Helpful Tips Concerning Medications:

• If the person is unable to swallow pills, ask your pharmacist if the medication comes in liquid form.
• Be certain that pills have been swallowed. Pills can be hidden in the cheek and under the tongue.
• Establish a routine for taking medications. It will help reduce the resistance and arguments.
• Medication boxes that separate pills by the day and time to be taken, can be a useful memory aid for both the person with dementia and the caregiver.

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Medications For Treating Dementia Symptoms

When the person with Alzheimer's disease exhibits extreme behavior, the doctor may prescribe certain psychotropic medications to help manage these symptoms. Drugs may be prescribed for agitation, depression, anxiety, hostility, delusions, hallucinations and other symptoms. The medications have the effect of normalizing mood, thought and behavior.

Each individual responds to medication differently. Some people may benefit. Some may show no change and some may even get worse. Older people generally have a lower tolerance for these medications than younger persons do. Brain impairments may keep the drugs from working as intended.

The physician usually begins with a low dosage and increases it slowly. This is a safer approach for the person with dementia. It allows the physician to monitor the individual's response to a medication. Lower dosages allow the body to gradually adjust to the medication.

Generally, medications can produce only moderate changes. Caregivers must not change the dosage even if the behavior is still occurring. In fact, more of the medication could create more severe symptoms. Giving more medicine than prescribed can also create more side effects, which can be dangerous, especially for the person with dementia. Only the physician should change dosages.

The caregiver should inform the physician of any other medications, vitamins and herbal pills the individual may be taking. The caregiver should consult the physician if side effects develop or if the medication is simply not working. It also is important for the caregiver to make sure the individual is receiving the proper dosage at the correct time.

Questions You Should Ask Your Doctor

• What are the benefits of taking the medication?
• How long will the person take the medication before an improvement will be seen?
• What dosage do you recommend?
• What should the person do if they miss taking a dosage?
• What are the known side effects of the medication?
• Should the person stop taking the medication immediately if a side effect occurs?
• What happens to the person if the drug is stopped suddenly?
• What changes in the person's condition should be reported immediately?
• What other prescription and over the counter drugs might interact with this medication?
• How might this medication affect other medical conditions?
• How often will the person need to visit the doctor?
• What are the costs of this medication?

Treating Cognitive Symptoms

Alzheimer's disease is most often characterized by loss of memory and decline in cognitive abilities such as thinking and reasoning. Four drugs have been approved by the U.S. Food and Drug Administration to treat these symptoms. Cognex®, Aricept®, Exelon® and Reminyl®. These medications are used with people in early to middle stages. They do not reverse the process or cure the disease, but some improvements in memory, attention, language, and the ability to perform simple tasks may occur.

Antipsychotics

The use of antipsychotic medication is intended to decrease psychotic symptoms. These symptoms may include hallucinations, delusions, excessive suspiciousness and paranoia. Other symptoms, such as agitation and aggression, are also frequently reduced with these drugs. In general, low doses of antipsychotics tend to be effective.

The side effects of the antipsychotics are numerous and often the person with dementia cannot express how they are feeling. Therefore, it is very important for the caregiver to be aware of the following potential symptoms. They include: drowsiness, sensitivity to light, weight gain, dry mouth, shakiness, difficulty urinating, constipation, restlessness, blurred vision, dizziness, hypotension, stiffness, fast heartbeat, drooling, headache and shuffling gait.

If the person is routinely taking an antipsychotic, it is recommended that periodically a dosage reduction be tried by physician order only. This is to assess if the current amount of medication the person is taking is still necessary. The person may benefit from reducing the amount of medication, there by reducing the potential side effects.

Antianxiety Agents

The purpose of antianxiety medications is to reduce symptoms of anxiety and agitation and related insomnia. They may be more appropriate for controlling anxiety and agitation when the individual is not experiencing more severe psychotic symptoms, such as hallucinations and delusions.

Side effects can include: over sedation, dizziness, fatigue, drowsiness, light-headedness, depression, unusual excitement, headache, blurred vision, nervousness, irritability and breathing problems.

As with other medications, use of antianxiety agents may not be appropriate if the person has certain other medical conditions. The doctor will take this into consideration. Withdrawal from this type of medication should also be supervised by a doctor since there can be problems if the person has taken the medication for a long time.

Pain Management

People with Alzheimer's disease and other dementia usually lose the ability to accurately express bodily discomfort or pain. The pain the person experienced from other medical conditions such as arthritis may be present with Alzheimer's disease and other dementia. They will also experience other common discomforts such as headaches, muscle aches, back pain, toothaches and skin conditions, to name a few.

The caregiver will need to watch for signs of unexpressed pain. These signs could include but would not be limited to increased pacing, inability to rest or relax, decreased appetite and increased agitation. Discuss these signs with the physician and provide pain medication to the person as ordered. The effectiveness of the medication and potential side effects will need to be monitored closely.

Antidepressants

It is difficult to know how common depression really is in older persons. It can be masked by other physical problems or the symptoms can be similar to those of dementia.

The purpose of the antidepressants is to improve the mood, increase energy, appetite, sleeping habits and social functioning. Some depressions can be treated successfully and the person's mental status will improve. The person with dementia cannot always tell you they are feeling "blue" or why they are sad. The caregiver can be aware of the following depressive symptoms of sleeping problems, agitation, fatigue, isolation, loss of appetite, excessive crying, feelings of hopelessness, or a preoccupation with physical complaints.

There are differences between each of the antidepressant medications that should be considered in choosing the right treatment. Side effects may include nausea, vomiting, diarrhea, headache, insomnia, nervousness and tremor. Some antidepressants may take several weeks to reach a level where they have an effect.

Sleeping Medications

Difficulty in falling asleep or awakening during the night without being able to go back to sleep, is frequently a problem for the person with Alzheimer's disease. There are some medications that can be helpful for short-term use. Sleeping medications that will take days to be metabolized by the body or habit forming should be avoided. They will "build up" in the body and have adverse effects on the person with dementia. Consult with your physician to obtain the most effective medication. Sleep aids should only be used for a short time while other non-drug treatments are tried.

Experimental Drugs and Treatments

Current research includes tests with experimental drugs and treatments. However, everyone will not be willing or eligible to become a research participant. Researchers have specific criteria, such as age, duration of disease and absence of other illnesses for those they accept into their studies. For those who do participate, there is the satisfaction of being involved in the development of a potential treatment for Alzheimer's disease.

Online resources with information about clinical trials includes the Alzheimer's Disease Clinical Trials Database (www.alzheimers.org/trials). This site provides information about Alzheimer's clinical trials, explanations of the Food and Drug Administration approval process and an e-mail announcement service regarding new trials.

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