Alzheimer's Disease Treatment

The diagnosis is in, and it's Alzheimer's disease. You may feel scared, frustrated, relieved, or may just not want to believe it. So now what? While there is no cure for Alzheimer's at this time, there are many ways to treat the symptoms. Treatment options include drug therapy and non-drug approaches, such as behavioral and environmental modifications.

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. Cognitive enhancers need to be monitored regularly for side effects and interaction with other medications.

Two classes of medication have been approved by the US Food and Drug Administration 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 these medications, brain functioning will stabilize or improve.

Researchers estimate that for about 50 percent 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 anymore by its manufacturer 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 glutamate (an amino acid) levels in the brain. Normal levels of glutamate facilitate learning, but too much glutatmate 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. 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 class of psychotropic medications consists of antidepressants, anti-anxiety medications, antipsychotics, mood stabilizers, and 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.

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

Non-drug approaches should generally be attempted before using psychotropic medications, since they do not have the potential for side effects or medication interactions.

• Behavior Assessment

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.

• Validation Therapy

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 the death of his mother. This is called validation therapy, and it can be very effective in calming the person who is upset.

• Meaningful Activities

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 moods and reduce feelings of restlessness and boredom.

• Physical Exercise

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.

• Know What to Expect

The familiar saying of "knowledge is power" is very true here. Knowing what to expect as Alzheimer's progresses can help you understand behavior and recognize its source as the disease, rather than the person. This can provide more compassion and reduce frustration.

Other non-drug approaches target the cognitive functioning of the person with Alzheimer's disease. For example, physical exercise—in addition to meeting needs and reducing some of the concerning behavioral or emotional symptoms in dementia—has the potential to improve cognition for some people. Likewise, staying mentally active has also shown to be helpful in maintaining memory and thinking skills in dementia. While these approaches won't cure the disease of Alzheimer's, they may still provide some limited benefit.

Since medications have had limited benefit in treating Alzheimer's, many have turned to alternative and complimentary treatments. The jury is still out on many of these approaches, and research is ongoing. Some people have reported an improvement in cognition with treatments such as coconut oil, but research is still pending on its effectiveness.

If you're interested in trying complimentary or alternative treatments, you should discuss them with your doctor, since some have the potential to interact with other medications or may trigger significant side effects.

There are many ongoing clinical trials that are rigorously regulated to test new treatments for Alzheimer's disease. Some trials are open and are recruiting individuals with Alzheimer's or other types of dementia to participate in them. A complete list of clinical trials can be found at clinicaltrials.gov.

Learning about Alzheimer's disease can feel overwhelming at times. Because of this, when meeting with your doctor, it may be helpful to have questions written down prior to the appointment. This should include asking about any treatments described above that you're interested in pursuing, rather than simply trying them on your own.

Don't hesitate to ask your doctor about specific decisions, such as if it remains safe to drive a car or live on your own. Your doctor can offer an objective evaluation of your ability to safely continue these activities, as well as recommend community resources that can help you, such as home health care agencies or Alzheimer's support groups.

Additionally, if you're struggling with symptoms such as significant restlessness, anxiety, or hallucinations, these should be discussed with your doctor. She may be focusing on evaluating your cognitive skills (thinking and memory abilities) and might not ask directly about these other behavioral and psychological symptoms of Alzheimer's. However, appropriate identification and treatment of these symptoms can improve quality of life in Alzheimer's.

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 on the development of a cure, treatment, and prevention.

Very importantly, don't neglect to harness the power of community as you cope with this disease. Alzheimer's is a disease where it is unfortunately easy to isolate ourselves, but this is rarely helpful. We can't "fix" Alzheimer's disease yet, but we can offer support, knowledge, and encouragement by joining together.