Medication

Most diseases which cause dementia are progressive, which means that the symptoms will worsen over time. Unfortunately, there are currently no drugs treatments that can cure Alzheimer's disease or any other common dementia and no medicine will reverse or stop dementia. However, some medication is available to help some of the causes of dementia in some people. Certain medications can temporarily alleviate symptoms that affect thinking and memory (cognitive symptoms), others can help treat symptoms that affect mood and behaviour (non-cognitive symptoms).

An enormous amount of dementia-related treatment information from a wide variety of sources is directed to consumers, including information on medications, herbal products, diet, exercise, and nutrition. The vast amount of material and its sometimes questionable reliability can make it difficult to distinguish fact from rumour. Only a dementia care specialist should initiate the prescribing of a new anti-dementia medicine. A GP will continue to prescribe anti-dementia medication once treatment has been established and found to be beneficial to the patient for as long as the patient remains under the supervision of the specialist team. In the past, Jersey Alzheimer's Association and dementia health professionals from the Memory Clinic issued a warning about the danger of buying anti-dementia medication on-line. We continue to do so.

There are currently two types of medication used the treat Alzheimer's disease which both work in different ways. These have the generic / common name for the drug and the branded (producing company) name in brackets.

Cholinesterase Inhibitors

Acetylcholine is a chemical that helps pass messages between certain brain cells involved in memory. In Alzheimer's disease, these brain cells start to die and the amount of acetylcholine is very much reduced. Memory starts to suffer. Cholinesterase inhibitors reduce the breakdown of acetylcholine and increases its levels in the brain. This reduces some of the symptoms of Alzheimer's disease.

Acetylcholinesterase inhibitors considered as treatment options for people with mild to moderate Alzheimer's Disease include:

Donezepil (Aricept)

Galantamine (Reminyl)

Rivastigmine (Exelon)

There are no major differences between these drugs in terms of side effects and efficacy. They are all designed to help the symptoms of Alzheimer's disease - for example, memory loss and anxiety. They are not a cure, though they may slow the course of the illness and all differ in terms of duration of effect and dosing regime. The medication should be started by a dementia care specialist, the treatment regularly reviewed and assessed and the medicine only continued as long as it is thought to have a worthwhile effect. The most common side-effects are feeling sick, loss of appetite, tiredness, diarrhoea, muscle cramps and sometimes poor sleep. These may be reduced or avoided by increasing the dose slowly, or taking the medicine after food. The side-effects usually fade after a few weeks and will go away if the medicine is stopped. More information about side-effects can be obtained from your GP, pharmacist or the Memory Clinic and by reading the leaflet that comes with the medicine.

Cholinesterase inhibitors are not usually beneficial for people with vascular dementia, though may be prescribed to those with 'mixed dementia'. They may be helpful for people with dementia with Lewy Bodies as several studies have suggested that they might help not only with memory loss and confusion, but also other symptoms such as visual hallucinations. (4)

Memantine (Ebixa)

This drug is also licensed for the treatment of Alzheimer's disease in some people. It is thought to work by affecting a chemical in the brain called glutamate. In Alzheimer's disease, too much glutamate leaks out of damaged brain cells and interferes with learning and memory. The main side-effects of Memantine - which are usually mild - are nausea, restlessness, stomach ache and headache. This drug is used in moderate dementia if the cholinesterase inhibitors cause undue side-effects. It may also help in the more severe stages of the illness.

It is thought that about half the people treated with a cholinesterase inhibitor will see an improvement in symptoms that affect thinking and memory. Whether they help with other symptoms such as aggression and agitation has still not been confirmed. The improvement in symptoms is usually only seen for about 6-12 months. For memantine, some studies have shown that it can slow down the progression of symptoms in some cases. (2)

Research continues and new medicines are being developed to help with dementia, which show some promise. However, no new drugs have been licensed in the UK for Alzheimer's disease since Memantine in 2002 (3).

Treating people with dementia

Many drugs used for dementia are limited by side effects, short duration of action, and the need for frequent monitoring. The specialists at the Memory Clinic or the GP may be more cautious in an older person, probably starting from a low dose and very gradually building up the dose as side effects of all drugs are more common in older people. Sometimes there is some doubt about the diagnosis in the very early stages of dementia. Older people who suffer depression may feel, or even act, mentally confused. It may therefore be reasonable to try a course of anti-depressants if a person goes to the doctor with memory problems but also shows some of the characteristic signs and symptoms of depression.

Taking the medicine

Forgetfulness and disorientation make the taking of medication a problem in dementia. You may need to use special reminders or reminder-boxes (dose boxes) to make sure that the person actually takes the drug and does not take too much. Ask the doctor to simplify the drug prescription as much as possible, cutting out unnecessary drugs and giving them only once or twice a day. You may request blister packs of medication from pharmacies, some of which provide a home delivery service. Usually medication is taken in capsule or tablet form, but some can be taken by dissolving on the tongue, liquid or patches. Speak to your doctor or pharmacist if you have trouble with taking your prescribed medicine for any reason or are finding that doses are being missed. Your team will want you to get the best from your medicines and will be able to work with you to find a medicine in a formulation and regimen that suits you best.

Details submitted online as at April 2016

For more detailed and continued up to date information you may wish to visit these useful sites by following the links below:

References:

1.  http://patient.info/health/memory-loss-and-dementia

2.   http://patient.info/health/medicines-for-dementia

3.   https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=147

4. http://www.alzheimersresearchuk.org/about-dementia/helpful-information/treatments-available/

5. http://www.healthtalk.org/peoples-experiences/nerves-brain/carers-people-dementia/treatment-dementia

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Did you know?

The number of people with dementia is increasing rapidly. It is estimated that there are currently 1,400 people in Jersey living with dementia, many of whom have not as yet obtained a formal diagnosis; this number is set to double over the next 25 years.