Seven Steps to Managing Your Memory by Andrew E. Budson MD

Author:Andrew E. Budson MD
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2017-10-15T00:00:00+00:00

CHOLINESTERASE INHIBITORS “TURN BACK THE CLOCK” ON MEMORY LOSS

“The medication that I am going to prescribe is called donepezil. You might have heard of it by its brand name, Aricept. Although it’s approved for those with Alzheimer’s disease dementia, in my experience it works quite well in those with mild cognitive impairment due to Alzheimer’s disease.”

“How does it work?” Sara asks.

“It works by stopping the breakdown of a chemical in the brain called acetylcholine.”

“This medication will improve my memory?” asks Jack.

“Yes. Most people experience an improvement in their memory equivalent to ‘turning back the clock’ on their memory problems six to twelve months.”

“You mean my memory will be like it was half a year or a year ago?” asks Jack.

“Yes, most likely. There are some people, perhaps a quarter, for whom it has a smaller effect or no effect. But most people see an improvement.”

“How long will it work?” asks Sara.

“It typically works as long as one keeps taking it,” explains the doctor. “But it is important to note that although it can ‘turn back the clock,’ it cannot stop the clock from ticking down.”

“Because it is not disease modifying?” asks Sara.

“Yes, exactly. Your memory will still get worse over time,” she says, looking at Jack, “because the medication cannot stop the Alzheimer’s disease from progressing. But your thinking and memory will always be better on the medication than off of it.”

“What happens if I stop taking it?” Jack asks.

“Your memory would decline in about two weeks the amount that it would normally decline in six to twelve months.”

“I’ll keep taking it then—I don’t want that to happen!” Jack responds.

“What are the side effects?” Sara asks.

“Most people do fine on this medication without any side effects, but maybe one in ten people experience an upset stomach and have loss of appetite, nausea, loose stools, or rarely vomiting. About one in fifteen people will have vivid dreams at night—not necessarily nightmares, but whatever dreams they typically have can seem very real. Maybe one in thirty people will develop a runny nose, increased saliva, or muscle aches. And maybe one in a thousand people will experience a slowing of the heart rate.”

“How will we know if Dad has a slowing of his heart?” asks Sara.

“He might feel lightheaded, like he might faint, or he could actually faint. If either of those symptoms happens you should call the office or 911 right away. We’ll take his pulse to get his heart rate now, and we will take it again when he’s been on the medication for a while. We’ll get an EKG as well, just to be safe. Any other questions about this medication?”

Jack shakes his head.

“OK, good. I’m starting you on 5 milligrams a day for one month followed by 10 milligrams after that. Starting slow will give your body a chance to get used to the medication and reduce the likelihood of side effects. I’d like to see you back in two to three months to see how you are doing on the medication.

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