What to Do After a Diagnosis of Alzheimer's Disease
Most patients with dementia are never treated.
Posted January 1, 2011
First of all, in some small measure, you are one of the lucky ones. Yes, that's true. Most of the people in the world who now suffer with Alzheimer's disease are living out their lives without ever being accurately diagnosed. The majority of these so-called hidden demented will never be given any medication to quiet the anger or depression that plague their minds. Furthermore, most patients who do receive a diagnosis of Alzheimer's disease tend to be in the moderate or severe stages of the disease and are less likely to respond significantly to pharmacological intervention. Hopefully, if you have decent health care, you will likely be given some medications to ease some of your symptoms and slow the progression of the dementia.
Let me begin with a short list of some drugs to not bother trying regardless of what you might read in the popular media because they are either useless or harmful; these include ginkgo biloba, estrogen replacement therapy, megadoses of Vitamin E or aspirin, chelation therapy, and anything homeopathic or naturopathic. I was once approached by a physician hoping to get my support for his favorite therapy: digested beaver thymus! Families with a loved one suffering with Alzheimer's disease are often willing to try any treatment regardless how ridiculous sounding the claim or the ingredient.
Things that might help, at least according to epidemiological evidence, include coffee drinking, moderate beer consumption, increased consumption of cinnamon, curcumin, chocolate, and any colorful fruit or vegetable, keeping your mind as active as possible, getting lots of sleep and daily moderate aerobic exercise such as walking. Jean Carper recently published an excellent review of all possible things that one might do to prevent Alzheimer's disease in the first place. Some of these might also slow the progression of the dementia.
My laboratory has shown that marijuana can be quite beneficial in slowing the progression of age-related diseases that involve brain inflammation, including multiple sclerosis, Parkinson's disease, Alzheimer's disease, Huntington's disease, and a variety of autoimmune diseases. A few recent studies have suggested that people who smoked marijuana in the 1960's are today somewhat less likely to develop Alzheimer's disease. This is not an advertisement for you to take up smoking pot or drinking beer because you think doing so will save you from the ravages of these diseases. I mention the beneficial effects of these substances only to emphasize a point: Scientists know about the correlations between the regular use of these drugs and the reduced incidence of some age-related brain disorders because millions of people have administered billions of doses of these substances during the past thousand years, but only relatively recently has careful record-keeping allowed us to observe the quite subtle, yet very consistent, benefits provided by these drugs. Thus, it is only because these drugs are so widely abused that we've noticed their positive effects on the brain. There may be wonderful new drugs to be discovered in, say, cauliflower or haggis, but too few people have been willing to eat them in sufficient numbers and for a sufficient period of time for epidemiologists to take notice of their hidden benefits on our brain, if they exist.
There are, of course, some prescription medications that you will likely be prescribed. These include drugs that will enhance the function of acetylcholine in the brain, such as donepezil or galantamine or slow the loss of neurons and reduce brain inflammation, such as memantine. Do these drugs work? Usually the answer is quite mixed: generally, most people will experience modest or slight improvements, although a small percentage of patients may see significant, although transient, benefits in their cognitive status.
Sometimes the benefits of these therapies can be difficult for the physician to notice during annual visits. One neurologist told me that the only way he was able to recognize that the medications being given to his patients were working was that their caregivers required less anti-depressant medication. The burden on the caregiver can never truly be overstated. Often, simply being a caregiver can accelerate cognitive decline. This is too often observed as a side effect in the patient's spouse.
Patients and their caregivers often wish to know how fast the symptoms will progress. Some patients do indeed decline faster than others. The earlier and later stages of the disease show the slowest rate of mental decline, while the middle stages are associated with the fastest advance of the dementia. Overall, the rate of cognitive decline is influenced by genetic factors as well as whether or not the patient displays an abnormal EEG and overt psychotic symptoms. Psychosis typically predicts a faster cognitive decline and forecasts an earlier nursing home admission than is seen in patients without psychosis. The caregiver's burden, and the patient's own anxiety, can often be eased if the patient is given an anti-psychotic medication.
The situation for a newly diagnosed patient is not without hope, particularly if the diagnosis is made during the early phases of the disease.