About Alzheimer's Disease: Caregiving

On this page:

Caregiving Tip Sheets and Resources

比如:

洗澡

日常活动

梳洗和穿衣

比如病人早晨起床就喜欢穿某一套服装或某件上衣或某条裤子，坚决不肯换下来洗。那就不要费力地解释或强制更换，尽量买到同样或差不多颜色的衣裤，晚上换掉，满足病人，不去刺激他/她变成wild animal似地狂躁。有一次ER接到一位病人。他曾在某餐馆工作。家属说可给他一些洗脸巾(wash cloth)去叠，会让他安静些。试了一下，是有些效果，叠成各式各样，让他忙着。不过不能等到他最高狂躁的状态。
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两个视频:

Biomarkers and Alzheimer's Disease: Dr. Neil Buckholtz
很喜欢以上这个视频。它提到一种蛋白---Tau protein对神经元的影响。
Tau是一种微管相关蛋白，当它有缺陷并不再正常稳定微管时，可导致神经系统病变和失智症，如阿滋海默病。
这是一个新研究: Tau protein, not plaque, may cause Alzheimer's, study says ...

Alzheimer's Disease Clinical Trials: Dr. Laurie Ryan

诊断:

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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.

看哪些专科医生?

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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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目前有哪些治疗药物?

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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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病人狂躁或颠倒时序不睡觉该怎么办?

实在无法控制病人时，有一些药物可以帮助。点击以下两个链接:

Treatments for Behavior

For Sleep Changes

来自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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来自另一网站的一些tips: