Drug Treatment: (Cognitive and Behavior)

Alzheimer' s Disease--> Decrease in Acetylcholine and serotonin levels, elevated amyloid deposition.

A) Tacrine- increases acetylcholine levels

Only FDA-approved drug for mild-moderate AD:

• 20-40% show small cognitive benefit on tests
• No survival or functional improvement.
• 4 pills/ day, weekly blood tests
• 25-50% have liver toxicity
• $125.00/ month

B) Research- Efforts focus on enhancing neuron function and preventing cell death. Many agents under study, none yet of proven benefit.

Problem Behaviors... Do Drugs Help or Hurt?

Principles:

1) Have clear and consistent target behavior

2) Assess for other possible causes - continence, meds, enviroment

3) Determine if drug truly needed- (?- For staff or caregiver convenience?)

4) Try non-drug approaches -

5) "Start low, go slow" --limited duration

6) Close monitoring for toxicity /effectiveness

Drug Options:

• Sleep disturbance- Trazodone, Choral Hydrate
• Hallucination/ Paranoia- Haldol
• Depression- Zoloft/ Pamelor

Potential Side Effects:

• Lethargy, poor food intake
• Constipation, Dry mouth
• Decreased movement, Falls
• Agitation, insomnia

Strict guidelines/ data are needed to prove that drugs do more benefit than harm ....