For the vast majority of the aging population, avoiding placement in a nursing home or assisted living facility is a top priority. There are countless ways to go about this, such as hiring in-home care services or using home and community-based services to supplement family care, but for individuals with Alzheimer’s or dementia, their options are more limited. As the disease progresses and cognitive function declines, care needs become increasingly complex. This can be overwhelming for family members and professional caregivers alike.
Only a few prescription medications have been developed and approved for the management of symptoms related to dementia. These include Razadyne (galantamine), Exelon (rivastigmine), Aricept (donepezil), Namenda (mementine), and Namzaric (a combination of Namenda and donepezil).
Countless members in the AgingCare.com Alzheimer’s & Dementia Support Group have posted questions about these medications, their effectiveness, and their risks and side-effects. It can be challenging to find the right prescription and dosage to treat or manage any kind of health issue, but this process can be especially harrowing for family caregivers who are watching their loved ones struggle with cognitive decline, confusion, and agitation.
Although it may seem helpful to seek out other caregivers’ experiences and advice, this can be misleading when it comes to medications. Each person’s unique body chemistry reacts to and metabolizes medications in a different way. Additionally, each case of dementia progresses in a distinct way as well. It is also important to keep in mind that these approved drugs are not slowing down the progression of Alzheimer’s or dementia or “treating” the disease. Rather, these prescriptions are intended to minimize the symptoms of these conditions.
Reliable medical trials and studies are our best bet at interpreting and predicting how diseases and medications interact and affect our overall health. Fortunately, a recent study on one of these popular dementia drugs, donepezil, has shed some light on caregivers’ common concerns.
Published in The Lancet Neurology, this study examined the effects of continuation or discontinuation of donepezil on nursing home placement in individuals with moderate-to-severe Alzheimer’s disease.
Since this medication is licensed for the early stages of Alzheimer's and appears to lose its effectiveness over time, donepezil is typically withdrawn when a patient progresses into the more severe stages. Doctors and family members assume that the drug is no longer of benefit to the patient as their decline becomes more pronounced. Reducing medical expenses and the number of prescription medications a loved one is taking are also common reasons for discontinuing donepezil.
However, this study strongly suggested that the benefits of donepezil actually last much longer than initially thought. Study participants who continued the drug experienced a 20 percent risk of being permanently placed in a nursing home within the first 12 months of treatment. Those who stopped taking donepezil experienced rearly double the risk: 37 percent within the first 12 months after stopping treatment.
Although the benefits of the drug were not sustained after this 12-month period, delaying nursing home placement by a year or a few months can have a significant impact on a loved one who would rather remain living in the community.
It is almost impossible to discern how much of an effect the drug is having on dementia symptoms until it is removed from the equation. Unfortunately, once that happens, any benefit the patient was experiencing is permanently lost once. Many caregivers and family members see an immediate decline in their loved one after discontinuing Alzheimer’s medications. The benefits they offer may be modest, but even a small improvement in cognitive and behavioral symptoms can improve the patient’s quality of life and be worthwhile for family caregivers.
Although this study is not a conclusive ruling on donepezil use, it does suggest that doctors and caregivers should carefully consider whether or not to discontinue this drug.
There is no one-size-fits-all answer for how prescription medications will or will not affect your loved one. You can only try your best to find a doctor you trust and respect, and honor the healthcare wishes that your loved one expressed or put into writing before they became ill.