Drugs in Dementialand (and Why Bighead Has a Bit More Pep As of Late)

In late 2008, my husband and I adopted an English mastiff from our local shelter. At the time, he was already a senior citizen at the age of six. Mastiffs only live about seven to nine years, so I feel very fortunate to say Karl is still with us at approximately twelve years of age. We call him Bighead, and if you look at his picture you’ll know why. His head is freakishly huge in an adorable way. Of course, I’m biased because I’m a big fan of the old drooly gentleman.

Last week, Bighead wasn’t moving too fast. He seemed to be having just a bit more trouble getting up and down steps. In addition, I had a feeling he had both a urinary tract infection and an ear infection. Off to the vet we went. I kept my expectations realistic. After all, he is the equivalent of an 105 year old man. To tell you the truth, I was worried.

In addition to the antibiotics, the vet gave Bighead a bottle of Rimadyl, which is a non-steroidal anti-inflammatory medication for dogs that have joint pain and arthritis. I can’t say he’s acting like a puppy, but he’s got a bit more pep in his step. It doesn’t seem like as much of a struggle for him to get up and down stairs. He runs a little bit faster to go bark at his arch nemesis, Bowser the neighbor dog, in the backyard. He even got into his awkward play bow and tried to get our older cat, Teela, to play with him. That didn’t go well for Bighead.

I’m more optimistic about Bighead’s quality of life after he started Rimadyl. I know his arthritis is just as bad as it was before he started the drug. The drug isn’t reversing the aging process. I know it hasn’t really turned back the hands of time. It’s not going to extend his lifespan, but he is functioning at a slighter higher level. He’s still a twelve year old English mastiff, and I know he won’t be with us that much longer–so I enjoy every day we have with the guy. To be fair, I’ve been saying the same thing for the last four years, and he’s still here, sitting in the recliner across the room as I write this.

Rimadyl is what I call a Band-aid drug. It doesn’t really change the outcome or the disease process, but it may cover up issues and improve quality of life. It’s a figurative crutch. Obviously, I’d be happier if the drug were actually repairing his old body, but–and I’m about to use my least favorite phrase here–it is what it is.

Contrary to popular beliefs, the common drugs taken by people with dementia (e.g., Aricept, Razadyne, and Exelon) are also Band-aid drugs. These are often prescribed for people with Alzheimer’s and may also be prescribed for people with other types of dementia, like vascular or Lewy-Body. Although many people who take the drugs believe that they will slow the progression of dementia, that’s not the case.

Last fall, I spoke at an Alzheimer’s Association conference and had the pleasure of being seated at lunch with a neurologist who had just given an enlightening (but also discouraging) presentation on drugs used to treat dementia. His take-home message? The drugs don’t change the progression of the disease, but they do improve functioning for some individuals. He summed it up by saying, “I guess they’re worth a shot.” Not exactly a rousing endorsement. He did mention that, for the most part, individuals don’t have significant side effect from the drugs. Of course, there are people who I know who have experienced side effects, particularly nausea and nightmares.

I’m all about drugs that improve quality of life and treat symptoms. I am in no way saying people with dementia shouldn’t be on these commonly prescribed medications. What I am saying is that we often overestimate what they are capable of doing. They do not cure or slow the progression of Alzheimer’s or other dementias. They are classified as “palliative” or “supportive” medications. However, the people taking these drugs and the families of these individuals don’t seem to understand this….because we haven’t told them.

When someone has dementia, brain cells die (yes, literally) and the connections among brain cells that are still alive become less active. The drugs we have cannot bring back brain cells or slow their dying process, but they can impact chemicals that are involved in carrying messages among nerve cells in the brain.

Basically, they help the damaged areas of the brain function better for some people. They may stabilize symptoms temporarily or even give the illusion that the dementia has been “reversed.” (And I stress that symptoms are not even lessened in all individuals with dementia. Most studies suggest that less than half of patients have any benefit at all. I can guide you to some research articles to support these statements upon request.)

I will also add that a higher level of cognitive functioning (or a more “active” brain), which is the goal of these medications, may not be beneficial to every individual with dementia. In some cases, medications may increase anxiety because individuals are aware enough of their situation to be frightened and disturbed. Higher cognitive functioning doesn’t always equal an improved quality of life.

That’s a summary of the conversation I have with people when they asked whether or not these dementia drugs are effective. You can tell I don’t have stock in Pfizer. However, I give the company credit for adding the following statement to their website: It’s important to remember that while ARICEPT treats the symptoms of Alzheimer’s disease, it is not a cure. All patients will get worse over time, even if they take ARICEPT 23 mg.

Recently, a woman at one of my presentations told me–along with the rest of the audience–that her father (who had been diagnosed with early-onset Alzheimer’s last year and is only 56) was considering stopping his Aricept and smoking pot instead. I had to take a deep breath and think carefully about my response. All I could come up with was, “No comment.” Everyone laughed, and I awkwardly moved on to the next question.

That’s a post for another day. Besides, my peppy guy Bighead and I have to go outside so he can run to the fence and bark at Bowser.

3 thoughts on “Drugs in Dementialand (and Why Bighead Has a Bit More Pep As of Late)

  1. I also feel that the drugs are not very effective, but how do you not take every chance that you can to improve the quality of life. We were told that the drugs were not very effective and myself and my siblings understand, but all that mom and dad heard was a drug for Alzheimer’s. So, at this stage, if this gives them hope and some comfort that they are battling this, we will continue the regime. I just have hope that I will see a different outcome in my lifetime.

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