Not Quite OT--Some Alzheimer's drugs very risky
11 Oct 2006, 8:54 pm
http://news.yahoo.com/s/ap/20061012/ap_ ... aggression
I think this is of interest to the autistic community because of
a)one of the drugs in the study is Risperdal, newly approved for use in autistic children
b)the sympathy bias for the caretakers, not the patients
The finding could increase the burden on families struggling to care for relatives with the mind-robbing disease at home.
"These medications are not the answer," said Dr. Thomas Insel, director of the National Institute of Mental Health, which paid for the study. He said better medications are at least several years away.
Three-fourths of the 4.5 million Americans with Alzheimer's disease develop aggression, hallucinations or delusions, which can lead them to lash out at caregivers or harm themselves. This behavior is the most common reason families put people with Alzheimer's in a nursing home.
The study tested Zyprexa, Risperdal and Seroquel — newer drugs developed for schizophrenia. Doctors are free to prescribe them for any use. However, the drugs carry a strong warning that they increase the risk of death for elderly people with dementia-related psychotic symptoms, mainly because of heart problems and pneumonia, and that they are not approved for such patients.
Yet roughly one-quarter of nursing home patients are on these drugs, and at least that many patients at home have used them, mainly because there are no great alternatives and there was some evidence they might help a little, experts say.
The study tested the drugs on 421 patients at 42 medical centers who needed considerable care but were living in their own home, a relative's or an assisted-living facility. The findings were reported in Thursday's New England Journal of Medicine.
Each patient got one of the drugs or a dummy pill, without knowing what they received. The doctor could raise the dose if needed. Patients were followed for nine months, longer than in most prior tests.
About four in five patients stopped taking their pills early — on average, within five to eight weeks — because the medications were ineffectiven or had side effects that included grogginess, worsening confusion, weight gain, and Parkinson's-like symptoms such as rigidity and trouble walking.
Five deaths were reported among the patients on the medication, versus two among those in the placebo group. But researchers said the difference could be a matter of chance. The causes of death were not disclosed.
Symptoms did improve in about 30 percent of patients taking the drugs, as well as in 21 percent of those getting dummy pills, partly because symptoms can naturally wax and wane.
Some patients who stopped taking one pill were switched to another treatment for the study's second phase, results of which are to be reported next spring.
While the federal government paid for the study, the medications were supplied by the manufacturers: AstraZeneca Pharmaceuticals LP, maker of Seroquel; Eli Lilly and Co., maker of Zyprexa; and Johnson & Johnson, maker of Risperdal. Most of the researchers have received grants or consulting or lecture fees from the industry.
Dr. Jason Karlawish of the University of Pennsylvania's Alzheimer's Disease Center wrote in an editorial that the drugs did help a small group of patients who had little or no side effects. He said Zyprexa and Risperdal were both better than Seroquel or the placebo in treating the behavioral problems.
Lead researcher Dr. Lon Schneider, director of the Alzheimer's Disease Center of California and a University of Southern California professor, said doctors should try the drugs if necessary, but watch patients closely and switch to something else after a few weeks if there is no improvement or side effects are too severe.
"Patients are put on these kinds of medications and not particularly monitored and treated for indefinite periods of time," Schneider said. "That just maximizes risk."
Schneider said nursing home residents need the drugs more because their behavior problems are generally worse than patients still at home, but their health is more fragile, raising the danger of side effects.
Dr. Claudia Kawas, an adviser to the Alzheimer's Association and a neurology professor at University of California-Irvine, said she sometimes prescribes the drugs. Kawas said that when delusions or aggression develop, it is best to determine if a change in the patient's life triggered the symptoms and whether the behavior can be managed with visits by a health worker.
Also, possible causes such as dehydration, infections and side effects from other medications should be ruled out.
Kawas noted that with the U.S. population aging, the number of Alzheimer's patients is expected to quadruple by mid-century to about 18 million.
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I wonder if long term effects have been studied with the use in children?
12 Oct 2006, 12:55 am
It's child abuse if you strike your child...and it should be, but how is OK to use them as guinea pigs?WHY?
Because this world is INSANE.
I work with a client who has beginning stage "dementia".He was put on several different medications to try and mellow his aggressive behavior and ease his anxiety,ALL of them,made his behavior worse.It took the company months to take him off the medication inspite of several staff mentioning the obvious correlation of the new meds and the increase of his aggression.Any time a new medication is started there should be specific follow up to check for negative side effects but this was never done.(I really hate my job).My concern for anyone put on these drugs is that a lot of people will fall through the cracks.I think the brain is a constantly evolving organism and there is no way to measure what each individual "might" have been like if they weren't exposed to a chemical.There are several people on the spectrum who were DXed as autistic who later gained ability to function at much higher ability with time.Who knows,or could ever know,what they might have happened if their brains had been exposed to such powerful chemicals(or ABA therapy).As long as somebody is making money from something,they should be put to a higher standard of "proof" that the "thing" is effective and not dangerous
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12 Oct 2006, 3:47 am
Alzheimer's patients can have the some of the same issues that autistics have. Not understanding English is one of them. Losing words (the meanings) can make a sentence meaningless. "Please sit down on the toilet" doesn't make sense if they have forgotten what a toilet is. Ironically, years before knowing a thing about autism (or having an autistic child) I worked with alzheimer's patients and figured out how to communicate effectively.
For one, I learned that they remember colors so that I didn't have to repeatedly, say, "Sit down on the toilet, sit on the toilet, over there! Sit on that toilet!!"
Instead, "grab gray thing (rail), you don't have to have that (doorknob), you can sit on the white toilet, there you are!"
Alzheimer tantrums almost always came from communication errors and the shame in forgetting common words (or faces). "Regular" people (family, idiot staff) would provoke these by insisting that they are saying the right thing, they are in the right of way, "she knew me yesterday, why is she doing this today?"
They picked up on volume and tone, but if they didn't know what was being said, could get really confused. They didn't like their personal space being invaded. Sound familiar?
Now, it's possible that the tantrums are internally provoked, trying to remember something, where the keys are, what did they want to say or do. But a lot of it is the lack of trying or empathy being given them.
