The treatment recommended for these patients includes addressing all areas of the patient’s needs. While there is no cure for the disease, there are medications that can slow the progression of symptoms or improve function. Pharmacological treatment mainly focuses on addressing memory and cognitive deficits. A medication that can reverse the disease would be groundbreaking. Research continues with hopes for advancements in the future.
Choosing a medication to treat someone with Alzheimer’s depends on many factors, but a decision that should be made with an educated provider, typically a primary care or specialist in geriatrics or neurology. As stated before there is no cure for Alzheimer’s, only treatments to slow the progression of symptoms and improve quality of life.
While there are several drugs on the market for Alzheimer’s disease, there are no drugs for other memory disorders such as mild cognitive impairment or frontotemporal dementia. It is important to recognize that the same drugs that are used to treat Alzheimer’s disease are frequently used to treat other types of memory disorders- so having a prescription for one of these medications does not mean that your doctor thinks you have Alzheimer’s and has not told you so! A conversation with your doctor is always reasonable if you have questions about your medications.
A question that arises over time is when to discontinue medications. There have been studies of using medications in advanced Alzheimer’s Disease, and it seems reasonable to continue medications or start them, if not previously done, in the setting of advanced disease.
- Cholinesterase Inhibitors
The first class of medications most commonly used with Alzheimer’s patients are Cholinesterase inhibitors. In patients with Alzheimer’s disease, there is a lack of the neurotransmitter acetylcholine. Cholinesterase inhibitors help by increasing levels of acetylcholine in the body. The result can be a decrease in depression and agitation, which are symptoms often experienced by these patients. Examples of Cholinesterase inhibitors include Aricept, Razadyne, and Exelon. The medication that has been around the longest is donepezil, which is marketed both as Aricept ™ or as a generic donepezil. This is used as a daily medication. Once the daily medication is always easier, particularly for people who already have some memory impairment. For this reason, and since it is generally very well-tolerated, donepezil is a commonly used medication, particularly at the start of treatment. One unusual side effect of donepezil is that it may cause very vivid dreams when taken at night. When this happens, switching to taking it in the morning often helps get rid of the sleep disruption.
Memantine is marketed as Namenda™ in the US and is a relative newcomer to the US market. Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist and works differently to the cholinesterase inhibitors. Unlike the cholinesterase inhibitors, memantine is very well tolerated and is frequently added to an acetylcholinesterase inhibitor as combination therapy. As with all these medications, it is started at a low dose and increased slowly over time.It works to slow the progression of symptoms in those patients who are in the later stages of the disease. It is important to remember that with any medication, it is imperative to discuss the risks versus the benefits with your health care provider. All medications have side effects and it is imperative to determine if the benefits outweigh those risks.
Donepezil has also been shown to be helpful for people who have Mild Cognitive Impairment, making it an ideal medication for people who have mild symptoms. The major side effects are nausea and sometimes upset stomach, so the medication is typically started at a low dose and increased slowly over about 4 weeks. Once someone is on medication, it is hard to know when to stop – typically, the medication is continued for a very long time.
Galantamine was previously known as Reminyl ™ in the US and now marketed as Razadyne ™. Just like donepezil, gastrointestinal side effects are the most common problem that patients report with the medication. Rivastigmine is also an effective medication. However, it is more likely to cause gastrointestinal side-effects, particularly nausea and vomiting. As a result, this has become available as a transdermal patch, which seems to reduce the gastrointestinal side-effects, and yet is just as effective. As with any patch, skin reactions at the site may become problematic. The patch is placed in different sites with each dose, and if irritation becomes a problem, the patch is no longer used.
Addressing the patient’s lifestyle and environment can also help in managing the disease. Providing a supportive and safe environment for the patient to function is imperative. These patients benefit from an established routine. Creating one step tasks, and keeping key items in the same place, can help to decrease the frustration that may occur with these patients.
- Diet and Nutrition
People with moderate to severe dementia commonly suffer from poor nutrition, as they forget to eat or don’t have an appetite. They may benefit from high-calorie supplements to reduce weight loss. Interestingly, loss of smell (also known as anosmia), is common in people with dementia, and this adds to the lack of appetite. Strategies that have been found to help improve the taste of food in people with no smell include adding spices and other agents to improve the taste and texture of food. Items like salsa, spices like ginger, pepper, paprika and soy sauce can be used.
Exercise has been studied scientifically and shown to be helpful for people with dementia. In particular, exercise can help reduce the risk of falls and fracture. Exercise has been associated with improved cognitive outcomes in healthy people, so may be a healthy strategy for lifelong wellness, in addition to its obvious cardiovascular benefits.
- Occupational Therapy
Occupational therapy can help both patients and their caregivers to understand how to use aids, coping behaviors, and other means to compensate for difficulties day to day. In addition, providing therapy can often overcome the isolation that many patients and families feel when living with dementia. Social connections become difficult due to behavioral challenges.
Clinical trials have shown mixed results, and there is little scientific evidence to recommend the daily use of Vitamin E to either prevent or treat dementia. Gingko Biloba, a plant extract, is safe but has not been shown to be effective in either the prevention or the treatment of dementia. Similarly, Vitamin B supplementation has not been found to help either improve or reduce the progression of dementia of the Alzheimer’s type. Omega-3 fatty acids have been associated with a lower risk for dementia. However, when studies in clinical trials were, no benefit was found. Supplements listed, while not found to be harmful, have not been found to be useful and are not currently recommended for the treatment of Alzheimer’s Disease. It is imperative before adding any additional supplements and/or vitamins to one’s treatment regimen that they are thoroughly discussed with your healthcare provider, to ensure there are not any contradictions.