How is Alzheimer’s Disease Treated?
Scientists have been trying to unfold the enigma of Alzheimer’s disease for years. As suggested by its complexity, no single medication or proper treatment for it is known to date. A single ‘magic bullet’ seems unlikely to be the possible treatment, prompting scientists to look into more depth to find its cure. Therefore, currently, its treatment involves targeting various issues such as assisting people in maintaining mental function and managing behavioral symptoms to slow down the progression of the disease.
A tremendous amount of research for Alzheimer’s treatment performed in the past years has led scientists to understand the disease and develop and test new treatments with various medications in late-stage clinical trials.
To find an effective treatment, scientists are also contemplating various mediating factors, such as heart disease treatment and Type 2 diabetes, cognitive training, immunization therapy, changes in diet, and physical activity, likely to be linked with disease.
What Drugs Are Currently Available For Alzheimer’s Disease Treatment?
There is no single treatment confirmed for Alzheimer’s disease. The treatment usually involves addressing underlying biology, while some approved medications can help minimize other symptoms such as confusion and memory loss.
FDA-approved Medications for Alzheimer’s Treatment
The U.S. Food and Drug Administration Authority (FDA) has approved several Alzheimer’s medications, classified into two categories: (i) the drug that may affect the disease progression and (ii) the drugs that alleviate some symptoms of the disease for some time.
It is important to note that most medicines are effective during the early or middle stages of the disease. Furthermore, you must see an experienced physician before taking any Alzheimer’s treatment or medication.
(i) Drugs that may affect disease progression
On June 7, 2021, FDA approved the most recent drug, aducanumab (Aduhelm™), that may help slow the disease progression in people with Alzheimer’s. The drug targets the beta-amyloid, a minute protein particle that develops in the brain and accumulates into plaques. These plaques obstruct the connection between the nerve cells in the brain and may activate the immune response in the body, triggering inflammation. Although the cause of cell death and tissue loss during the disease is still unclear, scientists are sure that beta-amyloid is a potential contributor to the disease.
Scientists are keen to know about the toxic effects of beta-amyloid. The prime focus of many studies nowadays is to perform preliminary testing in humans aimed to remove beta-amyloid, impede its formation, or degrade its early production before it can become detrimental. The anti-amyloid intravenous (IV) infusion therapy, aducanumab, is the fruit of such research and demonstrated that removing amyloid from the brain can likely curtail cognitive and functional deterioration in people with early-stage Alzheimer’s disease.
Common side-effects of aducanumab include amyloid-related imaging abnormalities (ARIA) that may result in fluid build-up or bleeding in the brain. Other side effects include headache, diarrhea, falls, and confusion.
(ii) Drugs that treat symptoms
Some FDA-approved drugs work to ease the cognitive or non-cognitive symptoms in people living with Alzheimer’s disease.
● Cognitive symptoms
Cognitive symptoms are associated with memory and thinking. Death of the brain cells occurs, and communications among cells are lost with the progression of Alzheimer’s disease, resulting in worsening cognitive symptoms. These Alzheimer’s medications help reduce or stabilize these symptoms for some time by influencing the chemical messengers of the nerve cells.
1. Cholinesterase Inhibitors
These drugs increase the levels of acetylcholine by preventing its breakdown. Acetylcholine is an imperative neural chemical messenger essential for memory and learning. Hence, such medications can help treat cognitive symptoms related to thought processes, including memory, judgment, thinking, and language. The most common FDA-approved cholinesterase inhibitors are donepezil (Aricept®), rivastigmine (Exelon®), or galantamine (Razadyne®). Donepezil can be prescribed for all stages (mild, moderate, and severe) of Alzheimer’s disease, while the other two are usually recommended for treating mild-to-moderate disease.
Patients usually tolerate these Alzheimer’s medications, but some may experience side effects such as nausea, vomiting, weight loss, fatigue, diarrhea, and loss of appetite.
2. Glutamate Regulators
Glutamate is another neurotransmitter that assists the brain in processing information. As suggested by the name, these drugs regulate glutamate activation and impede the toxic effects resulting from the excess of glutamate. These drugs can enhance memory, reason, attention, language, and the ability to carry out simple tasks. Memantine (Namenda®) is an FDA-approved glutamate regulator, usually prescribed for moderate to severe Alzheimer’s treatment.
These drugs may cause side effects such as diarrhea, constipation, headache, dizziness, and confusion in some patients.
3. Manufactured Combination of Memantine and Dopenzil (Namzeric®)
Namzaric® is an amalgam of a cholinesterase inhibitor (Dopenzil) and a glutamate inhibitor (Memetine), prescribed for treating the cognitive symptoms of moderate and severe Alzheimer’s disease.
Common side effects are headache, diarrhea, nausea, dizziness, vomiting, and anorexia.
● Non-cognitive Symptoms
Alzheimer’s is not just about the loss of memory and cognitive functions. It also involves the manifestation of various behavioral and psychological symptoms (BPS) in the patients. These non-cognitive symptoms include anxiety, aggression, agitation, insomnia, hallucinations, and delusions.
There are some approved medications for treating these symptoms. However, it is more suitable to opt for non-medication options for coping with these behaviors. If these strategies fail to work, only then a consultant psychiatrist or physician should prescribe certain drugs to the patients after clearly explaining all their risks and side effects.
Up till now, the FDA has approved only one drug for treating the non-cognitive behavior of sleeplessness. Trials for drugs that can treat other non-cognitive symptoms are still ongoing.
1. Medication for Insomnia
FDA has approved only one drug hitherto that can help address insomnia in Alzheimer’s patients. Doctors can recommend Suvorexant (Belsomra®) for mild to moderate Alzheimer’s disease. This drug is an orexin receptor antagonist that works by inhibiting the activity of orexin (a neural chemical messenger associated with the sleep-wake cycle).
Some of the side effects associated with this medication are complex sleep behavior (like sleep-walking), aggravation of depression and suicidal thinking, sleep paralysis, weakened respiratory function, and risk of impaired alertness.
2. Medications for other non-cognitive symptoms
Doctors may prescribe some medications for treating some n0n-cognitive symptoms in Alzheimer’s patients. These medications include anti-anxiety (for treating agitation), anticonvulsants (for severe aggression), and antipsychotics (for paranoia, hallucinations, agitation, and aggression).
These drugs can have severe side effects. Anti-anxiety medications can cause sleeplessness, dizziness, falls, and confusion and are usually prescribed for a short time. Anticonvulsants cause similar side effects along with mood swings. Antipsychotics can have serious side effects and can result in the death of dementia patients. Therefore, doctors prescribe them only in case of severe symptoms.
Alzheimer’s Treatment Involving Therapies and Activities
Besides medications, Alzheimer’s treatment may involve some non-drug therapies and activities that can be useful to cope with the behavioral and memory changes. One of these is cognitive stimulation therapy (CST), in which the patients take part in group activities and exercises to enhance their memories and problem-solving skills. Likewise, cognitive rehabilitation utilizes the concept of using the functional areas of the brain to assist the non-functional ones. In this approach, a trained therapist and a friend or relative work to help the patients in the early stages of the disease manage their everyday tasks.
Reminiscing the past events with photos, music, favorite things, life story work, and compilations of notes of the patient’s life events can also help in improving mood and wellbeing. To know more tips to cope with the behavioral changes, click here.
What Potential New Treatments Are Being Researched?
NIA, part of the National Institutes of Health, is the federal agency for Alzheimer’s disease research. NIA-supported scientists are testing several drugs and other interventions to see if they can prevent the disease, slow it down, or help reduce symptoms.
Alzheimer’s disease treatment research has developed to such an extent that besides exploring numerous ways to find the treatment for symptoms, scientists are also investigating the means to delay or prevent the disease by confronting the underlying disease process.
Aging and Azheimer’s
Some changes linked with age may aggravate the brain damage due to Alzheimer’s. Researchers believe that inflammation may have a role in disease development. According to the studies, common nonsteroidal anti-inflammatory drugs (NSAIDs) might help slow the advancement of the disease. However, the clinical trials of these drugs have exhibited no benefits so far. Scientists are continuously examining the possible effects of NSAIDs on the development or progression of Alzheimer’s disease to find its effective cure.
Research is underway to investigate the effects of free radicals on disease development. Free radicals are oxygen and nitrogen molecules with a tendency to combine with other molecules and are known for their detrimental effects on nerve cells. Beta-amyloid generates free radicals in the plaques of some Alzheimer’s disease patients, and this breakthrough has made the scientists one step closer to fathoming Alzheimer’s disease and its possible treatments.
Heart Disease And Diabetes
Researchers have started finding the link between vascular diseases (which affect the blood vessels) and Alzheimer’s disease. Research has suggested the role of some vascular system-affecting chronic conditions, such as diabetes and heart disease, in diminishing cognitive function or increasing the disease risk. Various clinical trials are underway to determine if treating these diseases can help improve memory and thinking skills in people with Alzheimer’s or mild cognitive impairment.
Alzheimer’s Treatment and Lifestyle Choices
Numerous studies have shown the possible relation of factors, including diet, exercise, and social engagement, with the risk of cognitive deterioration. For instance, growing evidence suggests that brain health is related to a healthy heart and blood vessels, and the risk of Alzheimer’s increases due to conditions that affect the heart. Considering that, physical activity might be good for our brains and hearts. Some reports have backed this finding by showing that high physical activity and exercise can help lower the risk of Alzheimer’s in older people. Furthermore, some ongoing clinical trials are trying to establish a link between exercise, healthy brain aging, and Alzheimer’s disease development.
Researchers are also studying the role of diet in preserving cognitive function and reducing Alzheimer’s risk. The findings of some studies have suggested the association of the “Mediterranean diet” with a decreased risk of Alzheimer’s disease. Scientists are currently conducting clinical trials to investigate the relationship between particular dietary components, cognitive function, and Alzheimer’s disease.
The Role of Hormones
Researchers are exploring some novel possible Alzheimer’s treatments also. One such study is directed on hormones and cognitive training to determine if they can help improve thinking skills in Alzheimer’s patients. This research also focuses on preventing the disease in people at risk.
Another study indicated the potential of estrogen-based hormone therapy that might help protect thinking and memory in women if given for at least a year during early menopause. However, some further studies nullified this finding by indicating no benefits of estrogen in this regard. More research is still underway to establish any possible link between estrogen and cognitive function.
How Clinical Trials Contribute to Alzheimer’s Treatment Research?
People who want to help scientists test possible treatments may be able to take part in clinical trials, which are research studies that test the safety, side effects, or effectiveness of a medication or other intervention in humans. Study volunteers for Alzheimer’s treatment and prevention trials help scientists learn about the brain in healthy aging and what happens in the disease. Consequently, the results of these clinical trials help to improve Alzheimer’s treatment and prevention approaches.