The U.S. population is getting older, and as it ages, Alzheimer’s disease is becoming an increasingly bigger concern. Within the next 50 years, the incidence of Alzheimer’s is expected to quadruple, affecting one in 45 Americans.
Today, there is still no cure for Alzheimer’s. People with the disease progressively lose memory and the ability to function as Alzheimer’s advances.
Alzheimer’s is a complex disease. Researchers are still trying to fully understand how its plaques and tangles lead to memory loss and other symptoms — and how to reverse those changes to prevent or stop the disease. However, there are treatments available today that can help patients manage the symptoms of Alzheimer’s disease and delay its progression.
Although memory loss is the hallmark of Alzheimer’s disease, people with the condition experience a wide range of other cognitive, behavioral, and psychiatric symptoms.
Alzheimer’s therapy involves a number of different treatments that address each of these problems. Because symptoms change over time, doctors need to adjust their Alzheimer’s patients’ therapies as new problems emerge.
Several different types of medications are used to treat the memory loss, behavior changes, sleep problems, and other symptoms of Alzheimer’s disease. These medications won’t stop the disease, but they can slow down the symptoms for a few months or even years. All of these medications can have side effects, which can be even more pronounced in the elderly.
Four medications in two classes are FDA-approved specifically for Alzheimer’s therapy.
Cholinesterase inhibitors help with the cognitive symptoms of Alzheimer’s. They work by preventing the breakdown of a chemical messenger in the brain called acetylcholine, which is important for learning, memory, and attention.
Three cholinesterase inhibitors are approved for Alzheimer’s disease therapy. Donepezil (Aricept) is approved to treat mild, moderate, and severe Alzheimer’s. Rivastigmine (Exelon) and galantamine (Razadyne) are approved to treat mild to moderate Alzheimer’s. Exelon is now also available in a skin patch, which is easier for some patients to take.
Memantine (Namenda) works by regulating the amount of another chemical messenger in the brain, called glutamate. Namenda is approved for moderate to severe Alzheimer’s disease. Side effects include dizziness, confusion, headache, constipation, nausea, and agitation. Because Namenda does not work the same way as a cholinesterase inhibitor, it may be used in combination with one.
It’s difficult to tell whether one drug is more effective than another for a given person. Alzheimer’s patients (with the help of their doctors) should choose whichever drug works best for them.
A few Alzheimer’s disease therapies treat the behavioral and psychiatric symptoms that may be related to the disease, including hallucinations, agitation, and sleep problems. However, none of these drugs is FDA-approved as an Alzheimer’s therapy.
- Antidepressants, such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) treat irritability and mood.
- Anxiolytics, such as lorazepam (Ativan) and oxazepam (Serax) treat anxiety and restlessness.
- Antipsychotic medications, such as aripiprazole (Abilify), clozapine (Clozaril),haloperidol (Haldol), and olanzapine (Zyprexa) treat hallucinations, delusions, agitation, and aggression. It’s important to note that antipsychotic drugs have been linked to increased risk of death in patients with dementia, and currently carry the FDA’s “black box” warning about their use in older patients with dementia
Other Alzheimer’s Therapies
Several non-medication therapies also can help Alzheimer’s patients cope with the symptoms of the condition.
Vitamin E . Vitamin E has been researched as a therapy for Alzheimer’s disease because it is an antioxidant that is thought to protect nerve cells from damage. However, many doctors no longer recommend vitamin E because there is little evidence that it’s effective and because it can interact with other medications, particularly blood thinners.
Hormone replacement therapy (HRT). Some studies have suggested that postmenopausal women who are taking hormone replacement therapy have a lower risk of developing Alzheimer’s disease. The female hormone, estrogen, is thought to help nerve cells make connections, and interfere with the production of beta amyloid — a protein that is the main component in the plaques that lead to Alzheimer’s disease. However, more recent research has found no improvement with HRT, and one study even suggested that estrogen use might actually increase the risk of developing Alzheimer’s rather than protect against it. HRT also increases the risk for heart attack, stroke, and breast cancer.
Sensory therapies. There is some evidence that sensory therapies such as music therapy and art therapy can improve Alzheimer’s patients’ mood, behavior, and day-to-day function. By stimulating the senses, these therapies may help trigger memory recall and enable Alzheimer’s patients to reconnect with the world around them.
Alternative therapies. Some people have tried alternative remedies, including coenzyme Q10, coral calcium, huperzine A, and omega-3 fatty acids to prevent or treat Alzheimer’s disease. However, there is not yet enough research on these treatments to recommend using any of them as an Alzheimer’s therapy. And, because these are supplements, the FDA does not regulate them as it does medications. Supplements may cause dangerous side effects or interact with other medications patients are taking.
Lifestyle changes might help slow cognitive decline in people with Alzheimer’s. For example, studies have shown that eating a Mediterranean diet (which is high in fish, nuts, and healthy oils) may reduce the risk of Alzheimer’s, and that exercise may improve the symptoms of the disease.
Researchers are looking into several new treatment options for Alzheimer’s. One of the most promising Alzheimer’s therapies in development focuses on beta amyloid. Researchers are trying to develop new therapies that prevent beta amyloid from forming, or break it down before it leads to Alzheimer’s.
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