Current Pharmacological Treatments for Alzheimer’s Disease by Dr. Ashok J Bharucha

Nearly six million Americans are afflicted with Alzheimer’s disease. By 2050, the number will nearly triple. There is an urgent need to discover treatments that may at least halt the progression of the disease, if not prevent it outright. The triad of the disease’s cognitive, functional, and behavioral consequences takes an immense toll on caregivers, who must take time away from work and their personal needs to attend to their loved ones. Moreover, nearly half of family caregivers for those with dementia are clinically depressed, warranting care and treatment of their own.

Most currently available pharmacological treatments for Alzheimer’s disease attempt to increase the availability of a brain messenger named acetylcholine which is thought to be progressively depleted in Alzheimer’s disease. These medications are called Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine).

Although these medications improve the cognitive symptoms of Alzheimer’s disease, they do not halt the progression of the underlying disease. The benefits are typically modest and effective for 6 to 18 months on average. However, certain individuals benefit much more significantly. In addition to improving cognitive symptoms such as attention and memory, these medications do improve day-to-day functional abilities (dressing, bathing, toileting, etc.) for some individuals and behavioral symptoms (agitation, hallucinations, delusions, etc.) for others. There is also some evidence that these medications may delay nursing home placement.

However, the studies are not conclusive. Since individuals with dementia may develop swallowing difficulties or refuse to take medications by mouth, these compounds are available in various formulations such as tablets, oral concentrate, and skin patches. Common side effects include nausea, vomiting, diarrhea, diminished appetite, possible weight loss, insomnia, nightmares, and slowing heart rate. The benefits and risks must be closely balanced in consultation with a dementia specialist.

In addition to the medications which raise acetylcholinesterase levels, one medication is available that reduces the toxicity to nerves of excessive glutamate stimulation. Namenda (memantine) is approved for the moderate to severe stages of Alzheimer’s disease and is often combined with the medications mentioned above. There is conflicting evidence as to whether combination therapy is more effective than treatment with a single medication. Common side effects of memantine may include headache, constipation, confusion, and occasionally, hallucinations.

Ultimately, we must find ways to diagnose Alzheimer’s disease and related dementias as early as possible before the brain damage begins to accumulate. Since the brain changes likely precede actual symptoms by decades, earlier recognition may provide an opportunity to halt disease progression more effectively. Medications currently in the pipelines are actively exploring the possibility of preventing brain damage or reversing the damage that may have already occurred by various means.

An evaluation by a dementia specialist is ultimately the key to proper diagnosis, management, long-term financial and care planning, and caregiver support. National organizations such as the American Association for Geriatric Psychiatry and the Alzheimer’s Association offer invaluable resources for understanding and accessing care.