Currently, there is no cure for Alzheimer’s and no way to stop the underlying death of brain cells. But drugs and non-drug treatments may help with both cognitive and behavioral symptoms.
A comprehensive care plan for Alzheimer’s disease:
- Considers appropriate treatment options.
- Monitors treatment effectiveness as the disease progresses.
- Changes course and explores alternatives as necessary.
- Respects individual and family goals for treatment and tolerance for risk.
Three types of drugs are currently approved by the FDA to treat cognitive symptoms of Alzheimer’s disease.
The first, cholinesterase (KOH-luh-NES-ter-ays) inhibitors, prevents the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical messenger important for memory and learning. By keeping levels of acetylcholine high, these drugs support communication among nerve cells.
Three cholinesterase inhibitors are commonly prescribed:
- Donepezil (Aricept®), approved in 1996 to treat mild-to-moderate Alzheimer’s and in 2006 for the severe stage.
- Rivastigmine (Exelon®), approved in 2000 for mild-to-moderate Alzheimer’s.
- Galantamine (Razadyne®), approved in 2001 for mild-to-moderate stages.
The second type of drug works by regulating the activity of glutamate, a different messenger chemical involved in information processing:
- Memantine (Namenda®), approved in 2003 for moderate-to-severe stages, is the only drug in this class currently available.
The third type is a combination of cholinesterase inhibitor and a glutamate regulator:
- Donepezil and memantine (Namzaric®), approved in 2014 for moderate-to-severe stages.
The effectiveness of these treatments varies from person to person. While they may temporarily help symptoms, they do not slow or stop the brain changes that cause Alzheimer’s to become more severe over time.
Many find behavioral changes, like anxiety, agitation, aggression and sleep disturbances, to be the most challenging and distressing effect of Alzheimer’s disease. These changes can greatly impact the quality of life for individuals.
As with cognitive symptoms of Alzheimer’s, the chief underlying cause of behavioral and psychiatric symptoms is the progressive damage to brain cells. Other possible causes of behavioral symptoms include:
- Drug side effects:
- Side effects from prescription medications may be at work. Drug interactions may occur when taking multiple medications for several conditions.
- Medical conditions:
- Symptoms of infection or illness, which may be treatable, can affect behavior. Pneumonia or urinary tract infections can bring discomfort. Untreated ear or sinus infections can cause dizziness and pain.
- Environmental influences:
- Situations affecting behavior include moving to a new private residence or residential care facility; misperceived threats; or fear and fatigue from trying to make sense of a confusing world.
There are two types of treatments for behavioral symptoms: non-drug treatments and prescription medications.
Steps to developing non-drug treatments include:
- Identifying the symptom.
- Understanding its cause.
- Changing the caregiving environment to remove challenges or obstacles.
Pinpointing what has triggered behaviors can often help guide the best approach. Often the trigger is a change in the person’s environment, such as:
- New caregivers.
- Different living arrangements.
- Admission to a hospital.
- Presence of houseguests.
- Being asked to bathe or change clothes.
Because people with Alzheimer’s gradually lose the ability to communicate, it is important to regularly monitor their comfort and anticipate their needs.
Medications can be effective in managing some behavioral symptoms, but they must be used carefully and are most effective when combined with non-drug treatments. Medications should target specific symptoms so that response to treatment can be monitored.
Prescribing any drug for a person with Alzheimer’s is medically challenging. Use of drugs for behavioral and psychiatric symptoms should be closely supervised.
Some medications, called psychotropic medications (antipsychotics, antidepressants, anti-convulsants and others), are associated with an increased risk of serious side effects. These drugs should only be considered when non-pharmacological approaches are unsuccessful in reducing dementia-related behaviors that are causing physical harm to the person with dementia or his or her caregivers.
SYMPTOMSCognitive: Symptoms that affect memory, awareness, language, judgment, and an individual’s ability to plan, organize and carry out other thought processes.
Behavioral: A group of additional symptoms that occur — at least to some degree — in many individuals with Alzheimer’s. Early on, people may experience personality changes such as irritability, anxiety or depression. In later stages, individuals may develop sleep disturbances; agitation (physical or verbal aggression, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there). Individuals with the disease may develop wandering impulses at any stage.
TREATMENTSFDA-approved: Medication approved by the U.S. Food and Drug Administration (FDA) that treats symptoms of Alzheimer’s disease.
Non-drug: A treatment other than medication that helps relieve symptoms of Alzheimer’s disease.