Posts Tagged ‘Aricept’

Adventias: Behold the power of pharma

Monday, February 14th, 2011

By the winter of 2009, dementia was really taking a toll on our Gran’mom. If I asked her whether she’d prefer turkey or ham in her sandwich, she’d look at me for a moment, look away for a moment, and then perk up brightly and tell me something about her cat. She called me less and less often, and when she did call, conversations were challenging.

Beginning an anti-dementia drug in March 2010 markedly improved Sarah’s function, albeit not without some hiccups.

In December 2010, I finally got motivated to find Sarah a new neurologist (or, new-rologist) in Houston. Our cousin Sharon is a research coordinator for Methodist Hospital’s Neurological Institute and she secured an appointment for Sarah with the director of their National Alzheimer Center. Dr. R is an experienced and knowledgeable clinician, and despite his impressive responsibilities, he spent almost two hours kindly and patiently learning Sarah’s history and evaluating her cognitive function.

When I told Dr. R about Sarah’s improvement on Aricept, he told us about a second anti-dementia drug called Namenda. He said that it works on a second set of metabolic pathways, and encouraged us to take home a 4-week trial. Sarah started it the next morning.

At first, I didn’t notice any changes as the dose ramped up. But during Sarah’s fifth week on Namenda, things got interesting. First, consider Tuesday:

  • Sarah called and woke me up (she called!) wanting to confirm that I would take her to the podiatrist. She was looking incorrectly at Wednesday (rather than Tuesday) in her calendar book, but she was using her calendar book again.
  • At 10:30 am, Sarah called again (she called!) wanting to know where Sammy and Gracie (her late parents) were. Startled, I asked what she meant. She told me that they’d flown to Jacksonville like they usually do and she’d picked them up at the airport, but now she was at “her office” and she couldn’t find them. (?!?) After I worked up to gently explaining that her parents had been dead for about 40 years, Sarah told me I was scaring the socks off her.
  • Around 4:00 pm, Sarah called again (she called!) wanting to know where my parents were. She told me that they had dropped her off at Belmont just long enough to go up and check on her cat (?!?), but when she came back downstairs, they were gone. After I worked up to gently explaining that my parents hadn’t been to visit her since Christmas, she again told me I was scaring the socks off her. I learned later from Belmont’s concierge that Sarah had actually gone outside several times, approached another family who drove a familiar-looking Honda, and walked as far as the street looking for my parents. Yikes!

Now, consider Wednesday:

  • I collected Sarah and we went to the podiatrist together. She seemed more alert, more observant, and more conversational than I remember her being in ages.
  • The in-house physical therapist told me excitedly that Sarah had just had the best PT session, ever. He said that her coordination was better, she was less distractable, and she stayed focused for a whole hour.
  • After lunch, we talked about making a grocery list. She asserted that she needed soap, and when I asked what kind, she thought for a moment with furrowed brow and then asked, “does Yardley’s make a lavender soap?” She used Yardley’s for decades but I haven’t seen her recall its existence in several years. Startled, I exclaimed, “I’m so delighted with how much sharper you seem this week!” to which she replied, “Me, too!” Turning toward the window she added, “It’s like when you open the blinds and the sun comes back in.”

Goosebumps. I don’t understand all of what happened Tuesday, but I’ll take it if it gets Sarah more Wednesdays.

* * *
I join Sarah for lunch or dinner about once a week, and we usually sit with some of her neighbors. A few are adept conversationalists who face physical challenges, but many face cognitive challenges similar to Sarah’s, and I’m often responsible for facilitating the conversation.

But not last week. For a change, I mostly listened while Sarah and her neighbor Evelyn swapped stories from their younger days. For more than an hour, they wove a fascinating conversation about S&H green stamps, and picking cotton, and what the stove and other amenities were like in their mothers’ kitchens, and more.

Sarah and neighbors at lunch
Sarah at lunch with her neighbors, Rhoda and Evelyn.

I don’t know how the Aricept and Namenda are working or for how long they will help. But seeing Sarah reclaim the ability to engage and reminisce is a gift for which I’m profoundly grateful.

Adventias: Intercepting dementia…

Monday, May 31st, 2010

When Sarah’s doctor first offered to prescribe an anti-dementia drug in early 2008, we told him “no, thank you.” Sarah hated the idea of taking “One. More. Pill.” I am skeptical of Big Pharma and the drugs seemed geared to help Alzheimer’s rather than vascular dementia. Worse, she’d had an adverse reaction to a new drug just months earlier. Gran’mom and I agreed to leave well enough alone.

Since then, Sarah’s cognitive function continued to decline:

  • She stopped using the menu to choose meals and succumbed to just letting servers bring her the daily “special”;
  • She forgot how to use her calendar book, and eventually forgot that she had a calendar book; and
  • She called me less and less often.

Over time, my fiercely independent Gran’mom became quiet and docile. In her confusion, she was eager to trust a confident family member to lead her through whatever would come next. Anytime I showed up, she was happy to see me and easy to please. If I pushed a visit back a day to meet a work deadline, she didn’t seem to notice, because being aware that I had rescheduled would require knowing to expect me in the first place.

I have to admit now that caring for Sarah seemed easier probably as much because confusion made her less able to experience and express frustration as because Belmont takes good care of her.

In February, I took Sarah for a routine checkup and she told Dr. Q that “I feel confused all of the time.” When he invited us to reconsider an anti-dementia drug, we did.

As Dr. Q walked us through the detailed pharmaceutical information, we learned that clinical trials for Aricept had differentiated between patients with vascular dementia versus Alzheimer’s dementia. The research indicated some benefits for memory function and specific benefits for “executive function.” It sounded like Aricept might actually help her.

I asked Sarah how she felt about trying a new drug that might relieve some of her confusion. This time, she said any improvement would be welcome, and allowed as how trying a new drug for a few weeks to see if it worked sounded like a good idea. Dr. Q wrote the scrip and the pharmacy delivered the new pills that same night.

The current scientific hypothesis for dementia is that some people, for a host of reasons over time, lose their ability to clear beta-amyloid protein from their brains. This sticky protein forms plaques and tangles that kill neurons and impair brain function as they accumulate, literally gumming up the works. Aricept ostensibly helps clear this protein to preserve brain function.

Patients who respond well generally see improvements over 6+ weeks. We saw differences in Sarah within four days.

At first she was still confused, but she became assertive again. Sarah rang my phone daily for a week with questions about when I would shop for groceries, and where her car is, and whether she still owned a condo in Galveston.

By April, she seemed less confused. Sarah knew what day it was and began using her calendar book again. She was already dressed and ready to accompany Jean to the symphony when Jean called to remind her to get ready. That hadn’t happened in months.

Now she’s even seeming more self-aware. I mentioned her condo last week, and sounding wistful she asked, “do you think I’ll ever get back there?” As gently as I could, I said, “I don’t think so.” We’ve had this exchange many times since Hurricane Ike and she usually asks me, “why not?” But this time she said quietly, “I don’t think so either. I’m acutely aware how dependent I have become on others to get by.”

Wow.

I’m really excited that Sarah is functioning better. I’m also challenged: as she improves, Sarah has more opinions and more persistence which means more opportunities to argue. But I’ll save those pitfalls for another post.

Regardless, it’s readily apparent that Aricept is making a difference for Sarah. I know that it can’t bring her all the way back from all the vascular damage that’s been done. But I’m optimistic that it will significantly slow the progression of this terrible disease. And that’s a good thing.