These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Alzheimer’s Disease – Stages
Question: Please explain the different stages of Alzheimer’s Disease. I am inquiring concerning a patient which was staged a 6c. How many different stages are there and what are the major differences between them?
Answer: There are many different Dementia Scales published in the literature. There is some controversy about which is the ‘best’ one and much of this is related to the fact that various scales will measure different features and also the nature of Alzheimer’s Disease itself which has some variability in it’s course. The staging that you refer to comes from “The Global Deterioration Scale for Assessment of Primary Degenerative Dementia”, Amer. Journal of Psychiatry, vol. 139, pp1136-39:
- No Cognitive decline
- Very Mild decline
- Mild decline
- Moderate decline
- Moderate to Severe decline
- Severe decline
- End Stage
Risperidone
Question: Is there any information available on the use of this drug in people with restlessness and agitation from Alzheimers?
Answer: Risperidone is a fairly new drug which is used in agitated patients for sedation. Consequently, it is commonly used in Alzheimers patients when there is agitation. It is also used for any patient with agitation – usually demented or psychotic patients. Indeed, it is listed as an anti-psychotic drug. Like other drugs of its class, it may have fairly severe side effects. These include the neuroleptic malignant syndrome(a potentially fatal side effect involving rigidity, fever, and altered mental status), tardive dyskinesia(involuntary movements of the facial muscles-sometimes irreversible) as well as lowered blood pressure, seizures, and elevated prolactin levels. This drug has less sedative effects than some of its predecessors like Thorazine, but similar side effects.
Cognex
Question: Is this considerd a safe drug for dementia problem which they claim is AD? Is there a better product for such a problem?
Answer: Cognex(tacrine hydrochloride) is a relatively new drug for the treatment of Alzheimer’s Dementia. It is not approved nor should be used for other forms of dementia. Unfortunately, to date there is no specific test for Alzheimerws Dementia. As a result, it is often used for dementias which seem to be Alzheimer’s in clinical presentation. Cognex is of a class of drugs called cholinesterase inhibitors. This can produce a slow heart rate(bradycardia), increased gastro-intestinal motility and diarrhea, and ulcers. Patients with a previous history of ulcers should use this medication with great care. Other potential risks include liver toxicity and low white blood cell counts. There have been fatalities involving liver damage with this drug.
The drug should be started at small doses and increased gradually with constant and regular monitoring of blood counts and liver function.
Currently, there is no other medical treatment for Alzheimer’s Dementia-the reason that clinicians are willing to take the above risks. In my own experience, I have seen occasional improvement with Cognex and it is definitely worth trying considering the discouraging course of
most dementias.
Hydrazine
Question: is there a drug called hydrazine(not the rocket fuel)ha! or hydragene used for memory enhancement? Is it prescription? I believe it is used in alzheimers cases. What about coline?
Are there any other memory enhancement drugs? Thanks for you time.
Ben
Answer: Hydergine (ergoloid mesylate) is a drug which has been used for years in patients with dementia and early dementia. Most studies demonstrate that patients improve in functional status. For some reason, this isn’t a very popular drug and tends not to be used. I reviewed the literature
on this several years ago to present to medical residents. I was surprised to find as many positive studies as I did and few to any negative studies. It is a drug which should be tried if there are no
other reversible causes of dementia. Don’t expect major improvements. Side effects are remarkably rare and is basically a previous reaction to the drug. Other treatments for general dementia are lacking; choline gets a lot of attention in health food stores. However, controlled
studies have not demonstrated effectiveness.
