My Mother's Memory Medication

Doctor Marion,

My 81-year-old mom has been on Aricept since midwinter 2003, and Namenda was added to the mix in October of that year, not long after it was approved by the FDA. That went well until she became violent, and Risperdal helped for a while, but when that made her dopey we halved the dose and then used it only as needed. However, we had to kidnap her from adult day care and spirit her off to a memory-care unit (where she had spent a respite week in August 2007) in October 2007 when it became obvious, even to me, that I (sole caregiver, 50-year-old daughter) could no longer keep her safe at home. She has finally adjusted to the East Wing, really a lovely facility, and no longer throws sobbing tantrums as I leave after a weekly visit.

My question is about taking her off the memory meds. It is my understanding that they are no longer effective in the later stages of the disease. Last summer she scored 11 on the MMSE, and is in mid-stage 6 (bladder incontinent, occasionally bowel, too.) She is fully ambulatory. Her PCP (not a specialist, sees her every 3 months) is reluctant to stop the meds, as he feels that one cannot tell if they're not working anymore until one discontinues them, and then it's too late, as whatever "there" the meds were keeping in place doesn't come back, and the patient lives about as long with or without meds.

The facilitator of my caregiver support group thinks it's a "quality of life" issue, whatever that means. Mom seems happy and healthy, but her mind is gone: she has maybe three topics of conversation, and each is four lines of dialog, tops. I don't think she gives a damn anymore, no interest in photo albums I take, unless there are pictures of her in her prime ("I'm gorgeous!"), plants, flowers, mail.  Advise, please?

Juliana in Georgia, 50

Dear Juliana,

Your mom is fortunate to have someone looking after her welfare and benefit the way you are. I understand your thoughts and concerns.  It can be very trying when someone like your mother has had a rigorous regime of medication and changes in medication.  Each individual is so unique and complex with their needs (both physical and emotional), that no one formula or combination is going to be right for everyone. In the healing profession, "one size fits all" does not apply.

I am not a medical doctor, so I cannot comment on any issues regarding her medications.  However, it is very important that each doctor, therapist, or specialist that your mother comes in contact with assess the situation from their particular expertise.  It’s often the case that different medications and different dosages are used until the perfect balance for that individual is discovered.  And as your mother ages, changes, or declines, medications may again need to be adjusted and readjusted.

Finally, when your facilitator said "quality of life," she was referring to your mother’s adjustment, attitude, state of mind, and emotional balance.  If your mother is happy or content and has people that care for her and care about her, then you are doing a good job.  I also want to commend you for participating in a caregiver support group.  Caregivers give so much of themselves that they very often neglect their own needs.  Keep up the diligent effort.  Your mother appreciates it even if she cannot express this to you.

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