The most common form of dementia, Alzheimer's disease, starts with mild memory problems and ends with severe brain damage and death. An estimated 5.5 million Americans have Alzheimer's disease, according to a January 2010 report in the New England Journal of Medicine. By midcentury, that number could reach 16 million as the U.S. population ages.
The time from diagnosis until death ranges from three to 10 years. In the interim, doctors prescribe medications to preserve mental function and control behavior. The FDA-approved drugs are divided into two groups--one for moderate to mild Alzheimer's, and the other for moderate to severe Alzheimer's. No published study has compared the benefits of the four approved Alzheimer's drugs, but authorities say certain drugs may work better in individual patients. It's a matter of matching the patient with the drug.
Earlier-Stage Treatment
The first line of pharmaceutical defense against Alzheimer's disease is a class of drugs known as cholinesterase inhibitors. These drugs for mild to moderate Alzheimer's prevent the breakdown of acetylcholine, a brain chemical used in thinking and memory. They include Razadyne (galantamine), Exelon (rivastigmine) and Aricept (donepezil). The first approved cholinesterase inhibitor, Cognex (tacrine), is seldom prescribed because of safety concerns, according to the National Institute on Aging.
Late-Stage Treatment
Namenda (memantine) and Aricept are the only two drugs approved for treating patients diagnosed with "moderate to severe" Alzheimer's. While Aricept increases the brain chemical acetylcholine, Namenda decreases the brain chemical glutamate, which plays a role in brain cell death. Neither Namenda nor Aricept provides dramatic improvement for patients in the later stage of Alzheimer's, but these drugs may make a difference in quality of life. For example, Namenda may extend for months the time patients are able to use the bathroom or eat on their own.
Other Drugs and Future Directions
Other drugs are also used to treat Alzheimer's patients. Doctors often prescribe psychiatric drugs to help control severe behavioral problems, depression and anxiety.
Scientists are now conducting several clinical trials in an effort to develop better treatments for Alzheimer's. They are looking at the effects of fish oil and alpha-lipoic acid on Alzheimer's patients. They are also studying pioglitazone, a drug already approved to treat diabetes, to see if it slows the progression of Alzheimer's, as well as combinations of vitamins E and C, along with alpha-lipoic acid and coenzyme Q (CoQ).
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