by Julie Cleveland
The 19th annual UW Alzheimer’s Disease Research Center (ADRC) public forum was held on June 2 at the King County Aquatics Center in Federal Way, Wash. The turnout was great, with over 100 attendees, and the program was well received. Informational booths by the ADRC and Alzheimer’s Association provided people with educational materials and answered questions before and after the presentations.
Dr. Linda Teri, UW ADRC Education and Information core leader, introduced the program speakers for the evening: Dr. James Leverenz, associate professor of Neurology and Psychiatry and Behavioral Sciences at the UW School of Medicine, staff neurologist at the VA Northwest Network, and investigator at the Mental Illness and Parkinson’s Disease Research, Education, and Clinical Centers, and Dr. Alan Stevens, director of the Dementia Care Research Program at the University of Alabama at Birmingham. After their presentations, both speakers answered questions from the audience, and provided an opportunity for them to share their stories and concerns about caregiving.
Dr. Leverenz presented "Medical Advances in the Treatment of Alzheimer’s Disease." He discussed the prevalence of the different types of dementia, assessment procedures in diagnosing dementia, signs and symptoms of AD, and the pharmacological treatment options for dementia.
The most widely used medications for treating dementia are cholinesterase inhibitors such as rivastigmine (Excelon), donepezil (Aricept) and galantamine (Reminyl). In clinical research trials, these medications have been shown to maintain or slow the decline of cognitive function over time, as well as help maintain activities of daily living, and decrease behavioral symptoms of depression, anxiety and apathy in people with AD. Clinical trial studies are also being done on the effect of these medications on vascular dementia and dementia with Lewy bodies. One negative aspect of these drugs is that side effects are common, and include nausea, diarrhea, dizziness, weight loss, agitation, and tremor.
Other pharmacologic options for treating dementia include Vitamin E and selegiline (Eldepryl). A trial done by the Alzheimer’s Disease Cooperative Study (ADCS) found that both delayed the progression from moderate to severe dementia, loss of basic activities of daily living, nursing home placement, and death. Vitamin E is a less expensive and relatively safe option, with the only caution being negative interactions with anticoagulant drug therapies such as warfarin.
Finally, a recently FDA-approved drug called memantine (Ebixa), which is a NMDA receptor antagonist, is being used for those with moderate to severe dementia. Studies show that memantine is effective in maintaining or slowing the decline of cognitive function in both AD and vascular dementia, and appears to have fewer side effects than the cholinesterase inhibitors.
Dr. Stevens presented "Caregivers: Attitudes, Actions, and Skills that Form the Tapestry of Care." He discussed the attributes that caregivers often have in caring for someone with dementia: love, acceptance, compassion and empathy, humor, self-preservation and courage. He also touched upon the importance of providing help and support for caregivers.
Love, Dr. Stevens stated, is the foundation of caregiving. Without love, caregivers would not be able to care for another person. Acceptance means acknowledging their loved one has a disease, and that it will not go away. Acceptance helps caregivers embrace this new part of life and move forward with the planning and care of the person with dementia. Compassion and empathy mean acting with kindness and concern, remembering what is important to the person receiving care. Humor is an essential ingredient that helps keep life manageable and enjoyable; it improves quality of life. Caregivers must learn to find things to laugh about – both from old memories and new experiences. Self-preservation is the concept that caregivers need to take care of themselves, so they can continue to care for their loved one over the course of the disease. Self-preservation also means accepting the fact that the caregiver is not the only person that can care for the person with dementia; it is OK to ask for and accept help from others. Courage is standing with strength and grace in the face of adversity. Caregivers never know what is coming next, and they will need more than learned skills to care for someone with dementia – they also need internal attributes to get them through.
Plans for next year’s public forum are already underway. Hold the date for May of 2005 on your calendar, and look for more details in upcoming issues of Dimensions.