How Alzheimer's Disease Is Treated

If you or someone you know has been diagnosed with Alzheimer's disease, you may feel scared, frustrated, and more. While there is no cure for Alzheimer's at this time, there are many ways to treat the symptoms and even help manage the disease's progression. Treatment options for the behavioral and psychological symptoms of Alzheimer's include drug therapy and non-drug approaches, such as behavioral and environmental modifications.

Non-drug approaches focus on treating the behavioral, psychological, and emotional symptoms of Alzheimer's by changing the way you understand and interact with the person with the disease.

These approaches recognize that behavior is often a way of communicating for those with Alzheimer's. The goal of non-drug approaches is to understand the meaning of the challenging behaviors and why they are present.

Identify a particular behavior and note what seems to trigger the behavior. For example, if a shower always makes your loved one agitated, try a bath instead. Or attempt to offer a shower at a different time of day.

Rather than using medication if someone is upset or agitated, a non-drug approach tries to understand why they might be agitated. Perhaps they need to use the bathroom, are in pain, or think they lost something.

Note what happens right before the behavior, try something different the next time, and track the results.

You can often avoid escalating troubling behaviors by changing your own perspective. For example, if your loved one is asking to see his mother (who may have been deceased for many years), ask him to tell you about her, rather than force him to confront her death. This is validation therapy, and it can be very effective in calming the person who is upset.

People living with dementia may feel lonely or bored at times, and they might not be able to clearly verbalize these feelings. Offering opportunities to engage socially with others, to perform familiar tasks such as organizing papers or washing the dishes, or to sing along with their favorite songs can improve mood and reduce feelings of restlessness and boredom.

Sometimes, challenging behaviors or feelings of frustration in people living with dementia are simply a result of not getting enough physical activity. Getting up and going for a walk, participating in a group aerobic activity class, or doing some stretching exercises can help meet this need. In addition, exercise has the potential to improve cognition for some people.

Other non-drug approaches target the cognitive functioning of the person with Alzheimer's disease. Staying mentally active—doing a puzzle or reading a book, for example—has been shown to be helpful in maintaining memory and thinking skills in people with dementia. While these approaches won't cure the disease of Alzheimer's—and some may be more possible than others, depending on the stage of disease—they may still provide some limited benefit.

Cognitive enhancers are medications that attempt to slow the progression of Alzheimer's symptoms. While these medications appear to improve thought processes for some people, the effectiveness overall varies greatly.

Two classes of medication have been approved by the U.S. Food and Drug Administration (FDA) for treatment of the cognitive symptoms of Alzheimer's. They include cholinesterase inhibitors and N-methyl D-aspartate (NMDA) antagonists.

Cholinesterase inhibitors act by preventing the breakdown of acetylcholine in the brain. Acetylcholine is a chemical that facilitates nerve cell communication in the areas of memory, learning, and other thought processes. Scientific research has found lower levels of acetylcholine in the brains of individuals with Alzheimer's, so the hope is that by protecting or increasing the acetylcholine levels through use of these medications, brain functioning will stabilize or improve.

Researchers estimate that for about 50% of people with Alzheimer's who take cholinesterase inhibitors, progression of Alzheimer's symptoms is delayed for an average of six to 12 months.

There are three cholinesterase inhibitor medications currently approved and prescribed to treat Alzheimer's disease:

• Aricept (donepezil): Approved for mild, moderate, and severe Alzheimer's
• Exelon (rivastigmine): Approved for mild to moderate Alzheimer's
• Razadyne (galantamine): Approved for mild to moderate Alzheimer's

Of note, Cognex (tacrine) had been previously FDA-approved for mild to moderate Alzheimer's; however, it is not marketed by its manufacturer anymore because it caused some significant side effects.

Namenda (memantine) is the only drug in this class, and it is approved for moderate to severe Alzheimer's. Namenda appears to work by regulating levels of glutamate, an amino acid, in the brain. Normal levels of glutamate facilitate learning, but too much can cause brain cells to die.

Namenda has been somewhat effective in delaying the progression of symptoms in later Alzheimer's disease.

In 2014, the FDA approved Namzaric, which is a combination of donepezil and memantine—one drug from each class above. It is designated for moderate to severe Alzheimer's disease.

Psychotropic medications are used at times to treat the behavioral, psychological, and emotional symptoms of Alzheimer's disease—what is sometimes referred to as Behavioral and Psychological Symptoms of Dementia (BPSD). These symptoms can include emotional distress, depression, anxiety, insomnia, hallucinations, and paranoia, as well as some challenging behaviors, so being proactive in identifying and treating them is important.

The classes of psychotropic medications used to manage the behavioral and psychological symptoms of dementia include:

• Antidepressants
• Anti-anxiety medications
• Antipsychotics
• Mood stabilizers
• Medications for insomnia (sometimes called sleeping pills or hypnotics)

These medications can be effective, but can also potentially cause significant side effects. Psychotropics are typically used in conjunction with other non-drug approaches or after attempting non-drug therapies and finding them to be inadequate.

Since medications have had limited benefit in treating Alzheimer's, many have turned to alternative and complementary treatments. The jury is still out on many of these approaches, and research is ongoing. Some people have reported an improvement in cognition with various supplements, but none have proven successful enough in clinical studies to warrant recommending them for people with Alzheimer's disease.

Vitamin E supplementation showed the most promise. But according to the National Center for Complementary and Integrative Medicine, there was only evidence from a single study that it might slow functional decline in Alzheimer's disease.

Studies have shown there may be a protective effect of eating more fish and other foods containing omega-3 fatty acids, specifically docosahexaenoic acid (DHA). But giving people supplements of DHA after they have been diagnosed with Alzheimer's disease has showed no benefit.

Other CAM options that have been studies include ginkgo biloba, which has no conclusive evidence of preventing or slowing Alzheimer's disease, and curcumin, which doesn't have enough research yet conducted to support its use.

Although there is no cure yet for Alzheimer's disease, be encouraged. Researchers are constantly working on finding more effective treatment and prevention methods. Much has been learned about how Alzheimer's affects the brain, and this increased knowledge continues to spur new thoughts related to the development of a cure, treatment, and prevention.