By Kristine Dwyer, Staff Writer
AD changes the brain in many ways, which results
in a decrease of acetylcholine levels. It is
believed that acetylcholine is a chemical messenger
that is important for memory, thought and judgment.
The US Food and Administration currently approves
five prescription drugs, yet only three are actively
marketed for the treatment of mild to moderate AD.
According to the Mayo Clinic, these medications are
referred to as cholinesterase (ko-lin-ES-tur-ase)
inhibitors and seem to improve the effectiveness of
acetylcholine, either by increasing the amount in
the brain or strengthening the way nerve cells
respond to it. The top three cholinesterase
inhibitors are Aricept, Razadyne and Exelon. They
have all been effective treatment options in
clinical trials. The other two medications are:
Cognex, which has been on the market since 1993 but
is rarely prescribed, and Namenda, which is the
first drug approved by the FDA to treat moderate to
severe dementia and may be co-prescribed with
cholinesterase inhibitors. Treatment with
medications has revealed delays in nursing home
placements and improvements in cognition and
functional abilities in many patients with AD.
Doctors usually start patients on a low dosage of
medication and then gradually increase the dosage
based on the tolerance level of the patient.
According to a journal of the American Academy of
Family Physicians, the above named medications have
a low incidence of serious reactions, but they do
have common side effects that can occur such as
nausea, vomiting, diarrhea or weight loss. Tolerance
to these medications often develops over time.
Cholinesterase inhibitors must be taken regularly
and in a sufficient dosage to benefit the patient.
Interruptions of the drug treatment over time will
result in sustained or irreversible cognitive
decline. If a patient is unlikely to follow a drug
regimen or has an illness that could interrupt the
drug regimen, benefits will decrease and patients
may face greater side effects. The healthcare
provider should consult with the patient and the
family to decide together on the best plan of
treatment. Pharmacists are also a valuable resource
for medication information.
It is important to understand that medication
alone cannot stop the disease and medications do not
work for everyone. For those who are helped, the
effects may be only modest or temporary. Treatment
with medication may help prevent symptoms such as
depression, sleeplessness or wandering from becoming
worse for a period of time and can help keep
behavioral symptoms under control. Periodic
monitoring and testing of a patient’s functional and
cognitive abilities is also recommended. These
results may offer encouragement to the patient’s
family and can serve as a guide for doctors,
patients and families in planning for the future.
Clinical Trials:
The best evidence of progress in AD research lies in
the growth of clinical testing of treatments,
prevention of the disease and diagnosis. This alone
gives patients and families a reason to hope.
Advances in our knowledge and understanding of AD
have also led to the development of many new drugs,
diagnostic tests and treatment plans. Scientists now
recognize the need for earlier detection of AD and
are devising new brain imaging techniques and lab
tests that could improve diagnosis. One landmark
trial that began in 2005 is the Alzheimer’s Disease
Neuroimaging Initiative. The goal of this trial is
to determine whether standardized brain images
combined with laboratory and psychological tests may
offer a better way to identify those at risk for
Alzheimer’s, track disease progression and monitor
treatment effects.
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