Drug Therapy Options For Alzheimer’s Patients

Drug therapy options for people with Alzheimer’s disease do not offer a cure for the disease itself, but they help patients cope with the symptoms and in some cases may temporarily slow down the progression of the illness.

The first type of drug used to treat Alzheimer’s disease is a class of medications called “cholinesterase inhibitors.” Drugs in this class are the most commonly prescribed to patients. The first cholinesterase inhibitor was approved by the FDA in 1996 and is called donepezil, or its brand name Aricept. In 2000, rivastigmine, brand name Exelon was approved. Galatamine was approved for treatment in 2001. Its original brand name was Reminyl, but in 2005, it was renamed Razadyne.

Cholinesterase inhibitors work by blocking the breakdown of acetylcholine in the brain. Acetylcholine is a chemical messenger that helps the brain in maintaining memory and process information. Only about half of the patients taking cholinesterase see any improvement in brain function, and these patients only see moderate improvement. This is because although the medications help keep acetylcholine levels high, they cannot prevent cell damage from spreading. Eventually, the damaged cells will not be able to make use of the acetylcholine. In early stage Alzheimer’s disease, however, these medications sometimes can delay the deterioration process.

A unique drug called Mematine, or its brand name Namenda, was approved in October, 2003 for moderate to severe Alzheimer’s disease. Mematine is in a class of drugs called “uncompetitive low to moderate affinity N-methyl-D-aspertate (NMDA) receptor antagonist.” Mematine is the only drug of its kind currently on the market in the US. Unlike the cholinesterase inhibitors, Mematine works by suppressing the activity of the chemical messenger glutamate in the brain. A certain amount of glutamate is needed to help the brain store and retrieve memories, as well as process information. This is achieved when the glutamate signals a cell to allow calcium into the cell, which in turn stimulates memory. However, too much glutamate in the brain signals the cells to allow too much calcium to penetrate. Too much calcium in the cells causes the cell to die, increasing the damage to the brain.  Studies into the effectiveness of Mematime have shown mixed results. The most significant improvement, or slowing of deteriorating, has been shown in patients taking both Mematine and one of the cholinesterase inhibitors.

Doctors sometimes prescribe Vitamin E because it is suspected that its antioxidant powers can help protect the brain from a certain amount of deterioration. Results of clinical trial have not proven Vitamin E to be conclusively effective. Patients should not add Vitamin E unless they are advised to do so by a doctor. Too much Vitamin E can cause damage to the heart, and Vitamin E in general is not safe for people who take blood-thinning medications.

In addition to the drugs that aim to address to brain chemistry causing Alzheimer’s disease, doctors often prescribe drugs that address the particular symptoms. A number of antidepressants and anti-anxiety medications can be given to Alzheimer’s patients, including Zoloft, Celexa, Prozac, and Ativan. As Alzheimer’s progresses, patients may experience hallucinations or become overly aggressive. In these instances, doctors often will prescribe antipsychotic medications, such as Zyprexa, Seroquel, and Clozaril.

Sleep disturbances can often be a problem with Alzheimer’s disease; however sedatives tend to cause instability and agitation and are generally avoided if at all possible.

Clinical trials are always available to Alzheimer’s patients, sometimes offering them a chance to try new treatment options. Of course, participation in a clinical trial offers no guarantee that the patient will be in the group who is receiving medication. There is naturally a certain amount of risk involved in trying new medications, but patients are under medical supervision at all times. Doctors or the local chapter of the Alzheimer’s Association can direct patients in finding studies to join.

Manufacturers touting “cure-all” Alzheimer’s tonics make tempting claims, but these claims should be treated with skepticism. Patients should never take a medication without informing their doctors. Some of these medications may simply be useless, while others may actually be harmful.