Care and Treatment in Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia in older adults. It’s a progressive disease that causes slowly worsening memory and thinking skills. The exact cause is unknown, but we do know that the brains of people with Alzheimer’s disease show abnormal deposits of proteins called amyloid plaques and neurofibrillary tangles. Eventually, persons with Alzheimer’s disease will need help with their day to day living.
Alzheimer’s is diagnosed through a series of clinical tests. There are a lot of conditions that can cause memory changes, so these need to be ruled out. First, your doctor will review your medical history and perform certain tests. They will give you a physical exam and will often order a brain scan and lab work. They may give you a brief cognitive test that takes about 15 minutes to get a general idea of how your memory is doing.
You may be referred to a specialist for this workup (usually a neurologist or a psychiatrist), and eventually, you will likely be referred for neuropsychological testing. Neuropsychological testing is a series of in-depth cognitive tests that give your doctors a detailed understanding of any problems with your thinking.
How is Alzheimer's Disease Treated?
Unfortunately, there is no cure for Alzheimer’s disease right now. Instead, treatment focuses on alleviating the symptoms and slowing the progression. Luckily, there are several different avenues of treatment available.
There is no medication that can cure or stop Alzheimer’s disease, but we do have medications that can help slow the progression for some people. These include drugs like donepezil, galantamine, rivastigmine, and memantine, and research has shown that they are most effective in the early stages of AD. Alzheimer’s drugs are generally well tolerated but can still have side effects. Your doctor can help you decide which, if any, of these medications is right for you.
Sometimes, people with AD begin to experience worsening insomnia, agitation, anxiety, paranoia, or even aggression. These behaviors can also be treated with medications. Treating behavioral symptoms can improve the quality of life for both the patient and their caregivers.
In addition to medications, your doctor can help you come up with behavioral strategies to address the symptoms of Alzheimer’s disease. Some important behavioral and environmental factors to consider include the following:
- Maintain a routine. Patients with Alzheimer's benefit from having a predictable environment. As their memory fails, they will rely more and more on their environment to give them cues. Make sure things are familiar and consistent to help patients feel less disoriented and reduce anxiety and agitation.
- Get good sleep. Sometimes, people with Alzheimer's will become more agitated in the evenings. They may begin to mix up their nights and days, or they may only sleep in short spurts. Disrupted sleep contributes to confusion, fatigue and agitation. Ask your doctor about good sleep hygiene practices and other ways to promote healthy sleep.
- Ensure effective communication. As your loved one’s dementia progresses, effective communication can become more challenging. People with Alzheimer's disease can have trouble understanding or responding to complex commands. Try to speak concisely and break tasks down into smaller parts, for example, “Can you put these glasses on the table?” rather than “Can you set the table?” Avoid overwhelming them with too many requests or information at once. Remember that most of the time, you don’t need to correct them or insist that they remember something.
- Keep hobbies going. If your loved one with dementia loved to knit or do jigsaw puzzles, make sure they still have access to these activities for as long as it’s safe. Knowing the activities your loved one still enjoys will allow you to redirect them if they are becoming anxious or agitated.
- Stay vigilant about safety issues. Most people with dementia are not able to drive safely. They may leave the home and get lost and may be more vulnerable to scams. They often have difficulty taking medications correctly and are at risk of overdosing. When they become upset or agitated, they may also become physically aggressive towards family members. All of these issues need to be closely monitored. You may need to take away car keys, install additional locks on the doors or take over their finances or medication management. Talk to your doctor if any of these are a concern, and they can work with you to build a plan.
Caregiver Support for Patients with Alzheimer's Disease
High-quality treatment of Alzheimer's disease will include the entire family. Caring for a loved one with dementia at home can be rewarding, but the demands will continue to grow as the disease progresses. Caregiver support is vital to the health of the entire family unit. Caregivers can get connected with various community resources, such as organizations like the Alzheimer’s Association. Educational seminars, meetings and books such as The 36 Hour Day can also be helpful. Caregiver support groups offer valuable emotional support and planning assistance.
Here at Ochsner, our Brain Health and Cognitive Disorders Program offers supportive services and regular check-ins with caregivers in addition to cognitive testing and evaluation for the patient. We help the patient and their family develop behavioral plans to manage symptoms, track safety issues, discuss new concerns as they arise and connect patients to additional services as needed.
Our goal is to ensure a high quality of life for both our patients and their families as they navigate this diagnosis. If you are concerned that you or a loved one is experiencing memory changes, don’t hesitate to reach out to your doctor.
Editor's note: This article was originally published on August 24, 2018.