My mom is on aricept, namenda, and risperdal prn, is at stage 6d, age 81. I have health care proxy. Yes, I know all AD sufferers are unique, but what would the best- and worst-case scenarios of stopping or tapering off the meds? Dr. appt tomorrow, will ask him, too. She has been diagnosed since 2003, but was showing symptoms for at least a year and a half before that. Caregiver support group leader indicated that this is a moral issue, hmmm. Any thoughts?
thx,
Julie

Dear juliejones,

Hello, and thank you for using the Alzheimer's Association Online Community.

Worse case scenario is that your mother suffers physical harm where the disease progresses faster than usual without her medication. We are not doctors here, so you are doing the right thing in taking your mother to the doctor for an evaluation. Yes you are correct in knowing that every person is different, and how they respond to medicines plays a huge factor into their regimen of health. Moral issues come into play when you consider alternative medications as well a personal feelings towards the disease. The best advice: talk with your mother's doctor and find out about the risks(side effects) of missing Aricept, Namenda and Risperdal. Should you have any questions, please feel free to call us 24 hours a day/7 days a week at (800) 272-3900. Thank you for using the Alzheimer's Association Online Community.

Sincerely,
Clifton, Care Consultant
Alzheimer's Association

Dear Julie: Even though I'm an RN, I too was unclear regarding my mother's medications.

I do know that Aricept and like drugs are thought to have a point at which they do not offer any further benefit. This is where the physician comes in.

As far as the Risperdal, that must be tapered slowly if it is to be stopped. However, your loved one will more than likely revert to whatever behaviors she had prior to the Risperdal.

In my mother's case, her .5mg of Risperdal helped only for a short time. Several months later, she was "breaking through" and the doctor increased her to 1 mg of Risperdal.

I don't think there will ever be a point at which I will discontinue Mom's Risperdal unless the drug brings a difficult side effect.

The reason for this stance is, that Mother was absolutey MISERABLE with her rampant delusions and agitation. It gravely lowered the quality of her life. She never knew a moment of peace within herself.

Risperdal is able to give her some of that quality back. However, I now have to discuss with the doctor the fact that my mother is now more or less in a bit of a fog secondary to the increased dose of her drug.

If we decrease the dose, and she is okay; that is fine. BUT, if Mom becomes the shouting virago, pounding on the furniture and steeped in hateful delusions, she will once again be back in that hellish state where her misery goes through the marrow of her bones and into her very spirit. She has no rest or peace in that state.

In that case, then a slight fog would be a bit better than living in overwhelming agitation.

I think the "moral" statement comes into play if discontinuing the Aricept causes her to decline in memory to a huge degree; and the Risperdal discontinuance causes her to revert to dread behaviors which is uncomfortable for her.

BUT - when studies tell us that Aricept and like products may have only limited value, then, if you are past that date/state, that moral arguement is moot.

I wish you well in your decision.

Dear juliejones:
A final thought on this topic: many prescription drugs require weaning off of when stopping their use; rather than stopping cold turkey. I happen to know that Namenda is one of these.

If you're unsure as to whether a drug needs to be withdrawn in phases, contact the company directly or your pharmacist. Certainly we don't want our loved ones to suffer more than they already are; however, our good intentions can be side-swiped by unknowingly adding further side effects when incorrectly stopping a medication.

Best of luck with this!