Brief Answer:
I share your concerns over side effects of drugs in a patient with dementia

Detailed Answer:
Thank for your question.

I too would be concerned for the side effects of ALL medications used to treat patients with dementia because the brains of such individuals lack the normal physiological and at times architectural framework that makes folks which NON-demented brains much more resilient and able to compensate for in a more robust fashion comparatively speaking. However, the truth behind the pharmacology of all prescription (and non-prescription as well) is that side effects will always be a POTENTIAL reality in a small number of patients.

I always choose to use the absolute MINIMUM of medications in my demented patients and find that many nursing home patients I'm asked to consult on tend to be on many drugs that are either unnecessary, not indicated, or otherwise obstructive or counterproductive of helping patients with dementia be as engaged and reactive/interactive as possible with family, friends, and care staff.

Medications such as sertraline and lamotrigine tend to make patients more lethargic and less capable of interacting or being engaged. However, they are also commonly used to treat either behavioral complications of dementia or if a patient is felt to be depressed, anxious, or otherwise psychiatrically impaired.

I personally believe that SSRI's such as sertraline are far too commonly used without real evidence or medical justification but because they are so common and reached for by so many physicians it becomes almost a 90 degree uphill battle to change that way of thinking. In my patient population I always strive to get full clarification from providers as to why each and every medication is being used and to try and remove any medication that could possibly interfere with a patient's status of alertness or ability to think as clearly as possible despite the dementing illness. Believe me, it's not easy to go against such a cacophany of opinion since both doctors and public again, in my humble opinion OVERUSE dementia medications based upon information from Big Pharma that somehow these medications are clearly indicated and NECESSARY and that there are no options.

Meta analyses of data on the current state of anti-dementia medications such as memantine, donepezil, and others has shown that over the past decade the slightest dents may have been made in patient quality of life when compared to no medication at all. I could go on and on about the reasons but suffice it to say that as stated previously my personal habit and actions when dealing with diagnosing or managing dementia patients is to reduce or eliminate what I consider to be UNNECESSARY (even antacids) and instead recommend COGNITIVE SUPPORT SYSTEMS which call for much more family, nursing, and support care interaction. PHYSICAL EXERCISE and plans that involve engaging the patient with things other than 8 hrs. of TV watching in a wheelchair while hunched over are far more productive, listening to music from their era and time can have DRAMATIC and cumulative effects on patient's abilities to kick start the brain.

However, these are very labor intensive and sometimes costly to families as opposed to pills that are covered by insurance plans. We do not have anything in the near future expected to change the course of dementia and I believe we need to really get on top of things as a society and realize that our approach to caring for these patients is sorely in error. Doctors need to promote the notion of LESS MEDICATION, MORE INTERACTION by families and support staff. Our care centers need to be focused on physical fitness, diet, and other activities that kick start the brain by asking IT to do what it does best....SOLVE PROBLEMS, CALCULATED BODY MOVEMENTS such as dance or other activities that require hand eye coordination, etc.

Learning foreign languages and musical instruments as well as how to write with the non-dominant hand are all examples of crazy activities that you will be hard pressed to find in many nursing homes or as part of any physician based set of recommendations and that's because the mind set is grounded in the PHARMACOLOGICAL SOLUTIONS as being the best and only ways to deal with the problem.....nothing can be further from the truth.

To understand how much I say what I mean and mean what I say I should tell you that I apply and execute all the above rules upon my own mother who suffers from dementia and I believe she has gained much more from resisting the knee jerk response that get people on the pharmacological merry go round and result in nothing but ongoing deterioration without any real promise of improvement whereas creative activities and changes of atmosphere and environment in the context of medications absolutely essential for life functions gives us the BEST CHANCE of managing the disease for as long as possible with the highest possible quality of life. At this time curing is not possible....but putting useless pills into my mother is of no consolation to me and simply intoxicates her system which otherwise is quite healthy and strong and I intend to make sure it stays that way with excellent nutrition and physical exercise.

Ok.....I will now get off the soapbox....you get the idea. I would have a conversation with the physician and ask for the evidence and clinical support that these medications make a clear and present difference to her condition. If you are convinced that they actually do work as intended and that without them your mother-in-law would be decidedly worse and live a poorer quality of life then, the medication should stay. To the contrary, the medication should go and my recommendation for a substitute is everything I've mentioned above.....and to also be sure that your mother-in-law has received the maximum metabolic and neurological workup and attention possible so that something as silly as a Vit. B12 or Vit. D deficiency which can be easily corrected is not somehow being missed which could turn around a lot of things in an instant.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 38 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
All the best

Detailed Answer:
You're welcome and I do hope that your mother-in-law can be taken off of things that are simply of no real utility so that she may have a chance at using her obvious very capable brain and neural networks to interact with her environment and family more meaningfully. The antidementia meds in the Phase III trials were never shown to be any more benefit than 12-18 months at the most and this was only from the perspective of "slowing down" or retarding the dementing illness. At 2 years from initial use the decline in cognition was at the same pace and gets to the same baseline level as a person who never took the medication to begin with...think about that one for just a moment. And this is what the trials that received FDA approval showed. However, you'll notice that virtually every doctor and every pharmaceutical rep that details these drugs will adamantly and staunchly defend the position that dementia patients should REMAIN on their drugs for life because somehow if they come off they were spiral at even a more rapid rate. The trials only showed a window of 12 months after which everyone looks identical (those who took such meds compared to those who never took such meds). Many neurologists even echo these notions of keeping patients on lifelong medication for which absolutely no proof exists for efficacy and if anything we actually have studies that demonstrate increased levels of toxicity since as people age their kidneys and livers will become less and less capable at processing and filtration medications out of the body which means that at some point the medications supposedly being used to defeat the dementia actually start contributing more heavily to accumulating toxins which is what causes more of demise than the disease itself. But how can one tell the difference? You can't. We need to rethink exactly WHY we must medicate dementia patients to get better when that is simply not possible. And so, in my opinion, if the goal being sought cannot be achieved by the only medications available on the market why use anything and why not better use the other methods I mentioned before to prod the brain into forced functionality albeit a difficult and arduous task for both patient and caregiver?

All the best to your mother-in-law....hopefully, the landscape will look differently when WE...the younger generation get there.....but my vote for quality actions and paths to follow when it comes to treating dementia patients (even if I become the patient one day) will be for doing those things which require the most toil and patience. Such activities will bear more fruit than anything else especially if the alternatives are easy, painless, and tend to be what everyone else would preferentially choose.... XXXXXXX Frost's trodden path vs. the Road "...less traveled by."

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 58 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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