Years ago, before I became a geriatrician, I visited my aunt and uncle in San Diego. On their kitchen counter, I saw more than twenty medicine bottles, some prescription, some over the counter herbals. These all belonged to my aunt. My uncle’s pill bottles were in the cabinet above. I asked them to tell me what the pills were and what they were for. The response was spotty. As I reviewed them, I saw that some were redundant, some not needed at all.
I spend time with every new patient, reviewing each medication taken and making sure that each medication is appropriate. I call it “validating the medication regimen”. The body changes as it ages: kidney function decreases, liver function decreases. The body’s ability to cleanse itself of medication and toxins slows down. Older people often take several medications simultaneously and, as a result, the risk of drug interactions and adverse side effects increases. Additionally, there are specific problems for people with dementia. Certain medications, such as antihistamines and antispasmotics may damage cognition and may lead to acute onset of confusion.
Familiarity with the Beers Criteria, a list of potentially inappropriate medication for use in older adults, is essential when a doctor is treating elderly patients. After evaluating the medications the patient is taking, the doctor can consider adding new ones. Once it has been determined that the existing medications are appropriate, it is time to consider use of the medications that are FDA approved for the treatment of Alzheimer’s dementia. There are still only two general classes of medication that have been approved. No medications will prevent or reverse the effects of Alzheimer’s disease, but there are medications that may slow the rate of progressive memory loss.