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Question.
My dad, who is in his late 70's,
seems to be having more and more problems with his memory. One part of
me wants to just think it is part of the aging process; and yet, another
part of me worries that he may have dementia or Alzheimer's Disease.
My other siblings and I have talked about some of the agents we read about
regarding helping those out with Alzheimer's. Yet, we seem to get into
fights and cannot resolve the main issue as to whether dad should be receiving
one of these medications or not.
Can you provide any help in this family matter?
ER Paso Robles, CA
Answer.
Like so many other adult children you and
your siblings are wrestling with a growing problem in our country, namely
the aging of our parents, the normal loss of memory associated with aging
and the possible development of dementia of which Alzheimer's is one type.
First, lets talk about a recent VHS/DVD that I came across that deals
with the subject of Alzheimer's and is geared for family members and care
providers. What I liked the most about this video/DVD is that the makers
of this program want you to know that there is hope at any stage of the
disorder and things are not hopeless
The VHS/DVD is called: "Alzheimer's Disease: A New Hope Through Understanding."
The program is ideal for those wanting to learn more, nursing homes or
residential care facilities to have in their help libraries or for small
groups of people to share.
The short and very informative presentation is well organized and focuses
on the very issue you and your other family members may currently be wrestling
with.
What I found interesting about this particular program is that is goes
into great detail to lay out a proper understanding about the early phases
of the disease and what progress has been made over the last decade with
regards to the management of this problem.
The program provides concise and helpful information that is easy to understand
and allows for the viewer to see just where their loved one may be in
the process of aging and possible dementia and Alzheimer's. In addition,
the role of various healthcare professionals is explained as well as what
tests, medications and other supportive tools are currently available
to help the person with the problem and the loved ones providing care.
I found and so may you, that the way the behavioral aspects of the disease
are presented is both refreshing and enlightening. It is easy for people
to see the subtle changes in personalities that can take place in people
who develop or may be developing dementia or Alzheimer's.
At the end of the program there is a nice list of support organizations
that one can contact to receive more information related to caring for
and managing the disorder.
Unfortunately, unlike movie DVD's, you cannot return to certain sections
on the DVD should you have to stop the DVD to carry on with other business
or find that you did not have time to write down the information provided
at the end of the program. Yet, the DVD is not long, the cost is reasonable
and there is no commercialization at all in the video....a rare treat
in today's commercially oriented world.
Interestingly if you happen to be a nurse reading this review you can
obtain 1.5 CE hours along with a work book. The CE is on either in VHS
or DVD format and the workbook is on a CD-ROM.
You can obtain a VHS or DVD copy of this fine program by contacting Models
of Hope Media at 866-823-8851.
There currently is an introductory price for readers of this column of
$24.95 or $29.95 if you also want CE credit. Or you can order by mailing
your request to 13240 Clairepoint Way, Oakland, CA 94619. There is a modest
shipping and handling fee of $6.95 along with obligatory taxes.
Next, if you find you cannot afford the VHS/DVD program I'd like to share
with you some excellent resources that are available locally and on-line
if you have a computer.
In a recent article that appeared in The Wall Street Journal (September
2004) the following web sites were briefly discussed. You may find some
useful and informative information to help aid your family's decision
process. You might want to start at the local association of the National
Alzheimer's Association. More can be learned at the national associations
web site www.alz.org At
the site you want to click on, "About Alzheimer's" to get more information.
The site also will direct you to local support chapters. Next, we have
the Alzheimer's Disease Education and Referral Center located at www.alzheimers.org
This site is provided by the National Institute on Aging and one of the
most useful bits of information provided is the clinical-trials database
link that allows you to get information about medications used for Alzheimer's.
Unfortunately, the studies reported are mostly government funded studies
and there is little information about studies that have been funded by
the actual drug manufacturers.
There is also the Alzheimer's Research Forum found at www.alzforum.org
A comprehensive site designed for both scientists and lay people. This
site can be thick at times. Yet, it is good for those that want to dig
deep into the problem. And finally, there is the Family Caregiver Alliance
that can be accessed by typing www.caregiver.org
These folks provide many useful fact sheets and information on "Therapeutic
Lying." A very interesting concept for dealing with those of us who develop
dementia or Alzheimer's.
Next, I'd like to share with you information about the medications that
we currently have at our disposal to aid those suffering from dementia.
What is important to remember is that these drugs seem to retard the progress
of the disease process and in some cases slow development down significantly.
Do these agents actually stop memory loss? No! Do these agents help to
improve the quality of life for the patient and/or the primary care providers?
Yes!
There is a growing body of medical evidence supporting the use of these
products for the long haul. Yes, these products can be expensive. It also
appears that these products not only help with memory loss but they may
also provide some behavioral help for close to half of the people with
Alzheimer's who experience anxiety and aggression with the disease.
There is also information that shows us that in many, but not all cases,
memory decline has remained fairly stable for 4-6 years. I think the secret
here is that medication use was started earlier on in the course of the
disease vs. later on.
Currently there are four agents approved for the management of memory
loss in dementia and/or Alzheimer's. The first three, Reminyl by Johnson
and Johnson, Aricept by Pfizer, Exelon by Novartis, all work to help keep
the levels of natural brain chemicals believed to be involved in memory
functioning stable for longer periods of time. The fourth agent, Namendia
by Merz, a German company, has a totally different mechanism of action.
This product retards the brain's chemical believed to be responsible for
brain cell damage and death.
More information about any of these products can be gained by simply typing
into your web browser the following: www.reminly.com
or www.aricept.com
or www.exelon.com
or finally, www.namendia.com
Once you are at these sites you will also be exposed to a wealth of information
about the care and management of Alzheimer's.
On a closing and personal note I would like to let readers know that for
more than 20 years I have served as a consultant pharmacist in skilled
nursing facilities. I have seen first hand the problems families experience
when a loved one develops dementia and/or Alzheimer's Disease. My experience
tells me that in many cases the family waited far to long before seeking
treatment and the quality of life of their loved one has suffered tremendously.
Also, I have seen family members asking to have the Alzheimer's agents
stopped because they did not want to prolong their loved one's life. In
many cases, these abrupt discontinuations have led to serious episodes
of aggression in patients as all of a sudden their memory loss and subsequent
confusion are now magnified.
The use of medication's designed to retard memory loss and possible brain
damage due to Alzheimer's are not known to increase one's life span. These
agents are designed and used to assist an individual's cognitive thought
processes so that during their waning years they have a higher quality
life.
In closing you should know that there are memory tests that doctor's use
to evaluate memory. One simple test you can do at home, providing your
dad will want to cooperate, is to do a word memory test. You can give
him a list of 10 short words to learn and tell him you are going to ask
him to recall this list in 5 minutes and 30 minutes. The normal for people
in their seventies and without dementia, is to be able to recall approximately
7 words.
I would encourage you and your other family members to learn all you can
about the problem of memory loss associated with aging and the possibility
of this memory loss being related dementia or Alzheimer's. You should
have many places to explore after reading this response.
Plus
12-04
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