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Alzheimer’s Treatment and Medications

Medically reviewed by Anis RehmanMD
Physician
Updated Oct. 5, 2020  •  Published Apr. 27, 2020
Fact Checked

Watching a loved one live with Alzheimer’s disease is difficult for the entire family. This degenerative condition is a form of dementia that causes memory loss and cognitive impairment over time.

Someone in the early stages of Alzheimer’s could face minor challenges such as remembering how to do daily tasks. However, as the condition progresses, the patient may not remember his or her family and become dependent on others for care. Sadly, there is no cure for Alzheimer's. However, there are several treatment methods available to help slow this progression.

Although a complex and challenging disease for patients and their loved ones to cope with, understanding the scope of Alzheimer’s and its treatment options may comfort all who are affected. We’ll discuss what Alzheimer’s disease is, how the condition is diagnosed, and the medications and remedies that are available.

What is Alzheimer's?

Alzheimer’s disease is an irreversible, degenerative condition that affects memory, cognition, and behavior typically in those who are in their mid-60s or older. This progressive form of dementia cannot be cured, though treatment may help slow the progression of symptoms and help those who are affected maintain mental function.

Alzheimer’s disease is a complex, on-going condition with seven stages. Early signs include trouble with memory and doing familiar daily tasks such as cooking or operating the microwave. As the disease progresses, memory loss and confusion worsen. Patients may have trouble recognizing friends and family members, along with experiencing hallucinations, delusions, and paranoia. The most severe stages of Alzheimer’s leaves patients in a state where they can’t communicate and become completely dependent on others.

Dr. Alois Alzheimer, a German physician, first identified the disease in 1906 during an autopsy of a patient who experienced profound memory loss and psychological changes. When examining her brain, he noticed extreme abnormalities in the physical structure of her brain. Modern research has identified these main abnormalities associated with Alzheimer’s as plaque deposits of the beta-protein amyloid and neurofibrillary tangles, also known as tau tangles, in the brain. Other physical changes in the brain include chronic inflammation, loss of neuronal connections, and cell death. All of these changes in the brain are extremely harmful and are responsible for the symptoms of dementia Alzheimer’s patient’s experience.

Current research is aimed at finding more effective ways to identify cases of Alzheimer’s as early as possible. In order to do so, it is important to be able to detect the brain degeneration that causes the cognitive issues people face. These changes can begin to occur as early as a decade before the first signs of symptoms, so with better detection treatment can start much sooner than it does today.

Alzheimer’s is common in older adults, affecting nearly 5.8 million people in the US. The exact cause of Alzheimer’s is unknown, but researchers have identified certain risk factors such as age, genetics, and a family history of the disease that make people more susceptible to Alzheimer’s. Some younger people are affected by a form of the condition known as early-onset Alzheimer’s, though these cases only account for less than 5% of cases.

How is Alzheimer's diagnosed?

People who begin experiencing memory issues or those who have a high risk for Alzheimer’s may visit their health care provider for a diagnosis of the condition. Alzheimer’s cannot be truly diagnosed until post-mortem examinations of the brain tissues, but certain tests and lab imaging can identify possible or probable cases of Alzheimer’s. In possible cases of Alzheimer’s, dementia may be due to other causes. In probable cases, no other cause of dementia is found.

“There is no single test that can help a doctor diagnose Alzheimer’s,” says Nodar Janas, MD, the medical director at Upper East Side Rehabilitation and Nursing Center in Manhattan, New York. “When a doctor does work to diagnose the disease, they review medical history and go through a series of tests to measure cognitive impairment, identify behavioral changes, and assess functional abilities and several other functions.”

During your medical history review, your doctor will ask you or a family member questions relating to your family medical history, current, and past health conditions and medications, and certain lifestyle factors relating to diet, alcohol/drug use, and physical activity level. Next, your doctor may perform cognitive tests by asking you what day it is or other simple orienting questions. These tests can be performed over time to monitor the mental functioning and progression of symptoms. Your doctor can also use these tests to rule out other possible causes of dementia or impairments.

Lab tests and imaging can also be used to detect probable Alzheimer’s cases. These include magnetic resonance imaging (MRI), computed tomography (CT) scans, and positron emission tomography (PET) scans. An MRI can detect structural issues, inflammation, and bleeding in the brain. CT scans can help your doctor identify any abnormal brain characteristics, and PET scans detect plaque build-ups, a key indicator of Alzheimer’s. Your doctor may also order blood tests to scan for potential genes that put you at a higher risk of developing Alzheimer’s.

Alzheimer's treatment options

Unfortunately, there is no cure for Alzheimer’s disease. This progressive condition is complex and typically cannot be successfully treated with only one drug or intervention. The current approach for treating Alzheimer’s focuses on helping patients maintain normal cognitive function for as long as possible, along with slowing memory loss and other symptoms such as behavioral changes.

Treatment options for Alzheimer’s include medications for maintaining mental functioning or managing behavioral problems. Your doctor may also recommend alternative forms of natural treatment to slow the progression of the condition such as maintaining a healthy diet and exercising.

Alzheimer's medications

There are two groups of medication the U.S. Food and Drug Administration (FDA) has approved for treating Alzheimer’s. These include cholinesterase inhibitors and memantine, an NMDA receptor antagonist. Keep in mind that these medications do not cure Alzheimer’s disease, but they can help treat symptoms and help patients maintain mental function.

Cholinesterase inhibitors

Cholinesterase inhibitors are a type of drug that work to block the enzyme cholinesterase that is responsible for the breakdown of acetylcholine. Cholinesterase inhibitors are the most common drug type used for the treatment of dementia in patients with Alzheimer’s because of the importance of maintaining the presence of acetylcholine in the brain. This neurotransmitter plays a key role in cognitive functions such as memory, learning, and attention.

Common cholinesterase inhibiting drugs used to treat Alzheimer’s include Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine). Each of these drugs can be used to treat mild to moderate cases of Alzheimer’s. Donepezil can be used to treat severe cases as well. The common side effects of these medications are mild and include vasodilation, increased perspiration, constriction of the pupils, and increased production of saliva and tears. Overall, cholinesterase inhibitors have been known to have a modest effect in treating Alzheimer’s patients’ symptoms.

Memantine

Namenda (memantine) is an NMDA receptor antagonist that works by decreasing abnormal brain activity and controlling the amount of glutamate, a chemical involved with learning and memory, in the brain. Memantine can slow memory loss and help improve cognition and mental functioning in Alzheimer’s patients so people can do everyday tasks with more ease.

Common side effects of memantine include dizziness, confusion, and aggression. More severe side effects include shortness of breath and hallucinations, and you should contact your doctor if you experience any unusual effects from taking the medication. Memantine does not cure Alzheimer’s disease or prevent loss of mental abilities in the future, but it can help effectively slow the progression of the disease in mild, moderate, and severe cases.

Every journey with Alzheimer’s disease is unique, so the best medication differs by patient. Certain factors such as age, medical history, and stage of the disease can affect a patient’s response to treatment.

That being said, there are a few common medications that are known to help manage symptoms in patients with Alzheimer’s. These include those listed in the table below.

What are the best medications for Alzheimer's disease?

The following table lists common medications to treat Alzheimer's disease. This is not a complete list and does not take into account a person's medical history, or possible contradictions with medications that are being used for other conditions.

Drug Name Drug Class Administration Route Standard Dosage Common Side Effects
Aricept (donepezil) Cholinesterase inhibitor Oral 5 mg tablet once per day in the evening as starting dose for 4 to 6 weeks before advancing to 10 mg tablet once per day Nausea, vomiting, diarrhea, insomnia, fatigue
Exelon (rivastigmine) Cholinesterase inhibitor Oral 1.5 mg capsule taken twice per day as starting dose before increasing to 6 mg or 12 mg capsule taken twice per day Nausea, vomiting, dizziness
Exelon (rivastigmine) Cholinesterase inhibitor Transdermal patch 4.6 mg patch applied to the skin once daily as starting dose before increasing to 9.5 mg/24 hour patch or 13.3 mg/24 hour patch Nausea, vomiting, diarrhea, depression
Razadyne (galantamine) Cholinesterase inhibitor Oral 4 mg tablet taken twice per day as starting dose before advancing to 16 or 32 mg tablet taken twice per day Nausea, vomiting, headache, decreased appetite, diarrhea, depression
Namenda (memantine) NMDA receptor antagonist Oral 5 mg tablet taken once per day as starting dose before advancing to 10 mg/day (5 mg tablet twice daily), 15 mg/day (5 mg and 10 mg tablet as separate doses), or 20 mg/day (10 mg tablet twice daily) Dizziness, headache, constipation, confusion

Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are common side effects of Alzheimer's medication?

Many patients can take cholinesterase inhibitors and memantine without experiencing harmful side effects. Those who do experience side effects from these medications typically only have mild reactions. Some of the most common side effects of Alzheimer’s medications include:

  • Dizziness
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Weight loss
  • Fatigue
  • Insomnia

The risk of adverse reactions to Alzheimer’s medications can be reduced by starting with the smallest initial dosage for several weeks before advancing to a larger dosage. You should speak with your doctor to determine the best dosage for your condition.

What works best for some patients may not work as effectively for others. It’s important to consider the stage of your conditions, other medications, and how they may interact with Alzheimer’s medications, and your body’s response to certain drugs. Your doctor can discuss all of these matters with you to prescribe a personalized treatment plan.

Of course, this is not a complete list of all potential side effects one can experience from taking Alzheimer’s medications. If you experience any unusual or adverse reactions to a drug, contact your doctor immediately.

What are the best natural remedies for Alzheimer's?

Some people with Alzheimer’s disease find it helpful to make small lifestyle changes or use natural treatment options to manage their symptoms.

Some of the best natural remedies for Alzheimer’s disease include:

  • Acupuncture
  • Aromatherapy with lemon, lavender, orange, and rosemary
  • Bright light therapy
  • Coconut oil
  • Omega 3
  • Coenzyme Q10
  • Coral calcium
  • Ginkgo biloba
  • Choto-san

The effectiveness of natural treatments for Alzheimer’s disease is unknown, and some options like dietary supplements or certain herbs may even have adverse interactions with Alzheimer’s medications.

Most of these home remedies can be used in conjunction with Alzheimer’s medications, but it’s best to speak with your healthcare provider about these alternative treatments before adding them to your treatment plan just to be safe.

Frequently asked questions about Alzheimer's

Can Alzheimer’s be slowed down?

Certain medications, natural remedies, and lifestyle changes may help to slow down the progression of Alzheimer’s; although, the condition is chronic and irreversible meaning it cannot be cured.

What is the new drug for Alzheimer’s?

Aducanumab is an intravenous infusion administered once a month that works by clearing beta-amyloid, a protein that accumulates in the brain and is associated with Alzheimer’s, in the brain. The drug is made by the company Biogen and is currently not approved by the FDA.

What are the seven stages of Alzheimer’s?

The seven stages of Alzheimer’s disease are:

  • Stage 1: No impairment
  • Stage 2: Very mild decline
  • Stage 3: Mild decline
  • Stage 4: Moderate decline
  • Stage 5: Moderately severe decline
  • Stage 6: Severe decline
  • Stage 7: Very severe decline

As Alzheimer’s progresses, the symptoms become more severe. Memory loss, cognition, and behavioral symptoms worsen with time.

How long does a person live after being diagnosed with Alzheimer’s?

Each person’s experience with Alzheimer’s is unique and lifespan after diagnosis is dependent on many factors such as what stage the disease was caught, family medical history, and personal health history. On average, most people live 8-10 years after being diagnosed with Alzheimer’s disease. Some patients can live as long as 20 years after diagnosis.

Is there a cure for Alzheimer’s?

Currently, there is no cure for Alzheimer's disease. Treatment with medications, alternative therapies, and lifestyle changes may help to slow the progression of the disease and help patients maintain cognition for a longer period of time.

What is the best medication for Alzheimer’s?

The best treatment plan differs by patient, but the most common medications for Alzheimer’s include cholinesterase inhibitors such as Aricept, Exelon, and galantamine. Namenda (memantine), an NMDA receptor antagonist is also a popular drug used to treat Alzheimer’s.

Medically reviewed by Anis RehmanMD
Physician

Dr. Anis Rehman is an American Board of Internal Medicine (ABIM) certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism who practices in Illinois. He completed his residency at Cleveland Clinic Akron General and fellowship training at University of Cincinnati in Ohio. Dr. Rehman has several dozen research publications in reputable journals and conferences. He also enjoys traveling and landscape photography. Dr. Rehman frequently writes medical blogs for District Endocrine (districtendocrine.com) and hosts an endocrine YouTube channel, District Endocrine.

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