Alzheimer's Disease
Medications
At this time, there are no medicines that can prevent or cure Alzheimer's disease or that will restore normal mental abilities. Medicine may help some people function better by temporarily reducing memory loss and thinking problems. Other medicines may be needed to treat associated conditions, such as depression.
Improving memory and daily functioning
Medicines include donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon). These medicines, called cholinesterase inhibitors, have been approved specifically for treatment of Alzheimer's disease. Research suggested that people with moderate to severe Alzheimer's disease who took cholinesterase inhibitors experienced improvement in thinking and daily functioning when they added memantine (Ebixa) to their treatment.7
All these medicines may temporarily help improve memory and daily functioning in some people who have Alzheimer's disease. The improvement varies from person to person. These medicines do not prevent the disease from getting worse, although they may slow down mental decline.
The main decision about using medicines to treat failing mental function usually is not whether to try a medicine but when to begin and, later, when to stop treatment. Medicine treatment can be started as soon as Alzheimer's disease is diagnosed. However, the person may or may not significantly improve when taking medicines because they do not work for everyone. If the medicines are effective, they are continued until the side effects outweigh the benefits or until the person no longer responds to the medicines. For more information, see:
Vitamin E is an antioxidant that may help protect nerve cells from damage or may improve the function of nerve cells. Research suggests that vitamin E may delay the loss of ability to perform basic everyday functions, such as dressing or bathing, but does not improve thinking or memory problems in people with Alzheimer's disease.8 When taken in reasonable amounts (less than 400 international units or IU a day), vitamin E is safe, inexpensive, and may be helpful for some people.
Talk with your doctor before using vitamin E and other antioxidants to prevent Alzheimer's disease.
Treating behaviour problems
Sometimes, medicine may be used to manage behaviours or symptoms that are causing strain for the person with Alzheimer's disease and his or her caregivers. Medicines generally are used only when other treatments have failed. For example, if the person still has trouble sleeping after trying regular exercise and avoiding naps, a medicine may be needed.
When it comes to disruptive behaviours, caregivers are encouraged to try to understand the reasons for the behaviours and to develop other ways to manage them whenever possible. Distracting the person, avoiding situations that seem to cause the behaviour, and using good communication often can help limit these behaviours.
Although other approaches to managing behaviours should always be tried first, medicines such as tranquilizers may be needed if:
- A behaviour is severely disruptive or harmful to the person or to others.
- Efforts to manage or reduce disruptive behaviour by making changes in the person's environment or routines have failed.
- The behaviour is making the situation intolerable for the caregiver.
- The person has trouble telling the difference between what is and is not real (psychosis) in addition to dementia. Psychosis causes the person to have false beliefs (delusions) and to hear or see things that are not there (hallucinations).
Treating depression
Depression occurs in close to half of people who have Alzheimer's disease. It is especially common during the early stages of the disease when a person may be aware of losing his or her ability to think and function independently. Antidepressants can relieve symptoms of depression and may improve quality of life, although they will not slow down the progression of Alzheimer's disease.
For more information, see the topic Depression.
Treating other causes of dementia
Conditions such as high blood pressure (which can lead to multi-infarct dementia), thyroid problems, or Parkinson's disease, also can contribute to dementia in an older person with Alzheimer's disease. Some of these conditions may respond well to treatment with medicines.
Medication Choices
Medicines used to treat symptoms of mental decline in people who have moderate Alzheimer's disease include Cholinesterase inhibitors such as donepezil (Aricept), galantamine (Reminyl), and rivastigmine (Exelon).
Memantine (Ebixa) is a medicine for treating severe symptoms of confusion and memory loss from Alzheimer's disease. It works differently than cholinesterase inhibitors, but, like cholinesterase inhibitors, it does not prevent Alzheimer's disease from progressing. This medicine may cause dizziness, confusion, headache, and/or constipation in some people.
Tranquilizers may be used to treat anxiety, agitated or hostile behaviour, sleep problems, frightening or disruptive false beliefs (delusions), suspicion of others (paranoia), or hallucinations (seeing or hearing things that aren't there).
A medicine called selegiline (Anipryl) has also been used to treat thinking and memory problems found in Alzheimer's disease. This medicine is most often used to treat people with Parkinson's disease and is not as effective at treating Alzheimer's disease as some other medicines.
What To Think About
Close monitoring and regular re-evaluation of the person with Alzheimer's disease are very important during treatment with medicine. As the disease progresses and symptoms change, the person's medicine needs often change. If you are a caregiver for someone with Alzheimer's disease, be alert for adverse drug reactions or side effects that further impair the person's ability to function.
Before deciding to manage behaviour problems with a medicine, try to figure out what is causing the behaviour. Understanding why a person is behaving in a certain way can point to better ways of dealing with that behaviour. If you are able to find other ways of dealing with behaviour problems, you may be able to avoid treatment with medicine and the side effects and costs that come with it.
One study provided some evidence that treating people who have mild to moderate Alzheimer's disease with a cholinesterase inhibitor reduced the burden on caregivers.9 Reducing that burden may allow people with Alzheimer's to live longer at home before being placed in a nursing home.
Some behaviours, such as agitation, wandering, and becoming restless and agitated in the early evening (called sundowning), do not always respond well to treatment with medicine. Figuring out what is causing the behaviour and taking steps to manage or change it can sometimes be helpful. It may be worth trying this approach before resorting to medicine.
Development of new drugs
As research on the causes and progression of Alzheimer's disease continues, the search for effective medicines continues.
Researchers are studying many medicines, including those used for other conditions, as possible treatments for Alzheimer's disease. Some of the medicines may be available only to people who are enrolled in clinical trials. It may be some time before researchers know whether these medicines are effective in treating Alzheimer's disease. For more information on clinical trials, contact the Alzheimer's Society by calling 1-800-616-8816 or visit the Web site at www.alzheimers.ca.
Research into a vaccine for Alzheimer's disease is ongoing.
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| Author: | Douglas Dana Sabra L. Katz-Wise Ralph Poore | Last Updated: January 26, 2007 |
| Medical Review: | Adam Husney, MD - Family Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine Peter J. Whitehouse, MD - Neurology | |
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