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Age Matters: Patients, families have more power than they think

Age Matters: Patients, families have more power than they think

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Dear Dr. Camardi,

I read your article last month with deep interest. My dad is 87 and in a nursing home and not doing well at all. I sat down and made notes about what you said. Then I made notes about what the person who wrote you said. When I read your comment about how we can’t hand out drugs that make dementia worse just because we don’t have a cure, I sat up like a lightning bolt struck me. Then I started to cry. Then I got really mad. My dad’s on every drug you warned about. I know he’s got the disease for those drugs, too, but where does it all end? I’d rather have whatever normal part that’s left in him than the way he is now. This has got to stop because they took a bad thing and really made it worse, just like you warned. I’m getting sick because of all this.

— Eugene, Oregon

I think you’ll feel better if you turn that uneasy feeling into action and get to work on a possible solution. First, take a deep breath and make a phone call to Dad’s doctor to make an appointment and discuss the situation completely. Make a list of goals you want for your dad. Then make a list of the medical problems he has and his drugs. If you’re not satisfied after the meeting, it’s time to change doctors and/or nursing homes.

Patients and their families may not realize the power and influence they have when coming up against the medical establishment. By demanding better care for your father, you are doing your part in making the system better for us all.

Certain diseases are treated with a class of drugs known as anticholinergic medications, which block acetylcholine, a chemical in the body that helps the brain function normally. Although these drugs are good for controlling conditions such as depression, allergies, poor bladder control or difficulty breathing due to chronic obstructive pulmonary disease, blocking acetylcholine may interfere with a person’s preservation of memory and mental sharpness.

I have long held that these drugs may usher in or accelerate the progression of dementia. This concept has met with resistance over the years, but as I have published before, when I have either lowered doses or gradually withdrawn these drugs with my patients, the problems of dementia have improved. To be clear, the underpinnings of dementia still exist, but the improved environment gives relief to the patient’s already struggling brain.

The challenge for the physician is to come up with alternatives to the anticholinergic class, or else face the risk of restarting these drugs all over again because the original problem has not been adequately controlled. This is the art of medicine.

A former medical student recently shared an article by Weigand’s group at the University of California, San Diego, in the journal Neurology. A small focused group of 688 patients with an average age of 74 who showed no signs of cognitive impairment and were participants in the Alzheimer’s Disease Neuroimaging Initiative were studied for 10 years. They underwent yearly cognitive testing, genetic studies and cerebrospinal fluid markers for Alzheimer’s dementia. Patients with positive risk factors who were given anticholinergic drugs developed signs of dementia, with almost half the patients testing in the mild cognitive impairment region of dementia when compared to the control group.

When a patient’s brain is already decreasing its acetylcholine production, the use of anticholinergic drugs can worsen the effect. At some point, the madness has to stop. It’s up to us all to demand improvement and expect better.

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