Deciding whether and when to treat Alzheimer's disease with medications can be a difficult decision. Taking a careful look at how bad your condition is can help you decide whether medications are right for you. Consider the following when making your decision:

• Your symptoms interfere with your daily living and are more bothersome than the potential side effects of the medication, so taking medications may be a good choice for you.
• Disruptive behaviors may be manageable without medications. If behavior problems can be managed in other ways, you may be able to avoid treatment with medication and the side effects and costs that come with it.
• Treatment with a cholinesterase inhibitor may reduce the burden on caregivers by producing small improvements in your memory and general ability to function.For example, you may be able to remember friends' names better and be able to dress yourself with less difficulty.
• Medications for Alzheimer's disease do not work for everyone who takes them, and their effectiveness is not always dramatic. Even if they do initially reduce your symptoms, the medications eventually will no longer control the progressive symptoms of memory problems, behavioral and personality changes, and thinking problems caused by Alzheimer's disease.
• Medications can relieve your symptoms and restore your ability to function. You can temporarily improve your physical and mental health by taking medications.
• Although medications may improve your Alzheimer's symptoms-thinking and memory problems, and personality changes-they will not completely eliminate the symptoms nor will they prevent the disease from progressing.
• Medications may be expensive.

What is Alzheimer's disease?

Alzheimer's disease is a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults. Symptoms include having:

• Significant memory loss, such as forgetting how to drive or how to tell time.
• Problems with language, such as not being able to think of words.
• Personality changes, such as becoming aggressive when your personality is non-aggressive.
• Confusion or becoming disoriented, such as not knowing where you are or not recognizing family members or friends.
• An inability to perform daily tasks, such as not being able to unload a dishwasher or pay the bills.

What medications are used to treat Alzheimer's disease?

The medications most often used to treat moderate symptoms of Alzheimer's disease are cholinesterase inhibitors such as donepezil (Aricept) and galantamine (Razadyne). Memantine (Namenda) was approved by the U.S. Food and Drug Administration (FDA) to treat mild to severe symptoms of confusion and memory loss from Alzheimer's disease. It works differently than cholinesterase inhibitors. But like cholinesterase inhibitors, it does not prevent Alzheimer's disease from progressing.

Other medications, such as tranquilizers, may be used to reduce anxiety, agitation or hostile behavior, sleep problems, or other similar symptoms.

What are the side effects of these medications?

In general, most people seem to tolerate the medications very well. The most common side effects of cholinesterase inhibitors are nausea, diarrhea, vomiting, indigestion, abdominal pain, loss of appetite, and weight loss. Less common side effects include insomnia, fatigue, and muscle cramps. Side effects tend to be mild and usually go away within a few weeks after starting treatment with the medication.

Common side effects of memantine are mild and include dizziness, confusion, headache, and constipation. Memantine should not be used by people who have kidney problems.

Tranquilizers can sometimes cause drowsiness.

Close monitoring and regular reevaluation of the severity of Alzheimer's symptoms are very important during treatment with medication. As the disease progresses and symptoms change, your medication needs often change. If you are a caregiver for someone with Alzheimer's disease, be alert for adverse drug reactions or side effects that further impair the person's ability to function.

How can behavior problems be treated without medications?

Before deciding to manage behavior problems with a medication, try to figure out what is causing the behavior. Some behaviors, such as agitation, wandering, and becoming restless and agitated in the early evening (sundowning), do not always respond well to treatment with medication. Understanding what is causing the behavior and taking steps to manage or change it can sometimes be helpful. It is worthwhile to explore the cause of behavior problems both before and during the time you are taking medication.

If you need more information, see the topic Alzheimer's Disease.

Your choices are:

• Treat Alzheimer's disease symptoms with medications for as long as they are effective.
• Try other means to reduce anxiety and agitation and to improve thinking and memory abilities. For example, a caregiver can label all the items in your room for you and list your daily activities to remind you what to do.

The decision about whether to take medications to treat your Alzheimer's disease takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking medications to treat Alzheimer's disease. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers on the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medications to treat Alzheimer's disease.

Check the box below that represents your overall impression about your decision.

Citations

1. Bentham P, et al. (2004). Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): Randomised double-blind trial. Lancet, 363(9427): 2105¨C2115.