A Guide to 13 Alzheimer’s Disease Treatments
How is Alzheimer's treated?
No one wants to hear “You've got Alzheimer's disease," a progressive memory-robbing disorder that doesn't have a cure. But the diagnosis may not be quite as grim as it was in the past
There are now a handful of medications that can help ease symptoms, like memory loss and confusion. What's more, the evidence suggests that there are certain lifestyle changes that might help, and there are other types of treatments that address specific symptoms (rather than the underlying cause of the disease) that may make life a little easier for people with Alzheimer's.
While the number of treatments is limited—and far from a perfect solution—“there is value in getting the proper care,” said James Hendrix, Ph.D., director of global science initiatives at the Alzheimer’s Association in Chicago. Treating symptoms can give people more time, allowing them to make decisions about their future while they still can, he explained.
Scientists continue to explore potential disease pathways to treat and prevent this insidious brain disorder, which affects more than 5 million Americans.
Here’s a rundown of current therapies, lifestyle changes, and promising treatments on the horizon that could help people with Alzheimer's disease.
Approved for treating mild, moderate, and severe Alzheimer’s symptoms, donepezil doesn’t stop the disease. But it does prevent the breakdown of a brain chemical called acetylcholine, believed to be important for memory, thinking, and reasoning.
This medicine comes as a once-daily tablet, so it’s easy for patients to take and doctors to adjust the dosage.
“You can start a patient on 5 milligrams a day and after several weeks move them up to 10 milligrams,” said Gregory Jicha, M.D., Ph.D., professor of neurology at the University of Kentucky and a neurologist at the UK Sanders-Brown Center on Aging.
Rivastigmine is in the same class of medicines as donepezil (Aricept) and a third drug, galantamine (Razadyne). It eases dementia symptoms by protecting levels of the brain chemical acetylcholine.
This twice-daily medication, available as a capsule or an oral solution, has three-step dosing.
It’s also the only Alzheimer’s medication available as a skin patch. It can be a good option for patients with severe gastrointestinal symptoms or a history of bleeding ulcers who cannot tolerate oral drugs in this class of medicines.
“That makes it a little more complex than just an additional pill in the pillbox,” but may be a safer option for patients with severe GI symptoms, Dr. Jicha said.
Galantamine works by boosting brain levels of acetylcholine, which helps brain cells communicate.
This twice-daily medicine comes as a liquid or a tablet. Patients take 8 milligrams per day (two 4-milligram doses) to start and slowly work up to 16 or 24 milligrams per day.
Like its cousins donepezil (Aricept) and rivastigmine (Exelon), galantamine can cause GI symptoms.
But it’s the only drug in its class that’s available in an extended-release capsule. It may be helpful in treating people with severe stomach or intestinal problems.
Memantine is the first drug of its kind. It regulates levels of glutamate, a chemical messenger crucial for memory and learning. Too much glutamate is believed to be toxic to the brain.
It’s available as a tablet, an oral solution, and an extended release capsule, and it has four-step dosing.
While approved for moderate-to-severe Alzheimer’s, it’s frequently prescribed for patients with mild disease as well.
Dr. Jicha said memantine is usually added after patients have dosed up to recommended levels of donepezil (Aricept), rivastigmine (Exelon) or galantamine (Razadyne). But if a patient has a history of stomach problems, he sometimes starts them on memantine first.
Side effects include constipation, headache, and dizziness.
Memantine extended-release and donepezil (Namzaric)
This treatment combines two Alzheimer’s medicines—memantine and donepezil—in a single, once-a-day capsule.
“The real benefit to Namzaric would be for individuals where providing multiple pills a day is problematic or providing twice-daily dosing is problematic,” Dr. Jicha said.
Many drug plans won’t pay for the combo pill. But that doesn’t stop doctors from prescribing a drug from each of the two classes of Alzheimer’s medicines.
Like other approved Alzheimer’s treatments, Namzaric doesn’t prevent the disease or slow its progression. But it may improve patients’ mental processes and overall function.
Common side effects include headache, diarrhea, dizziness, not wanting to eat, and bruising.
Heart-pounding physical activity is great for overall health. And, it appears to boost brain health, too. Studies presented at the Alzheimer’s Association 2015 International Conference highlight the potential benefit.
In one study, researchers at Wake Forest School of Medicine randomly assigned adults with early dementia to aerobic training (at 70-80% of their maximum heart rate) or stretching. Participants exercised for 45 to 60 minutes four times a week for six months. Not only did the aerobics group boost blood flow to key areas of the brain, but levels of tau, a protein linked to Alzheimer’s dementia, also declined compared with the control group.
In a Danish study, patients with mild or moderate Alzheimer’s were randomized to aerobic exercise or a control groups. After 16 weeks, researchers found no difference in patients’ mental function. But the exercisers had fewer symptoms, like anxiety, irritability, and depression.
Dr. Jicha's advice? Aim for at least 20 to 30 minutes of exercise three days a week, even if it’s just brisk walking.
Social and mental engagement
Being socially active and mentally challenged are two of the Alzheimer’s Association’s “10 Ways to Love Your Brain.”
These activities won’t reverse the course of the disease. But each plays a role in maintaining brain vitality, especially when combined with physical exercise and a healthy diet. Plus, connecting with other people may reduce the risk for depression, the association says.
Liana Apostolova, M.D., professor of neurology and Baekgaard chair in Alzheimer’s disease research at Indiana University in Indianapolis, encourages patients to pursue interests, like attending concerts and plays, solving Sudoku puzzles or taking up knitting, to ward off symptoms.
“It buys time,” she said.
Feeding the brain is no different than fueling the body. People should aim for a balanced diet that's low in saturated fat from meat and animal products.
In addition, reduce salt and sugar intake and build meals that include fruits and vegetables, poultry, fish, nuts, whole grains, and healthy fats.
The Alzheimer’s Association says research on the relationship between diet and mental function is somewhat limited. Evidence points to the benefits of the heart-healthy DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets, but aren't necessarily proven to help. (Here are 9 Foods That May Help Save Your Memory and 22 Mediterranean Diet Recipes.)
Can these diets reduce dementia risk, too? There’s no harm in trying and lots of potential upside, experts say.
“Things we told people for years about your heart health seem to apply to brain health,” Hendrix said.
A small study in the journal Aging highlighted a personalized, metabolic approach to treating dementia.
Researchers at the University California’s Buck Institute on Aging followed 10 patients with cognitive impairment or early Alzheimer’s. Each followed a therapeutic regimen of diet, exercise, brain stimulation, sleep optimization, medication, and vitamins called MEND, or Metabolic Enhancement for Neurodegeneration.
The study consisted of case reports. Some people returned to work, while others picked up new skills. One stopped forgetting things. The authors noted improvements in certain biologic measures, including a marker for inflammation thought to play a role in Alzheimer’s.
The study was not a clinical trial, and the tailored approach may be difficult to replicate on a larger scale, Hendrix noted. Still, it underscores the potential benefits of improving overall health.
Build your support system
Don’t be shy about asking your doctor or local hospital about support groups for patients with chronic joint pain. Find community resources and events in your area with the Arthritis Foundation’s search tool, or consider calling a local chapter of the American Chronic Pain Association (ACPA). CreakyJoints, an online community for arthritis patients of all ages, also helps users find and list support groups. And if you have psoriatic arthritis, check out the National Psoriasis Foundation, which is home to TalkPsoriasis, the world’s largest online support group and discussion community for psoriasis and psoriatic arthritis patients.
Can’t find something near you? Create your own support group. The ACPA offers members a manual with how-to information on organizing and managing new chapters.
Medicines for agitation and aggression
No medicine is FDA-approved to treat the behavioral symptoms of Alzheimer’s dementia. That’s why doctors often prescribe treatments “off-label” and from a variety of drug classes.
Bryan Spann, D.O., Ph.D., a neurologist and clinical director of Nantz National Alzheimer Center at Houston Methodist Neurological Institute starts with citalopram (Celexa), a selective serotonin reuptake inhibitor (SSRI) antidepressant.
Another option is Nuedexta. This medicine is approved for treating pseudobulbar affect, the uncontrollable laughing and crying spells that people with neurologic diseases sometimes experience. It comes as a capsule combining a cough medicine and heart medicine—dextromethorphan and quinidine.
While antipsychotic medicines are an option, they should only be given when symptoms are severe, the Alzheimer’s Association cautions.
Treating depression in Alzheimer’s patients may involve a combination of medicines and counseling.
Doctors may prescribe SSRI antidepressants, like citalopram (Celexa) and sertraline (Zoloft) to combat symptoms. These medicines increase levels of serotonin, an important chemical messenger in the brain.
Atypical antidepressants also enhance brain chemical activity and may be another option. These include drugs like mirtazapine (Remeron) trazodone (Desyrel).
Possible side effects of these medicines include drowsiness, dizziness, and dry mouth.
Aducanumab and solanezumab
In the quest for a cure, scientists are targeting underlying features of Alzheimer’s.
One approach is to attack amyloid, a hallmark of the disease. Amyloid protein forms clumps in the brains of patients, creating sticky plaques that lead to brain cell death. Solanezumab, an injectable antibody, is among a handful of potential plaque-clearing medicines in the pipeline. Clinical results are expected in later in 2016 or early 2017. And a new study that looked at a similar drug, aducanumab, also seemed promising. Neither drug is on the market yet, but patients in clinical trials have shown some small improvements.
Drugs that prevent tangles are also in the works. Tangles are the twisted strands of tau protein found in the brain cells of Alzheimer’s patients.
Some scientists are developing medicines to alleviate brain inflammation—a new therapeutic target. Inflammation is the body’s natural infection-fighting response. But too much may damage brain cells and circuitry.
In one animal study, mefenamic acid, a non-steroidal anti-inflammatory or NSAID in the same class as ibuprofen and aspirin, helped reverse memory loss in mice. The mice had been genetically engineered to develop Alzheimer's disease symptoms.
However, treatments that work in mice often don't pan out when tried in humans. The results, while promising, are just the first steps in determining if mefenamic acid is truly useful in treating Alzheimer's disease.