Alzheimer´s Disease

No drugs are available to treat Alzheimer's disease. But the doctors give medicines to improve behavioral symptoms that often accompany Alzheimer's, including sleeplessness, wandering, anxiety, agitation and depression.

At present there is no known cure for Alzheimer's disease. However by following a multi-disciplinary approach a patient with this condition can improve the overall quality of life. The specialists who are involved with the treatment of this condition include:

Neurologists
Psychiatrists
Neuro-psychologists
Sleep Medicine Specialists
Physical Rehabilitation Medicine specialists

The treatment plan should be tailor-made for each patient. One must also keep in mind that there are many clinical trials that are currently underway and some patients may benefit from the newer drugs that are not necessarily approved by FDA.

The treatment aims at controlling the symptoms of the disease and helps in controlling changes in memory, mood and behavior that commonly occur with Alzheimer's disease.

There are many medications currently available and this section provides an overall view of the current medications that are used for the conditions and the rationale for their use.

1. Anti-oxidants -The free radicals circulating in the blood cause tissue damage and reducing their levels helps the patient in long run . Usually Vitamin E maybe prescribed by a doctor. However changing the dietary habits can also produce the same result.

2. Cholinesterase Inhibitors - Acetylcholine is a chemical that keeps the nerve signals well charged and helps the messaging system within the brain cells. Delay in their breakdown by giving some drugs can help in improving the symptoms related to the cognitive function of a person with Alzheimer's disease. These drugs have been tested over the years and include -

Tacrine
Donepezil
Rivastigmine
Galantamine

Tacrine was used in the past and was found to have serious side effects in 50% of the patients especially on the liver and gastro-intestinal tract. It also needs to be taken four times a day and this is not easy for someone suffering from Alzheimer's. As the overall serious effects outweigh the benefits this drug has not been very useful.

Donepezil has very little side effects and can be used as once daily and has a half life of about 70 hours. The standard dose is 5mgs daily and after one month, this can be increased to 10mgs. The main side effects are on the gastro-intestinal tract, mainly nausea or increased bowel frequency. It is beneficial for those with mild to moderate Alzheimer's disease.

Rivastigmine in a Cochrane review report was found to be beneficial for people with mild to moderate Alzheimer's disease. It improves cognitive function, activities of daily living, and severity of dementia with daily doses of 6 to 12 mg.

The main side effects of most cholinesterase inhibitors include - nausea, vomiting, anorexia and dizziness. There can be weight loss with the drug too. Other known side-effects to the drug are- stomach pain, diarrhea, weakness, dizziness, headache, extreme tiredness, lack of energy, tremor, constipation, increased sweating, difficulty falling asleep or staying asleep, confusion and runny nose. The more serious side effects include - blood loss - causing fainting, black and tarry stools or red blood in stools or vomiting coffee ground liquid, difficutty in passing urine, depression, hallucination and seizures. However the incidence of side-effects with this drug is low.

Galantamine - Similar to other drugs in the group. Has less side-effects.

Memantine - It is used in patient with moderate to severe Alzheimer's. Another chemical called Glutamate acts on a receptor called NMDA. If these receptors are overcharged it causes damage to the brain. Memantine blocks these receptors.

Antipsychotic, Anti-depressants, Anxiolytics and sleeping medicines

Different symptoms may predominance and require different medication. Some of these drugs help with depression and anxiety while others help in controlling the behavior such as sudden anger and agitation, hallucinations and delusions. A common finding is a patient becoming agitated, confused and restless at the end of the day and may require a sleeping medicine or a tranquilizer to reduce these symptoms.

Other Drugs
Anti-inflammatory drugs have some neuro-protective effect and is occasionally prescribed.

Ginko Biloba - has modest benefit on cognitive function but can have severe side effects like bleeding, coma and seizures.

Selegline - Some Improvement in memory, behavior and mood has been described but most trials have shown it not to be of any great benefit.

Rehabilitation Strategies
Various methods can be used to improve cognitive skills such as memory and using objects with adequate dexterity. Training can be given on how to use a calculator, manipulating keys to open doors, counting money for purchases, using checkbooks etc

New Research
Stem cells and vaccine hold a promising future to find a permanent cure for this debilitating disease.