PRESCRIPTIONS
Drugs may help senility, but there is no cure for it
By Landis Lum
Q. My mom is senile and it's getting worse. What's good for memory?
A. Alzheimer's disease is the most common type of senility or dementia, which leads to memory loss, poor judgment and inability to perform everyday tasks such as shopping and bathing. The brain is like a damaged circuit board — sometimes the circuits connect; sometimes they don't. Therefore, it's not true that your mom could remember if she "really tried."
Personality changes such as anxiety, aggression and suspiciousness can occur. Behavioral problems can sometimes be traced to drugs that can cause confusion or drowsiness. Or from sensory overload such as music during conversation or too many people around. So try to determine what was going on just before an outburst. Was there too much noise?
Sometimes simply getting a person's vision or hearing corrected will improve behavior.
Sudden behavior changes such as confusion could be because of a bladder infection, constipation, dehydration or something else, so tell the doctor.
Activities like getting dressed or brushing teeth are actually very complex and may be overwhelming. Breaking down a task into smaller steps to be done one at a time may be needed. You may even have to do the first few steps of the task to get the person started, and eventually may have to do most of the steps yourself.
People have trouble remembering to drive at the right speed, to stop when the lights change, or to react quickly in emergencies. They are a danger both to themselves and others and must stop driving. Call the Alzheimer's Association (591-2771) for hints on getting people to stop driving, ideas on other issues (such as wandering) and for Alzheimer's support groups.
Drugs may help memory and function a bit, but will not cure Alzheimer's. A great book, "Clinical Evidence," considers Aricept and Reminyl the best, though they may cause dizziness or drowsiness.
There is promising evidence of improvement with Ginkgo biloba, though three recent studies showed inconsistent results. Selegiline, a Parkinson's disease drug, may act as an antioxidant and reduce neuronal damage. But while the evidence for a beneficial effect of selegiline is promising, there is not yet enough evidence to recommend routine use.
Lecithin and vitamin E don't work. For behavioral problems such as agitation, "Clinical Evidence" liked carbamazepine, Zyprexa, Risperdal, sodium valproate and reality orientation therapy. And read "The 36-hour day," a wonderful book by Nancy Mace and Peter Rabins.
Dr. Landis Lum is a family practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i's John A. Burns School of Medicine.
