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Alzheimer's Disease

Functioning Better Without Aricept?

09/10/2008

Question:

My husband`s 90-year-old father has lived with us for 2 years, after it became apparent that his ability to live alone had reached the point where he needed closer supervision. He was diagnosed with Alzheimer`s 5 years ago, but we have questioned that diagnosis now that he lives with us. His symptoms actually seem to be more consistent with multi-infarct dementia.

He has been taking Aricept and Namenda since his diagnosis. We are grateful that he has a sweet and uncomplaining disposition, and there have been no personality changes, but the downside of that is that he never asks for anything or tells us how he is feeling. He is always "All right", so we have only his behavior to tell us how he is feeling. He appears to have "good days`, when he can make his own breakfast and manage his daily routines, and "bad days" when he just sits in his Lazy Boy all day, dozing off frequently. He is also incontinent, but that is every day, and we manage that by giving him Depends to wear, which my husband always tactfully calls his "underwear."

Two weeks ago he went off Aricept and Namenda, and we have been watching him carefully to see if there is any decline in his memory and functioning. Oddly enough, he is now more alert, remembers things better, and makes connections between events more readily. He takes more interest in his surroundings, and is more sociable. We have been very surprised and pleased by this, but have many questions about those 2 medications. Have you seen people improve after stopping them? Now we feel like maybe all this time he would have been better off if he had never taken them, and it is puzzling.

Thanks for your help.

Answer:

80% to 90% of individuals with Alzheimer's disease do better on medications like Aricept and Namenda. Aricept in particular is known for increasing attention and improving apathy. We have less data on these medications for vascular dementia although Aricept has shown benefit in 2 large studies of people with stroke related dementia. However, not everyone is helped by these medications. Some have side effects and can not tolerate them and others do better off then on them. There is always individual variation.

An important point to keep in mind is that Aricept and Namenda are more designed to slow down the deterioration of Alzheimer's disease than help in the short run. If your father-in-law's disease is progressing slower than the average decline, than it is possible that these medications were of some use.

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Response by:

Douglas W Scharre, MD Douglas W Scharre, MD
Clinical Associate Professor of Neurology
Clinical Associate Professor of Psychiatry
College of Medicine
The Ohio State University