Are there any medications that someone with Alzheimer’s disease should avoid?
A person with Alzheimer’s disease may be taking medicines to treat symptoms of the disease, as well as other health problems (high blood pressure, diabetes, high cholesterol, etc.). However, when a person takes many medications — a situation called polypharmacy — there is an increased risk of adverse reactions, including confusion, agitation, sleepiness or sleeplessness, mood swings, memory problems, stomach upset, and/or changes in appetite.
While it may become necessary for a person to take medicine to treat the severe symptoms of Alzheimer’s disease — such as hallucinations or aggressive behavior — some of these medications can worsen other symptoms of the disease. For example:
- Some sedatives or hypnotics, such as benzodiazepines and barbiturates, can cause confusion, increased memory impairment, and slowed reactions, which can lead to falls.
- Certain antidepressant medicines, particularly the tricyclic antidepressant amitriptyline (Elavil), can cause sedation. These drugs also can react with the medicines used to treat Alzheimer’s, including rivastigmire (Exelon), donepezil (Aricept), and galantamine (Reminyl).
- Some antipsychotics (medicine used to treat hallucinations) can cause sedation, cognitive impairment, and drops in blood pressure. They also can react with the medicines used to treat Alzheimer’s disease.
It is important to discuss the pros and cons of these medication options with your doctor before making a decision regarding medication.
In addition, it is important to consider the possible side effects of over-the-counter medicines, including cough and cold remedies, and sleep medicines. These drugs also may react with other medications taken by the person with Alzheimer’s disease. It is best to consult your doctor before using over-the-counter medication.
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I’m thinking about taking a trip with my father, who has Alzheimer’s disease. Is there anything special I should do?
The most important things to do when traveling with someone with Alzheimer’s disease are to plan ahead and try to anticipate the person’s needs, so you’ll be ready for any changes or problems. As you plan, be sure to consider the stage of the person’s illness and any behaviors that may be affected by traveling away from home. You may want to try taking a short trip to see how your loved one reacts to traveling.
Here are a few other tips to consider:
- Plan some activities for the person with Alzheimer’s disease. Simple things — such as a magazine, deck of cards, favorite music tape, etc. — can help keep the person calm when traveling.
- Never leave a person with dementia alone in a car. When moving, be sure to keep the seat belt buckled and the doors locked.
- Plan regular rest stops.
- Bring an extra driver if your trip involves more than six hours of driving time.
- If the person becomes agitated while traveling in a car, stop at the first available place. Don’t try to calm the person while driving.
- Consider planning your vacation at a place that is familiar to the person with Alzheimer’s disease; for example, at a lake cabin that he or she has visited in the past.
- If your loved one is easily agitated, it may be wise to avoid places that are very crowded. You also may want to avoid fast-paced sightseeing trips.
- If your loved one has never been on a plane, it may be wise to consider driving, if possible.
- Alert the airlines and hotel staff that you are traveling with a person who is memory impaired. Make sure the person is carrying or wearing some sort of identification.
- Don’t forget that your caregiving responsibilities continue, even though you are on vacation. It may help to bring someone along who can help you with these duties.
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I’m having trouble getting my loved one to eat. What can I do?
Good nutrition is important for people with Alzheimer’s disease. In fact, poor nutrition can worsen some symptoms of dementia, such as listlessness and confusion. For a person with Alzheimer’s disease, the illness itself and/or associated depression can affect his or her desire and ability to eat. Your loved one also may be suffering from a treatable disorder — such as heartburn, constipation, diarrhea, nausea, or sore mouth — that may be affecting his or her eating.
If poor appetite is becoming a concern for your loved one, try following these nutrition guidelines:
General guidelines:
- Talk to your doctor. Sometimes, poor appetite is caused by depression, which can be treated. Your loved one's appetite will probably improve after depression is treated.
- Don’t force feed. Try to encourage the person to eat, and try to find out why he or she doesn't want to eat (it’s cold, doesn’t taste good, not hungry, etc.).
- Avoid non-nutritious beverages such as black coffee and tea.
- Try to get your loved one to eat more protein and fat and fewer simple sugars.
- Encourage your loved one to eat small, frequent meals and snacks.
- Get the person to walk or participate in another light activity to stimulate his or her appetite.
- Consider serving finger foods that are easy for the person to handle and eat.
- Remember to treat the person as an adult, not a child. Don’t punish the person for not eating.
Meal guidelines:
- Drink beverages after a meal instead of before or during a meal so that you do not feel full before you begin eating.
- Plan meals to include your favorite foods.
- Try eating the high-calorie foods in your meal first.
- Use your imagination to increase the variety of food you're eating. Prepare meals that offer a variety of textures, colors, and temperatures.
Snack guidelines:
- Don't waste your energy eating foods that provide little or no nutritional value (such as potato chips, candy bars, colas, and other snack foods).
- Choose high-protein and high-calorie snacks.
Dining guidelines:
- Make food preparation an easy task: choose foods that are easy to prepare and eat.
- Make eating a pleasurable experience, not a chore:
- Liven up your meals by using colorful place settings.
- Play background music during meals.
- Try not to eat alone: invite a guest to share your meal or go out to dinner.
- Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.
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My mother has Alzheimer’s disease, and I’ve noticed she is getting more confused. How can I help her?
There are several things you can try to help a person who is confused:
- Try to minimize any changes in the surroundings or to your loved one’s daily routine. If you have to make changes in routines, do so gradually.
- Follow simple routines and avoid situations that require the person with Alzheimer’s disease to make decisions.
- Help your loved one maintain his or her orientation by describing the events for the day; reminding him or her of the date, day, time, place, etc.; and repeating the names of the people with whom he or she has contact.
- Try placing large labels (with words or pictures) on drawers and shelves to identify their contents.
- Simplify or re-word your statements or requests if the person doesn’t seem to understand.
- Make certain that medications are being taken regularly and at the right times.
- Provide a nutritious diet and encourage your loved one to exercise, if he or she is able. Exercise increases circulation and can help improve mental clarity.
- Be patient and supportive.
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Is there anything I can do to help my mother preserve what memory she has left?
Alzheimer’s disease is a progressive disorder, which means it gets worse over time. Losing cherished memories is one of the devastating consequences of this illness. Some medications used to treat Alzheimer’s disease (tacrine, donepezil) may help slow down memory loss, but as yet there is no cure. However, there are some techniques you can use to help enhance what memory exists.
- Use notes, lists, memos, etc., to help remind the person with Alzheimer’s disease of his or her daily tasks.
- Keep photos of family members and friends where the person can see them. Label photos with names, if necessary. Reminisce with him or her about the family, or activities he or she once enjoyed (sports, hobbies, etc.).
- Use memory "tricks"; for example, thinking of the word HOMES to remember the great lakes: H uron, O ntario, M ichigan, E rie and S uperior.
- Use labels (with words or pictures) placed on drawers and shelves to identify their contents.
- Limit alcohol consumption and try to ensure your loved one gets adequate sleep.
- Remind him or her of the date, day, time, place, etc.; and repeat the names of the people with whom he or she has contact.
- Encourage your loved one to exercise his or her mind by reading, doing puzzles, writing, etc., as well as to exercise his or her body as appropriate. However, avoid challenging your loved one to the point of frustration.
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Is it true that researchers are testing hormones as a treatment for Alzheimer’s disease?
Reports of lower rates of Alzheimer's disease among postmenopausal women taking estrogen have stimulated investigation of the possible preventive effect of estrogen replacement therapy (ERT) on the development of Alzheimer’s disease.
In their initial study, researchers at the National Institute on Aging found evidence that the brains of postmenopausal women on ERT age differently and have greater blood flow to areas of the brain involved in memory formation than do women not receiving hormones. The study findings also suggest that ERT may lower susceptibility to the changes in the brain associated with Alzheimer’s disease.
While these findings are promising, other studies have found no decrease in risk of developing Alzheimer’s disease or any cognitive improvement using ERT. Additional research is necessary to better understand the relationship among estrogen, the brain, and Alzheimer’s disease. Several studies currently are underway to further evaluate the potential value of ERT for Alzheimer’s disease patients.
Note: Because ERT may cause uterine bleeding, and its long-term use may be associated with an increased risk of breast cancer, ERT is not routinely used in women with Alzheimer’s disease. The risks and benefits of ERT must be evaluated on an individual basis.
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Can ginkgo biloba cure Alzheimer’s disease?
Ginkgo biloba, an extract from the leaves of the ginkgo tree, has been touted by many as a memory enhancer. Although a 1997 study in the United States suggested that a ginkgo extract may be of some value in treating the symptoms of Alzheimer’s disease and other forms of dementia, there is no evidence that ginkgo biloba will cure or prevent Alzheimer’s disease. Other studies, however, imply that daily use of ginkgo biloba may cause side effects, such as excessive bleeding (especially when combined with daily use of aspirin).
The National Institute on Aging and the Office of Alternative Medicine, both part of the National Institutes of Health, currently are funding a study to test the effectiveness of ginkgo biloba in treating Alzheimer’s disease. To date, there simply is not enough information available for doctors to recommend the broad use of ginkgo biloba for Alzheimer’s disease or other forms of dementia.
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Is exercise recommended for someone with Alzheimer’s disease?
Exercise offers many benefits for people with Alzheimer’s disease. The major benefits include improved strength, endurance and cardiovascular fitness. Exercise also can increase energy, and improve mood and sleep. Exercise also helps people with Alzheimer’s disease preserve motor skills and improve balance, which in turn can help prevent serious injury from falls. Further, exercise increases circulation and can help improve mental clarity
The type and intensity of exercise appropriate for someone with Alzheimer’s disease depends on the person’s degree of impairment. People in the early stages of the disease may enjoy exercises such as walking, bowling, dancing, golf, and swimming, although supervision may be necessary. Greater supervision may be required as the disease progresses, and activities that could lead to injury should be avoided.
It is important to talk to the person’s doctor before beginning any exercise program. There may be other factors — such as osteoporosis, a heart condition, or balance problem (possibly due to medication) — that could limit or restrict activity.
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What is "sundown syndrome?"
Sundown syndrome — also called sundowning or sunsetting — is a behavior common in people with Alzheimer’s disease. It describes the episodes of confusion, anxiety, agitation, or disorientation that often occur at dusk and into the evening hours. The episodes may last a few hours or throughout the night.
While the exact cause of sundown syndrome is not known, experts believe there are several contributing factors. These include physical and mental exhaustion (after a long day), and a shift in the "internal body clock" caused by the change from daylight to dark. Some people with Alzheimer’s disease have trouble sleeping at night, which may contribute to their disorientation. Medication that can cause agitation or confusion also may be a contributing factor to this syndrome.
Sundown syndrome can be draining for the person with Alzheimer’s disease and his or her caregivers. Here are some suggestions for helping a loved one with sundown syndrome:
- Schedule your day so that the more difficult tasks are done early in the day, when the person is less like to become agitated.
- Watch the person’s diet and eating habits. Restrict sweets and drinks with caffeine to the morning hours. Try serving the person a late afternoon snack or early dinner.
- To help the person relax, try decaffeinated herbal tea or warm milk.
- Keep the house or room well lit. Close the drapes before the sun goes down, so the person doesn’t watch it become dark outside.
- If the person falls asleep on the sofa or in a chair, let him or her stay there. Don’t wake the person to go to bed.
- Try distracting the person with activities he or she enjoys. Soothing music or a favorite video may help, as well.
- Encourage the person to engage in some physical activity—such as walking, if able—during the day. This may help him or her to sleep better at night.
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When will the new Alzheimer’s vaccine be available?
The Alzheimer's disease vaccine, recently undergoing clinical testing, produced an unacceptably high rate of serious side effects and the study is currently on hold. As such, no patients are currently undergoing this treatment. Alternative forms of vaccine are currently being worked on.
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Does the desire for sex diminish or totally disappear in people (particularly females) with early or mid-stage Alzheimer’s disease? Do you have any suggestions for "keeping the fire alive" in our mates if this starts to happen?
Sexuality is a complex part of human physiology. Sexual function can be affected by aging, hormonal changes, emotions, medication, smoking, alcohol use, and chronic medical problems such as cardiovascular disease, diabetes, arthritis, Parkinson’s disease, Alzheimer’s disease, emphysema, and others.
Researchers have begun to devote more attention to sexuality and sexual function in older adults. Studies suggest that healthy older adults continue the patterns of sexual function that they developed in their middle years. Vaginal changes after menopause in women can cause pain or bleeding with intercourse, but this can be improved with topical estrogen (such as creams, gels, vaginal tablet, or ring) or with a lubricant. Men continue the capacity for erection and ejaculations with aging, although ejaculation may be less forceful.
Depression can cause sexual dysfunction, including the loss of sexual desire. Common medications used to treat depression — such as sertraline, fluoxetine, and paroxetine — also can cause sexual dysfunction.
Sexuality has not been studied in Alzheimer’s disease per se. However, many individuals with Alzheimer’s disease have mood disorders such as depression. As mentioned above, both depression and the medications commonly used in treatment can cause sexual dysfunction. Many persons with dementia also have apathy, or decreased motivation, that affects much of their lives, such as their interest in their appearance, clothes, friends, etc., and may affect their sexual function as well.
If you are concerned about your partner’s sexuality, try the following recommendations:
- Have your loved one’s doctor assess the presence of a mood disorder, which may cause sexual dysfunction.
- Make sure your loved one’s medical problems are managed optimally, including pain issues from arthritis, possible urinary tract infections, shortness of breath from heart or lung disease, etc.
- Have your loved one’s doctor review each medication for its possible effect on sexuality.
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My mother is 73 and in good physical health. During the past few years, however, she has developed a problem finding words, which seems to be worsening. This has progressed to the point where sometimes she can barely get a sentence out. Other times she is more fluent and can make herself understood or ask a question. She also has exhibited signs of confusion and forgetfulness. I suspect she may be depressed, but other than that I don't know what could be wrong. Her doctor cannot find any pathology responsible for this. She has not had a stroke. She is aware that she has this problem. Any thoughts?
You have noticed that your mother has aphasia, a disorder in speech and language. There are other worrisome symptoms, such as confusion and forgetfulness; and you mention that this problem has developed over the course of a few years. The major causes of aphasia in older adults include stroke and neurodegenerative diseases, such as Alzheimer’s disease.
A complete history and physical examination to evaluate your mother for subtle neurological abnormalities is necessary. Medications that your mother is taking, including prescription and over-the-counter medications, must be reviewed to make sure that she is not suffering from an adverse drug side effect or from an interaction between two drugs. Alcohol use must be reviewed honestly. Certainly your mother’s mood must be evaluated, as well.
There is no specific test for Alzheimer’s disease, but it can be diagnosed accurately by history, exam and by making sure that no medical problems — such as B12 deficiency, thyroid disorder, infection, or metabolic changes from kidney or liver disease — are contributing to the symptoms. A CAT scan with contrast, or MRI, can help diagnose a stroke. In some cases, for instance if an infection is suspected, a lumbar puncture is performed to examine the spinal fluid.
If your mother is living alone, then you and she may wish to speak your local office of the aging or a social worker, to determine if she needs more assistance to live more safely at home for as long as possible. A neurologist may help sort out the diagnostic issues. A geriatric clinic may be better equipped to help you and your mother evaluate the need for social services, a need that may increase with time.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 5/28/2003
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