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Ency. home > Disease > A > Alzheimer's disease

Alzheimer's disease   

Overview | Symptoms | Treatment | Prevention

Alternative names:

Senile dementia/Alzheimer's type (SDAT)

Treatment

AD cannot be cured and the impaired functions cannot be restored.  Currently, the progression can be slowed but not stopped. 

Treatment focuses on attempting to slow the progression; managing the behavior problems, confusion, and agitation; modifying the home environment; and most importantly, supporting the family.  As the disease progresses, it may take a greater toll on the family than the patient.

Drug Treatment
There are currently three drugs available to try to slow the progression of the disease and possibly improve cognitive function.  These three are tacrine (Cognex), donepezil (Aricept), and rivostigmine (Exxelon). 

All three affect the level of acetylcholine (a neurotransmitter) in the brain.  All three have potential side effects, such as nausea and vomiting.

Tacrine, the first drug of this type approved, also causes an elevation in liver enzymes and must be taken four times a day.  It is now seldom used. 

Of the two other drugs, Aricpet has been available longer.  It is taken once a day and has been reported to improve or stabilize cognitive functioning and is well tolerated.  Exxelon, a new drug, shows similar efficacy as Aricept and is taken twice a day. New drugs are scheduled for release in the near future.

To improve cognitive function, it may be necessary to stop medications that worsen confusion or that are not essential to the care of the person. This may include medications such as anticholinergics, analgesics, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and other medications.

Behavioral Problems
Underlying disorders that contribute to confusion should be identified and treated. These include heart failure, decreased oxygen (hypoxia), thyroid disorders, anemia, nutritional disorders, infections, and psychiatric conditions such as depression. The correction of these medical and psychiatric disorders often greatly improves the patient's mental function.

Medications may be required to control aggressive, agitated, or dangerous behaviors. These are usually given in very low doses, with adjustment as required.

Behavior modification may be helpful for some people in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety).

Support for the Family
Family members of people with AD need to know:
  • About the disease and effective approaches to care
  • How to locate and use respite services, such as adult day care and home companions
  • How to receive individual and family counseling
  • How to participate in support groups

The Alzheimer's Association is a voluntary organization with chapters in many states. It offers information on the disease, resources for health care, and support groups. Their web site offers a way to locate chapters through out the US.

The National Institute on Aging provides a web site and toll-free telephone line to answer questions about the disease, order publications, and learn about the latest research findings.  The telephone number is 800-438-4380. 

Another resource is The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life by Nancy L. MacE, et al. This book helps equip families with the tools to care for relatives with dementia.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for people with AD and can help relieve stress on the family.

Legal advice early in the course of the disorder is essential to avoid legal and financial problems for the patient and the family as the disease progresses.  Advance directives, a power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of an AD patient.

Modifying The Home Environment
The person with AD also needs support.  Family members or other caregivers can help by understanding how the person with AD perceives his or her world.  Provide structured activities that promote the remaining abilities and reduce the effects of the compromised abilities. 

Simplify the patient's surroundings, and give frequent reminders, notes, lists of routine tasks, or directions for daily activities.  Give the person with AD a chance to talk about their challenges and to participate in their own care.

Other Practical Steps
The sensory functions of the person with AD should be evaluated.  If deficits are found, the patient should be assisted by hearing aids, glasses, and cataract surgery. General nutrition and health maintenance is important, but special diets or nutritional supplements are usually unnecessary. Exercise is important and should be encouraged.

Eventually, 24-hour monitoring and assistance may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs. This may include in-home care, boarding homes, adult day care, or convalescent homes.

Prognosis

The probable outcome is poor. The disorder is usually not acute, but progresses steadily. Total disability is common. Death normally occurs within 15 years, usually from an infection or a failure of other body systems.

Complications

  • Loss of ability to function or care for self
  • Complications caused by immobility
  • Bedsores
  • Broken bones
  • Muscle contractures (loss of ability to move joints because of loss of muscle function)
  • Loss of ability to interact
  • Increased incidence of infections anywhere in the body
  • Failure of body systems
  • Reduced life span
  • Abuse by an over-stressed caregiver
  • Side effects of medications

Call Your Health Care Provider If:

Call your health care provider if someone close to you experiences symptoms of senile dementia/Alzheimer's type.

Call your health care provider if a person with this disorder experiences a sudden change in mental status. (A rapid change may indicate other illness.)

Discuss the situation with your health care provider if you are caring for a person with this disorder and the condition deteriorates to the point where you can no longer care for the person in your home.

Ency. home > Disease > A > Alzheimer's disease

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