Alzheimer’s Treatment Guide: Medication and Supplemental Options

Alzheimer’s disease treatments aim to address symptoms such as memory loss, cognitive decline, difficulty with daily activities, and behavioral changes.

While there is no current cure for Alzheimer’s disease, several medications can help manage symptoms and possibly slow its progression.

Researchers are also exploring experimental treatments and off-label medication uses, offering hope for future advancements.

Pharmacological treatments

Several types of medications are approved by the Food and Drug Administration (FDA) to treat Alzheimer’s disease. Some are used specifically for managing cognitive symptoms, and others are used to manage other symptoms associated with Alzheimer’s.

FDA-approved drugs

Cholinesterase inhibitors

Cholinesterase inhibitors manage Alzheimer’s disease by increasing acetylcholine levels, a neurotransmitter crucial for memory and learning. Increasing acetylcholine levels can help improve or stabilize cognitive symptoms, especially in the early to moderate stages of the disease.

While beneficial, cholinesterase inhibitors generally provide modest improvements. They can slow cognitive decline and enhance quality of life but don’t stop or reverse disease progression.

For example, galantamine improves thinking and memory in about 14 out of 100 people.

A few of the more common cholinesterase inhibitors include:

• Donepezil (Aricept): approved for all stages of Alzheimer’s disease
• Rivastigmine (Exelon): approved for mild to moderate Alzheimer’s and Parkinson’s disease dementia
• Galantamine (Razadyne): approved for mild to moderate Alzheimer’s disease

NMDA receptor antagonist

NMDA receptor antagonists, like memantine (Namenda), help manage Alzheimer’s by controlling glutamate activity in the brain. This protects brain cells from too much stimulation.

Memantine can improve memory, attention, and problem-solving. Doctors often prescribe it with cholinesterase inhibitors for better results.

However, similar to cholinesterase inhibitors, NMDA receptor antagonists only offer modest improvements in managing Alzheimer’s symptoms.

Combination drugs

Combination drugs for Alzheimer’s mix two types of medications to treat the disease from different angles. They often combine a cholinesterase inhibitor with an NMDA receptor antagonist to better improve thinking ability and slow disease progression than using either drug alone.

Examples of combination drugs include:

• memantine extended-release and donepezil (Namzaric)
• rivastigmine transdermal patch (Exelon Patch)

According to a 2020 meta-analysis, memantine and donepezil work better together than either drug alone or a placebo. This combination can improve thinking ability and daily activities and reduce neuropsychiatric symptoms.

Monoclonal antibodies

Aducanumab (Aduhelm)

Aducanumab is a monoclonal antibody that targets and helps clear amyloid-beta plaques in the brain. The goal is to reduce plaque buildup, which may slow or stop cognitive decline in people with Alzheimer’s disease.

The drug received accelerated FDA approval in 2021 despite mixed trial results and ongoing debates about its effectiveness.

It will be discontinued in 2024 in order for its manufacturer “to reprioritize its resources in Alzheimer’s disease” and not for reasons related to safety or efficacy.

Lecanemab (Leqembi)

Lecanemab is another type of monoclonal antibody that targets amyloid-beta plaques in the brain. However, it specifically targets a different form of amyloid-beta, known as protofibrils. They are believed to be toxic and contribute to Alzheimer’s.

Drugs that address other symptoms

Antipsychotics

Antipsychotics are sometimes used to manage behavioral and psychological symptoms of Alzheimer’s, such as agitation, aggression, hallucinations, and delusions. However, doctors prescribe them cautiously due to potential side effects and risks.

Common antipsychotics used for Alzheimer’s include:

• risperidone (Risperdal)
• olanzapine (Zyprexa)
• quetiapine (Seroquel)

Antidepressants

Antidepressants are used to manage symptoms of depression and anxiety, which are common in people with Alzheimer’s disease. These medications can help improve mood, appetite, sleep, and overall quality of life.

Common antidepressants used for Alzheimer’s include:

• sertraline (Zoloft)
• citalopram (Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac)

Anti-anxiety medications

Doctors may prescribe anti-anxiety medications to help manage symptoms of anxiety, agitation, and restlessness, which are common in Alzheimer’s disease. These medications can help improve overall comfort and quality of life.

Common anti-anxiety medications used for Alzheimer’s include:

• lorazepam (Ativan)
• diazepam (Valium)
• alprazolam (Xanax)
• clonazepam (Klonopin)
• buspirone (BuSpar)

Off-label drugs

Metformin

Metformin, primarily used for type 2 diabetes, is being investigated for its potential benefits in Alzheimer’s disease. It enhances insulin sensitivity and lowers blood glucose, which may help Alzheimer’s disease since insulin resistance and diabetes are linked to higher Alzheimer’s risk.

Additionally, metformin might offer neuroprotective effects by reducing oxidative stress and inflammation, both associated with Alzheimer’s too.

Hypertension medications

Hypertension medications may help Alzheimer’s disease by managing high blood pressure, which is a risk factor for cognitive decline. Managing high blood pressure can improve blood flow to the brain and potentially reduce the risk of vascular damage that contributes to Alzheimer’s.

Some common hypertension medications include:

• ACE inhibitors, such as lisinopril and enalapril
• angiotensin II receptor blockers (ARBs), such as losartan and valsartan
• calcium channel blockers, such as amlodipine and diltiazem
• beta-blockers, such as metoprolol and atenolol

Non-pharmacological treatments

Although drug therapy is frequently used to treat Alzheimer’s disease, it can be ineffective and may cause serious side effects, such as severe sleep disturbances.

To enhance quality of life and address medication side effects, non-pharmacological treatments can complement treatment.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy that targets negative thought patterns and behaviors. CBT is especially useful for people with Alzheimer’s, as 38% to 50% experience depression.

According to a 2023 review and meta-analysis, CBT significantly reduces depression scores in people with Alzheimer’s compared with control groups.

By addressing cognitive distortions, CBT enhances emotional well-being and quality of life, helping individuals better manage the cognitive and functional challenges of the disease.

Acupuncture

Acupuncture is a traditional Chinese medicine technique that involves inserting fine needles into specific points on the body to promote healing and balance.

For Alzheimer’s disease, acupuncture aims to alleviate symptoms such as cognitive decline and behavioral issues.

A 2023 research review indicates that acupuncture may enhance cognitive function and slow Alzheimer’s progression by managing neurotransmitter levels and improving brain blood flow.

Exercise

Exercise offers significant benefits for people with Alzheimer’s. According to a 2023 review, exercise can enhance memory, cognitive function, and brain health by increasing blood flow, boosting beneficial brain chemicals, and reducing harmful proteins and inflammation.

Regular aerobic and strength exercises improve brain connectivity and cell health, which can slow disease progression and enhance overall well-being.

Diet

A balanced diet can contribute to better brain health, potentially delaying the onset and progression of Alzheimer’s disease.

The following diets have been studied for their ability to slow the progression of Alzheimer’s disease:

• Mediterranean diet: Rich in fruits, vegetables, whole grains, nuts, and olive oil, the Mediterranean diet reduces inflammation and supports heart and brain health.
• DASH diet: The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes fruits, vegetables, whole grains, and lean proteins, which help manage blood pressure and improve cognitive function.
• MIND diet: This diet combines elements of the Mediterranean and DASH diets. The MIND diet focuses on brain-healthy foods, like leafy greens and berries, to slow cognitive decline.
• Ketogenic diet: High in fats and low in carbs, the keto diet may improve brain function by providing an alternative energy source to glucose.

Research shows that following the Mediterranean, DASH, or MIND diets can help reduce cognitive decline and lower Alzheimer’s risk. These diets limit ultra-processed foods with added sugar and saturated fat while emphasizing fruits, vegetables, whole grains, and nuts and minimizing red and processed meats.

The ketogenic diet takes a totally different approach to Alzheimer’s disease. It shifts the brain’s primary energy source from glucose to ketones. Studies indicate that the keto diet can enhance memory and cognitive function across various stages of Alzheimer’s, from mild to severe.

Light therapy

Transcranial near-infrared (tNIR) light therapy shows promise for treating Alzheimer’s disease. A 2021 study with 57 participants with mild to moderate dementia found that low power tNIR light, applied twice daily for 8 weeks, significantly improved memory and verbal learning.

Additionally, the therapy enhanced sleep quality, reduced anxiety, and boosted mood. The results suggest that tNIR light therapy is safe and could be an effective treatment for dementia, though more research is needed.

Supplements

Some supplements commonly used for Alzheimer’s disease include:

• Omega-3 fatty acids: thought to reduce inflammation and support brain health
• Ginkgo biloba: believed to improve blood flow to the brain and enhance thinking ability
• Curcumin: the active ingredient in turmeric; thought to reduce inflammation and oxidative stress
• Vitamin D: may support brain function and overall cognitive health
• B vitamins: may help reduce levels of homocysteine, a compound linked to cognitive decline
• Probiotics: may support gut health, which can influence brain function and overall cognitive health through the gut-brain axis

Before starting any new supplement, be sure to talk with a doctor or pharmacist. Some supplements can interact with medications and cause side effects.

Emerging treatments

Some research points out that current medications for Alzheimer’s disease only manage symptoms and don’t cure the disease. These drugs can also cause side effects. This has led researchers to seek new treatments with different approaches.

One development is the creation of multi-target inhibitors. These new drugs aim to tackle several aspects of Alzheimer’s at once, such as amyloid-beta plaques, tau tangles, and neurotransmitter imbalances.

Researchers are using advanced techniques to better design new drugs by studying how they interact with their targets at a molecular level.

Many of these innovative treatments are still being tested in clinical trials, with some making significant progress.

What are the main types of medications used for Alzheimer’s treatment?

The primary⁣ medications used‌ in Alzheimer’s treatment are cholinesterase inhibitors (such as Donepezil, Rivastigmine, and Galantamine) ‍and the NMDA receptor antagonist, Memantine. These medications⁢ help‍ manage ⁤symptoms by improving communication between nerve ⁤cells in the ⁣brain.

How⁣ do​ cholinesterase inhibitors help in treating Alzheimer’s?

Cholinesterase inhibitors work by preventing the ⁣breakdown ⁣of acetylcholine, a neurotransmitter important for memory and learning. This helps improve communication between neurons, potentially stabilizing‍ or slowing the worsening ⁣of symptoms in mild to moderate Alzheimer’s.

What is Memantine, and how does it assist in ⁢Alzheimer’s‌ management?

Memantine is an ‍NMDA receptor antagonist that regulates glutamate activity, preventing excess calcium from ⁣entering ​brain cells.​ It is typically prescribed for moderate to severe Alzheimer’s and can ​help with memory, attention, and ‍language, ⁤contributing ⁢to better cognitive function.

Are⁤ there supplemental options available for Alzheimer’s treatment?

Yes,⁣ there‌ are several supplements that may support ⁣Alzheimer’s treatment, although their effectiveness can vary. ‍Common options include​ omega-3 fatty acids, vitamin ⁢E, ginkgo biloba, and coconut oil,⁣ though scientific support for their⁣ efficacy is ⁤limited.

Can lifestyle changes complement Alzheimer’s medication?

Yes, lifestyle modifications such as a balanced diet, regular physical exercise, mental stimulation, and social engagement can complement medication. These changes can help improve ⁣overall brain health and emotional well-being.

Is it possible to prevent Alzheimer’s with current treatments?

While current ​treatments can manage symptoms ⁢and ⁤potentially slow progression, they do not prevent or cure Alzheimer’s disease. Research continues to search for effective preventive measures.

Should‌ supplements be used ‍as⁣ a standalone treatment for Alzheimer’s?

Supplements should not replace standard Alzheimer’s⁢ medications. They may be used as complementary options, but it’s​ essential⁢ to consult a healthcare professional before starting ‌any new supplements to ensure safety and ‍appropriateness.

Are there any side effects associated with Alzheimer’s medications?

Yes, Alzheimer’s medications can have side effects.‍ Cholinesterase inhibitors⁢ may cause nausea, diarrhea,⁣ and insomnia, while Memantine might lead to dizziness ⁤or headaches. It’s crucial for patients to discuss any ​adverse effects with ⁣their healthcare provider

Takeaway

Alzheimer’s disease significantly affects people and their families due to its progressive nature. While pharmaceutical treatments like cholinesterase inhibitors and memantine can alleviate some symptoms, they cannot cure the disease and often have side effects.

Non-pharmaceutical approaches, such as CBT, exercise, specific diets, and acupuncture, show promise in improving thinking ability and quality of life.

New treatments on the horizon, including multi-target inhibitors, offer hope for more effective management of Alzheimer’s.