Portraits of Patients: "CHARLES"
"Charles, a widower, had been a steady employee of an oil refinery for 34 years. He helped raise a granddaughter and three great grandchildren. But at age 71, he began experiencing a mental decline and needed a full time, professional caregiver. He was so combative that his family was about to place him in a nursing facility. If not locked in his own house, he'd walk into his neighbors' homes. Infuriated by closed doors, he would try to kick them down.

When Dr. G. B. Ryder, a geriatric psychiatrist, saw him, Charles was hallucinating and could no longer talk or even move purposely. Dr. Ryder staged his previously diagnosed Alzheimer's disease (AD) as moderate but worsening.

Charles had continued to decline on the Alzheimer's medication he was taking, so Dr. Ryder wanted to try a different Alzheimer's medication, EXELON. He increased the dose slowly until he reached the maximum EXELON dose.

Charles's response has been outstanding. Dr. Ryder now stages his AD as mild. He is completely able to care for himself; the only outside help he needs is a housekeeper for a few hours a day. Most important to Charles, he can come and go as he pleases..."

How Can You Tell If Exelon Is Working?
"There are 3 ways to determine how well Exelon is working:

If the abilities of a person with Alzheimer's disease improve. For example, the person is able to do or remember things better or find that tasks that were once hard to do are now easier.

If a person's abilities stay about the same. In other words, his or her symptoms are not getting any better or worse.

If a person's abilities decline slightly (but more slowly than before staring treatment). In other words, symptoms are somewhat worse than before starting Exelon therapy but better than would be expected without Exelon.

Alzheimer's disease is a progressive disease. That means that the symptoms of the disease will get progressively worse over time no matter what medicine is taken. However, Exelon has been shown to slow the progression of symptoms.

Because there are so many factors to consider with AD, it is possible that Exelon may still be working even if symptoms continue to get worse.

Factors to consider are:

The rate of decline before starting Exelon therapy. Some people find that after they start taking Exelon, their rate of decline slows down. Others find that their symptoms stay the same or improve.

The stage of the disease (mild, moderate, or severe). Exelon is prescribed to treat the symptoms of mild to moderate Alzheimer's disease. The earlier that Exelon is started, the better the chance that it will work.

The types of abilities kept or lost. For example, some people taking Exelon see improvement in their ability to remember names or recent events. Others see improvement in their ability to follow a recipe or engage in a favorite activity, such as golfing or knitting.

To help you figure out how Exelon is working, it is helpful to keep track of symptoms and changes. The dosing diary can help you do that..."

MANAGING EXELON SIDE EFFECTS
"Exelon is an effective medicine, but like other Alzheimer's disease medicines, it may cause some side effects in some people. Side effects may include nausea, loss of appetite, vomiting, and diarrhea. These side effects often go away with time as the body gets used to the medicine. Side effects may be managed by starting with a low dose and increasing the dose slowly.

Side effects are more likely to happen when:

Treatment with Exelon begins

The health care provider increases the dose of Exelon

These side effects may happen less frequently as the body adjusts to the medicine. Taking Exelon with a full meal may help manage side effects. A full meal is a hearty meal or a big snack. Starting Exelon at the lowest dose and increasing the dose slowly may also help manage side effects.

Talk with the health care provider for advice about how best to manage side effects if they occur. Never make changes in dosing on your own..."

TAKING EXELON
"Exelon capsules come in 4 doses, or strengths — 1.5 mg, 3 mg, 4.5 mg, and 6 mg. Exelon also comes as a liquid for people who have a hard time taking capsules. To get the most benefit from Exelon, it is important to work with the health care provider.

Exelon is started at the lowest dosage — one 1.5 mg capsule twice a day. Starting Exelon at the lowest dose gives the body time to adjust to the medicine. After about 4 weeks, talk with the health care provider about increasing the dosage to 3 mg twice a day with food. This dose has been shown to be the lowest dose effective in treating the symptoms of mild to moderate Alzheimer's disease. Higher doses of Exelon can have added benefits. Higher doses may also increase stomach-related side effects for a brief period. If the current dose of Exelon is well tolerated, the health care provider may increase the dose further up to the maximum dose.

Exelon should be taken twice a day, once in the morning and once in the evening, with a full meal. Think of a full meal as a hearty meal or a big snack. Examples of a full meal are:

Scrambled eggs and toast
Bowl of oatmeal or cereal
Soup and a sandwich
Chicken with rice and vegetables
Cheese and crackers
Taking Exelon with a full meal is important because it may help manage potential stomach-related side effects, such as nausea and vomiting.

If a dose of Exelon is missed, take the next dose at the usual time. Do not double the dose. Always work closely with the health care provider. Never make changes in dosing on your own..."

Portraits of Patients: "DELLA"
"When Dr. Agha first saw 86-year-old Della, she was argumentative, aggressive, and refused to talk to anyone, including him.

Her caregiver, Kim, a devoted granddaughter, was struggling to cope with her grandmother's agitation, paranoia, and unpleasant outbursts. Della was so forgetful, she couldn't recall whether or not she had eaten. Kim didn't feel safe leaving her alone and was forced to leave her job.

Dr. Agha diagnosed moderate Alzheimer's disease (AD) and started an Alzheimer's medication, but saw no improvement. He decided to try a different medication, EXELON.

EXELON therapy has made the world of difference to both Della and Kim. Della keeps her medical appointments and follows the doctor's instructions. Alone during the day, she bathes, dresses herself, and makes her own breakfast. Kim, returning to work, has gotten a piece of her life back, thanks to EXELON..."

Portraits of Patients: "DON"
"Don, a 72-year-old retired chef and WWII veteran, lived alone. He was cared for by a neighbor. Increasing confusion and frequent car accidents brought him to Dr. Steven Treon.

When Dr. Treon first saw him, Don didn't know the date, the time, or even where he was. He repeated stories, got lost often, and claimed to be looking for his parents.

Dr. Treon diagnosed moderate Alzheimer's disease (AD) and prescribed EXELON. Because it can improve a patient's ability to perform activities of daily living, timely treatment with EXELON was important for a patient like Don, who needed to get by on his own.

It was Spring when Don started taking EXELON. At Christmas, he suddenly figured out why he was taking it and began reading about EXELON. Don has now been on EXELON for close to a year and continues to do well. He has returned to work part time—baking cakes at a restaurant in his hometown!

Don is an excellent example of how EXELON can enable patients to continue activities they might otherwise have abandoned—and even resume activities they had given up..."

HOW EXELON HELPS YOU
"It takes courage to speak up when you are concerned about changes that may be caused by Alzheimer's disease. It also can take courage to talk with your health care provider about switching to an effective medicine like Exelon if you feel that the medicine you currently take is not working well. Remember, if one medicine does not work, there are others that may be effective.

To learn more about changes in memory, behavior, or daily activities that concern you, use the Memory Questionnaire to compare the changes you have noticed with the top 10 symptoms of Alzheimer's disease.

It is important to talk about these changes with the health care provider. Make an appointment to discuss:

Your concerns about these changes

Treatment options, including Exelon

If the diagnosis is mild to moderate Alzheimer's disease, ask the health care provider about treatment with Exelon.

If another medicine for treating the symptoms of Alzheimer's disease has already been prescribed but does not seem to be working, ask the health care provider about Exelon. Remember, it may take courage to talk you're your health care provider about wanting to change. But, if one medicine does not seem to be working, there are others that may be effective..."

Portraits of Patients: "ANA"

"Ana, 94, was losing the ability to communicate. Meaningful conversation had been replaced with relentless screaming, frustrating her daughter, who served as her caregiver.

When Ana presented to Dr. Jose Pujols, her symptoms included confusion and memory loss. Dr. Pujols staged her previously diagnosed Alzheimer's disease (AD) as moderate. Since Ana had continued to decline on the Alzheimer's medication she was taking, Dr. Pujols wanted her to try a different medication, EXELON.

At her advanced age, Ana had other medical problems, including arthritis and heart disease, and was taking a number of medications. So Dr. Pujols increased her dose slowly. He showed that with careful titration even elderly patients on multiple medications can experience the benefits of the maximum dose of EXELON.

Today, Dr. Pujols has "changed" Ana's disease stage to mild. Besides regaining her ability to carry on a meaningful conversation, Ana is more active in her daily living. Thanks to EXELON, Ana is able to share her lifetime of experiences with her daughter and appreciate the world around her..."

GOALS of EXELON THERAPY
"The goals of Exelon therapy are to slow the progression of Alzheimer's disease symptoms and to help people with the disease remain independent in their daily activities longer than would have been expected without treatment.

By slowing the progression of symptoms, Exelon may help people with Alzheimer's disease:

Maintain their abilities for as long as possible

Stay connected with the people and activities that mean the most to them..."

Portraits of Patients: "William"
"When William was admitted to the Alzheimer's unit, nobody thought he'd return home. They were wrong.

William's life was completely disrupted by Alzheimer's disease (AD). Although he had a master's degree in science, he'd stopped talking—and started threatening his wife. His abusive behavior continued when he was admitted to an AD unit.

When Dr. Ghooray, a neurologist, saw the 79-year- old man, his diagnosis was moderately severe AD. Along with William's behavioral problems, he was almost entirely unable to care for himself. Dr. Ghooray started EXELON therapy.

The change in William was remarkable. After a year of EXELON therapy, Dr. Ghooray now stages his disease as mild and has discontinued other medication that William was taking to control his behavior.

Most impressive, though, was William's release from the nursing home. He simply no longer belonged there. Back home, his wife sees him getting better every day. She not only enjoys being able to leave him home alone while she shops—but also appreciates his help with the housework!..."

Alzheimer's Disease Medications Fact Sheet:
Five prescription drugs currently are approved by the U.S. Food and Drug Administration to treat people who have been diagnosed with Alzheimer's disease (AD)...

Effective Therapy With Exelon®(rivastigmine tartrate):
Many clinical studies have been carried out to learn more about the effectiveness of Exelon...

Alzheimer's and Parkinson's Drugs - The Good, The Bad and The Funny. From People Who Have Taken These Crazy Meds:
I didn't group these drugs together because they are old people diseases. Hardly. Mouse's father was hit hard with Alzheimer's in his mid-50s. And many people in the US knows about Michael J. Fox and his battle with Parkinson's.

No, I lumped them together because the meds are used off-label as antidepressants and/or to deal with the side effects of anticonvulsants and antipsychotics. So those of us dealing with bipolar disorder, epilepsy, schizophrenia, clinical depression, other affective mood disorders or whatever else antidepressants, anticonvulsants and/or antipsychotics are used for may require an anti-Alzheimer's or anti-Parkinson's med to either deal with our illnesses or ward off the side effects of the meds we're already taking. I've tried Exelon (rivastigmaine tartrate) in the past and didn't get all that much bang for the buck. I'm now evaluating Reminyl (galantamine HBr). Mouse has tried Exelon (rivastigmaine tartrate) and Aricept (donepezil). She's also evaluating Reminyl (galantamine HBr) as well as Requip (ropinirole hydrochloride).

The Parkinson's meds tend to work on dopamine, one way or another. There are variations from med to med on exactly how they work on which receptors, and whatever neurotransmitters may be involved. But some kind of dopamine action is the main attraction. In the US there are only two dopaminergic meds available as official antidepressants, Wellbutrin (bupropion) and, if you take enough of it and get lucky, Effexor (venlafaxine). If dopamine is the answer for you, or part of the answer, and neither of those meds work for whatever reason, you and your doctor should be exploring the Parkinson's meds. The Parkinson's meds are also the first line of meds for serious cases of restless leg / periodic limb movement syndrome.

The Alzheimer's meds work in ways that are completely new to me. I'll have to get back to you on them. Hell, I'm taking one now, so you can bet I'll figure it out soon enough.

Another reason for grouping these meds together is that they have common effects that people like for some reason:

They tend to make you lose weight.

They tend to make you horny.

They tend to improve your memory.

They are effective antidepressants.

While those first two items are the last thing I need more of, I'll risk it for the last two. I've needed more Topamax (topiramate) and Neurontin (gabapentin) in my cocktail, so I've been much more of an idjit on psychiatric drugs. And with all the crap in my life of late I've been pretty damned depressed. While there really isn't much of a pharmacological answer to that depression, more a case where I just have to work out my freaking issues, I can use all the help I can get from an antidepressant. I can accept sleeping 9-10 hours a night because of all the meds I take, but 12 hours a night and being tired most of the day like I was two years ago is, well, depressing.

Exelon (Rivastigmine Tartrate) Now Available In US For Alzheimer's Disease:
Novartis Pharmaceuticals Corporation announced today that Exelon® (rivastigmine tartrate) capsules -- the first new Alzheimer's disease medication in three years -- is now on pharmacy shelves and available by prescription.

Exelon is a cholinesterase inhibitor for the treatment of mild to moderate Alzheimer's disease (AD). The safety and efficacy of Exelon were demonstrated in the largest phase III clinical program to date of any Alzheimer's disease medication. Patients treated with Exelon demonstrated a significant benefit in global functioning based on evaluation of activities of daily living (ADLs), behavior and cognition.

Portraits of Patients - William:
William's back home helping with the household chores*

When William was admitted to the Alzheimer's unit, nobody thought he'd return home. They were wrong.

William's life was completely disrupted by Alzheimer's disease (AD). Although he had a master's degree in science, he'd stopped talking—and started threatening his wife. His abusive behavior continued when he was admitted to an AD unit...

The Brain and Alzheimer's Disease:
A number of changes in the brain are caused by Alzheimer's disease. To understand these changes, it is important to understand how the brain works.

The human brain is made up of billions of neurons, or nerve cells. Neurons are responsible for enabling us to think, remember, and direct our body movement...

Exelon:
Rivastigmine (Exelon) was approved in 2000 by the U.S. Food and Drug Administration (FDA) to treat cognitive symptoms of Alzheimer’s disease. Exelon is a cholinesterase inhibitor. Cholinesterase Inhibitors are believed to work by delaying the breakdown of acetylcholine in the brain. Acetylcholine helps communication between the nerve cells and is important for memory.

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