Medications Used to Treat Mild, Moderate, and Severe Alzheimer's Symptoms
Though Alzheimer's is a disease without a cure, several drug treatments have been approved by the FDA to treat its effects. The drugs commonly used to treat Alzheimer's disease fall into two types:
* Medications for memory and cognition
* Medications for symptoms and related conditions
Treatment for Alzheimer's varies according to the stage of disease a person is in.
Early-stage treatment
Memory-Cognition Drugs
Upon diagnosis, many patients in early-stage Alzheimer's are prescribed one of three cholinesterase inhibitors, a type of drug that helps to preserve levels of acetylcholine, a chemical messenger in the brain that is important for memory and learning but is in low supply in people with Alzheimer's. The drugs are:
* Aricept (donepezil)
* Exelon (rivastigmine)
* Razadyne (galantamine)
The medications work to improve mental function by blocking the enzyme cholinesterase, which normally removes excess acetylcholine from the brain. They help stabilize mental function and delay declines, especially for those whose symptoms are still mild. Each drug varies slightly in its chemistry and has different side effects. So sometimes if one isn't well tolerated, another is prescribed.
A fourth cholinesterase inhibitor, Cognex (tacrine hydrochloride), was prescribed in the past but is no longer recommended because it can cause liver damage.
Other Drugs
A patient with early-stage Alzheimer's could also be treated with an antidepressant if found to have depression. Depression and dementia often go hand in hand.
Middle-stage treatment
Memory-Cognition Drugs
In addition to one of the cholinesterase inhibitors described above, people with middle-stage Alzheimer's may also be prescribed a second drug, Namenda (memantine). (Some people are given Namenda in the early stage of the disease, but it is only FDA-approved for middle- to late-stage Alzheimer's.) Namenda belongs to a different class of drug that works on glutamate, a chemical messenger in the brain that affects learning and long-term memory. Like the cholinesterase inhibitors, it slows the decline of thinking ability and the ability to perform everyday functions. At the middle stage of disease, decline is often more rapid than in the early stage.
Other medications may be prescribed to deal with related problems that can develop by this stage of Alzheimer's:
* Disturbed sleep: Sedative-hynotics ("sleep meds")
* Depression: Antidepressants
* Behavioral issues (aggression, hallucinations, agitation): Antipsychotics
Nondrug approaches are usually tried first (or simultaneously) to deal with these problems. The specific drug prescribed will depend on the person's complete medical history.
Late-stage treatment
Memory-Cognition Drugs
The only cholinesterase inhibitor approved for all stages of Alzheimer's is Aricept. Namenda is the only medication approved specifically for middle- to late-stage Alzheimer's. Typically a patient is on one or both of these medications by this stage.
Other Drugs
Other medications may be prescribed to deal with related problems that may develop by this stage of Alzheimer's:
* Disturbed sleep: Sedative-hynotics ("sleep meds")
* Depression: Antidepressants
* Behavioral issues (aggression, hallucinations, agitation): Antipsychotics
Nondrug approaches are usually tried first (or simultaneously) to deal with these problems. The specific drug prescribed will depend on the person's complete medical history.
For details on dosages for memory drugs, see the National Institute on Aging's Alzheimer's Disease Medications Fact Sheet.
http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm
By Paula Spencer, Caring.com senior editor
