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Health Care - Treatment and Medication

  • 1) Treatment options
  • 2) Pharmacological treatment options
  • 3) Medication and side effects
  • 4) Non-pharmacological treatment options

1) Treatment options

Frequently Asked Questions

What treatment options are available?
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There are two main treatment options for those diagnosed with dementia: pharmacological and non-pharmacological therapies(1).

Pharmacological therapies include cholinesterase inhibitors for the mild to moderate stage of dementia (Aricept, Exelon, Reminyl), and Memantine for the moderate to severe stage (Ebixa). There are also additional medications for mood and behavioural symptoms.

Non-pharmacological therapies include:

  • Cognitive Therapies (e.g., memory exercises, reality orientation in the early stages, and reminiscence therapy).
  • Non-cognitive Therapies (e.g., music therapy; art therapy, massage therapy; aroma therapy; pet therapy)
  • Environmental Modification (e.g., home safety; job restructuring; aids to travel)

Can my memory loss be reversed with treatment and medication?
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Memory loss due to dementia and the damage inside your brain is not reversible, although treatment options and lifestyle choices can work to slow the progression. Other dementia related memory problems and confusion can be reversed with the proper diagnosis of any number of conditions such as depression, thyroid disease, infections, adverse drug effects, drug interactions, and so forth. Stress can have a negative impact on memory so it is important to find effective ways to cope with stress.

Can medications cure dementia?
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Medications can help with some of the symptoms people experience, but at this time there is no cure for dementia. While some people respond to certain medications, others may not, because dementia affects no two people in the same way.

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Sources:

The information above comes from the following source(s):

(1) Cohen, S. (2005). Lifestyle changes: the physician's perspective. Presented at the A Changing Melody Forum, Toronto, Ontario, November 12, 2005.

2) Pharmacological treatment options

Frequently Asked Questions

Can I buy medications over the counter?
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Medications specifically meant to treat dementia and associated symptoms (e.g., cholinesterase inhibitor, memantine hydrochloride) are only available by getting a prescription from your doctor.

Are these dementia medications covered by my provincial health plan?
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Some provinces may cover medications for dementia and associated symptoms. Your pharmacist should be able to tell you which medications are covered and which are not. If you do not live in Canada, check with your doctor regarding treatment coverage options.

What should I ask my pharmacist?
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Being diagnosed with a dementia will likely mean you will be prescribed medication to help with the symptoms of the illness. It is important to understand how to use the medication properly. Here is a list of questions you may want to ask your pharmacist (Questions for Pharmacist PDF):

  1. Why am I taking this medication?
  2. How will I know if this medication is working?
  3. How will I remember to take my medication?
  4. Are there any side effects? Will it make me sleepy?
  5. Will this medication interact with other medications I am taking or with my other medical conditions?
  6. Can I still take painkillers and other over the counter medications? Which over the counter medications should I avoid taking?
  7. Will it affect my herbal and vitamin supplements? Should I still take my current herbal and vitamin supplements?
  8. How and when should I take the medication?
  9. Will I need to take this medication for the rest of my life?
  10. Is "four times a day" the same as "every six hours"?
  11. Do I have to wake up during the night to take my medication?
  12. Am I supposed to take this medication with food or water?
  13. Is there anything I should or should not eat or drink while I am taking this medication?
  14. What should I do if I miss a dose? What if I take two doses too close together?
  15. I have drug allergies, is it safe for me to take this medication?
  16. Can I drink alcohol on this medication?
  17. When will I feel better?
  18. When should I see my doctor?
  19. Can I get my medication in a container that is easier to open?
  20. Where should I keep this medication?(1)
  21. Should I take my medication in the morning or evening?

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Source:

The information above comes from the following source(s):

(1) List reprinted with additions and revisions with permission from College of Pharmacists of British Columbia. (n.d). What to ask your pharmacist. Retrieved December 2011 from http://www.bcpharmacists.org/you_your_pharmacist/what_to_ask_your_pharmacist.

3) Medication and side effects

Frequently Asked Questions

What is a cholinesterase inhibitor?
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Cholinesterase inhibitors are medications that help preserve the ability of damaged nerve endings so they continue to send the messages from one nerve to another. These medications may be helpful for two to three years or even longer. There are three main drugs approved for people with mild to moderate symptoms:

  1. Aricept (also known as donepezil)
  2. Exelon (also known as rivastigmine)
  3. Reminyl (also known as extended release galantamine hydrobromide)(1)

These medications, although meant for the same purpose, have subtle differences in their medicinal properties and therefore, one may be prescribed over the other. That is, an individual may respond to one cholinesterase inhibitor, but not another.

Some factors that may influence the type of dementia medication you are prescribed may include the type of dementia you have, how you tolerate the medication (side-effects), convenience of dosage (1x per day versus 2x per day), and if the medication is covered under the provincial drug plan, and other medical conditions that you have (e.g., underlying liver or kidney disease, asthma).

Some people with certain cardiac problems related to abnormal electrical function of the heart, are at increased risk of passing out; such problems should be reviewed by a doctor before the medication is prescribed.

What is Aricept?
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It is a medication, also known as Donepezil or E2020. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia(2).

How does Aricept work and how does it help?
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Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory). People with dementia have lower levels of acetylcholine. Aricept helps to stop the breakdown of the chemical, which keeps more in the brain. Those who take Aricept may have less cognitive (memory, orientation, language) decline and show some improvement to their current state. The medication takes about 12 weeks to work and everyone's response is different to how well and how long it will continue to work(2).

Are there side effects to taking Aricept?
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The most common listed side effects are nausea, diarrhea, difficulty sleeping, vomiting, muscle cramps, tiredness and loss of appetite. In most cases, these effects are mild and go away. Some studies have reported people fainting, so if you feel unwell, or unexplained issues start to occur, see you doctor immediately(2).

What is Exelon?
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It is a medication, also known as Rivastigmine. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia(3).

How does Exelon work and help?
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Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory), so there are lower levels of acetylcholine in people with dementia. Exelon helps to stop the breakdown of the chemical, which keeps more in the brain. Those who take Exelon may have less cognitive (memory, orientation, language) decline and show some improvement to their current state. Exelon takes about 12 weeks to work and everyone's response is different to how well and how long it will continue to work(3).

Are there side effects to taking Exelon?
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The most common listed side effects are nausea, vomiting and weight loss due to loss of appetite. In most cases, these effects are mild and go away. Diarrhea, heartburn, stomach pains, dizziness, headache, weakness, tiredness and difficulty sleeping are other reported side effects. Side effects will likely go away; if they do not, tell your doctor(3).

What is Reminyl?
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It is a medication, also known as galantamine hydrobromide. It is in the group of medications called cholinesterase inhibitors. This medication is used to treat mild to moderate symptoms of dementia(4).

How does Reminyl work and help?
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Brain cells break down, specifically cells that make acetylcholine (a chemical thought to be important for learning and memory), so there are lower levels of acetylcholine in people with dementia. Reminyl helps to stop the breakdown of the chemical, which keeps more in the brain. Those who take Reminyl may have less cognitive (memory, orientation, language) decline and show some improvement to their current state(4).

Are there side effects to taking Reminyl?
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The most common listed side effects are nausea, vomiting, diarrhea and weight loss due to loss of appetite. Other reactions are abdominal pain, indigestion, headache, dizziness, tiredness, difficulty sleeping, and depression. In most cases, side effects go away. If they do not, make sure to tell your doctor(4).

What is Ebixa (also known as memantine hydrochloride)?
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Damage to brain cells occurs in persons diagnosed with dementia. Ebixa works to block the toxic re-absorption of glutamate leakages that damages brain cells, leaving them healthy and alive(5).

How does Ebixa work and help?
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In studies, people with dementia taking Ebixa have shown slower decline in memory and become more stable for some time. The success of Ebixa and the length of time it works varies from person to person(5).

Are there side effects to taking Ebixa?
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Overall, this drug is well tolerated. In clinical trials, the most commonly reported side effects included agitation, falls, dizziness and diarrhea, but these occurred at the same (or lower) rate as placebo treated patients. If you have epileptic seizures, Ebixa may increase the chances of you having more seizures(5).

Can I take cholinesterase inhibitors (Aricept, Exelon, Reminyl) and Ebixa together?
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New research says there may be more benefit to taking the two drugs together, but larger studies need to confirm this(5). Talk to your doctor and/or pharmacist about these medications and whether taking both would be beneficial to you.

What medication related issues need to be considered during the different stages of the disease progression?
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There are a multitude of medication related issues that you and your family and care partners need to understand as you embark on your journey with dementia. The issues are dynamic and change over time with the different stages of the disease.

Early stages:

When you are diagnosed with dementia, there are four general considerations:

a) Are you taking medications that could contribute to, or worsen memory and thinking? (e.g., anticholinergics, sedatives) [there are many examples of these, here are some common drugs: Benadryl, gravol, chlortripolon, ativan, serax, valium, rivotril, and others]

b) If there is a significant vascular component to your dementia, are these vascular risk factors (e.g., hypertension, heart failure, diabetes, hypercholesterolaemia) well controlled?

c) You will be offered cognitive enhancers and need appropriate education regarding treatment expectations (effectiveness and what this means in dementia) and common, but usually temporary, side effects associated with these medications.

d) It is not uncommon for persons with dementia to also have depression, anxiety, and/or insomnia, and these can and should be managed with appropriate medications.

Middle stages:

At this stage, it is not uncommon for persons with dementia to develop behavioural and psychological symptoms of dementia (e.g., apathy, depression, responsive behaviours, psychosis, etc). The considerations here are as follows:

a) For some behavioural and psychological symptoms of dementia (i.e., responsive behaviours, psychosis) the first step is to search for reversible causes and deal with these without use of medications if possible.

b) In the event that drug therapy is deemed necessary, it is important to keep in mind that different so called "psychotropic" drugs may be used to treat these symptoms. These include antidepressants, antiepileptics and antipsychotics, all of which have multiple possible uses.

c) Treatment of these behavioural and psychological symptoms of dementia are also dynamic in that it is usually not necessary to continue these medications indefinitely.

Late stages (residential care):

a) Is there a need to continue cognitive enhancers?
Upon admission to a long term care home, one should NOT automatically stop these medications as the person with dementia may well still be getting functional and/or behavioural benefits.

b) Once the person with dementia is no longer engaged with their environment, these drugs are not likely providing benefit and could likely be discontinued with no ill effects.

c) Certain other medications are likely also not necessary, and include, but are not limited to: cholesterol lowering drugs, blood pressure medications and others.

d) Some medications should NOT be discontinued as they are for symptomatic relief of pain, or breathing (e.g., pain medications, medications for heart failure or Chronic obstructive pulmonary disease).

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Source(s):

The information above comes from the following source(s):

(1) Alzheimer Society of Canada. (2009). Alzheimer's disease: Treatment options. [Brochure]. Ontario, Canada: Alzheimer Society of Canada.

(2) Alzheimer Society of Canada. (2005, May). Drugs: Aricept™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

(3) Alzheimer Society of Canada. (2007, May). Drugs: Exelon™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

(4) Alzheimer Society of Canada. (2004, May). Drugs: Reminyl™. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

(5) Alzheimer Society of Canada. (2007, May). Drugs: Ebixa®. [Fact Sheet] Ontario, Canada: Alzheimer Society of Canada.

4) Non-pharmacological treatment options

Frequently Asked Questions

What complementary or alternative therapies are available?
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There are a number of other alternative practices such as acupuncture, chiropractic, and naturopathy, to name a few. Other therapies such as music therapy, pet therapy, recreation therapy, aromatherapy and massage therapy may be beneficial. If you consider using natural services and products, please keep these things in mind:

  • Natural does not always mean safe
  • Ask for evidence that supports the safety and effectiveness of the therapies or products
  • Understand how herbal remedies may interact with other prescription drugs you are taking. Tell your doctor if you are on any herbal remedies and ask your pharmacist about mixing herbal remedies with the medications you are on
  • Ask about potential risks and side effects(1)

What alternative medications are being studied?
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There are several herbal, vitamin and dietary supplements which are promoted as beneficial for people with dementia, including Ginkgo biloba, Huperzine A, ginseng, vitamin B12, and coral calcium.

Conventional medicine is based on scientific fact which proves that there are benefits to certain treatments. But there has been very little scientific research into complementary or alternative therapies, and so some doctors believe they offer false hope and could be harmful. It is important that you check with your doctor before starting any therapy or trying an alternative remedy(2).

What new research on medications and treatments is being conducted?
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Researchers continue to explore new medications and treatments for the symptoms of dementia. Researchers are:

  • looking for the cause of Alzheimer's disease and other related dementias
  • trying to figure out how to replace lost nerve cells using bone marrow
  • finding out if there is a link between estrogen and dementia
  • working to develop a vaccine to prevent buildup of toxic matter effecting cells
  • using other medications to see if it will help slow dementia, by decreasing brain inflammation(3)

In addition, many researchers are studying the psychological and social effects of dementia on those who have dementia and their family care partners.

Can I be involved in research, including clinical drug trials, or get more information on current studies taking place?
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Yes! Contact your local Alzheimer's Society or memory clinic and they will be able to link you to the appropriate people and resources. This is a great way to play an active part in your community, meet others with similar life experiences and learn more. The Alzheimer Society of Canada also has information about clinical trials and research studies recruiting in Canada on their website. Please visit the Alzheimer Society of Canada's website for more information.

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Sources:

The information above comes from the following source(s):

(1) Alzheimer Society of Canada. (2009). Alzheimer's disease: Treatment options. Ontario, Canada: Alzheimer Society of Canada.

(2) Guide4Living. (2011). Alternative therapies and treatments - Alzheimer's disease. Retrieved October 24, 2011, from http://www.guide4living.com/alzheimers/alternative-treatment.htm.

(3) Diamond, J. (2006, November). A report on Alzheimer's disease and current research. Ontario, Canada: Alzheimer Society of Canada.

Helpful Links and Resources

Alzheimer Society of Canada Information about clinical trials and research studies recruiting in Canada http://www.alzheimer.ca/en/Living-with-dementia/Treatment-options/How-drugs-are-approved-in-Canada
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[This page updated on December 13, 2012]
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