There is, as yet, no cure for Alzheimer's disease, but there is treatment to help alleviate symptoms and try to slow the development of new ones. Treatment comes in two main forms: behavioral intervention and drug therapy. Both are integral parts of helping a person with Alzheimer's disease live the fullest life she can.
Behavioral and Cognitive Interventions
Behavioral interventions include helping someone orient herself daily using easily sighted time and date cues and by discussing what is going on in the news and with a patient's family and friends. Validation therapy can help with distress by recognizing and discussing a patient's confusion with her situation; aggression and shouting may be helped with relaxation techniques such as aromatherapy and music therapy, and general social interaction, game playing, and exercise can help a patient remain more functionally active and aware of her surroundings.
Medications for Alzheimer's Disease
Current medications approved by the FDA for the treatment of Alzheimer's disease are the acetylcholinesterase inhibitors and the noncompetitive NMDA-receptor antagonist memantine (Nameda).
One of the central problems in people with Alzheimer's disease is the loss of brain cells (neurons) containing the neurotransmitter acetylcholine. AChEIs work by blocking the breakdown of the acetylcholine that is available from the remaining neurons. The AChEIs currently used are donepezil (Aricept), galantamine (Razadyne) and rivastigmine (Exelon). The individual AChEIs have slightly different mechanisms so there are different options for patients who do not tolerate a particular medication. General adverse effects include gastrointestinal problems such as nausea, vomiting and decreased appetite, muscle cramps and bradycardia. These normally resolve within a few days and depend on specific medication and patient reaction.
Memantine works on a different neurotransmitter, called glutamate. Over-activity of glutamate may also be involved in the loss of neurons, and memantine works by dampening this activity. Memantine may significantly slow the progression of Alzheimer's disease symptoms, and alleviate aggressive and delusional symptoms.
As they have different mechanisms of action, memantine and donepezil are often used together for greater effect.
Medications for Problems Related to Alzheimer's Disease
Pharmacotherapy can also be used to address other symptoms associated with Alzheimer's disease. Psychotic symptoms can include hallucinations, agitation, aggression and restlessness, and antipsychotic medications can be used to help alleviate these. However, the FDA warns that these must be used with extreme caution in elderly patients due to possibly fatal side effects.
Depression in Alzheimer's patients can be due to the patient's view of his disease and damage to his brain. A combination of behavioral measures, such as mentally and physically stimulating activities, and an antidepressant may be used to help alleviate depression.
Sleep problems---including insomnia, fragmented sleep and sleep apnea---may arise due to the insult on the brain in Alzheimer's disease or as a medication side-effect. Behavioral interventions should be tried first for any sleep problems, but medications may be used, with the exception of those containing diphenhydramine (found in some non-prescription sleep aids) as they interfere with the action of acetylcholine, and benzodiazepines, as they may add to cognitive, behavioral and physical problems.
References
- "American Journal of Psychiatry"; American Psychiatric Association Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias. Second Edition; APA Work Group on Alzheimer's Disease and Other Dementias; December 2007
- "Dementia and Geriatric Cognitive Disorders," Treatment Options in Alzheimer's Disease: Maximizing Benefit, Managing Expectations; Martin Farlow, Michael Miller, Vojislav Pejovic; April 2008
- "Primary Care Companion to the Journal of Clinical Psychiatry," Treatment Guidelines for Alzheimer's Disease: Redefining Perceptions in Primary Care; David S. Geldmacher; March-April 2007
