Treatment Options for Alzheimer’s Disease
There is currently no cure for Alzheimer’s disease, and there are no treatments that stop the progression of the disease, but there are therapies that can help alleviate symptoms such as memory loss, behavioral changes, and changes in sleep patterns. Research is needed to identify and develop ways to stop, prevent and cure Alzheimer’s disease.
FDA-approved Medications for Alzheimer’s Disease
Two categories of drugs have been approved by the FDA to treat the cognitive symptoms of Alzheimer’s disease: cholinesterase inhibitors and memantine. These drugs can help slow the decline in memory and thinking abilities for a time, but they will not stop the damage that this disease causes in the brain.
- Cholinesterase inhibitors work by boosting the level of a chemical called acetylcholine, which helps with cell-to-cell communication in the brain. Cognitive decline is a result of the decreasing ability of the brain’s cells to communicate with each other. The use of cholinesterase inhibitors is an attempt to extend the time that cells can accurately communicate to create memories and support other cognitive functions such as language, judgment and thinking.
The most commonly prescribed cholinesterase inhibitors are donepezil (brand name: Aricept), rivastigmine (Exelon), and galantamine (Razadyne). Exelon and Razadyne are approved to treat early to moderate stages of Alzheimer’s. Aricept is the only drug approved to treat all stages of Alzheimer’s.
- Memantine (brand name: Namenda) is approved to treat moderate to severe Alzheimer’s disease. It works on a different brain chemical, glutamate, with the goal of improving brain cell communications, thus boosting memory, judgment and the ability to perform simple tasks.
As Alzheimer’s disease advances, patients may develop behavioral issues. Our clinical social workers can help caregivers understand valuable coping techniques that can help the caregiver and the patient. They are happy to talk with you one-on-one about your unique questions and concerns. In addition, many caregivers face similar challenges, simply due to the nature of the disease. Here are some general guidelines.
- Ask about pain and discomfort. It is frustrating for both the caregiver and the patient when the patient cannot communicate about pain or discomfort, which may affect some of the behavioral issues. Being proactive in addressing pain or discomfort can help with behavioral issues.
- Exercise and good nutrition. Promote better sleep, relaxed muscles, flexible joints, heart health and appetite, among other things. Exercise and good nutrition benefit both the caregiver and patient.
- Create a safe home. To someone with decreasing cognitive skills, communication abilities and physical dexterity, what seemed normal before may be confusing and challenging today. Remove clutter and obstacles such as small rugs or sharp-edged coffee tables. Provide shoes, slippers or socks with traction to avoid slips and falls around the house. Install handrails or supports in the bathrooms, if possible. Put slide-resistant grip in the shower and bath tubs. See also, How to handle different behaviors
- Personal coping tools are important for the caregiver. Consider joining a support group to connect with people who have similar experiences. Understand that your loved one’s behavior is a symptom of disease, not just meanness or stubbornness. Speak with the social workers at NNAC. They can help.See also, How to handle different behaviors
There are no medications approved by the FDA to treat behavioral or psychiatric dementia symptoms in Alzheimer’s patients. Some drugs can be used in very careful and specific circumstances. These medications are not approved by the FDA for use in Alzheimer’s patients, but in certain circumstances, physicians legally prescribe them “off-label,” meaning outside of the parameters of FDA approval. These antipsychotics, antidepressants and anxiolytics may help with more extreme behaviors that have the potential to cause harm to the caregiver or patient. All of these medications come with side effects and should be used with extreme caution and with close monitoring by your physician.
Medications that are available today help slow the progression of the disease by boosting chemicals that help the cells communicate inside the brain. Much of today’s current research addresses the underlying disease process that causes the death of brain cells. Discoveries that show how Alzheimer’s affects the brain have led to promising new directions in research.
- Targeting plaques (beta amyloid). We know that plaques made of a protein called beta amyloid form in the brains of people with Alzheimer’s disease. Plaques are a hallmark of the disease. Some researchers are testing ways to block production of beta amyloid proteins in the brain to reduce the level of plaque. Others are looking at vaccine-like therapies to reduce the development of plaques in the brain.
- Targeting tangles (tau). A protein called tau appears smooth in healthy brains, but in patients with Alzheimer’s, the tau tangles and prevents effective cell-to-cell communication. Scientists are looking at ways to prevent tau from tangling.
- Targeting inflammation. Brain inflammation is common in patients with Alzheimer’s disease. Scientists are looking at how inflammation, the body’s natural response to disease, can go awry and affect neurological diseases including Alzheimer’s.
- Targeting heart and vascular disease. There is a tie between diseases of the brain and heart. Just as the arteries feed blood to the heart to keep it healthy, arteries feed blood to the brain to keep it healthy. High blood pressure raises the risk for heart disease as well as stroke. High cholesterol has a negative effect on both the heart and the brain. Researchers are studying therapies for heart disease to see if there is a correlation with Alzheimer’s disease, as well.
- Getting treatment to patients faster. A typical drug development cycle is 10+ years, from early research to patient bedside. Researchers are looking at ways to get effective drugs to patients faster. Houston Methodist’s Dr. Stephen Wong is nationally recognized for his methods of drug repositioning. He develops advanced computer protocols to identify existing FDA-approved drugs that have high probability of working on diseases other than the ones for which they were approved. This can reduce by one-third, the time necessary to get a treatment into the hands of a patient. He is applying these innovative methods to Alzheimer’s.