Neurologists Can Help Alzheimer Patients
by Subroto Kundu, M.D.
Alzheimer’s disease is a devastating diagnosis for patients and their families. Knowing that there are medications available that can alleviate its symptoms is heartening, even though there is no cure available at present. Starting treatment early is a decided advantage.
Sometimes unfortunately for Alzheimer patients, a “negative placebo effect” can result in a delay or denial of use of these Alzheimer drugs. Repeated emphasis on the “side effects” of medications, either by other members of the family, or even by a pharmacist, can raise apprehensions to the point of the patient or the family having hesitation about it, or even not taking the medications at all.
Medical experiments have shown that when test subjects expect to benefit from a new drug treatment, they sometimes experience positive results, regardless of whether they receive the real medication or only a look-alike pill. Such a response is called the “placebo effect.” An emphasis on the potential “negative qualities” of a medication similarly can generate a “negative placebo” effect, by the same psychological mechanism.
For the most part, commonly prescribed Alzheimer’s medications are very safe.
Neurologists can help family members and caregivers to learn the best ways to manage the care of Alzheimer patients. For instance, giving patients their medication with meals, or gradually increasing the dose, may prevent many side effects.
In treating Alzheimer’s disease, physicians primarily prescribe two types of drugs. The first type increases the action of the neurochemical acetylcholine, which allows brain cells to communicate with each other (cholinesterase inhibitors, CAI). Examples of this type of drug are donepezil (brand name “Aricept”), rivastigmine (“Exelon”) and galantamine (“Razadyne”).
The second category of drugs prevents brain cells from dying prematurely (glutamate receptor blockers), and there is only one available medication in this category, namely, memantine (“Namenda”).
Alzheimer patients not only lose cognitive function, but they can also become depressed, agitated or manic, so some antipsychotic medications may also be included in their treatment.
Some experimental drugs for fighting Alzheimer’s disease focus on preventing plaques and tangles from spreading. Plaques, which contain deposits of a protein fragment (beta-amyloid), can build up between nerve cells in the brain; and tangles are twisted fibers of another protein called “tau.” Plaques and tangles develop in most people as they age, but those with Alzheimer’s appear to develop more of them.
New drugs being developed, such as CTS-21166, aim to inhibit tangles by blocking the accumulation of these particular proteins, and thereby preventing the disease.
When properly administered, Alzheimer medications offer patients and their families the possibility of extending the amount of quality time they can experience together.
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Dr. Kundu is a board-certified neurologist affiliated with Eden Medical Center in Castro Valley and San Leandro. He sees patients at his offices in San Leandro and Alameda, and can be reached at (510) 351-4400.