Best Treatment For Alzheimer’s

What Effects Can These Drugs Have

They can improve memory. They can also have general benefits including improving alertness and motivation.

It may take some months for there to be a noticeable improvement or slowing down of memory loss. Some people feel brighter in their mood and will be able to do things that were too hard for them, such as going shopping.

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.

Behavioural Therapy For Dementia

Behavioural therapy works to understand the source of the behaviour, and then suggest alternative strategies to address the underlying cause.

For example, a person with dementia may have a history of wandering out of their home because they feel restless. Therefore, encouraging such people to find another outlet for their restlessness, such as regular physical activity, might address the problematic behaviour.

Behavioural therapy is not a solution to the many behavioural problems associated with dementia , but it is a useful tool in lessening their impact. Behavioural therapy is supervised by a healthcare professional, but can often be given by a trained friend or relative, usually the main family carer.

As in all treatments for any disease, everyone is different and reacts differently results can vary by day or even parts of days. It is, therefore, important to keep checking in with the medical team if you notice any changes in your parents behaviour. It may be possible to change the dementia drugs or try a new dementia therapy to support their condition as it progresses.

To help make sure you know what to look out for, weve put together a list of the most common early signs of dementia, which you can take a look at in more detail. You can also download our free guide to dementia for information on diagnosis, legal considerations and support available.

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Diet And Supplements For Alzheimers Disease

Theres no diet or supplement that can reverse Alzheimers, but theres some evidence that diet can play a role in preventing Alzheimers disease.

Specifically, there seems to be a link between the Mediterranean diet and memory. Since high blood pressure is known to be an additional risk for Alzheimers, the MIND diet is sometimes recommended. The MIND diet is a variation of the Mediterranean diet that blends it with the Dietary Approaches to Stop Hypertension diet.

Following the MIND diet involves cooking with olive oil and eating more:

• leafy green vegetables

• fast food and convenience items

Evidence to support following a Mediterranean or MIND diet to improve memory and cognition isnt definitive. Studies have been done, but they arent conclusive. These diets wont reverse any Alzheimers symptoms, and its still unclear whether theyll reduce your risk.

However, the foods suggested in these diets have high nutritional value. This could offer benefits for your overall health in addition to the possibility of lowering your risk for Alzheimers.

What Are Alzheimer’s Treatment Options

In addition to the newly approved aducanumab, there are five other FDA-approved medications to treat the cognitive symptoms of Alzheimers. These medications cant reverse or stop the progression of Alzheimers, but what they can do is turn up the volume between the brain cells so they can communicate better, Edelmayer explains. She also points out that patients see the most benefits when these medications are taken at the earliest stages of cognitive decline. An early and accurate diagnosis is really important, she says. The biology of it is that you may not see as much benefit later, when the cells that it is meant to work on no longer exist in the brain.

These treatments fall into two categories:

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Taking Medications By Mouth

Giving medications by mouth to an AD patient can be a real challenge. For example, they may refuse or spit the pill out, or they may not swallow it at all because they do it know it is a medication. It could also be that the individual may have a physical problem that prevents swallowing. In such cases, it is important to speak to the pharmacist and obtain the medication in a liquid form, if possible. Another option is to break the pill in half or open the capsule and sprinkle the powder into food or a beverage.

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

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Reminiscence And Life Story Work

Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.

Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.

These approaches are sometimes combined. Evidence shows they can improve mood and wellbeing.

Find out how to live well with dementia and more useful information in the NHS Dementia Guide.

Page last reviewed: 05 July 2021 Next review due: 05 July 2024

How Much Does It Cost And How Soon Can I Get It

Biogen, the company that makes aducanumab, estimates its cost at $56,000 per year. It is not yet clear whether Medicare, Medicaid, or private insurance companies will pay for this medication. In its press release, Biogen noted that they are working on an agreement with the Veterans Health Administration to cover this medication for veterans enrolled in VA healthcare. Aducanumab is not currently available, but the company is working to make the drug available quickly, perhaps in a few months.

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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.

Who Is The Drug For And What Are The Benefits

The NICE guidance recommends use of Memantine for people with severe Alzheimers disease, and for those with moderate Alzheimers who may suffer significant side effects from cholinesterase inhibitor drugs.

For those in the middle and later stages of the disease it can slow down the progression of symptoms such as disorientation, as well as difficulties with daily activities .

There is some evidence that memantine may also help with symptoms such as aggression and delusion.

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Preview Of Best Dementia Treatments In Michigan

Medicines Medication can help control some symptoms of dementia, such as anxiety, agitation, and insomnia. They can also help reduce hallucinations and delusions caused by the condition. In addition, some people may get better from antidepressants or painkillers to ease any depression they experience.

Occupational Therapy Therapy helps people continue to live independently in their own homes. For example, they can find what they need more quickly by using simple techniques such as organizing things in cupboards or drawers. It may also involve practical advice about how to cope with everyday tasks such as cooking and cleaning.

Physical TherapyPhysical therapy aims to improve mobility in people who have difficulty walking due to muscle weakness or coordination problems. Physical therapists can also teach caregivers how best to assist those with memory loss, so they dont fall or get injured during everyday activities such as bathing.

Psychological TherapiesThese exercises include cognitive behavioral therapy , which aims to teach people how to change negative thoughts into positive ones. It involves counseling, which helps them deal with anxiety or depression related to their illness. In addition, reminiscence therapy encourages older adults with dementia to recount and share past experiences with others.

Drugs To Manage Dementia

Over the past three decades, several drugs have been developed to manage the thinking and memory problems seen in patients with Alzheimers disease. These include the best medications for Alzheimers patients to date. Overall, these drugs do help with some neuropsychiatric problems but only in the mild stage of the disease. Known as cholinesterase inhibitors, the drugs include:

Some patients with AD do obtain benefits from these drugs, such as better concentration, decreased anxiety, and more motivation, and some are even able to maintain their regular daily activities. But these improvements usually only last 6-12 months. Their main benefit is that they delay disease worsening for some time.

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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.

Pharmacological Therapies For The Cognitive Symptoms Associated With Alzheimer’s Disease

There are different medications and treatment regimes for dementia. The main types of medication that can be used are:

• Cholinesterase Inhibitors

These approved medications help assist the symptoms of Alzheimer’s disease but they do not treat the underlying disease or delay its progression

It is important to communicate to patients and their families what the expected modest benefits of these medications are, and the fact that decline will continue despite the medication provided.

Medication Management and Medication Review

After starting a medication, patients should be regularly reassessed. This should include standardised tests of cognition and function to determine the medication’s effectiveness and possible side-effects (and drug interactions relating to the use of multiple medications. Carers or family members should ideally also be consulted.

Regular reviews of the patient’s general practice dementia management/care plan is recommended and ensure that your patient and their family/carers are empowered with information about their medications in order that they can make informed decisions concerning their own health.

For more information please visit the government health website

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Heart And Brain Connection

More evidence seems to link the brain and the heart as an extremely important connection in Alzheimers patients. Population studies reveal that people whose blood pressure is controlled and who lead a healthy lifestyle have a far lower risk of AD compared to populations who have high blood pressure and live an unhealthy lifestyle. Hence, the current emphasis is on adopting a positive lifestyle in the hopes of preventing AD in the first place. This means eating healthy, exercising regularly, discontinuing smoking, maintaining a healthy weight, and keeping blood pressure within normal limits. Speak to your healthcare provider if you want to know more about lowering your risk of getting diagnosed with Alzheimers disease. Preventing AD in the first place is a far better option than treating it later.

Neurodegenerative Pathways Implicated In Ad

Several overlapping mechanisms have been proposed to explain the underlying pathology of AD, and both current and potential future treatments are based on modification of these pathways

Aetiology of Alzheimer’s disease with therapeutic targets. A secretase enzyme inhibitors B NMDA receptor modulators, eg memantine C immunotherapy, including immunisation and direct anti-amyloid therapy, including monoclonal antibodies D anti-tau therapy E anti-inflammatory treatments, including NSAIDs F anticholinesterase inhibitors, eg donepezil. APP = amyloid precursor protein NFTs = neurofibrillary tangles NMDA = N-methyl-D-aspartate NSAIDs = non-steroidal anti-inflammatory drugs.

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What You Can Do About Medications And Difficult Dementia Behaviors

If your relative with dementia is not yet taking medications for behaviors, consider these tips:

• Start keeping a journal and learn to identify triggers of difficult behaviors. You will need to observe the person carefully. Your journaling will come in handy later if you start medications, as this will help you monitor for benefit and side-effects.

• Learn to redirect and de-escalate difficult dementia behaviors. Contact your local Alzheimers Association chapter or local Area Agency on Aging to find support near you. You can also learn a good approach in this article: 7 Steps to Managing Difficult Dementia Behaviors

• Ask your doctor to help assess for pain and/or constipation. Consider a trial of scheduled acetaminophen, and see if this helps.

• Consider the possibility of depression. Consider a trial of escitalopram or a related antidepressant, but realize any effect will take weeks to appear.

• For all medications for dementia behaviors:
• Monitor carefully for evidence of improvement and for signs of side-effects.
• Doses should be increased a little bit at a time.
• Especially for antipsychotics, the goal is to find the minimum necessary dose to keep behavior manageable.

If your relative with dementia is currently taking medications for behaviors, then you will have to consider at least the following two issues.

The other issue is to make sure you are aware of any risks or side-effects that the current medications may be causing.

But Does The Drug Work

In a prior blog post I reviewed the publicly available data and the daylong FDA hearing on aducanumab. In a nutshell, there were two large clinical trials to assess effectiveness, side effects, safety, and how the drug might be used in clinical practice. One of the studies was positive, meaning that the drug worked to slow down the decline of thinking, memory, and function that is usually impossible to stop in Alzheimers. The other large study was negative. In my view and that of the FDA advisory panel these results mean that we dont know if the drug works or not.

Another factor to consider is that the potential benefit if the drug works as well as it did in the positive study was fairly small. Looking at the two objective measures, in the positive trial, the high dose made a 0.6-point change on the 30-point Mini-Mental State Examination. On the 85-point Alzheimers Disease Assessment ScaleCognitive Subscale-13, the high dose made a 1.4-point change.

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Treatment For Moderate To Severe Alzheimers

A medication known as memantine, an N-methyl D-aspartate antagonist, is prescribed to treat moderate to severe Alzheimers disease. This drugs main effect is to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both the person with Alzheimer’s and caregivers.

Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for the treatment of moderate to severe Alzheimers.

How Is Alzheimer’s Disease Treated

Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.

Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.

Most medicines work best for people in the early or middle stages of Alzheimers. However, it is important to understand that none of the medications available at this time will cure Alzheimers.

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