Archive for May, 2010

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.”


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.