By Micha Shalev, MHA CDP CDCM
Alzheimer’s is a terminal disease. This means it has no cure and will end in death. However, there are various medications which can help slow down the progression of the disease, and others that can improve the signs and symptoms, such as sleeplessness, wandering, depression, anxiety and agitation.
The doctor may prescribe cholinesterase inhibitors to help slow down the disease. These improve the levels of neurotransmitters in the brain. The medication contains a chemical that inhibits the cholinesterase enzyme from breaking down the neurotransmitter acetylcholine, resulting in an increase in both the neurotransmitter’s level and duration of action.
Cholinesterase inhibitors are prescribed to treat problems related to memory, thinking, language, judgment and other thought processes.
Clinical trials showed that about half of all patients did not get any benefit from this type of drug. Experts believe cholinesterase inhibitors may delay or slow worsening symptoms by about six to 12 months. However, some patients experience longer periods of delay.
Examples of cholinesterase inhibitors include:
- Donepezil (Aricept) – approved in the US to treat all stages;
- Galantamine (Razadyne) – approved in the US to treat mild to moderate stages. A study presented at the American College of Neuropsychopharmacology in 2012 showed that galantamine considerably reduces mortality in patients with mild to moderately severe Alzheimer’s disease.
- Rivastigmine (Exelon) – approved in the US to treat mild to moderate stages.
Cholinesterase inhibitors are generally well tolerated (side effects minimal). Side effects may include diarrhea, nausea, vomiting and loss of appetite.
Memantine protects brain cells from damage caused by glutamate, a chemical messenger. It is used to treat moderate to severe stages of Alzheimer’s. Some doctors prescribe memantine along with a cholinesterase inhibitor. Examples include Axura, Akatinol, Namenda, Ebixa and Abixa, and Memox.
Memantine is prescribed to improve memory, language, reason, attention, and the ability to carry out simple tasks.
A clinical trial showed that patients taking memantine showed a small, but statistically significant improvement in mental function and their ability to carry out daily activities.
Memantine is generally well tolerated with minimal side effects that may include dizziness, drowsiness, headache, insomnia, constipation, and agitation and delusional behavior in some patients.
ACE inhibitors may also help treat Alzheimer’s. Researchers from the Wake Forest School of Medicine found that ACE inhibitors that affect the brain by crossing the blood-brain barrier, may reduce inflammation that could contribute to the development of Alzheimer’s disease.
Meanwhile, scientists at the University of California Irvine showed that neural stem cells can rescue memory in mice with advanced Alzheimer’s disease, raising hopes of a potential treatment for humans.
According to researchers from Northwestern University in the US and the University of Rio de Janeiro in Brazil, insulin could protect against damage to brain cells key to memory. They claim that treating Alzheimer’s disease with insulin, or with drugs to boost its effect, may help people with the condition.
Micha Shalev, MHA CDP CDCM CADDCT, is the co-owner of The Oasis at Dodge Park, Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 and 102 Randolph Road in Worcester. He holds a master’s degree in healthcare management, graduated from the National Council of Certified Dementia Practitioners program, and is well-known speaker covering Alzheimer’s and dementia training topics. He can be reached at 508-853-8180 or m.shalev@dodgepark.com. Archives of articles from previous issues can be read at www.fiftyplusadvocate.com.
