About Alzheimer's Disease: Caregiving

On this page:

Caregiving Tip Sheets and Resources

比如:

洗澡

日常活動

梳洗和穿衣

比如病人早晨起床就喜歡穿某一套服裝或某件上衣或某條褲子，堅決不肯換下來洗。那就不要費力地解釋或強製更換，盡量買到同樣或差不多顏色的衣褲，晚上換掉，滿足病人，不去刺激他/她變成wild animal似地狂躁。有一次ER接到一位病人。他曾在某餐館工作。家屬說可給他一些洗臉巾(wash cloth)去疊，會讓他安靜些。試了一下，是有些效果，疊成各式各樣，讓他忙著。不過不能等到他最高狂躁的狀態。
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兩個視頻:

Biomarkers and Alzheimer's Disease: Dr. Neil Buckholtz
很喜歡以上這個視頻。它提到一種蛋白---Tau protein對神經元的影響。
Tau是一種微管相關蛋白，當它有缺陷並不再正常穩定微管時，可導致神經係統病變和失智症，如阿滋海默病。
這是一個新研究: Tau protein, not plaque, may cause Alzheimer's, study says ...

Alzheimer's Disease Clinical Trials: Dr. Laurie Ryan

診斷:

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To diagnose Alzheimer’s, doctors may:

ask questions about overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality
conduct tests of memory, problem solving, attention, counting, and language
carry out standard medical tests, such as blood and urine tests, to identify other possible causes of the problem
perform brain scans, such as computed tomography (CT) or magnetic resonance imaging (MRI), to distinguish Alzheimer’s from other possible causes for symptoms

These tests may be repeated to give doctors information about how the person’s health and memory are changing over time. Tests can also help diagnose other causes of memory problems, such as mild cognitive impairment and vascular dementia.

For more information, see Understanding Memory Loss.

看哪些專科醫生?

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If a primary care doctor suspects mild cognitive impairment or possible Alzheimer’s, he or she may refer you to a specialist who can provide a detailed diagnosis, or you may decide to go to a specialist for further assessment. You can find specialists through memory clinics and centers or through local organizations or referral services. Specialists include:

Geriatricians, who manage health care in older adults. They know how the body changes as it ages and whether symptoms indicate a serious problem.
Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems
Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans
Neuropsychologists, who can conduct tests of memory and thinking

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目前有哪些治療藥物?

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Medications to Treat Alzheimer's Disease

Note: This brief summary does not include all information important for patient use and should not be used as a substitute for professional medical advice. Consult the prescribing doctor and read the package insert before using these or any other medications or supplements. Drugs are listed in order of FDA approval, starting with the most recent.

(To view this as one table, please open the PDF version of this publication.)

DRUG NAME	DRUG TYPE AND USE	HOW IT WORKS	COMMON SIDE EFFECTS
Namenda® (memantine)	N-methyl D-aspartate (NMDA) antagonist prescribed to treat symptoms of moderate to severe Alzheimer’s	Blocks the toxic effects associated with excess glutamate and regulates glutamate activation	Dizziness, headache, constipation, confusion
Razadyne® (galantamine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer’s	Prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain	Nausea, vomiting, diarrhea, weight loss, loss of appetite
Exelon® (rivastigmine)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate Alzheimer’s (patch is also for severe Alzheimer's)	Prevents the breakdown of acetylcholine and butyrylcholine (a brain chemical similar to acetylcholine) in the brain	Nausea, vomiting, diarrhea, weight loss, loss of appetite, muscle weakness
Aricept® (donepezil)	Cholinesterase inhibitor prescribed to treat symptoms of mild to moderate, and moderate to severe Alzheimer’s	Prevents the breakdown of acetylcholine in the brain	Nausea, vomiting, diarrhea

DRUG NAME	MANUFACTURER’S RECOMMENDED DOSAGE	FOR MORE INFORMATION
Namenda® (memantine)	Tablet: Initial dose of 5 mg once a day May increase dose to 10 mg/day (5 mg twice a day), 15 mg/day (5 mg and 10 mg as separate doses), and 20 mg/day (10 mg twice a day) at minimum 1-week intervals if well tolerated Oral solution: same dosage as above Extended-release tablet: Initial dose of 7 mg once a day; may increase dose to 14 mg/day, 21 mg/day, and 28 mg/day at minimum 1-week intervals if well tolerated	For current information about this drug’s safety and use, visit www.namenda.com. See Full Prescribing Information (PDF, 555K).
Razadyne® (galantamine)	Tablet: Initial dose of 8 mg/day (4 mg twice a day) May increase dose to 16 mg/day (8 mg twice a day) and 24 mg/day (12 mg twice a day) at minimum 4-week intervals if well tolerated Oral solution: same dosage as above Extended-release capsule*: same dosage as above but taken once a day	For current information about this drug’s safety and use, visit www.razadyneer.com. See Full Prescribing Information (PDF, 677K).
Exelon® (rivastigmine)	Capsule*: Initial dose of 3 mg/day (1.5 mg twice a day) May increase dose to 6 mg/day (3 mg twice a day), 9 mg (4.5 mg twice a day), and 12 mg/day (6 mg twice a day) at minimum 2-week intervals if well tolerated Patch: Initial dose of 4.6 mg once a day; may increase to 9.5 mg once a day and 13.3 mg once a day at minimum 4-week intervals if well tolerated Oral solution: same dosage as capsule	For current information about this drug’s safety and use, visit the www.fda.gov/Drugs. Click on "Drugs @ FDA," search for Exelon, and click on drug-name links to see "Label Information."
Aricept® (donepezil)	Tablet: Initial dose of 5 mg once a day May increase dose to 10 mg/day after 4-6 weeks if well tolerated, then to 23 mg/day after at least 3 months Orally disintegrating tablet: same dosage as above 23-mg dose available as brand-name tablet only	For current information about this drug’s safety and use, visit www.fda.gov/Drugs. Click on “Drugs @ FDA,” search for Aricept, and click on drug-name links to see “Label Information.”

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病人狂躁或顛倒時序不睡覺該怎麽辦?

實在無法控製病人時，有一些藥物可以幫助。點擊以下兩個鏈接:

Treatments for Behavior

For Sleep Changes

來自alz.org: http://www.alz.org/alzheimers_disease_treatments_for_behavior.asp

Medication examples

Some medications commonly used to treat behavioral and psychiatric symptoms of Alzheimer's disease, listed in alphabetical order by generic name, include the following:

Antidepressants for low mood and irritability:

citalopram (Celexa)
fluoxetine (Prozac)
paroxeine (Paxil)
sertraline (Zoloft)
trazodone (Desyrel)

Anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance:

lorazepam (Ativan)
oxazepam (Serax)

Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness:

aripiprazole (Abilify)
clozapine (Clozaril)
haloperidol (Haldol)
olanzapine (Zyprexa)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

Antipsychotic Medications

The decision to use an antipsychotic drug needs to be considered with extreme caution. Research has shown that these drugs are associated with an increased risk of stroke and death in older adults with dementia. The FDA has ordered manufacturers to label such drugs with a “black box” warning about their risks and a reminder that they are not approved to treat dementia symptoms.

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來自另一網站的一些tips: