Alzheimer’s Disease Medications Overview:
Alzheimer’s disease medications have been prescribed over the last couple of decades and have had some benefit for individuals suffering from this devastating disease. However, it is essential to recognize that medications for Alzheimer’s disease and other forms of dementia are not a cure and have some limitations in preventing the continuing deterioration of the brain. The American Academy of Neurology concluded that these drugs which are primarily cholinesterase inhibitors “should be considered in patients with mild to moderate Alzheimer’s disease although studies suggest a small average degree of benefit.” Clinicians who prescribe these drugs frequently will give them for about a two months trial and may discontinue their use if no improvement is seen.
Alzheimer’s Disease Overview:
In order to determine the necessity for Alzheimer’s disease medications, first you must have a good understanding of the disease and its various forms. Alzheimer’s disease is a progressive deterioration of the brain that significantly impairs memory, thinking, problem-solving and eventually activities of daily living. It is most commonly found among the elderly, and currently is believed to account for 50% to 60% of all cases of dementia. It is estimated that by the year 2050 a possible estimated 11.3 million to 16 million Americans may suffer from Alzheimer’s disease.
It is not currently understood what causes Alzheimer’s disease, although several factors have been identified which may impact upon its development including family history and genetics and advanced age. Some estimates state that approximately 10% of individuals over the age of 65 may have the disease and nearly half of individuals over the age of 85 may be affected by the disease as well.
It is believed that Alzheimer’s disease causes a loss of brain cells resulting in memory loss, language difficulties, problems performing familiar tasks, disorientation to time and place, problems in abstract thinking, changes in mood or behavior, and even changes in personality. The disease process is varied and progressive and may occur over several years or many.
Alzheimer’s Disease Medications and Diagnosis:
In order to determine whether Alzheimer’s disease medications are necessary or appropriate, a definitive diagnosis is required. The most well defined diagnosis can only be conducted by examining the brain tissue upon autopsy. Obviously, prior to an autopsy, in order to have the most probable diagnosis, a complete medical examination needs to be completed evaluating a complete medical history, physical assessment, neurologic and mental evaluation, radiological findings and laboratory tests by a doctor familiar with the disease and the testing process associated with Alzheimer’s disease. There is no one test that can be conducted at this time to determine whether Alzheimer’s disease exists. Research and clinical experience has found that the disease progression for Alzheimer’s can vary from 3 to 20 years after the onset and possibly another 8 to 10 years after it has been diagnosed. This extensive diagnostic process will be conducted prior to prescribing any Alzheimer’s disease medications.
Alzheimer’s Disease Medications and Treatment:
Currently there are no medical treatments or medications known to cure or even stop the progression of Alzheimer’s disease although several have been found to delay the progression. Currently the most widely used Alzheimer’s disease medications are:
galantamine (Razadyn, Reminyl),
and tacrine (Cognex).
These medications are believed to primarily increase a neurotransmitter (brain messenger) called acetylcholine in the brain, which is believed to be affected by the Alzheimer’s disease process.
Alzheimer’s Disease Medications and the Progression of the Disease:
The Alzheimer’s disease medications currently on the market cannot cure or even stop the progression of the disease process. However, they are believed to limit the severity of the symptoms of confusion and memory loss for a period of time and to delay its progression.
Two types of medications have been approved by the US Food and Drug Administration (FDA) to treat the symptoms of Alzheimer’s disease. The first is the cholinesterase inhibitors which includes Aricept, Exelon and Razadyn and memantine (Namenda). These are used to treat some of the basic symptoms of memory loss, confusion, disorientation, problem solving and reasoning. More recently there is a medication that combines one of the cholinesterase inhibitors (donepezil) with memantine called Namzaric.
Medications for the Early to Moderate Stages of Alzheimer’s Disease:
The medications that are currently used to treat the early to moderate stages of Alzheimer’s disease all fall within the classification of cholinesterase inhibitors. These medications are used to treat the symptoms of memory loss, language difficulties and the basic thinking and reasoning skills.
The cholinesterase inhibitors are believed to prevent the breakdown of acetylcholine, which is a neurotransmitter in the brain. This chemical messenger is very important in the process of learning and memory and is involved in the communication process between nerve cells. It is believed to be necessary to keep the acetylcholine levels high in the brain if possible. By keeping the levels of these chemical messengers high it seems to delay or slow down the progression of the disease process. The effectiveness however varies from individual to individual. These medications are usually well-tolerated although side effects have been noted to include nausea, vomiting, increased frequency of bowel movements and loss of appetite.
Alzheimer’s Disease Medications for the Moderate to Severe Stages:
The only medications prescribed for the moderate to severe stages of Alzheimer’s disease are memantine (Namenda) and a combination of memantine and donepezil referred to as Namzaric. Memantine is usually prescribed to improve memory, reasoning, language skills, attention and the ability to perform simple tasks. Memantine can be used alone or with donepezil (Aricept). There has been some research that indicates that taking a cholinesterase inhibitor such as Aricept along with memantine may be helpful. Namzaric combines the two into one medication.
Memantine is believed to regulate glutamate in the brain which is a chemical involved in information processing, as well as storage and retrieval of information. It has been found to improve the mental and daily functioning for some people. No medication however is harmless and side effect free, with some of the basic side effects including confusion, dizziness, headache and constipation.
Alzheimer’s Disease Medications and the Future:
Medications used to treat Alzheimer’s disease are relatively new and have been developed primarily over the last couple of decades. Currently, there is no cure for Alzheimer’s disease and medications are used to moderate and possibly delay the progress of the disease. Research is constantly being developed using people with mild cognitive impairment compared to healthy volunteers used as control subjects. However, we are only on the cutting edge of developing effective Alzheimer’s disease medications.
Some information adapted by Paul Susic Ph.D. Licensed Psychologist from Worst Pill Best Pills: A Consumer’s Guide to Avoiding Drug-Induced Death or Illness and additional information from alz.org.