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Despite decades of research and promising developments, there is still no cure for Alzheimer’s disease. One or more of the drugs currently being tested may offer hope, but the results of those studies are still a few years away. In the meantime, there are Alzheimer’s treatment options that can help reduce some of the symptoms.
The plaques and tangles of Alzheimer’s disease cause neurons in the brain to die, resulting in deteriorating brain function. Cholinesterase inhibitors—donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne)—don’t stop neurons from dying. Instead, they help to boost the function of the cells that remain. Brain cells communicate via chemicals called neurotransmitters. Acetylcholine is a neurotransmitter that is depleted in the brains of people with Alzheimer’s disease. Cholinesterase inhibitor drugs stop the enzyme cholinesterase from deactivating acetylcholine. In this way, more acetylcholine remains in the brain for mental functioning.
Cholinesterase inhibitor drugs can help to maintain brain function for a period of time, but once the function is lost it generally cannot be recovered. Because the drugs can’t prevent neurons from dying, they don’t stop the disease from worsening. And some people are not helped by these drugs at all.
Memantine for Moderate-to-Severe Alzheimer’s
Memantine works on a different neurotransmitter than the cholinesterase inhibitors and appears to be helpful for people in the moderate-to-severe stages of Alzheimer’s disease. This distinguishes it from cholinesterase inhibitors, which are useful mainly in the mild-to-moderate stages. Rather than increasing levels of acetylcholine, memantine affects the neurotransmitter glutamate.
Glutamate plays an important role in the parts of the brain responsible for learning and memory. Too little of the neurotransmitter can impair learning and memory, but too much can have damaging effects on brain cells. Alzheimer’s disease may be affected by both too much and too little glutamate at different times.
It’s often thought that damage to memory and learning systems in the brains of people with Alzheimer’s disease makes it almost impossible to form new memories and learn new information. However, people in the early stage of Alzheimer’s can still learn, and this ability can be enhanced with cognitive rehabilitation techniques. These techniques can help teach people how to recall important information and to perform better at daily tasks.
Rehabilitation programs may involve learning face-name recognition techniques, getting memory notebooks in which to record appointments and schedules, and learning ways to improve financial skills.
Treating Behavioral Symptoms
In addition to cognitive symptoms, people with Alzheimer’s disease may exhibit behavioral symptoms, including anxiety, agitation, aggression, apathy, depression, delusions, and hallucinations. Drugs may help with some of these symptoms, but they are not always effective and can have undesirable side effects. Before medication is used, caregivers should try non-drug strategies.
Non-Drug Alzheimer’s Treatment Strategies
Address Physical Complaints
A person with Alzheimer’s disease may be unable to describe specific physical complaints. Therefore, physical discomfort may be expressed as agitation. Look for evidence of common physical discomforts, such as pain, hunger, constipation, urinary tract infection, pneumonia, skin infection, or bone fracture. If present, these conditions should be appropriately treated.
Once medical conditions have been addressed, there are other effective non-drug strategies that may help with some behavioral problems. For example, consistency in the home environment is important. The home should be arranged to reduce confusion, disorientation, and agitation. Lighting and noise levels should be adjusted to provide a calm environment (the lights shouldn’t be so dim that they cause problems for people with low vision, however). Loud and erratic noises should be avoided. To make the home feel safe and to reduce anxiety, don’t rearrange furniture or make any other drastic changes. Keep personal possessions, including favorite photographs, in visible locations, and don’t move them around.
Handling Agitation, Irritability, and Aggression
Caregivers can often lessen agitation, irritability, and aggression in a person with Alzheimer’s disease by learning what to expect and how to communicate effectively. Sometimes breaking down a task into its component parts can decrease frustration and help the person to be more self-sufficient. For example, if a person with Alzheimer’s disease gets agitated when asked to brush his teeth, break down the task into smaller directions. Say: “Take the toothbrush.” “Put it under the water.” “Here’s the toothpaste.” “Put the brush in your mouth.” “OK, now you can brush.”
Counseling and support groups are valuable resources for caregivers to discuss specific behaviors and get advice on how to handle them. The Alzheimer’s Association has chapters across the United States that offer assistance and support groups.
Drugs for Alzheimer’s Treatment
If non-drug strategies are not effective and symptoms of depression, anxiety, agitation, sleeplessness, and aggression are severe, a doctor may prescribe anti-depressants, anti-anxiety drugs, or antipsychotic medications. Although there are no FDA-approved medications specifically for managing behavioral disturbances due to dementia, doctors have found that a variety of medications can be helpful to patients with these problems.
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