Cognitive Symptoms
Cognitive symptoms include problems with thought processes like memory, language, and judgment. Two kinds of medications have been approved by the U.S. Food and Drug Administration for treatment of cognitive symptoms of Alzheimer’s disease:
- Cholinesterase inhibitors increase the levels of acetylcholine in the brain, which plays a key role in memory and learning. This kind of drug postpones the worsening of symptoms for 6 to 12 months in about half of the people who take it. Cholinesterase inhibitors most commonly prescribed for mild to moderate Alzheimer’s disease include Aricept (donezepil HCL), Exelon (rivastigmine), and Razadyne (galantamine). Because of varying side effects and possible interactions with other medications, doctors may try different cholinesterase inhibitors until the most effective one is found for the individual.
- Namenda (memantine) regulates glutamate in the brain, which plays a key role in processing information. This drug is used to treat moderate to severe Alzheimer’s disease and may delay the worsening of symptoms in some people.
Cholinesterase inhibitors can be started as soon as Alzheimer's symptoms appear -- in fact, they are most effective in the early stages of the disease. When a physician determines that the cholinesterase inhibitor is no longer effective, he or she often recommends tapering off the cholinesterase inhibitor and introducing memantine. Sometimes, memantine and a cholinesterase inhibitor are taken simultaneously during the moderate stage of the disease.
Behavioral Symptoms
Often the most challenging for caregivers, behavioral symptoms include agitation, suspicion, and depression. Although caregivers often take personally the behaviors exhibited toward them, it’s important to remember that behavioral symptoms are just as much a result of damage to brain cells as are cognitive symptoms.
Some medications are useful for managing behavioral symptoms. For instance, anti-anxiety medications can treat agitation and aggression, while anti-psychotic medications have been used to address suspicion and paranoia. However, the risk of drug reactions and/or interactions runs high among those with Alzheimer’s, so caution should be used when medications are prescribed to deal with behavioral issues. A combination of drug and non-drug treatments often works best.
Non-drug treatments involve analyzing the behavior, identifying what may have triggered it, and devising an approach that either changes the person’s environment or the caregiver’s reaction to the behavior.
For example, excessive noise can worsen agitation in individuals with Alzheimer’s. Simply creating a calmer environment may eliminate the behavior. Likewise, when caregivers become angry in response to a difficult behavior, this usually only upsets the person with Alzheimer’s and increases the behavior’s frequency. Reacting in a calm, controlled manner can reduce the tension long enough to distract the person to a more pleasant activity, such as looking at a family photo album or listening to a favorite kind of music.
While physicians are skilled at prescribing medications to treat behavioral symptoms, they may not be familiar with non-drug interventions. Most caregivers learn about behavioral management through their own research and by connecting with other caregivers through support groups and online support networks.
Sources:
Basics of Alzheimer’s disease: What it is and what you can do. Alzheimer's Association. 2005. http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf
Behavioral challenges: Potential causes of behavior problems. Alzheimer's Foundation of America. 2008. http://www.alzfdn.org/EducationandCare/causes.html
FDA-approved treatments for Alzheimer's. Alzheimer's Association. July 2007. http://www.alz.org/national/documents/topicsheet_treatments.pdf
