How Alzheimer's Disease Is Treated

Alzheimer’s disease is a brain condition that is extremely complex in nature. The scientific community still doesn't fully understand what causes it and believes it is a variety of factors, including genetics, lifestyle, and environment.

In previous years, Alzheimer's could only be definitively diagnosed after death. Today, tools such as testing cerebrospinal fluid, PET scans, and blood work help make an accurate diagnosis.

Unfortunately, there is still no cure for this condition; however, researchers are working around the clock to find the best treatments to slow the progression and help patients cope with the symptoms of Alzheimer's disease.

Medication to Improve Symptoms

Different types of medications can help treat the cognitive and behavioral symptoms of Alzheimer’s disease.

These medications can treat the manifestations of the disease but do not affect the underlying disease process, says Richard Marottoli, MD, MPH, a geriatrician at Yale Medicine who specializes in treating Alzheimer’s disease and other forms of dementia.

Patients are often given low doses of medication at first and then monitored to see how well they respond to it. The dosage is gradually increased depending on how well they tolerate it. While higher doses can sometimes be more effective, they can also result in stronger side effects.

Cholinesterase Inhibitors

There is a group of drugs known as cholinesterase inhibitors that can help with the cognitive and behavioral symptoms of Alzheimer’s disease.

While the exact mechanism of these drugs is still unclear, research indicates that they work by blocking an enzyme known as acetylcholinesterase, which breaks down a neurotransmitter (brain chemical) known as acetylcholine.

Acetylcholine plays an important role in cognitive functions like thinking, planning, and remembering. Low acetylcholine levels are responsible for some of the symptoms of Alzheimer’s disease, like memory loss.

By blocking the enzyme and inhibiting the breakdown of acetylcholine, these medications can help with some of the symptoms of Alzheimer’s disease, including memory loss.

Cholinesterase inhibitors include:

• Aricept (donepezil): For treatment of all stages of Alzheimer’s disease
• Exelon (rivastigmine): For treatment of early and middle stages of Alzheimer’s disease
• Razadyne (galantamine): For treatment of early and middle stages of Alzheimer’s disease

These three drugs work in a similar fashion; however, the patient may respond better to one drug over another.

These medications can cause side effects such as fatigue, nausea, vomiting, indigestion, diarrhea, reduced appetite, weight loss, muscle cramps, dizziness, and headaches.

NMDA Antagonist

Another class of medication helps with the symptoms of Alzheimer’s disease. Memantine is an N-methyl D-aspartate (NMDA) antagonist sold under the brand name Namenda. It is used to treat middle—to late-stage Alzheimer’s disease.

Memantine works by regulating the neurotransmitter glutamate, which activates NMDA receptors on nerve cells. Excess glutamate production can lead to brain cell death, so by inhibiting glutamate, it protects your brain cells.

Side effects of memantine include dizziness, headaches, constipation, diarrhea, and nausea.

Since this drug works differently than cholinesterase inhibitors, it is sometimes used in combination with cholinesterase inhibitors. Namzaric is a medication that combines donepezil and memantine.

Medication for Behavioral and Mood Symptoms

As Alzheimer’s disease progresses, it can cause several behavioral and mood symptoms, such as wandering, restlessness, sleeplessness, aggression, agitation, anxiety, and depression.

These symptoms can take a toll on the patient as well as their caregivers. Treating these symptoms can make patients more comfortable and easier to care for.

These are some of the types of medication that can help:

• Anti-anxiety medication can help treat agitation.
• Anticonvulsant drugs can help treat severe aggression.
• Antidepressants can help treat depression, anxiety, restlessness, and aggression.
• Antipsychotics can help treat symptoms like hallucinations and paranoia.
• Sleep aids can help you sleep through the night.

However, these medications can cause severe side effects in people with Alzheimer’s disease. Side effects can include confusion, dizziness, sleepiness, mood swings, and increased chances of falling.

Because of their side effects, it is only advisable to use these medicines occasionally or for short periods of time. They are often used as a last resort after carefully considering the risks and side effects and only if other strategies have failed. 

Medication to Slow Disease Progression

There are also newer medications that may be able to reduce the rate of cognitive decline and slow down the progression of Alzheimer’s disease. The U.S. Food and Drug Administration (FDA) gave accelerated approval for a drug known as ​​aducanumab (brand name Aduhelm) in 2021, and traditional approval for lecanamab (brand name Leqembi) in 2023.

These drugs are a new brand of immunotherapy medications that target the underlying pathophysiology of Alzheimer's disease by reducing the amyloid protein deposits in the brain. These protein deposits interfere with the function of brain cells, causing them to lose touch with each other and eventually die, which leads to cognitive impairment. 

Fortunately, the clinical trials for Leqembi showed a significant and meaningful reduction in the rate of cognitive decline when taking this medication, and the results were consistent across trials.

Side effects of Leqembi include allergic reactions, headaches, and an increased risk of falling. People may also experience amyloid-related imaging abnormalities (ARIA), which can include confusion, dizziness, nausea, vision changes, and temporary swelling in certain parts of the brain that is sometimes accompanied by small spots of blood on the surface of the brain.

Psychotherapy

Being diagnosed with a progressive, terminal illness can cause a lot of distress to patients and their loved ones. Therapy can help you accept the situation and develop coping skills to navigate it.

As Alzheimer’s disease progresses, it can make it difficult for you to manage daily chores, personal tasks, and finances without assistance. Losing your independence and agency can be painful and embarrassing. Therapy can help you process your feelings, ask for help, and build the kind of support you will need to cope with this condition.

You can seek either individual therapy or group therapy. Individual therapy can offer a safe space for you to discuss your feelings and concerns in private, whereas group therapy can help you connect with others who are living with the same condition you are.

Various forms of psychotherapy are available for people experiencing symptoms of dementia, regardless of which type. A few examples are:

• Art therapy
• Cognitive-behavioral therapy
• Cognitive-stimulation therapy
• Narrative therapy, storytelling, and reminiscence therapy

How to Make Your Treatment Most Effective

These are some steps you can take to help make your treatment most effective and maintain your quality of life for as long as possible:

• Take medication as prescribed: Seeking medical treatment, taking your medicines as prescribed, and reporting any side effects to your doctor can help you manage the symptoms of this condition and slow down the progression of the disease.
• Get regular health check-ups: It’s important to check in with your healthcare provider regularly to evaluate the progression of the condition, discuss any symptoms and side effects, and check for other health conditions.
• Treat other health conditions: Identifying and treating other health conditions, like vision and hearing loss, can also be helpful. Marottoli says optimizing hearing and vision is important, as improved sensory input can make it easier for the brain to process this information.
• Stay active and engaged: “Be physically, socially, and cognitively active and stay engaged. Check on resources in your community regarding activity programs and support groups,” says Marottoli.
• Maintain a healthy lifestyle: Marottoli recommends following a healthy diet, such as the Mediterranean diet, and exercising regularly.
• Work on a care plan: Work with a healthcare provider, family, friends, caregivers, and community to educate yourself about this condition and how you can maintain your independence for as long as possible, as well as to plan out your care when you need assistance.