The basic goal in the management of individuals having Alzheimer’s disease or dementia is to preserve their autonomy and ability to function. Treatment also seeks to preserve quality of life not only for patients but also for those who provide care.
With the current medical technologies available, there is as yet no cure for dementia or Alzheimer’s disease. Researchers are evaluating a wide variety of treatments. In addition, some medications have been approved by federal agencies for treatment of Alzheimer’s disease. Some of the treatment approaches in use are summarized by the National Institute of Aging, a part of the U.S. National Institutes of Health.
The U.S. Food and Drug Administration (FDA) has approved four drugs for treatment of mild to moderate forms of the disease. All of the four belong to a family of drugs known as acetyl-cholinesterase inhibitors. Their chemical names are: donepezil, galantamine, tacrine, and rivastigmine.
These drugs have shown beneficial, albeit modest effects, in delaying for a time the deterioration of some cognitive functions in patients with mild to moderate forms of Alzheimer’s disease. Though approved primarily for treatment of Alzheimer’s disease, the drugs have shown some promise in cases of dementia with Lewy bodies, and Alzheimer’s disease mixed with vascular dementia.
According to the research center at Northwestern University, these drugs inhibit the action of acetyl-cholinestrase, an enzyme that helps in the breakdown of acetylcholine. Acetylcholine is a brain neurotransmitter that plays a key role in memory formation.
For treating moderate to severe forms of Alzheimer’s, the FDA has recently approved another drug, memantine. This drug is thought to act as a neuroprotector, and enhances cognitive function by protecting against the action of glutamate. Excess amounts of glutamate contribute significantly to cell damage.
The observed link of non-steroidal anti-inflammatory drugs (NSAIDs) with lower incidence of Alzheimer’s is being studied. NSAIDs may help to decrease inflammation in the brain that can lead to formation of plaques, although the research evidence is still weak. There is also a risk of serious side effects when using NSAIDs on elderly patients.
Antioxidants have attracted some research interest. There have been investigations into the effects of ginkgo biloba and vitamin E. Leaves from ginkgo seem to help in delaying cognitive deterioration in cases of mild dementia, but there is no clinical evidence as yet.
Use of estrogen among women in their menopausal stages has been observed to have protective benefits on the brain. Researchers have wondered if this would translate into lower risk for Alzheimer’s disease, but this has not been confirmed in clinical trials. On the contrary, a number of trials provide substantive evidence that estrogen is not effective in treatment of Alzheimer’s disease.
Psychiatric medications are used to address behavioral issues, such as depression, agitation, aggressive behavior and anxiety, which often arise in the later stages of dementia.
These treatments do provide some comfort and relief to patients who have to endure the symptoms. Happily, the beneficial effects on patients also enable caregivers to perform their tasks with less stress.