Treatment Options for Alzheimer's Disease

Detailed information on treatments for Alzheimer's disease, including Cholinesterase Inhibitors, Namenda, Vitamin E.

Currently, there is no cure for Alzheimer's disease, however, drug and non-drug treatments may help with both cognitive and behavioral symptoms and slow the progression of the disease. Researchers are looking for new treatments to alter the course of the disease and improve the quality of life for people with dementia.

Standard Prescriptions for Alzheimer's

Introduction

The primary symptoms of Alzheimer's disease include memory loss, disorientation, confusion, and problems with reasoning and thinking. These symptoms worsen as brain cells die and the connections between cells are lost. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms. These medications may also delay the need for nursing home care.

Alzheimer's and Cholinesterase Inhibitors

The U.S. Food and Drug Administration (FDA) has approved two classes of drugs to treat cognitive symptoms of Alzheimer's disease. The first Alzheimer medications to be approved were cholinesterase (KOH luh NES ter ays) inhibitors. Three of these drugs are commonly prescribed: donepezil (Aricept^®), approved in 1996; rivastigmine (Exelon^®), approved in 2000; and galantamine (approved in 2001 under the trade name Reminyl^® and renamed Razadyne^® in 2005). Tacrine (Cognex^®), the first cholinesterase inhibitor, was approved in 1993 but is rarely prescribed today because of associated side effects, including possible liver damage.

All of these drugs are designed to prevent the breakdown of acetylcholine (pronounced a SEA til KOH lean), a chemical messenger in the brain that is important for memory and other thinking skills. The drugs work to keep levels of the chemical messenger high, even while the cells that produce the messenger continue to become damaged or die. About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms.

For more information, see the Cholineterase Inhibitors Fact Sheet.

Alzheimer's and Namenda

Memantine (Namenda^®) is a drug approved in October 2003 by the FDA for treatment of moderate to severe Alzheimer's disease.

Memantine is classified as an uncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) receptor antagonist, the first Alzheimer drug of this type approved in the United States. It appears to work by regulating the activity of glutamate, one of the brain's specialized messenger chemicals involved in information processing, storage and retrieval. Glutamate plays an essential role in learning and memory by triggering NMDA receptors to allow a controlled amount of calcium to flow into a nerve cell, creating the chemical environment required for information storage.

Excess glutamate, on the other hand, overstimulates NMDA receptors to allow too much calcium into nerve cells, leading to disruption and death of cells. Memantine may protect cells against excess glutamate by partially blocking NMDA receptors.

For more information, see the Namenda Fact Sheet.

Alzheimer's and Vitamin E

Vitamin E supplements are often prescribed as a treatment for Alzheimer's disease, because they may help brain cells defend themselves from "attacks". Normal cell functions create a byproduct a called free radical, a kind of oxygen molecule that can damage cell structures and genetic material. This damage, called oxidative stress, may play a role in Alzheimer's disease.

Cells have natural defenses against this damage, including the antioxidants vitamins C and E, but with age some of these natural defenses decline. Research has shown that taking vitamin E supplements may offer some benefit to people with Alzheimer's.

Most people can take vitamin E without side effects. However, any change in medications should first be discussed with a primary care physician because all medication can cause side effects or interactions with other medications. A person taking "blood-thinners," for example, may not be able to take Vitamin E or will need to be monitored closely by a physician.

Sources:

• Alzheimer's Disease and Related Disorders Association
• Alzheimer's Association

next: Treating Behavioral and Psychiatric Symptoms of Alzheimer's