Alzheimer's Disease Treatment

It is becoming increasingly clear that Alzheimer’s disease (AD) is a seriously complex—and in many ways highly personalized—disease and that a one-size-fits-all solution to prevent, treat, or potentially cure it is unlikely. Instead, scientists believe that developing multi-prong approaches that include combining medication with lifestyle strategies is far more likely to offer improved outcomes for most people affected.

The National Institutes of Health, the National Institute on Aging, as well as private industry, are researching and conducting clinical trials focusing upon:

• helping people with AD maintain their mental functioning
• managing their symptoms
• slowing, delaying and/or preventing AD

Current Medication Options

A small selection of medications for AD has been shown to provide some modest behavioral or cognitive benefit. Currently, they are four, clinically tested AD medications approved by the FDA. However, the effectiveness of these medications varies from person to person and that effectiveness invariably diminishes over time.

The four medications (with some brand name examples) are:

• donepezil (Aricept)
  • FDA-approved for mild, moderate and severe AD symptoms
  • Common side effects include nausea, vomiting, and diarrhea
• galantamine (Razadyne)
  • FDA-approved for mild and moderate AD symptoms
  • common side effects include nausea, vomiting, diarrhea, weight loss, and loss of appetite
• memantine (Namenda)
  • FDA-approved for moderate and severe AD symptoms, but not for mild AD symptoms (as currently, there’s little evidence of benefit in the early-stages of AD)
  • common side effects include dizziness, headache, constipation, and confusion
• rivastigmine (Exelon)
  • FDA-approved for mild and moderate AD symptoms
  • common side effects include nausea, vomiting, diarrhea, weight loss, loss of appetite, and muscle weakness

To learn more, read about drugs for Alzheimer’s disease.

How Do These Medications Work?

Each of these medications works by regulating the chemicals that transmit messages between neurons (called “neurotransmitters”). They may help maintain thinking, memory, and skills and may help with certain behavioral problems.

Which Medication is Best?

As explained by the National Institute on Aging (NIA), no published study directly compares the four approved AD drugs. However, donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly called Reminyl) work in similar ways, i.e., they all affect the level of a neurotransmitter called acetylcholine. Memantine (Namenda) appears to work by regulating levels of glutamate—another neurotransmitter involved with memory function.

Thus, it’s not expected that switching from one of these medications to another will produce significantly different results, but there may be some variation in the side effects associated with each of these medications.

What About Non AD-Specific Medications?

There are medications that may either temporarily treat or at least ease symptoms, such as sleeplessness, agitation, anxiety, anger, severe aggression, wandering, and depression. These include: antidepressants, anti-anxiety medications, sleep aids, and antipsychotics—all of which have their own side effects.

To receive the maximum benefit, balanced with the least amount of discomfort and potential for harm, it's crucial to consult a doctor experienced in AD. 

To learn more, read about drugs for Alzheimer’s disease.