Alzheimer's Disease Health Center

Alzheimer's Disease Therapy Options

The U.S. population is getting older, and as it ages, Alzheimer's disease is becoming an increasingly bigger concern. Within the next 50 years, the incidence of Alzheimer's is expected to quadruple, affecting one in 45 Americans.

Today, there is still no cure for Alzheimer's. People with the disease progressively lose memory and the ability to function. Researchers are still trying to fully understand how its brain plaques and tangles lead to memory loss and other cognitive, behavioral and psychiatric symptoms -- and how to reverse those changes to prevent or stop the disease. 

However, there are treatments available today that can help patients manage the symptoms of Alzheimer's disease, allowing them to function at a higher level for a longer period of time. Alzheimer's therapy involves a number of different treatments that address each of these problems. Because symptoms change over time, doctors need to adjust their Alzheimer's patients' therapies as new problems emerge.

Alzheimer's Disease Medications

Several different types of medications are used to treat the memory loss, behavior changes, sleep problems, and other symptoms of Alzheimer's disease. These medications won't stop the disease, but they can slow down the progression of symptoms for a few months or even years.  All of these medications can have side effects, which can be even more pronounced in older people.

Four medications in two classes are FDA-approved specifically for Alzheimer's therapy.

Cholinesterase inhibitors help with the cognitive symptoms of Alzheimer's. They work by preventing the breakdown of a chemical messenger in the brain called acetylcholine, which is important for learning, memory, and attention.  

Three cholinesterase inhibitors are approved for Alzheimer's disease therapy: Donepezil (Aricept) is approved to treat mild, moderate, and severe Alzheimer's. Rivastigmine (Exelon) and galantamine (Razadyne) are approved to treat mild to moderate Alzheimer's.  Exelon is now also available in a skin patch, which is easier for some patients to use, because it is applied to the skin and the medication is slowly released throughout the day.

Side effects of the cholinesterase inhibitors include nausea, vomiting, diarrhea, weight loss, and dizziness.

Memantine (Namenda) works by regulating the amount of another chemical messenger in the brain, called glutamate. Namenda is approved for moderate to severe Alzheimer's disease. Side effects include dizziness, confusion, headache, constipation, nausea, and agitation. Because Namenda does not work the same way as a cholinesterase inhibitor, it may be used in combination with one.

It's difficult to tell whether one drug is more effective than another for a given person. Alzheimer's patients (with the help of their doctors) should choose whichever drug works best for them.

A few Alzheimer's disease therapies treat the behavioral and psychiatric symptoms that may be related to the disease, including hallucinations, agitation, and sleep problems. However, none of these drugs is FDA-approved as an Alzheimer's therapy.

• Antidepressants, such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft) treat irritability and mood.
• Anxiolytics, such as lorazepam (Ativan) and oxazepam (Serax) treat anxiety and restlessness.
• Antipsychotic medications, such as aripiprazole (Abilify), haloperidol (Haldol), and olanzapine (Zyprexa) treat hallucinations, delusions, agitation, and aggression. It's important to note that antipsychotic drugs have been linked to increased risk of death in patients with dementia, and currently carry the FDA's "black box" warning about their use in older patients with dementia. They can, however, still be necessary and helpful to many patients.