Alzheimer's Disease
Treatment Overview
While there is not yet a cure for Alzheimer's disease, there is much that can be done to maintain quality of life, and help the person stay active.
Initial treatment
Medicines called cholinesterase inhibitors may be started as soon as Alzheimer's disease is diagnosed. These medicines—which include donepezil hydrochloride (Aricept), galantamine (Reminyl), and rivastigmine (Exelon)—may temporarily help with memory and thinking problems caused by the disease. The effect of these medicines usually is not dramatic, and they may not work for everyone who has the disease. Even though cholinesterase inhibitors may slow the progression of symptoms, they do not prevent the disease from getting worse. However, most experts agree that cholinesterase inhibitors are worth trying for most people who have Alzheimer's disease.
Another medicine, called memantine (Ebixa), may be used alone or with cholinesterase inhibitors to treat moderate to severe symptoms of confusion and memory loss caused by Alzheimer's disease.
For more information on when or whether to take medicines, see:
Another important aspect of initial treatment is detecting and treating any other medical problems the person may have. For instance, depression occurs in nearly half of people with Alzheimer's disease, especially those in the early stage of the disease who are aware of what the future holds for them. Detecting and treating conditions such as depression can minimize disability and maximize the person's remaining abilities.
Newly diagnosed individuals and their families face important questions during initial treatment:
- What kind of care does the person need right now?
- Who will take care of the person in the future?
- What can the family expect as the disease progresses?
- What kind of planning needs to be done?
Education of the family and other caregivers is critical to successful care for a person with Alzheimer's. If you are or will be the caregiver, start learning what you can expect and what you can do to manage problems as they arise.
Ongoing treatment
If treatment with a cholinesterase inhibitor medicine seems to be helping the person with Alzheimer's disease, it can be continued until it is no longer helpful. The medicine may remain effective longer in some people than in others. Treatment may be stopped at any time if the person is unable to tolerate side effects from the medicine.
Regular assessment by a health professional helps evaluate the person's response to medicine, detect new problems, monitor changing symptoms, and provide continuing education to the family. Decisions about treatment for behaviour problems or other issues often need to be revisited as the disease progresses. A general guideline is that a person with Alzheimer's should see the doctor every 6 months, or sooner if a problem arises.
It is important to continue watching for and treating other conditions. Hearing and vision loss, arthritis, thyroid problems, kidney problems, and other conditions are common in older adults and may aggravate symptoms of Alzheimer's. Arthritis may make it harder to move around without help. A hearing or vision problem may make the person more agitated, anxious, or unresponsive. Treating these problems can improve quality of life and ease the burden on the caregiver.
Most people with Alzheimer's disease can be cared for at home by family or friends, at least until the disease becomes severe. Ongoing treatment focuses on making the most of the person's abilities as they change and dealing with new problems as they arise. Caregiving tasks range from maintaining a safe environment and helping the person get dressed every day to finding ways to manage or minimize disruptive behaviours such as wandering and sleep problems. No single strategy works for everyone. Successful care also depends on making sure the caregiver is involved in making decisions about treatment. These decisions will affect both the person with the disease and the caregivers.
If you are a caregiver for someone with Alzheimer's, finding help and support is crucial to the person with Alzheimer's and your own well-being. Taking advantage of respite services or adult daycare, seeking help from family and friends, and taking care of yourself are key to providing ongoing care. Seek support as soon as you need it. Contact the Alzheimer's Society at 1-800-616-8816 or visit the Web site (www.alzheimers.ca) for help and advice on being a caregiver for someone with Alzheimer's disease.
Treatment when the condition gets worse
As Alzheimer's disease progresses, providing care at home usually becomes more and more challenging. Being a caregiver for someone with Alzheimer's is not easy, no matter how much you know about the disease and how committed you are to taking care of the person. The decision to place a family member in a nursing home or other facility can be a very difficult one, but sometimes nursing home placement is the best choice. For more information, see:
What To Think About
Hospice palliative care
As Alzheimer's disease gets worse, you may want to think about hospice palliative care. Hospice palliative care is a kind of care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure a disease, called curative treatment. Hospice palliative care focuses on improving quality of life—not just in the body, but also in the mind and spirit. Some people combine hospice palliative care with curative care.
Hospice palliative care may help with symptoms or side effects from treatment. It may also help your family make future plans around medical care. It could even help the person living with the disease or his or her caregivers to understand Alzheimer's disease or better cope with feelings about living with the disease.
If you are interested in hospice palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Hospice Palliative Care.
End-of-life care
Because Alzheimer's disease gets worse over time, people may want to consider discussing health care and other legal issues that may arise near the end of life. Many people find it helpful and comforting to state their health care choices in writing (with an advance directive or living will ) while they are still able to make and communicate these decisions. Some people want every possible medical treatment to sustain life, while others prefer measures to maintain their comfort without prolonging life. It may be helpful to think about what kind of medical treatment you want. For more information, see the topic Care at the End of Life.
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| Author: | Douglas Dana Sabra L. Katz-Wise Ralph Poore | Last Updated: January 26, 2007 |
| Medical Review: | Adam Husney, MD - Family Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine Peter J. Whitehouse, MD - Neurology | |
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