Adjunct Treatments for Alzheimer's

If you have someone in your family who is suffering from Alzheimer 's Disease, whether it's your mother, father, grandmother, or aunt, you probably know that they gradually forget things. That is the main symptom of this disease. But, in addition to losing their memory, you may have noticed big changes in their behavior. Sometimes they get restless, angry, sad, or just keep walking around at night without sleeping. When you see these things, you must also feel very sad. Today we are talking about additional treatments, or ``Adjunct Treatments``, that are given for behavioral and mental problems that occur in addition to memory loss in Alzheimer's disease.

Simply put, when Alzheimer's disease damages nerve cells in the brain, it affects not only memory but also the parts that control our behavior. This is why these problems occur.

• Agitation
• Aggression
• Anxiety​
• Delusions (believing in things that don't exist)
• Depression
• Seeing things that are not visible or hearing things that are not (Hallucinations)
• Insomnia
• Restlessness

These symptoms can be very stressful for the patient and for you, the caregiver. Doctors usually recommend that you first try to manage these symptoms with lifestyle changes and behavioral therapy before resorting to medication. You should also first determine if there is another cause for the changes in behavior (for example, an infection, a vision or hearing problem, or a side effect of another medication).

But sometimes medication is the best option. Many of the medications we're talking about here aren't specifically approved for Alzheimer's disease. Doctors prescribe these "off-label." That is, a drug approved for another condition (such as depression) is given because the doctor's experience suggests it may also be appropriate for the behavioral problems of an Alzheimer's patient.

Sleep aids

Many people have sleep problems as they age.It happens. But it's most common among Alzheimer's patients. Because of brain changes, they wake up frequently at night and are tired during the day.

Only if lifestyle changes don't help you sleep, and staying awake at night is very bothersome, may your doctor prescribe a medication like this:

• Suvorexant (Belsomra): This is the only drug approved by the US FDA for sleep problems associated with Alzheimer's disease. It belongs to a class of drugs called ``Orexin inhibitors.'' Simply put, it works by blocking a chemical in our brain that signals "it's time to wake up." However, this drug can cause side effects such as sleepwalking, depression, and daytime sleepiness.
• Other Sedatives: Your doctor may prescribe other sleeping pills, such as `Eszopiclone (Lunesta)` or `Zolpidem (Ambien).` However, taking these can cause you to do unusual things while you are asleep (such as eating or driving in your sleep). They can also cause daytime confusion, memory loss, and an increased risk of losing your balance and falling.

Very important: Sleeping pills should only be used for the shortest possible time . They can make you dizzy and easily fall asleep. Once your sleep pattern has returned to normal, you should talk to your doctor and try to stop taking them.

Also, some sleeping pills (containing antihistamines, e.g. diphenhydramine) that you can buy over-the-counter from pharmacies are not suitable for Alzheimer's patients at all . They can interfere with communication between nerve cells in the brain, worsening memory and thinking skills.

Antidepressants & Anti-anxiety Drugs

Depression is also very common with Alzheimer's disease. To improve the patient's mood, the doctor may prescribe antidepressants. These medications can help not only with depression, but also with anxiety, sleep problems, agitation, and hallucinations.

Warning: Older antidepressants, such as tricyclic antidepressants (e.g., amitriptyline) and SSRIs such as paroxetine (Paxil), are not recommended for people with Alzheimer's disease. They can further impair memory and thinking skills.

Sometimes doctors prescribe short-term medications called benzodiazepines (e.g., Lorazepam (Ativan), Diazepam (Valium)) to treat anxiety, restlessness, and aggressive behavior. However, these can also cause drowsiness, dizziness, confusion, and a higher risk of falls.

Antipsychotics (medications for severe anxiety and mental problems)

Some behavioral problems that occur with Alzheimer's disease can be dangerous for the patient or their caregivers. For example, extreme aggression, attempts to harm themselves or others, and seeing or hearing things that are not there. In such cases, antipsychotic medications may be used as a last resort, if there is no other option .

Before starting this medication,

• Creating a calm environment
• Getting used to a routine
• Engaging in physical activity

You should definitely try things like that.

Antipsychotic medications (e.g., `Risperidone (Risperdal)`, `Quetiapine (Seroquel)`, `Olanzapine (Zyprexa)`) are used to:

• If the patient is in a position to endanger themselves or others.
• If the behavior problem makes it impossible to provide the necessary medical treatment.
• If you have another mental illness (e.g. schizophrenia ) in addition to Alzheimer's disease.

In these medicinesThere is a serious risk. That is, it increases the risk of stroke and death in elderly patients with Alzheimer's disease. In addition, they cause severe drowsiness and increase the risk of falls. In addition, some of them can counteract the action of drugs that improve memory and thinking in Alzheimer's disease, reducing the benefit of those drugs.

Other additional treatments

In addition to the medications mentioned above, other medications are sometimes used "off-label".

• Anticonvulsants: Antiepileptic drugs such as Carbamazepine and Gabapentin are sometimes used to control agitation in Alzheimer's patients.
• Anti-Parkinson's drugs: Some drugs used to treat Parkinson's disease are being studied to see if they can also help with Alzheimer's symptoms.