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Adjunct Treatments for Alzheimer's Disease

Medically Reviewed by Sabrina Felson, MD on August 17, 2022

Most treatments for Alzheimer’s disease work on the symptoms, rather than the disease itself. Several drugs are approved to treat memory and thinking problems. But you may also get adjunct treatments for behavioral and psychological symptoms. Adjunct treatments are additional therapies that treat symptoms associated with Alzheimer's other than the main symptom of memory loss.

As the disease progresses, it destroys nerve cells in different parts of your brain. The neurons lose their connections with each other and can no longer communicate. People with Alzheimer's often develop changes in their behavior. These changes can include:

  • Agitation
  • Aggression
  • Anxiety
  • Delusions
  • Depression
  • Hallucinations
  • Insomnia
  • Restlessness

These symptoms can be hard on both the person with Alzheimer’s and the people taking care of them.

Most doctors recommend you first try lifestyle changes and behavior therapies to deal with these problems before you turn to a medical approach. You should also rule out other things that can cause behavior changes, like an infection, hearing and vision problems, and drug side effects.

But sometimes medication is the best alternative. Most adjunct treatments aren’t approved specifically for use in Alzheimer’s disease. But doctors often prescribe them “off-label.” That means they can take a drug that’s been approved to treat a different condition and use it to try to help you.

Sleep Aids

Many people have trouble sleeping as they get older, but it’s an especially common problem with Alzheimer’s disease. Brain changes can cause you to wake up more often in the night and feel tired during the day.

Non-drug strategies for better sleep are usually the best option. Using sleep medications can be dangerous for people with Alzheimer’s, and studies haven’t found much benefit.

If lifestyle adjustments don’t help, or if being awake in the night is very disruptive, your doctor may prescribe one of these sleep aids:

Suvorexant (Belsomra). This is the only drug approved by the FDA for Alzheimer’s-related sleep problems.

  • It’s an orexin inhibitor that stops a certain brain chemical from telling your body it’s time to wake up.
  • This drug can cause other sleep issues like sleep paralysis and sleepwalking. It can cause depression or suicidal thoughts and make you drowsy during the day.

Sedatives. Your doctor may prescribe other kinds of sleeping pills, like eszopiclone (Lunesta), zaleplon (Sonata), or zolpidem (Ambien). These drugs can make you do unusual things while you’re asleep, like drive or eat. And they can affect your thinking, memory, balance, and coordination during the day.

In general, you should use sleep medicines for as short a time as possible. They can make you confused and likely to fall. Once you’ve gotten into a normal sleep pattern, you should try to stop taking them.

Some sleep aids you shouldn’t take at all when you have Alzheimer’s. Certain over-the-counter and prescription sleep drugs contain an antihistamine, like diphenhydramine. These drugs can disrupt the communication between brain cells and make thinking and memory problems worse.

Antidepressants

Depression is also a very common problem when you have Alzheimer’s. Your doctor may prescribe an antidepressant to help improve your mood. They may also help you with anxiety, sleep problems, agitation, and hallucinations.

Selective serotonin reuptake Inhibitors (SSRIs). These drugs are used most often in people with Alzheimer’s because they’re safe and are less likely to interact with other drugs than different kinds of antidepressants. Your doctor may prescribe:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)
  • Vortioxetine (Trintellix)

Serotonin-noradrenaline reuptake inhibitors (SNRIs). These work on two brain chemicals. Examples include:

  • Duloxetine (Cymbalta)
  • Venlafaxine (Effexor)

Atypical antidepressants. Some drugs in this category are safe for use by people with Alzheimer’s. They include:

  • Bupropion (Wellbutrin)
  • Mirtazapine (Remeron)
  • Trazodone (Desyrel)

You shouldn’t take certain older drugs, called tricyclic antidepressants, if you have Alzheimer’s disease. Like antihistamines, they can make cognitive problems worse. These include amitriptyline (Elavil) and nortriptyline (Pamelor). The SSRI paroxetine (Paxil) has a similar effect.

It’s an off-label use of antidepressants if you take them for Alzheimer’s. But research has shown citalopram, mirtazapine, sertraline, and trazodone may help with agitation.

Antidepressants can cause a heart issue called a prolonged QT interval that can cause irregular heartbeat. Other side effects include stomach and intestinal problems and bleeding.

Anti-anxiety Drugs (Anxiolytics)

Doctors may prescribe sedative drugs called benzodiazepines off-label for anxiety and agitation. They’re sometimes also used for restlessness, resistance, and disruptive behavior like verbal outbursts. But they’re risky in people with Alzheimer’s.

Some of these drugs are:

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)
  • Oxazepam (Serax)
  • Temazepam (Restoril)

You should take these drugs for the shortest time possible to address your symptoms. They can make you sleepy, dizzy, confused, and more likely to fall.

You shouldn’t take some prescription anti-anxiety drugs if you have Alzheimer’s disease. Hydroxyzine (Atarax) is an antihistamine that can make thinking and memory problems worse.

Antipsychotics (Neuroleptics)

Some of the symptoms that can go along with Alzheimer’s disease can be dangerous for you or the people taking care of you. Antipsychotic drugs can make you have fewer aggressive or hostile feelings. They can also treat hallucinations and delusions.

But they aren’t approved for Alzheimer’s treatment, and you should weigh the risks and benefits carefully before you use them. Experts only recommend them as a last resort. They can be very dangerous, and studies have only shown limited benefit.

You should first look for another cause of the problem behavior, like an infection or a drug side effect. It may help to create a calm environment and stick to a routine with familiar people and places. You can also try behavior therapies and physical activity.

In general, antipsychotics should only be used if someone:

  • Is a danger to themselves or others
  • Behaves in a way that keeps them from getting the medical care they need
  • Has a mental illness, like schizophrenia, that’s not connected to Alzheimer’s

You should take these drugs at the lowest dose that controls symptoms for as short a time as possible.

Drugs that could be prescribed include:

  • Aripiprazole (Abilify)
  • Clozapine (Clozaril)
  • Haloperidol (Haldol)
  • Olanzapine (Zyprexa)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

Antipsychotics raise the chance of stroke and death for people with Alzheimer’s. They can make you very sleepy and more likely to fall. Several of these drugs also have what are called anticholinergic properties. That means they disrupt communication between certain nerve cells in the brain. They work the opposite of Alzheimer’s drugs you may be taking for thinking and memory problems.

Other Adjunct Treatments for Alzheimer’s

Other drugs used off-label in Alzheimer’s treatment include:

  • Anticonvulsants. Carbamazepine and gabapentin are anti-seizure drugs often prescribed for epilepsy. They’re also sometimes used to treat agitation in Alzheimer’s.
  • Anti-Parkinson’s drugs. Certain drugs used to treat Parkinson’s disease are being tested to see if they can help with Alzheimer’s symptoms. Rotigotine and rasagiline increase the levels of brain chemicals that help nerve cells communicate.

Show Sources

SOURCES:

Alzheimer’s Association: “Medications for Memory, Cognition and Dementia-Related Behaviors,” “Treatments for Sleep Changes,” “Depression,” “Treatments for Behavior.”

National Institute on Aging: “What Happens to the Brain in Alzheimer's Disease?” “How Is Alzheimer's Disease Treated?”

Neuropsychiatric Disease and Treatment: “Treatment of behavioral and psychological symptoms of dementias with psychopharmaceuticals: a review.”

University of California San Francisco: “Medications & Dementia.”

World Journal of Psychiatry: “Pharmacological management of behavioral symptoms associated with dementia.”

FDA: “Understanding Unapproved Use of Approved Drugs "Off Label.”

Belsomra.com.

Journal of Medical Toxicology: “The Clinical and Forensic Toxicology of Z-drugs.”

Current Psychiatry: “Prevent drug-drug interactions with cholinesterase inhibitors.”

UpToDate.com: “ Anticholinergic activity of medications.”

The American Journal of Psychiatry: “The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia.”

Molecular Degeneration: “New approaches to symptomatic treatments for Alzheimer’s disease.”

National Cancer Institute: “Adjunct Therapy.”

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