Alzheimer’s disease is a degenerative brain disease and the most common type of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Age is the biggest risk factor for the disease, followed by sex and family history.
There is currently no cure for Alzheimer’s disease. However, there is progress in Alzheimer’s and dementia research that is creating promising new treatments for those living with the disease.
The U.S. Food and Drug Administration (FDA) has approved medications for Alzheimer’s disease, which fall into two categories:
· Drugs that change disease progression in people living with early Alzheimer’s
· Drugs that temporarily ease some symptoms of Alzheimer’s
Drugs that change disease progression target the underlying biology of the disease process by aiming to slow the decline of memory and thinking, as well as function.
Anti-amyloid treatments work by removing a protein that accumulates into plaques in the brain, called beta-amyloid. Each treatment works differently and targets beta-amyloid at a different stage of plaque formation.
These treatments change the course of the disease significantly for those who are in the early stages by giving them more time to be able to participate in daily activities and live independently.
The two treatment therapies that change disease progression are Donanemab and Lecanemab.
Donanemab is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks to treat early Alzheimer’s disease, which includes people who are living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer’s who have been diagnosed with elevated beta-amyloid in the brain.
Donanemab was the third therapy that demonstrated that removing beta-amyloid from the brain decreases cognitive and functional decline in people living with early Alzheimer’s disease.
Lecanemab was the second therapy to demonstrate that removing beta-amyloid from the brain decreases cognitive and functional decline in people living with early Alzheimer’s disease.
It is important to note that anti-amyloid treatments do have side effects, such as allergic reactions, amyloid-related abnormalities (ARIA), infusion-related reactions, headaches, and falls.
As Alzheimer’s progresses, brain cells die, and the connections among those cells are lost. When this occurs, it causes cognitive and noncognitive symptoms to worsen.
Although these medications don’t stop the damage that Alzheimer’s disease causes to brain cells, they may lessen or stabilize symptoms for a limited time by affecting specific chemicals involved in delivering messages among and between the brain’s nerve cells.
The medications that are prescribed to treat symptoms related to memory and thinking include:
Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment, and other thought processes. These medications prevent the breakdown of a chemical messenger important for memory and learning, called acetylcholine. Cholinesterase inhibitors support communication between nerve cells. The most prescribed cholinesterase inhibitors include:
· Benzgalantamine treats mild-to-moderate dementia due to Alzheimer’s disease
· Donepezil treats mild-to-severe dementia due to Alzheimer’s disease
· Galantamine treats mild-to-moderate dementia due to Alzheimer’s disease
· Rivastigmine treats mild-to-moderate dementia due to Alzheimer’s disease as well as mild-to-moderate dementia due to Parkinson’s disease
Possible side effects for these medications include:
· Headache
· Dizziness
· Diarrhea
· Increased frequency of bowel movements
· Nausea
· Vomiting
· Loss of appetite
Glutamate regulators are medications prescribed to improve memory, attention, reasoning, language, and the ability to perform simple tasks. This medication regulates the activity of glutamate, a different chemical messenger that helps the brain process information.
Memantine is a glutamate regulator that treats moderate-to-severe Alzheimer’s disease. It can cause side effects that include headaches, constipation, confusion, and dizziness.
A cholinesterase inhibitor combined with a glutamate regulator, such as donepezil and memantine, treats moderate-to-severe Alzheimer’s disease. Possible side effects can include nausea, vomiting, loss of appetite, confusion, dizziness, increased frequency of bowel movements, and constipation.
Alzheimer’s disease doesn’t just impact memory and thinking. It also impacts a person’s quality of life by affecting a variety of behavioral and psychological symptoms that come with dementia, such as agitation, hallucinations and delusions, and sleep disturbances. Some medications focus on treating these non-cognitive symptoms for a time; however, it is important to try non-drug strategies to manage behaviors before adding medications.
The FDA has approved only one drug to manage symptoms of insomnia that has been tested in people who are living with dementia, and one that treats agitation.
Orexin receptor antagonists are prescribed to address symptoms of insomnia and inhibit the activity of a type of neurotransmitter involved in the sleep-wake cycle called orexin.
Suvorexant treats insomnia and has been shown in clinical trials to be effective for people who are living with mild to moderate Alzheimer’s disease. Possible side effects can include a risk of impaired alertness and motor function, worsening depression or suicidal thinking, complex sleep behaviors, sleep paralysis, and compromised respiratory function.
Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are mainly used to treat schizophrenia and bipolar disorder, as well as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients who are experiencing dementia related psychosis.
Many atypical antipsychotic medications are used “off-label” to treat dementia-related behaviors, and there is only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer’s disease. It is important to try non-drug strategies to help manage non-cognitive symptoms such as agitation before adding any medications.
Brexpiprazole treats agitation associated with dementia due to Alzheimer’s disease. Possible side effects may include weight gain, sleepiness, common cold symptoms, dizziness, and restlessness.
If you or a loved one is experiencing any symptoms of Alzheimer’s disease or would like to learn more about treatment options, you can consult with a neurologist at Jamaica Hospital Medical Center. To schedule an appointment, please call (718) 206-7246.
All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.
September is National AFib Awareness Month, a month dedicated to promoting education, early detection, and improved care for AFib.
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