Understanding Alzheimer's Disease - Treatment

How Is It Diagnosed?

Diagnosis by a professional is particularly important because a number of other ailments -- many of which are treatable -- share symptoms associated with Alzheimer's disease. These include respiratory infections, inadequate nutrition, vitamin B-12 deficiency, anemia, hypoglycemia, depression, and cerebral vascular insufficiency (decreased blood flow to the brain due to constricted or obstructed arteries).

An adverse reaction to prescribed medication or a harmful combination of medicines can sometimes cause Alzheimer's-like symptoms. Other diseases and conditions sometimes confused with Alzheimer's disease are Parkinson's disease, stroke, thyroid problems, brain tumors, advanced syphilis and Huntington's chorea -- an inherited degenerative nerve disease.

To check for Alzheimer's disease, the doctor will probably begin with physical and psychological tests designed to eliminate other possible causes of mental impairment. Verbal tests and interviews of the family are the usual next steps, but they will not produce a definitive diagnosis. Today, only an examination of brain tissue after death can yield absolute proof of Alzheimer's disease -- the telltale evidence of nerve tangles, protein plaques, and general brain shrinkage from cell death.

What Is the Treatment?

Alzheimer's disease is incurable: Nothing can halt or reverse it. However, certain medications seem to slow its general progress to some degree in the early stages and others can help with mood changes and other specific behavioral problems of the disease.

• Cognex. In 1993, Cognex became the first drug approved by the FDA for treatment of Alzheimer's disease. The drug works by slowing the breakdown of acetylcholine, a chemical that helps nerve cells in the brain communicate. Cognex does not cure Alzheimer's disease or keep it from getting worse, but it can help relieve some of the memory impairment associated with the disease. Side effects of the drug include nausea, vomiting, diarrhea, abdominal pain and indigestion. In addition, Cognex can damage the liver, so your doctor will need to perform tests regularly to make sure this isn't happening. Due to its potential effects on the liver and need for frequent blood tests it is rarely used.
• Aricept Exelon and Razadyne (formerly known as Reminyl). These medications work by the same mechanism as Cognex but are better tolerated. They can improve mental functioning in early cases and perhaps delay the need for nursing home care, but do not seem to delay the actual progression of the disease.
• Namenda. This is a newer drug approved in October 2003 that works by blocking a substance called glutamate which may be overactive in someone with Alzheimer's disease. It improves mental function and may be more effective in moderate to severe symptoms, but is not a cure for Alzheimer's disease.

Other Therapies

Although hormone replacement therapy was initially thought to be beneficial, more recent studies actually show an increased risk in developing Alzheimer's for those taking combination hormone replacement (both estrogen and progesterone) and to a lesser degree estrogen replacement alone.