There is no drug that prevents or cures Alzheimer’s disease, but medication may help lessen symptoms like memory loss and confusion.
The drugs do not affect the deposit of “bad” amyloid and tau protein, which are thought to be the causes of Alzheimer’s disease, says University of Arizona neurologist Dr. Geoffrey L. Ahern.
Rather, they attempt to “chemically compensate” for alterations in brain function that are a result of the disease, says Ahern, director of the UA’s Behavioral Neuroscience and Alzheimer’s Clinic, as well as its Bruce and Lorraine Cumming Endowed Chair in Alzheimer’s Research.
The medications available are in two classes:
Acetylchoinesterase inhibitors
Acetylchoinesterase inhibitors are usually prescribed for early to moderate Alzheimer’s.
They prevent the breakdown of acetylcholine, a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels within a reasonable range of normal.
Drugs in this class include donepezil (Aricept), galantamine (Reminyl, Razadyne) and rivastigmine (Exelon).
They delay the worsening of symptoms for six to 12 months, on average, for about half the people who take them, the Alzheimer’s Association says.
Memantine
Memantine (Namenda) is usually prescribed for people with moderate to severe Alzheimer’s.
Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with other Alzheimer’s disease treatments.
There is some evidence that individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking memantine. Aricept is the only cholinesterase inhibitor approved to treat all stages of Alzheimer’s, including moderate to severe.
Strictly speaking, there are no similar drugs to treat other forms of dementia, Ahern says.
However, there may be instances where medications originally developed to treat Alzheimer’s are useful in treating other dementias, such as dementia with Lewy bodies.
Other medications that may be prescribed:
- Antidepressants for low mood and irritability;
- Anxiolytics such as Ativan or BuSpar for anxiety, restlessness, verbally disruptive behavior and resistance;
- Antipsychotic medications for hallucinations, delusions, aggression, agitation and hostility.
- Nonpharmacological interventions are recommended as a first-line therapy for agitation. Moreover, Ahern says the FDA has applied a “black box warning” regarding the use of these medications in the demented elderly. Thus, they should be used judiciously, he says.
