FDA-approved medications for Alzheimer’s disease
Two categories of drugs have been approved by the U.S. Food and Drug Administration (FDA) to treat the cognitive symptoms of Alzheimer’s disease, which include cholinesterase inhibitors and memantine. These drugs can help slow the decline in memory and thinking abilities for a while, but will not stop the damage the disease causes in the brain.
- Cholinesterase inhibitors boost the level of a chemical (neurotransmitter) called acetylcholine, which helps with cell-to-cell communication in the brain. Cognitive decline is thought to be a result of the decreasing ability of the brain’s cells to communicate with each other. The use of cholinesterase inhibitors may extend the time that cells can accurately communicate with each other to create memories and support other cognitive functions, such as language, judgment and thinking.
The most commonly prescribed cholinesterase inhibitors are donepezil (Aricept®), rivastigmine (Exelon®) and galantamine (Razadyne®). Exelon and Razadyne are approved to treat early to moderate stages of Alzheimer’s disease. Aricept is the only drug approved to date to treat all stages of Alzheimer’s disease.
- Memantine (Namenda®) is approved to treat moderate to severe Alzheimer’s disease. It works on a different brain chemical (neurotransmitter), called 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 will teach caregivers valuable coping techniques to help them and the patient, and will work with the patient and caregiver face-to-face to answer your questions and address concerns you may have. Due to the nature of Alzheimer’s disease, many caregivers face similar challenges.
Some general guidelines can help you cope with these challenges.
- Ask about pain and discomfort. It is frustrating for everyone when the patient cannot communicate about pain or discomfort. Proactively addressing pain or discomfort can help with behavioral issues.
- Encourage exercise and good nutrition. Better sleep, relaxed muscles, flexible joints, heart health and appetite all 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, and include slide-resistant grips in the shower and bath tub.
- 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 the Nantz National Alzheimer Center — they can help.
Medications that are available today help slow the progression of the disease by boosting chemicals (neurotransmitters) that help the cells communicate inside the brain. Current research is addressing the underlying disease process that causes the death of brain cells, and discoveries have been made that show how Alzheimer’s disease affects the brain — leading to promising new directions in research.
- Targeting plaques (beta amyloid) — Plaques, made of a protein called beta amyloid, form in the brain of people with Alzheimer’s disease and 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 protein) — A protein called tau forms structures that appear smooth in healthy brains, but in patients with Alzheimer’s disease, the structures formed by tau protein appear tangled. These tangles are thought to prevent effective cell-to-cell communication. Scientists are looking at ways to prevent tau protein 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 many diseases, can go awry. Inflammation of the brain and nerves occurs and can affect neurological diseases, including Alzheimer’s disease.
- 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. These conditions can cause dementia symptoms in a person even if the changes associated with Alzheimer’s disease are not present. 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 — It typically takes more than 10 years to develop a new drug, from early research to patient bedside. Researchers at Houston Methodist’s Neurological Institute and Research Institute are looking at ways to get effective drugs to patients faster and on finding new uses for medications (sometimes called drug repositioning). Initiatives include developing 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, which can reduce the time necessary to allow a treatment to become available. These innovative methods are now being applied to Alzheimer’s disease.
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