Drug Therapy for Cognitive Symptoms
Cognitive enhancers are medications that attempt to slow the progression of Alzheimer's symptoms. While these medications appear to improve thought processes for some people, the effectiveness overall varies greatly. Cognitive enhancers need to be monitored regularly for side effects and interaction with other medications.
Two classes of medication have been approved by the US Food and Drug Administration for treatment of the cognitive symptoms of Alzheimer's. They include Cholinesterase Inhibitors and N-Methyl D-Aspartate (NMDA) Antagonists.
Class 1: Cholinesterase InhibitorsCholinesterase Inhibitors act by increasing the levels of acetylcholine in the brain. Acetylcholine is a chemical that facilitates nerve cell communication in the areas of memory, judgment and other thought processes. Researchers have found lower levels of acetylcholine in the brains of individuals with Alzheimer's. There are four Cholinesterase Inhibitor medications:
- Aricept (donepezil): Approved for mild, moderate and severe Alzheimer's
- Cognex (tacrine): Approved for mild to moderate Alzheimer's; however, Cognex is not marketed anymore by its manufacturer because it has some significant side effects.
- Exelon (revastigmine): Approved for mild to moderate Alzheimer's
- Razadyne (galantamine): Approved for mild to moderate Alzheimer's
Class 2: N-Methyl D-Aspartate (NMDA) AntagonistsNamenda (memantine) is the only drug in this class and is approved for moderate to severe Alzheimer's. Namenda appears to work by regulating glutamate levels in the brain. Normal levels of glutamate facilitate learning but too much glutatmate causes brain cells to die. Namenda has been somewhat effective in delaying the progression of symptoms in later Alzheimer's disease.
Drug Therapy for Behavioral and Emotional Symptoms
Psychotropic medications are used at times to treat the behavioral and emotional symptoms of Alzheimer's disease. Psychotropics address the psychological and emotional aspects of brain functioning.
These drugs can be effective but can also potentially cause severe side effects. This class of medications is typically used after attempting non-drug therapy and finding it to be inadequate.
Psychotropic medications include antidepressants, antipsychotics and anti-anxiety medications, as well as mood stabilizers and hypnotic medications. These medications are prescribed to address symptoms such as depression, anxiety, insomnia, hallucinations and paranoia.
Non-Drug ApproachesNon-drug approaches focus on treating the behavioral and emotional symptoms of Alzheimer's by changing the way we understand and interact with the person with Alzheimer's, These approaches recognize that behavior is often a way of communicating for those with Alzheimer's. The goal of non-drug approaches is to understand the meaning of the challenging behaviors and why they are present.
Non-drug approaches should generally be attempted before using psychotropic medications since they do not have the potential for side effects or medication interactions.
- Behavior Assessment
Identify a particular behavior and note what seems to trigger the behavior. For example, if a shower always makes your loved one agitated, try a bath instead. Or, attempt to offer a shower at a different time of day. Rather than using medication if someone is upset or agitated, a non-drug approach tries to understand why they might be agitated. Perhaps they need to use the bathroom, are in pain or think they lost something. Note what precedes the behavior, try something different and track the results.
- Know What to Expect
The old saying "Knowledge is power" is very true here. Knowing what to expect can help you understand behavior and recognize its source as the disease rather than the person.
- See Things His Way
You can often avoid escalating troubling behaviors by changing your own perspective. For example, if your loved one is asking to see his mother (who may have been deceased for many years), ask him to tell you about her, rather than forcing him to confront the death of his mother. This is called Validation Therapy, and it can be very effective in calming the person who is upset.
Alternative Treatments and Clinical TrialsWhile some will tout the benefits of alternative treatments, research has not clearly supported the use of these herbal supplements for Alzheimer's.
There are, however, many ongoing clinical trials that are rigorously regulated to test new treatments for Alzheimer's disease. Some trials are open and are recruiting individuals with Alzheimer's to participate in them.
Research Provides Hope
Although there is no cure yet for Alzheimer's disease, be encouraged. Researchers are constantly working to find a cure as well as determine more effective treatment and prevention methods. Much has been learned about how Alzheimer's affects the brain, and this increased knowledge continues to spur new thoughts on the development of a cure, treatment and prevention.
Alzheimer's Association. FDA-Approved Treatments for Alzheimer's. Accessed July 15, 2011. http://www.alz.org/national/documents/topicsheet_treatments.pdf
US National Institutes of Health. National Institute on Aging. Alzheimer's Disease Medications Fact Sheet. Accessed July 17, 2011. http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm
US National Institutes of Health. National Institute on Aging. Medicines to Treat AD Symptoms and Behaviors. Accessed July 17, 2011.http://www.nia.nih.gov/Alzheimers/Publications/CaringAD/medical/medicines.htm