Jan 28, 2010

Antipsychotics, Aricept, and a Good Point Guard

The use of antipsychotic drugs to "control" difficult behavior, agitation, outbursts and sometimes combative behavior of dementia and Alzheimer's patients is soaring.

The use of antipsychotic drugs to "control" difficult behavior, agitation, outbursts and sometimes combative behavior of dementia and Alzheimer's patients is soaring.

Antipsychotics, Aricept | Alzheimer's Reading Room


Sales of newer antipsychotics like Risperdal, Seroquel and Zyprexa have more than tripled to $14 billion, up from $4 billion in 2000, according to currently available statistics.

Most of this increase can be traced to prescriptions in nursing homes. Current estimates indicate that about one-third of all nursing home patients have been given antipsychotic drugs. Yikes.

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By Bob DeMarco
Alzheimer's Reading Room

There are at least seventeen studies of elderly people with dementia that compared patients taking an anitpsychotic drug with those taking a placebo. These studies indicate that patients taking the drugs died at a rate almost two times the rate of patients taking the placebo over the course of the study.

If you look beyond the obvious in the studies being done on antipsychotic medications and dementia you will be surprised to learn that 30 to 60 percent of patients in the placebo groups improved.

You might want to read the above again. Antiphsychotic medications can kill you at a rate twice that those not taking the drugs. Thirty to sixty percent of patients improved when they received no drug -- a placebo.

It seems to me that the likely explanation of why patients receiving the placebo responded positively was because they are receiving lots of personal "attention". Tender loving care.

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I am not a doctor so I decided to look in my copy of The Alzheimer's Action Plan: The Experts' Guide to the Best Diagnosis and Treatment for Memory Problems to see if it contained any advice on how to deal with this issue. I was pleased to learn that the federal government has developed guidelines that doctor's must follow when prescribing these drugs.

The guidelines** cover the following mistakes that are often made by doctors:
  • prescribing antipsychotic drugs to treat minor behavior problems such as occassional insomnia, mild anxiety, or wandering
  • prescribing an antipsychotic drug over the telephone without seeing the person
  • start someone on an antipsychotic drug without going over the risks of the drug with family members
  • recommend a combination of antipsychotic drugs
  • continue antipsychotic drugs for months after the behavior has improved
  • put someone on antipsychotic medication but fail to monitor for neurological problems such as stiffness or tics, weight changes, or hormonal or cholesterol problems
  • promise the drugs can keep Alzheimer's from getting worse as quickly
  • say the newer anti psychotic medications are far superior to the older (less expensive) versions.
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In our case, early on my mother was evidencing peculiar behavior(s) that I had never seen in her before. She was flying off the handle, she was being mean to me, and she was saying things that I cannot repeat in print. I knew something was dramatically wrong. But, I was clueless as to what was wrong.

Welcome to the world of the Alzheimer's caregiver. The vast majority of Alzheimer's caregivers come to the task with little or no education about Alzheimer's disease, little or no understanding of the disease, and are often ill equipped to deal with the changes in behavior that almost always come with Alzheimer's disease. Most often we are left to learn on the job. And, learn on the job we do.
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We had a doctor that tried to put my mother on an antipsychotic medication before she was diagnosed with Alzheimer's. I said, "No". I had read several of the articles on this issue and I wanted to make sure that I didn't do anything that would worsen her situation before we actually knew the real extent, cause, and diagnosis of her illness.

Eventually, we identified a wonderful personal care physician that was familiar with dementia and Alzheimer's disease. He took us through all the identification steps and then prescribed Aricept. The Aricept helped. There are several studies that show that drugs like Aricept are being underutilized in the treatment of Alzheimer's.

Research shows that 10 to 20 percent of Alzheimer’s patients had noticeable positive responses to the drug, and 40 percent more showed some cognitive improvement, even if it was not noticeable to an observer.
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I am sad to say that over the years I have seen personal caregivers put patients on antipsychotic medications as way to "smooth out" behavior. Unfortunately, when someone in an early stage of dementia is put on an anitpsychotic their health can deteriorate-- fast. I have seen this happen more than once

Personal care doctors hasten to use antipsychotics instead of Aricept without a psych consult, geriatric consult, or neurological consult. Like it or not, this is the sad state of affairs in much of American today. Its all about money.

The healthcare companies want the point guard, the personal care doctor, to keep costs down and they provide them with incentives to do so. This means persons suffering from dementia don't get the appropriate test to make a proper diagnosis.

In basketball, a great point guard is on the floor to distribute the ball. The point guard touches the ball and holds the ball more than any other player on the floor. A great point guard is often measured by the number of assists he gets each game. A great point guard makes all the players around him better.

Whether its Alzheimer's disease or any other illness you need a great point guard. Most basketball fans can name the great point guard off the top of their head. The list is shorter than one hand. There are more than six handfuls of starting point guards in the NBA. Get yourself an All Star point guard. Don't be lazy.

Also see: Antipsychotics, J & J, Kickbacks to Nursing Homes, the Feds Step In

**Source: The Alzheimer's Action Plan, page 324
Advice and Insight into Alzheimer's and Dementia

Bob DeMarco
Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver. The ARR knowledge base contains more than 3,811 articles with more than 306,100 links on the Internet. Bob lives in Delray Beach, FL.

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