive dementias like Alzheimer's, multi-infarct (mini-strokes), Lewy Body, Parkinson's etc. I would be very cautious about giving vitamins or minerals to anyone without consulting with their doctor first. Many people with dementia are older and have complicated health situations, and sometimes supplements are not really a good idea. A proper balanced diet is really the best approach. If you are afraid the person is not eating properly, you might want to try adding balanced nutrition drinks like Boost or Ensure to their menu.

What is a good idea to preserve mental function is to follow medical advice and make sure the person's overall health is well looked after. This means eating well, getting enough sleep, exercising, taking medications as prescribed, keeping diabestes, cholesterol and blood pressure under control etc.

You also have to keep in mind that everyone is very different. Among the various medications used for Alzheimer's, not one is a cure. The best you can hope for is that the medications will slow down the progress somewhat and only for a while. None of the medications work for everyone, and some of them have side effects, interactions with other medications, or impacts on other health problems that rule them out for the person.  

The most common medications are cholinesterase inhibitors such as Razadyne® (galantamine, formerly known as Reminyl® and now available as a generic drug), Exelon® (rivastigmine), and Aricept® (donepezil). Another drug, Cognex® (tacrine), was the first approved cholinesterase inhibitor but is rarely prescribed today due to safety concerns. There is also a glutamate regulator called Namenda® (memantine) which works very differently that the prior category of medications. It is often prescribed in combination with the cholinesterase inhibitors (i.e. the person may be on namenda and aricept together.

Besides these medications, a person with Alzheimers may have a number of problems due to their dementia, such as mood and sleep problems. They may be very depressed, anxious, agitated. They can have delusions or hallucinations, be paranoid - all things that can be very distressing both for them and those who care for them. Because of this, many people are prescribed sleep drugs, and psychiatric medications like anti-psychotics, anti-depressants, sedatives etc. These drugs often require a lot of trial and error to find the right ones, and the right dose, and are often needed only short term - in other words, the agitation or depression may pass off as the illness progresses. Also, what works for one person will not work for another, so it's often necessary to be patient and try a few before hitting on something that helps make the person feel less miserable.

Here is some general information on the various drugs for behavior and mood problems.
http://www.alz.org/alzheimers_disease_behavioral_symptoms_ad.asp


Hope this helps.

Mary