Best Medicine For Alzheimer’s Disease

Cerebrovasculature Health In Alzheimers Disease

Cheryl L. Wellington from the University of British Columbia shared her research on understanding the role of the cerebrovasculature and lipoprotein metabolism in Alzheimers disease. In the highly vascularized brain, proper cerebrovasculature function is important for neuronal activity. In patients with Alzheimers disease, accumulation of A in the cerebral arteries, known as cerebral amyloid angiopathy , can weaken cerebral blood vessels, making them more susceptible to damage, leakage, and stroke, and compromise blood flow throughout the brain. Up to 90% of patients experience some type of cerebrovascular dysfunction, including CAA, leaky bloodbrain barrier , and changes in cerebral blood flow.7275

While these studies suggest that HDL has a protective effect on cerebral vessels, key differences between mouse and human lipoprotein metabolism mean that these results need to be interpreted with caution. To understand how lipoproteins affect A clearance across the arterial wall, Wellingtons group has developed a bioengineered cerebrovascular model that incorporates many of the features of cerebral vessels, including an anatomically correct vascular anatomy, functional BBB, and dynamic perfusion.84,85

What Treatments Are In The Pipeline For Alzheimer’s

There are hundreds of clinical trials going on right now, in which scientists are exploring many different pathways toward diagnosis, treatment, and prevention of Alzheimer’s, says Edelmayer. There are a number of different types of therapeutics being evaluated, she explains. Some change the progression of the disease and some lessen the symptomswe need both approaches going forward. Some promising areas of research involve vaccines that prevent tau proteins from forming and drugs that reduce inflammation in the brain.

“One of the biggest hurdles in making progress is recruiting and retaining patients for these trials,” Edelmayer adds. “We especially need more diverse people, including those from underrepresented populations.”

The Best Dementia Treatments Available

Sadly, there is no cure for dementia. But, if diagnosed early there are medications and therapies which can help slow down the progression of the disease and ease some of the symptoms.

Most of the medication available is used to treat Alzheimers Disease as the most common form of dementia. They can help temporarily to reduce symptoms.

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What Everyone Can Do Today

I am hopeful that this medication will work to slow Alzheimers and reduce the suffering it causes individuals and their families. We should remember that the other FDA-approved medications for Alzheimers can also be helpful , as can controlling blood pressure, engaging in aerobic exercise, eating a Mediterranean menu of foods, staying socially active, keeping a positive attitude, and using memory strategies.

About the Author

Andrew E. Budson, MD, Contributor

Who Are These Medications For And What Are The Benefits

These medications are prescribed for people with mild to moderate Alzheimers disease. Studies show that between 40 70% of people taking the drugs benefit from them with symptoms improving temporarily for between 6-12 months.

The impact of taking cholinesterase inhibitor medications can include: reduced anxiety, improvements in memory and concentration daily activities such as personal care, dressing and shopping.

Trials to determine if these drugs also bring benefits for behavioural changes such as agitation or aggression are inconclusive, with mixed results. Unfortunately the impact of these medications gradually reduces with symptoms then gradually worsening.

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A New Alzheimers Drug Has Been Approved But Should You Take It

• By Andrew E. Budson, MD, Contributor

On June 7, 2021, the FDA granted accelerated approval to aducanumab , the first drug in 18 years for Alzheimers disease. Since then the FDA has modified the original language of the approval to recommend that it only be used in certain patients with mild cognitive impairment or early Alzheimer’s disease.

Concerns over the FDA approval of Aduhelm have led to further investigation into its safety, effectiveness, and cost. Some insurers are declining to cover it and some medical centers have decided not to prescribe it.

What You Should Know About Alzheimers Disease Symptoms Causes Treatment And Diagnosis

Alzheimer’s disease is a terrifying prospect for anyone, but especially for family members who may have to care for someone with this frightening condition. Fortunately, there are many ways to prevent the development of Alzheimer’s and other related dementias. The key is recognizing the risk factors and taking action before it’s too late.

This blog post shares some eye-opening facts about Alzheimer’s disease and how you can reduce your risk. The more you know about Alzheimer’s and what you can do to lower your risk, the better your chances of avoiding this terrible fate. Let us help you take action today!

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Questions To Ask The Doctor

If your loved one’s doctor prescribes a new medication, you could ask:

• What is its name? Does it go by any other names?
• Why have you prescribed this?
• Do they have to take this medication? Are there any alternatives?
• How often and at what time of day should they take it?
• Should they take it with food or on an empty stomach?
• Are there any side effects that I should watch for?
• How much does it cost? Are there less costly or free alternatives?

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Evaluating The Latest Alzheimer’s Disease Prevention Research

A recent review of research looked carefully at the evidence on ways to prevent or delay Alzheimer’s dementia or age-related cognitive decline. Led by a committee of experts from the National Academies of Sciences, Engineering, and Medicine , the review found “encouraging but inconclusive” evidence for three types of interventions:

The evidence for other interventions, such as medications and diet, was not as strong. However, scientists are continuing to explore these and other possible preventions.

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Alzheimers Disease: What Is The Best Treatment

Alzheimers Disease is a complex disorder that ultimately results in death after a prolonged period of mental and physical decline. The Alzheimers Association describes it as a type of dementia that affects memory, thinking, and behavior. Symptoms eventually grow severe enough to interfere with daily tasks.

Even though thousands of scientists worldwide are working on treatment and ultimately a cure for Alzheimers disease, there is still no way to stop the diseases progression.

Alzheimers disease is a very complex brain condition. There is no particular medication or therapy that can cure it, so most medical professionals focus on helping patients maintain their cognition, manage their moods and behavior, and slow down the diseases progression.

What Medications Can Help

The FDA has approved the drug aducanumab-avwa as the first therapy that targets the fundamental pathophysiology of the disease by reducing amyloid beta plaques in the brain. It is not without controversy because of concerns it may cause swelling of bleeding in the brain.

Some drugs curb the breakdown of a chemical in the brain, called acetylcholine, thatâs important for memory and learning. They may slow down how fast symptoms get worse for about half of people who take them. The effect lasts for a limited time, on average 6 to 12 months. Common side effects are usually mild for these medications and include diarrhea, vomiting, nausea, fatigue, insomnia, loss of appetite, and weight loss. There are three drugs of this type: donepezil , galantamine , and rivastigmine .

Doctors can also prescribe medicines for other health problems that happen along with the disease, including depression, sleeplessness, and behavior problems like agitation and aggression.

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Talk With Your Doctor

It can be hard to face a diagnosis of Alzheimers disease, but learning all you can about medications that could ease symptoms can help. Talking to your doctor is another important step. Before your doctor visit, you may want to write down topics and questions like these to make sure you get the answers you need:

• Which medications and medication combinations will you prescribe now and in the near future? What symptom changes can we expect after treatment begins, and what is the typical timeframe for these changes?
• What are the possible side effects of treatment? When should we call the doctor for help?
• Are there any clinical treatment trials that we could consider joining?
• In addition to medications, what lifestyle changes can we make to slow down symptoms?

What Is Alzheimers Disease

Alzheimers is the most common type of dementia, accounting for between 60 and 80% of those who are suffering from memory loss and cognitive decline that is not due to typical aging. Though there is still a lot to learn about the disease, we know that it involves changes in the brain, including shrinking, blood vessel damage, and most crucially, the development of protein deposits known as plaques and tangles: Plaques, which are made up of beta-amyloids, clog the area between nerve cells, while tangles, which are twisted fibers of the tau protein, accumulate inside the cells. Both interfere with the ability of neurons to talk to each other, and they eventually cause brain cells to die.

These changes in the brain can begin years before the person notices anything unusual is going on. In the earliest stage of the disease , the most common symptom is not being able to remember new informationthe individual may ask the same questions over and over again, get confused with simple directions, lose track of household items, and more.

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Are There Any Side Effects

Most people can take cholinesterase inhibitors and memantine without too many side effects. Not everyone has the same side effects, or has them for the same length of time.

The most common side effects of donepezil, rivastigmine and galantamine are:

• loss of appetite

Other side effects include muscle cramps, headaches, dizziness, fatigue and insomnia. Side effects can be less likely for people who start treatment by taking the lower prescribed dose for at least a month .

The side effects of memantine are less common and less severe than for the cholinesterase inhibitors. They include:

What Are The Symptoms Of Early

For most people with early-onset Alzheimer disease, the symptoms closely mirror those of other forms of Alzheimer disease.

Early symptoms:

• Withdrawal from work and social situations

• Changes in mood and personality

Later symptoms:

• Severe mood swings and behavior changes

• Deepening confusion about time, place, and life events

• Suspicions about friends, family, or caregivers

• Trouble speaking, swallowing, or walking

• Severe memory loss

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Can Increasing Physical Activity Prevent Alzheimer’s Disease

Physical activity has many health benefits, such as reducing falls, maintaining mobility and independence, and reducing the risk of chronic conditions like depression, diabetes, and high blood pressure. Based on research to date, there’s not enough evidence to recommend exercise as a way to prevent Alzheimer’s dementia or mild cognitive impairment , a condition of mild memory problems that often leads to Alzheimer’s dementia.

Years of animal and human observational studies suggest the possible benefits of exercise for the brain. Some studies have shown that people who exercise have a lower risk of cognitive decline than those who don’t. Exercise has also been associated with fewer Alzheimer’s plaques and tangles in the brain and better performance on certain cognitive tests.

While clinical trials suggest that exercise may help delay or slow age-related cognitive decline, there is not enough evidence to conclude that it can prevent or slow MCI or Alzheimer’s dementia. One study compared high-intensity aerobic exercise, such as walking or running on a treadmill, to low-intensity stretching and balance exercises in 65 volunteers with MCI and prediabetes. After 6 months, researchers found that the aerobic group had better executive functionthe ability to plan and organizethan the stretching/balance group, but not better short-term memory.

Medication For Other Forms Of Dementia

Unfortunately the medications for other forms of Dementia are minimal. Cholinesterase inhibitors may be offered to patients with dementia with Lewy bodies or Parkinsons disease dementia if they have particular symptoms such as hallucinations or challenging agitation or aggression. There are no firm scientific conclusions as to the efficacy of Memantine for either of these forms of dementia.

There are very small studies around the effectiveness of either inhibitors or Memantine for those with vascular dementia, mixed dementia or frontal temporal dementia including Picks disease.

Other Treatments available:

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Medications Used To Help Treat Alzheimers Disease

Below are examples of the drugs most commonly prescribed to prevent or slow the development of AD symptoms. How effective these drugs are can vary from person to person. All of these drugs also become less effective over time as AD becomes gradually worse.

Donepezil : This drug is used to delay or slow the symptoms of mild, moderate, and severe AD. It comes in a tablet or disintegrating tablet.

Galantamine : This drug is used to prevent or slow the symptoms of mild to moderate AD. It comes as a tablet, extended-release capsule, or oral solution .

Memantine : This drug is sometimes given with Aricept, Exelon, or Razadyne. Its used to delay or slow the symptoms of moderate to severe AD. It comes in a tablet, extended-release capsule, and oral solution.

Rivastigmine : This drug is used to prevent or slow the symptoms of mild to moderate AD. It comes in a capsule or extended-release transdermal patch.

Memantine extended-release and donepezil : This drug capsule is used to treat moderate to severe AD. Its prescribed for certain people who take donepezil and who have not had bad reactions to the ingredients. No evidence suggests that it prevents or slows underlying disease process.

Targeting The Immune System

Malú Gámez Tansey from the University of Florida College of Medicine discussed her work in targeting inflammation, specifically the proinflammatory cytokine tumor necrosis factor , in Alzheimers disease. Genetic analyses, neuroimaging studies, neurohistology, epidemiological, and most recently genome-wide association studies indicate that inflammation plays a central role in Alzheimers disease. The prevailing view of inflammation in Alzheimers disease is that accumulation of A activates microglia, which attempt to clear the plaques. At some point, the plaques overwhelm the microglia.24 On the basis of the fact that over 60% of GWAS hits implicate immune-specific genes in risk for late-onset Alzheimers disease,25 Tansey proposed an alternate view wherein age-related immune dysfunction leads to dysfunctional microglia that are unable to clear plaques in Alzheimers disease. She suggested that similar immune dysfunction may be the precipitating mechanism for many other neurodegenerative diseases.

A phase 1b trial of XPro1595 is currently enrolling in Australia. Eighteen patients with mild cognitive impairment or early Alzheimers disease will receive XPro1595 once weekly for 3 months. The trial is investigating whether XPro1595 can mitigate biomarkers of inflammation and will also investigate the drugs safety profile.32 The results could inform the design of longer, larger trials to investigate XPro1595s effects on clinical manifestations of Alzheimers disease.

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What Is Aducanumab

This is the first drug approved by the FDA to treat Alzheimer’s disease in decades. If your loved one is in the early stages of Alzheimer’s disease, the most common form of dementia, their doctor may prescribe this monthly infusion.

What it does: It’s a monoclonal antibody that lessens the buildup of things called amyloid plaques in your brain. These plaques are part of what leads to the memory loss associated with Alzheimer’s disease.

What to expect: For people with mild cognitive impairment or early Alzheimer’s disease, the drug appears to slow down the progression of Alzheimer’s disease.

Side effects: The most common appears to be something called ARIA: amyloid-related imaging abnormalities. One study suggests that 41% of people who take this drug will develop ARIA. These problems include temporary swelling in the brain and small areas of bleeding.

What The Data Show

The late-stage development program for Aduhelm consisted of two phase 3 clinical trials. One study met the primary endpoint, showing reduction in clinical decline. The second trial did not meet the primary endpoint. In all studies in which it was evaluated, however, Aduhelm consistently and very convincingly reduced the level of amyloid plaques in the brain in a dose- and time-dependent fashion. It is expected that the reduction in amyloid plaque will result in a reduction in clinical decline.

We know that the Peripheral and Central Nervous System Drugs Advisory Committee, which convened in November 2020 to review the clinical trial data and discuss the evidence supporting the Aduhelm application, did not agree that it was reasonable to consider the clinical benefit of the one successful trial as the primary evidence supporting approval. The option of Accelerated Approval was not discussed by the Advisory Committee. As mentioned above, treatment with Aduhelm was clearly shown in all trials to substantially reduce amyloid beta plaques. This reduction in plaques is reasonably likely to result in clinical benefit. After the Advisory Committee provided its feedback, our review and deliberations continued, and we decided that the evidence presented in the Aduhelm application met the standard for Accelerated Approval. We thank the Advisory Committee for its independent review of the data and valuable advice.

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What Are The Cholinesterase Inhibitor Medications Called

Donepezil: originally patented as the brand name Aricept, but more widely available now as the generic Donepezil

Rivastigmine: originally patented as Exelon, and is now also available as other brands as well as generic Rivastigmine

Galantamine originally patented as Reminyl and is now also available as generic galantamine and the brands Reminyl XL, Acumor XL, Galsya XL and Gatalin XL.

How Long Should Alzheimer’s Drugs Be Taken For

These drugs are usually prescribed for a trial period of 3 to 4 months to see if they show signs of helping.

There is no clear view as to how long they should be taken. If the condition progresses in spite of treatment, there may come a point when you and your doctor decide that there is little point in staying on them.

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