Background: Aricept was prescribed for both mum and dad. Not so many months ago we decided that it was no longer (if it had ever been) doing any good for mum. She has been on Risperidone to calm her aggression. Dad has continued with Aricept, to which we added Ebixa, for a few weeks.

Now...

Even those who support the use of Aricept seem to agree that its effectiveness is limited to the early stages of Alzheimers. I am not convinced that even then it did very much for mum, or has been doing very much for dad. Yes, there were instances of behaviour that could be interpreted as 'improvement' but then again, they could just as easily be explained away as the daily fluctuations in lucidity that seem to be part of dementia of all types. One day mum, or dad, could be very bad, the next they could be surprisingly competent, relatively speaking.

As far as Aricept is concerned, we have given up on mum in any case. I think we've probably reached the end of the line with dad too, though I suspect my brother and sister think differently.

The Risperidone, on the other hand, is remarkably powerful. We first turned mum into a zombie by giving her 7 mg per week. We have since wound that dosage back to three tablets a week, which add up to may 1.5 mg or 2 mg in total - depending on whether we give her 0.5 mg or 1 mg at a time. We play this by ear. For a while, I was not giving mum this medication, as she always seemed quite manageable. However, I soon learnt from Rachel and Greg that in skipping the administration on Thursdays, I was letting them in for a hard time at the weekend. I've since resumed the Thursday tablet, giving mum either 1 mg or 0.5 mg, depending on how well she behaves herself.

It seems that Risperidone may be around for a while, as mum has not really mellowed, and we have found, as I said, that in reducing the dosage we invite the return of the attack mother.

So, finally we come to the Ebixa. This was an experiment which we ran on dad for several weeks. All of us, and the nurses too, think that in those few weeks dad has deteriorated quite significantly. Whether the Ebixa was accelerating the decline, retarding it, or doing nothing, we cannot tell. I therefore sent the following to Dr Humerus, the Psychogeriatrician in charge of psychopharmacological experimentation in our lives:

Some time ago, when you gave us several boxes of Ebixa for my father, Donald Pritchard, you said that we ought to contact you for more when they ran out. They have run out, and we are wondering what to do now. Here's the situation:

None of us has been aware of any improvement in dad's memory, alertness or mood since combining Ebixa with Aricept. In fact, the unanimous opinion is that he has worsened rather alarmingly over the last few months. We are not in any position to attribute this to the medication, nor are we at all sure he would be better without it now.

Dad's memory has become quite woeful; he is exhibiting signs of forgetting the most everyday words such as 'telephone'. Today he called it 'that instrument for getting in touch'. His mood is often one of depression, I would say, and his appetite, once consistently voracious, is now quite poor.

If you think we should continue with Ebixa, we are happy to do so. If you feel it is no longer effective, we are happy to accept that instead.

Hope you had a pleasant time over the holidays.

And her verdict: let's not continue.

So, we persevere with 10 mg per day of Aricept for dad and ward off the attack mother with Risperidone at 0.5 mg or 1 mg three times a week.