Cholinesterase Inhibitors
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®)
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.
Other Treatments
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.
Treating Behavioral & Psychiatric Symptoms
There are no medications approved by the FDA to treat behavioral or psychiatric dementia symptoms in those with Alzheimer’s disease. Some medications can be used in very careful and specific circumstances. Although medications are not approved by the FDA for use in Alzheimer’s patients, sometimes 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.
New Directions in Research
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.
Additional information is available to help you learn more about Alzheimer’s disease: