I cannot count the times that clients have told me, “My doctor prescribed (we’ll fill in the blank below) and said it would slow the progress of dementia.” Sorry, it’s not so!
There are two categories of drugs approved by the Federal Drug Administration for use for dementia. One type, approved only recently, is a class of drugs that have been shown to reduce the beta-amyloid protein (plaques) in the brain that are thought to be the precursor for Alzheimer’s disease.
There are two such drugs (a third is in development), and both have been shown in trials to be effective only in the very early stages of Alzheimer’s disease. They reduce the plaques that we associate with early cognitive decline, but to what extent they actually reduce memory loss is still being determined. These are marketed under the names Aduhelm and Legembi, and both are extraordinarily expensive; upwards of $25,000 a year! And if they actually slow the disease, it is only by a few months; not by years.
The more commonly-used category of medicine frequently prescribed for dementia are Acetylcholinesterase inhibitors and psychotropics that were never designed or originally approved for dementia. These drugs were created to treat psychosis, schizophrenia, bipolar disorder, and other types of mental illness. Most were approved for their intended purpose nearly two decades ago, then later approved for use for Alzheimer’s and other forms of dementia.
This group of drugs includes Donepezil, sold as Aricept; Galantamine, sold as Razadyne; Memantine, sold as Namenda; Rivastigmine, sold as Exelon; and Namzeric, which is a combination of Memantine and Donepezil. Very recently, Brexpiprazole – sold as Rexulti – has been added to this list. Like the others, it was developed for mental illness and was subsequently approved for dementia. Several of these carry a warning of being potentially fatal for seniors!
Dementia involves degradation of the brain at a cellular level. It is not a chemical disorder only, nor is it classified as a mental illness. The psychotropics used for dementia will only alter the person’s behavior by reducing anxiety. They will not stop or slow the progress of the disease or the physical degradation of the brain.
Let me make an analogy. You have arthritis, and you are having a very bad day. You take a pain killer, and now you are having a better day. But you fully understand that the medicine you have taken has not cured your arthritis; it has affected only its symptoms. Still, many of us wrongly believe that altering the behavior of a person with dementia means we are curing or slowing the disease.
Many practitioners in memory care – including some doctors — believe that the behaviors we find difficult or objectional are caused by the disease. I believe they are mostly caused by how we treat people with dementia because we so poorly understand the disease. I believe that behavioral problems are caused mostly by US, not THEM, which leads to my belief that the behaviors that we try to eliminate with drugs might never happen if we simply use the proven principles of person-centered compassionate care.
I am not an “anti-vaxxer!” I believe there are circumstances when psychotropics can improve the quality of life of a person living with dementia. But I believe these circumstances are relatively rare and demand the close supervision of a qualified expert in neuropsychology.
And I am not opposed to research. Because we have not found a silver bullet in more than 20 years of trying; it does not follow that we should stop trying. But we also need better education to eliminate the misunderstands and false hopes that swirl around the pharmaceuticals prescribed for dementia.
Let’s remember that we all deserve the best, and dumbing down our loved ones living with dementia with psychotropics because it may make OUR life easier is not a good solution.
Debbie Selsavage is a Certified Trainer and Consultant in the Positive Approach to Care®, and a Certified Dementia Practitioner. Her company, Coping with Dementia LLC, is dedicated to making life better for individuals living with dementia. Contact Debbie at [email protected] to learn about free support groups on line.
Until next time remember: “We all deserve the Best”
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