Treatments for Alzheimer's Disease

Currently, there is no cure for Alzheimer’s disease. However, there are medications that can help control or delay its symptoms for some time, particularly in the early stages of the disease.

Some treatments help manage agitation, depression, or psychotic symptoms (hallucinations or delusions) that may occur as the disease progresses. Consult a physician before taking any medications. Commonly prescribed treatments include cholinesterase inhibitors, glutamate inhibitors, combination drugs, and non-medical intervention.

Cholinesterase Inhibitors

There are four drugs, called cholinesterase inhibitors, approved by the U.S. Food and Drug Administration (FDA), which are designed to regulate and manage Alzheimer’s disease symptoms. People suffering from Alzheimer’s have low levels of acetylcholine, an important brain chemical involved in nerve cell communication. Cholinesterase inhibitors slow the metabolic breakdown of acetylcholine and make more of this chemical available for communication between cells. This helps slow the progression of cognitive impairment and can be effective for some patients in the early to middle stages of Alzheimer’s disease.

Razadyne®

Generic name: galantamine 
Year approved by the FDA: 2001
Effective for: Early to moderate Alzheimer’s disease
How it works: Razadyne prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain.
Most-common side effects: Nausea, vomiting, diarrhea, weight loss, dizziness, headache, tiredness
Miscellaneous: This medication was formerly known as Reminyl®.

Exelon®

Generic name: rivastigmine
Year approved by the FDA: 2000
Effective for: Early to moderate Alzheimer’s disease
How it works: Exelon prevents the breakdown of acetylcholine and butyrylcholine (a chemical similar to acetylcholine) in the brain.
Most-common side effects: Nausea, diarrhea, increased frequency of bowel movements, vomiting, muscle weakness, loss of appetite, weight loss, dizziness, drowsiness, and upset stomach
Miscellaneous: In 2007, the FDA approved the Exelon® Patch (rivastigmine transdermal system) to deliver this medication through a skin patch as an option to the oral capsule.

Aricept®

Generic name: donepezil
Year approved by the FDA: 1996
Effective for: Early, moderate, and severe Alzheimer’s disease
How it works: Aricept prevents the breakdown of acetylcholine in the brain.
Most-common side effects: Diarrhea, dizziness, loss of appetite, muscle cramps, nausea, tiredness, trouble sleeping, vomiting, weight loss
Miscellaneous: Aricept may also have a limited slowing effect on the progression from mild cognitive impairment (MCI) to Alzheimer’s disease. In 2006, Aricept was also approved by the FDA for the management of severe Alzheimer’s symptoms.

Cognex®

Generic name: tacrine
Year approved by the FDA: 1993 
Effective for: Early to moderate Alzheimer’s disease
How it works: Cognex prevents the breakdown of acetylcholine in the brain.
Most-common side effects: Constipation, diarrhea, gas, loss of appetite, muscle aches or pain, nausea, stomach upset, stuffy nose, vomiting, weight loss, with possible liver damage
Miscellaneous: Cognex is still available but no longer actively marketed by the manufacturer, due to the severe side effects.

Glutamate Inhibitors

Some drugs, called glutamate inhibitors, protect brain cells by regulating a nerve communication chemical, called glutamate, which is released in great quantities by Alzheimer’s-damaged cells. Glutamate is normally involved with learning and memory, but when released in excess by damaged cells, it attaches to “docking sites” called N-methyl-D-aspartate (NMDA) receptors that in turn accelerate cell damage. There is currently one FDA-approved glutamate inhibitor.

Namenda®

Generic Name: memantine
Year approved by the FDA: 2003
Effective for: moderate to severe Alzheimer’s disease
How it works: Namenda appears to protect the brain’s nerve cells against excess amounts of glutamate, a messenger chemical released in large amounts by cells damaged by Alzheimer’s (and some other neurological disorders). When glutamate attaches to cell surface “docking sites” called N-methyl-d-aspartate (NMDA) receptors, calcium can flow freely into the cell, which may lead to cell degeneration. Namenda may prevent this destructive sequence by adjusting the activity of glutamate.
Most common side effects: back pain, constipation, diarrhea, dizziness, drowsiness, headache, pain, and weight gain
Miscellaneous: In July of 2010, Namenda XR (a 28-milligram, once-daily, extended-release form of medication) was approved by the FDA. The most common side effects of Namenda XR are headaches, diarrhea, dizziness, high blood pressure (hypertension), and the flu.

Combination Drugs

There is one FDA-approved drug that combines cholinesterase inhibitors and glutamate inhibitors. It both prevents the breakdown of acetylcholine in the brain, and protects the brain’s nerve cells against excess amounts of glutamate.

Namzaric®

Generic name: combination drug containing both donepezil and memantine
Year approved by the FDA: 2014
Effective for: moderate to severe Alzheimer’s disease
How it works: Namzaric is a combination of two drugs that have already been on the market: memantine (Namenda) and donepezil (Aricept). Aricept prevents the breakdown of acetylcholine in the brain, and Namenda appears to protect the brain’s nerve cells against excess amounts of glutamate, a messenger chemical released in large amounts by cells damaged by Alzheimer’s (and some other neurological disorders.)
Most common side effects: diarrhea, nausea, vomiting, loss of appetite, increased weight, loss of bladder control, back pain, headache, bruising, drowsiness, and dizziness
Miscellaneous: Namzaric capsules can be opened to allow the contents to be sprinkled on food to facilitate dosing for patients who may have difficulty swallowing.

Treatment for Anxiety, Depression, and Psychosis

Often, as Alzheimer’s disease progresses, people experience depression, agitation, and psychotic symptoms (paranoid thoughts, delusions, or hallucinations). These behaviors may be manifested verbally (screaming, repetitive questions, etc.) or physically (hoarding, pacing, etc.), and they can sometimes lead to aggression, hyperactivity, or combativeness. The symptoms may have an underlying medical origin such as a drug interaction or physical pain. If this is suspected, a physician should be consulted.

Agitation or psychotic behavior may also be triggered by something that has altered in the person’s environment. Often, a change in routine, caregivers, or surroundings can cause fear, anxiety, or fatigue and lead to agitation. The individual may be unable to communicate, be frustrated by his or her limitations, misunderstand what is happening, or simply forget how to respond appropriately. In these cases, non-medical intervention is recommended to determine the source of the problem, modify the environment, and change the behavior. If non-medical intervention does not work or the person becomes a danger to himself or others, a physician should be consulted to evaluate the need for medical treatments for depression, psychosis, or anxiety.

Potential Future Treatments

Many potential treatments for Alzheimer’s disease are being investigated in laboratories and tested in human clinical trials. Below is a list of services to identify clinical trials and sign up as a volunteer:

Antidote. Antidote helps you discover new treatment options being developed by medical researchers. They put technology to work so that by answering a few health questions, their smart search engine quickly and easily finds a trial that’s right for you.
www.antidote.me 
1-888-509-1308

Clinicaltrials.gov. An online registry and results database hosted by National Institutes of Health (NIH) that lists all publicly and privately supported clinical studies being conducted with human participants around the world. Follow prompts to look for active clinical trials located near you for a specific medical condition.
www.clinicaltrials.gov

National Institutes of Health (NIH). Provides information on government-sponsored human trials and recruitment, with locations, purpose, eligibility requirements, and phone contacts.
www.nih.gov/health/clinicaltrials

• National Institute on Aging (NIA)
  www.nia.nih.gov/alzheimers/clinical-trials
  1-800-438-4380


• ClinicalTrials.gov
  https://clinicaltrials.gov/

ResearchMatch. This free and secure registry brings together people who are trying to find research studies, and researchers who are looking for people to participate in their studies.
www.researchmatch.org