Alzheimer’s medications & treatments
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Alzheimer’s disease (AD) is the most common type of dementia, accounting for 60% to 80% of cases. It is the sixth leading cause of death in the U.S. It is estimated that it could affect as many as 24 million people worldwide. That number is predicted to increase to almost 106 million people by the year 2050, according to the Alzheimer’s Association. Alzheimer’s is a costly disease as well with an estimated $172 billion per year in the U.S. alone.
What is Alzheimer’s?
Alzheimer’s disease is a progressive brain disorder that can severely affect your memory and thinking skills and can affect your ability to carry out simple daily activities. You can also experience personality and behavioral changes. Alzheimer’s is not a part of the normal aging process but a form of dementia.
While the exact cause of Alzheimer’s is not known, it is thought to be due to the damage and death of nerve cells in the brain. This damage is usually because of protein (beta-amyloid) build-up between the nerve cells or tangles of protein (tau) that build up inside the cells.
The reason you get these plaques and tangles is not understood but experts think it is a combination of the following:
- Advancing age. Most cases of Alzheimer’s occur in people over the age of 65.
- Family history. If you have a close family member with this condition, you are more likely to develop it.
- Lifestyle and environmental risk factors. It is thought that exposure to pollutants, cardiovascular disease, high blood pressure, smoking, and obesity can increase your risk.
Some other factors that increase your risk of Alzheimer’s include diabetes, Down syndrome, and traumatic brain injury.
Stages of Alzheimer’s
Alzheimer’s is a progressive disease that slowly worsens over time. The rate at which the disease progresses will differ between people. There are several stages of the disease, including:
- Early-stage Alzheimer’s. You may still live and function independently in the early stage of Alzheimer’s. You can still suffer from mild cognitive impairment (MCI) and memory lapses such as forgetting a phone number or recent events. Alzheimer’s is often diagnosed at this stage.
- Middle-stage Alzheimer’s. This stage can last for many years. During the middle stage, damage occurs to nerve cells in your brain that can cause more confusion, anger, frustration, and trouble recognizing familiar faces. As the disease progresses in this stage, you may need more help performing routine tasks.
- Late-stage Alzheimer’s. In the final stage of Alzheimer’s, dementia symptoms are severe. You will lose your ability to communicate and control your movement. At this stage, you will require around-the-clock assistance with your daily personal care.
How is Alzheimer’s diagnosed?
To confirm a diagnosis of Alzheimer’s, your doctor or healthcare professional will look at your symptoms, review your medical history, perform a physical exam, and run some mental or cognitive tests.
Symptoms of Alzheimer’s come on gradually over time. Some symptoms that can appear include:
- Memory loss (typically the first symptom you experience)
- Trouble doing ordinary activities of daily life
- Difficulty problem-solving
- Mood swings and personality changes
- Confused about time and place
- Trouble communicating or finding the right words
- Disorientation, wandering, or getting lost
- Agitation or aggression towards loved ones or caregivers
- Poor judgment
- Unable to recognize family and friends
- Trouble walking
- Trouble swallowing
If your symptoms suggest Alzheimer’s, your doctor may run additional tests such as:
- Mental status exam. This can include testing your memory, problem-solving, verbal skills, mood, and focus. This exam can also be used to monitor the progression of the disease.
- Blood and urine tests. These are performed to rule out other causes of your symptoms such as infections, liver and kidney impairment, thyroid disease, and low blood sugar.
- Magnetic resonance imaging (MRI) scan. An MRI scan can reveal if the brain is shrinking (atrophy) which can be associated with Alzheimer’s. It can also show tumors or other structural damage that could be the cause of your symptoms.
- Positron emission tomography (PET) scan. A PET scan can show the buildup of amyloid protein in your brain as well as how well your brain uses glucose. Poor absorption of glucose can be a sign of Alzheimer’s.
- Spinal tap. A lumbar puncture is used to check for abnormal clumps of proteins called amyloid and tau that are also found in the brain of people with Alzheimer’s.
What are some Alzheimer’s treatment options?
There is no cure for this disease but there are several treatment options you can use to help slow the progression of Alzheimer’s and help with symptoms such as mood and behavioral changes.
Most medications work best in the early or middle stages of Alzheimer’s but they will have some benefits in the later stages. Some FDA-approved medications you may be prescribed include:
- Cholinesterase inhibitors. These medications are approved to treat mild to moderate Alzheimer’s symptoms. They work by blocking an enzyme (acetylcholinesterase) in your brain to increase the levels of acetylcholine. This helps nerve cells communicate which can help improve your memory and reduce some behavioral symptoms. Examples include Aricept (donepezil) and Exelon (rivastigmine).
- NMDA antagonist. Namenda (memantine) is approved for the treatment of moderate to severe Alzheimer’s disease. It works by regulating the activity of glutamate, a chemical messenger that helps your brain process information.
- Aduhelm (aducanumab). This new treatment of Alzheimer’s is a monoclonal antibody that is the first drug approved in the U.S. to treat Alzheimer’s by targeting and removing amyloid plaques in the brain. It may help reduce functional and cognitive decline in people with early-stage Alzheimer’s.
Your doctor may also prescribe medications may prescribe antipsychotics or antidepressants to treat symptoms of Alzheimer’s such as paranoia, hallucinations, agitation, and aggression.
What is the best medication for Alzheimer’s?
The best medication for the treatment of Alzheimer’s will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with Alzheimer’s medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter Alzheimer’s medications approved by the Food and Drug Administration (FDA).
Best medications for Alzheimer’s
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|Adulhelm (aducanumab)||Monoclonal antibody||Injection||The dose will be titrated up to 10mg/kg of body weight via IV infusion every 4 weeks.||Amyloid-related imaging abnormalities-edema (ARIA-E), headache, falls, diarrhea, confusion, delirium|
|Aricept (donepezil)||Acetylcholinesterase inhibitor||Oral||1 tablet (5mg to 23mg) once daily at bedtime.||Nausea, diarrhea, insomnia, infection, headache, vomiting, muscle cramps, loss of appetite|
|Aricept ODT (donepezil)||Acetylcholinesterase inhibitor||Orally disintegrating tablet||Dissolve 1 tablet (5mg to 10mg) on the tongue once daily at bedtime.||Nausea, diarrhea, insomnia, infection, headache, vomiting, muscle cramps|
|Adlarity (donepezil)||Acetylcholinesterase inhibitor||Transdermal||Apply 1 patch (5mg/day or 10mg/day) once weekly.||Headache, itching, and redness at the application site, muscle spasms, insomnia|
|Razadyne ER (galantamine)||Acetylcholinesterase inhibitor||Oral||1 capsule (8mg to 24mg) once daily in the morning.||Nausea, diarrhea, vomiting, stomach pain, fatigue, headache|
|Exelon (rivastigmine)||Acetylcholinesterase inhibitor||Oral||1 capsule (3mg to 6mg) every 12 hours.||Nausea, vomiting, dizziness, diarrhea, headache, stomach pain, insomnia|
|Exelon Patch (rivastigmine)||Acetylcholinesterase inhibitor||Transdermal||Apply 1 patch (4.6mg/24hr to 13.3mg/24hr) every 24 hours.||Nausea, vomiting, dizziness, diarrhea, headache, stomach pain, insomnia|
|Namzaric (memantine/donepezil)||Acetylcholinesterase inhibitor/NMDA antagonist||Oral||1 capsule (28mg/10mg) once daily.||Nausea, diarrhea, insomnia, dizziness, confusion, headache, infection|
|Namenda (memantine)||NMDA receptor antagonist||Oral||1 tablet (5mg to 10mg) twice daily.||Dizziness, confusion, headache, constipation, cough, high blood pressure|
|Namenda XR (memantine)||NMDA receptor antagonist||Oral||1 capsule (7mg to 28mg) once daily.||Dizziness, confusion, headache, constipation, cough, high blood pressure|
Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.
What are the most common side effects of Alzheimer’s medications?
As with all medicines, those used for Alzheimer’s will have some side effects, depending on the class you are taking:
- Cholinesterase inhibitors can commonly cause nausea, diarrhea, insomnia, loss of appetite, headache, vomiting, and muscle cramps.
- Namenda (memantine) can cause dizziness, confusion, headache, constipation, and high blood pressure.
- Adulhelm (aducanumab) may cause amyloid-related imaging abnormalities-edema (ARIA-E), headache, falls, diarrhea, confusion, and delirium.
What are some home remedies for Alzheimer’s?
A study of almost 3,000 people found that combining more healthy lifestyle changes helped lower the risk of Alzheimer’s, including:
- A minimum of 150 minutes per week of at least moderate physical activity.
- Not smoking
- Limiting alcohol consumption
- Eating a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet.
- Participating in cognitive activities such as volunteering or hobbies.
The participants in the study who adhered to four or five of the healthy behaviors had a 60% lower risk of developing Alzheimer’s.
Frequently asked questions about Alzheimer’s
Is there a cure for Alzheimer’s?
Currently, there is no cure for Alzheimer’s, but there are medications and lifestyle changes that may help slow the progression of the disease.
What is the life expectancy for someone with Alzheimer’s?
The average life expectancy for someone aged 65 years or older is 4 to 8 years after being diagnosed. However, some people may live up to 20 years after experiencing the first symptoms.
What are the early signs of Alzheimer’s?
Memory problems are typically the first sign of Alzheimer’s. Difficulty finding the right words, confusion, and impaired reasoning or judgment is often seen in the early stages of Alzheimer’s as well.
Where can I find more information on clinical trials for Alzheimer’s?
Clinical trials are ongoing to find new treatments for Alzheimer’s. Check out the Alzheimer’s Association for more information.
Related resources for Alzheimer’s
- Alzheimer disease. StatPearl, National Library of Medicine
- What is Alzheimer’s disease? Alzheimers.gov
- Alzheimer’s disease symptoms and causes. Cleveland Clinic
- What is Alzheimer’s disease? Alzheimer’s Association
- What is Alzheimer’s disease? National Institute on Aging
- Alzheimer’s disease practice essentials. MedScape