Treatment for Alzheimer’s Disease
A growing number of medications can treat some symptoms of Alzheimer's disease temporarily, but researchers are on the trail for better treatments.
Pharmaceutical companies are looking for drugs to slow or stop the progress of Alzheimer’s disease, the most common form of dementia. Researchers want to identify people at risk for Alzheimer’s early and give them safe medication to prevent or delay serious symptoms.
Effective disease management may require a combination of medications, an approach that has proven to be important in the treatment of many cancers and HIV.
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Current treatments for Alzheimer’s disease
So far, the Alzheimer’s disease treatment field is strewn with drugs that failed in clinical trials. But a growing number of drugs can help improve some symptoms of Alzheimer’s disease, usually only temporarily.
Galantamine (Razadyne), rivastigmine (Exelon), and donepezil (Aricept) all work in similar ways to boost levels of acetylcholine, a chemical that carries messages between certain nerve cells. In Alzheimer’s disease, some of the nerves that are dependent on acetycholine are lost. The changes are associated with a worsening of Alzheimer’s symptoms.
For some people, acetylcholine-boosting drugs can delay worsening memory, but they don’t stop the disease over time. Side effects (including nausea and vomiting) can be severe, the Alzheimer’s Association explains.
Namenda is the only drug approved by the Food and Drug Administration (FDA) for moderate-to-severe Alzheimer’s disease. It improves the function of glutamate, a neurotransmitter that helps the brain process information.
The drug may benefit some Alzheimer’s patients, improving attention, language, and the ability to perform simple tasks. The benefits, however, usually last for only a few months. Side effects can include dizziness and headache.
Are better treatments on the horizon?
Some initially promising clinical trials for Alzheimer’s disease vaccines have failed, while other vaccines are still being researched.
But two monoclonal antibody treatments —aducanumab (Aduhelm) and lecanemab (Leqembi) — have shown so much potential promise the FDA has given them accelerated approval. Monoclonal antibodies are manufactured proteins that help the immune system seek and destroy antigens (foreign materials) in the body.
While they’re not a cure for Alzheimer’s disease, the treatments can significantly slow disease progression.
Another experimental monoclonal drug, donanemab, may reduce cognitive decline.
In a placebo-controlled study involving more than 1,700 people with early Alzheimer’s disease, donanemab slowed symptoms by 35 percent over a year and a half.
That means many of those patients were able to carry out daily tasks like talking about current events, paying bills, and driving. The promising results follow an earlier study that showed the drug slowed mental decline in Alzheimer’s patients by almost 30 percent.
“Alzheimer’s disease is a devastating illness that can have a profound impact on the lives of people diagnosed with the disease as well as their loved ones,” Patrizia Cavazzoni, MD, director of the FDA’s Center for Drug Evaluation and Research, said. “Currently available therapies only treat symptoms of the disease; this treatment option is the first therapy to target and affect the underlying disease process of Alzheimer’s. As we have learned from the fight against cancer, the accelerated approval pathway can bring therapies to patients faster while spurring more research and innovation.”
There’s even more reason to believe Alzheimer’s treatments, prevention, and possibly a cure could be on the horizon as knowledge about the disease increases.
After decades of focusing on the sticky amyloid plaques and tangled tau fibers found posthumously in the brains of people with the disease, researchers are looking for other causes of Alzheimer’s.
"Certainly, plaques and tangles are a hallmark (of the disease). It doesn't mean plaques are the cause of cell death,” explains Maria C. Carrillo, PhD, chief science officer of the Alzheimer's Association.
In fact, scientists are widening their concept of what may trigger Alzheimer’s disease. International teams of scientists are exploring how genes, cardiovascular disease, brain injuries, and inflammation may play roles in the development of Alzheimer’s disease.
Researchers from Seattle-based Allen Institute for Brain Science have produced a detailed Alzheimer’s Disease Brain Atlas, documenting changes in specific brain cells in people with Alzheimer’s to help identify potential causes and develop new treatment approaches.
May 15, 2023
Christopher Nystuen, MD, MBA and Janet O'Dell, RN