Your Top Alzeheimer's Questions Answered
Over the last months, we have had some interesting and provocative comments from our readers and I would like to take this opportunity to thank them for both reading this blog and taking the time to put their thoughts into words and replying. Also, I would like to address some of the important issues that the comments raise.
First, in October 2008, Sharon and Nhoffman raise some important concerns about beta blockers. Beta blockers are medications that are most commonly used to treat high blood pressure. (They may also be used to treat migraine headaches.) "Beta blocker" is short for beta adrenergic blocker. Beta adrenergic action causes a constriction (narrowing of blood vessels) and increases blood pressure. Blocking this activity with these drugs is therefore one of the ways that health practioners treat high blood pressure. As Sharon and Nhoffman point out, there may be cognitive side effects from this class of drugs. Slower thinking may occur in the setting of beta blockers, and beta blockers may increase depression. Either or both of these situations may mimic dementia. It should be noted that there are numerous beta blockers and some beta blockers have a greater risk for cognitive impairment or depression than others. Therefore, it is important that patients and their health care providers communicate regarding the use of these drugs.
I would like to clear up one misconception regarding beta blockers. Although beta blocker and beta amyloid (the protein that accumulates in the brain and is associated with Alzheimer's disease) both contain the adjective beta, they are not related. The cognitive side effects that may occur with beta blockers are not related to beta amyloid.
In November 2008 Clarke Schacter commented that his wife has symptoms of dementia, including trouble with directions and vocabulary, but is usually in good humor and able to sing or hum. This observation raises some important points about Alzheimer's dementia. It is not a disorder of all cognitive functions. Some abilities are affected more than others in any given individual. Some long term memories, such as songs and tunes may be well remembered even when other abilities are impaired. The second important point is that not all patients with dementia have associated depression. People may have depression and so-called psuedodementia (depression that makes a person appear to be demented), dementia with depression or dementia without depression. As with so many medical circumstances, disorders may commonly occur with each other but may also occur alone.
Jumping back quite a bit to February 2007, Tracy Brooks asked two important questions: "should hospice pay for Alzheimer's medications?" and "when is it appropriate to stop these medications?" There are no "black and white" answers to these questions, but I would like to give a couple of thoughts about them. In the first case, when a family chooses hospice, the goal of the treatment is patient comfort. Therefore, the drugs we use to treat Alzheimer's disease may have limited or no use in that setting. Therefore, it would seem that in most cases, they could be discontinued in that setting. If they are not discontinued, the issue of who should pay for them is uncertain, and probably more dependant on insurance circumstances than anything else. In response to the second question, stopping the medications is most common when there are problems from the medications, such as side effects or interactions with other drugs. Otherwise, stopping them might occur when there is a question about the appropriateness of the drugs, such as perhaps an incorrect diagnosis. A medication may be started because it is believed that a patient has Alzheimer's disease, but it is determined that there is an alternative diagnosis. In such a situation it might be reasonable to discontinue the medications. There are arguments whether medication should be discontinued if they are not working. However, it is very difficult to be certain that they are not working. Therefore, the decision in this circumstance is very difficult.
I would like to thank you all again for reading these comments on Alzheimer's disease and look forward to comments in the future.