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.
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.”
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
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Sign And Symptoms Of Alzheimer Diseases
The most common indication of the occurrence of Alzheimers disease in the initial stage is short-term memory loss. Difficulty in remembering recent events. Slowly, with the advancement of the disease, the sufferers start having difficulties with language. Along with mood swings, disorientation, problems in performing familiar tasks, depression, loss of motivation, behavioral problems, vision problems, and inability to manage self-care.
A further deterioration in the condition generally leads to loss of interest in day-to-day activities and withdrawal from the family and the society. Eventually, the sufferers lose control over their bodily functions, and the condition finally leads to death.
In nearly one-third of the cases, the risk of the disease is believed to be genetic. Besides genetics, some of the other risk factors for the disease include hypertension, depression, or head injuries in the past. The progression of the disease is linked to plaques and tangles in the brain.
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.
| Drug Name | For More Information |
|---|---|
| Aducanumab |
|
|
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How Alzheimer’s Disease Is Treated
If you or someone you know has been diagnosed with Alzheimer’s disease, you may feel scared, frustrated, and more. While there is no cure for Alzheimer’s at this time, there are many ways to treat the symptoms and even help manage the disease’s progression.
Treatment options for the behavioral and psychological symptoms of Alzheimer’s include drug therapy and non-drug approaches, such as behavioral and environmental modifications.
Other Important Aetiological Mechanisms
Vascular disease
While traditionally it was felt that vascular disease was the underlying factor in the development of VaD, it is clear that vascular burden also plays a role in AD pathogenesis, and that there is significant overlap between these two dementia subtypes. Vascular risk factors, such as high BMI, smoking, hypercholesterolemia and hypertension, have been associated with an increased risk of developing clinical AD. While vascular lesions such as cerebral amyloid angiopathy and white matter hyperintensities are common in patients with AD, hypertension is also associated with the development of specific neuropathological hallmarks of AD such as NFTs, and this association appears to be stronger when hypertension is present in mid rather than late life. Thus, vascular disease may directly affect amyloid plaques or NFTs by increasing their formation or reducing their elimination from the brain.
Given these findings, it would seem to follow that control of vascular risk factors may slow the rate of decline of cognition in patients with AD however, this is not yet supported by data from randomised controlled trials.
Diabetes and hyperinsulinaemia
These findings have led to the theory that drugs used in diabetes may be able to modify the pathophysiology of AD and a study of intranasal insulin as a therapy in mild cognitive impairment and AD is currently being conducted after encouraging results from small pilot studies.
Apolipoprotein gene
Neuroinflammation
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When Will The Treatment Be Available
Lecanemab may be on track to become available to patients aged 65 years and over in the U.S. as soon as next year, but the experts MNT interviewed cautioned that there is still a very long road ahead in finding the best, most effective treatment for Alzheimers disease.
I think this drug is a monumental step in the right direction, but we are still probably 5-10 years from the type of powerful drug intervention we are all waiting for, Dr. Sullivan added.
And while Dr. Porter called the clinical trial results encouraging, she said they are still learning more about Alzheimers disease that may impact future medications.
We are learning that deposition of amyloid plaques leads to disorganization of another protein, tau, which creates tangles that disrupt the critical connections between neurons, she explained. Potentially, combining an anti-amyloid drug with an anti-tau compound may prove even more effective in putting the brakes on the neurodegeneration that is associated with Alzheimers.
We still have more to learn about the pathophysiology of Alzheimers disease and the primary, inciting events that lead to its development which may prove to be the most effective targets for future therapeutic interventions, Dr. Porter pointed out.
What Are The Stages Of Alzheimers Disease
Alzheimers disease organizations and healthcare providers use various terms to describe the stages of Alzheimers disease based on symptoms.
While the terms vary, the stages all follow the same pattern AD symptoms progressively worsen over time.
No two people experience AD in the same way, though. Each person with Alzheimers disease will progress through the stages at different speeds. Not all changes will occur in each person. It can sometimes be difficult for providers to place a person with AD in a specific stage as stages may overlap.
Some organizations and providers frame the stages of Alzheimers disease in terms of dementia:
- Preclinical Alzheimers disease.
- Mild cognitive impairment due to Alzheimers disease.
- Mild dementia due to Alzheimers disease.
- Moderate dementia due to Alzheimers disease
- Severe dementia due to Alzheimers disease.
Other organizations and providers more broadly explain the stages as:
Dont be afraid to ask your healthcare provider or your loved ones provider what they mean when they use certain words to describe the stages of Alzheimers.
What is preclinical Alzheimers disease?
Providers typically only reference the preclinical stage in research on Alzheimers disease. People with AD in the preclinical stage typically have no symptoms .
There are now brain imaging tests that can detect deposits of a protein in your brain called amyloid that interfere with your brains communication system before symptoms start.
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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:
Gene Expression Data Point To Exercise As The Most Effective Treatment For Alzheimers Disease
An analysis of 22 large-scale gene expression datasets pointed to exercise and activity in general as the most effective theoretical treatment for reversing gene expressions typical of Alzheimers disease. Fluoxetine, a well-known antidepressant sold often commercially as Prozac or Zoloft, also showed effect, particularly when combined with exercise. Curcumin showed positive effects as well. The study was published in Scientific Reports.
Alzheimers disease is a complex neurodegenerative disorder that affects multiple brain regions. It is the most common disease that causes dementia and is very difficult to treat. In the course of the disease, abnormal collections of proteins called tau accumulate inside neurons.
Another type of protein clumps together to form so-called amyloid plaques that collect between neurons and disrupt cell functions. These and other changes harm the functioning of the brain across different regions and lead to dysfunction and death of brain cells.
Alzheimers disease is a devastating disease for individuals, but also negatively impacts family members. We were interested in exploring the basis of the disease and possible treatments, said Stephen C. Gammie, a professor at the University of Wisconsin-Madison and the corresponding author of the new study.
The paper Alzheimers disease largescale gene expression portrait identifies exercise as the top theoretical treatment was authored by Mason A. Hill and Stephen C. Gammie.
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How Promising Is Lecanemab
Knowing what we do so far about lecanemab, what should be our most realistic expectations on its safety and efficacy?
Dr. Heather Snyder, Alzheimers Association vice president of medical and scientific relations, told MNT these are the most encouraging results in clinical trials treating Alzheimers to date.
These results indicate lecanemab can give people more time at or near their full abilities to participate in daily life, remain independent and make future healthcare decisions, she said.
Treatments that deliver these benefits to those with mild cognitive impairment due to Alzheimers disease and early Alzheimers dementia are just as valuable as treatments that extend the lives of those with other terminal diseases, added Dr. Snyder.
I am hopeful from a research perspective, this is a breakthrough that those of us who study Alzheimers disease have been waiting for, but I am less hopeful that this will be the big thing that will help most of my current patients. In clinical trials, participants who took this drug saw a 27% reduction over 18 months in expected cognitive decline which sounds really meaningful, but the real-world impact of this may not be noticeable to families and thats what really matters. What is effective statistically isnt always effective clinically. The full data set has not been realized yet so I remain open-minded that this could be a game-changer.
Dr. Karen D. Sullivan
Treatment For Mild To Moderate Alzheimers
Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.
Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.
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How Is Alzheimers Disease Diagnosed
Healthcare providers use several methods to determine if a person with memory issues has Alzheimers disease. This is because many other conditions, especially neurological conditions, can cause dementia and other symptoms of Alzheimers.
In the beginning steps of an Alzheimers diagnosis, a provider will ask questions to better understand your health and daily living. Your provider may also ask someone close to you, like a family member or caregiver, for insight into your symptoms. Theyll ask about:
- Overall health.
- Ability to carry out daily activities.
- Changes in mood, behavior and personality.
A provider will also:
- Perform a physical exam and a neurological exam.
- Perform a mental status exam, which includes tests to assess memory, problem-solving, attention, basic math and language.
- Order standard medical tests, such as blood and urine tests, to rule out other possible causes of the symptoms.
- Order brain imaging tests, such as a brain CT, brain MRI or positron emission tomography, to support an Alzheimers diagnosis or to rule out other possible conditions.
What The Fda’s Accelerated Approval Of A New Alzheimer’s Drug Could Mean For Those With The Disease 5 Questions Answered About Lecanemab
The U.S. Food and Drug Administration approved the medication lecanemab, sold under the brand name Leqembi, on Jan. 6, 2023, through an accelerated approval pathway that fast-tracks promising clinical treatments for diseases in which there are no other currently effective options.
The Conversation asked James E. Galvin, a neurologist from the University of Miami School of Medicine who specializes in the study of Alzheimers disease and Lewy body dementia, to explain the drugs clinical potential to help ease the suffering of the roughly 6.5 million Americans who live with Alzheimers.
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What To Expect From Treatment For Alzheimer’s Disease Or Another Dementia
There are numerous causes of memory and thinking difficulties. Many, including Alzheimer’s disease, are treatable. Others, such as depression, thyroid problems, severe nutritional deficiency, or medication interaction, may be reversible. Patients who are evaluated through the ADMDC should expect to have their options for treatment identified and explained to them so that they may make a well informed decision about their care. If a diagnosis of Alzheimer’s is made, regardless of the severity of the disease, treatment options are available.
Treatments for the symptoms of AD have been available for some time. Initially, the only medications available were treatment for the non-cognitive or behavioral symptoms of AD which may or may not develop during the course of illness. In 1993, the Food and Drug Administration approved the first medication intended to treat the cognitive symptoms of AD. That drug was Cognex. Cognex is no longer prescribed due to difficult side effects and the development of better tolerated medications. The FDA has since approved three drugs for the treatment of mild to moderate AD: Donepezil was approved in 1996, Rivastigmine was approved in 2000, and galantamine was approved in 2001. In October, 2003, the FDA approved Memantine for the treatment of moderate to severe AD.
Persons seeking treatment for memory or thinking problems must establish realistic expectations for treatment, and a clear understanding of the goals of therapy.
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How Well Does Lecanemab Work
In late November 2022, Eisai presented the full findings of its Phase 3 Clarity AD clinical trial for lecanemab at the 15th Clinical Trials on Alzheimers Disease conference.
During the clinical trial, about 1,800 adults ages 50 to 90 with early Alzheimers disease received either lecanemab or a placebo. Participants also received assessments of certain cognitive and functional skills both before the trial began, and 18 months later.
Finally, the participants undertook PET scans to check for the presence of amyloid in the brain.
At the 18-month follow-up, researchers reported people who took lecanemab slowed their cognitive decline by 27% compared to those who took the placebo.
Results of the Clarity clinical trial also demonstrated lecanemab had beneficial effects on biomarkers for amyloid,
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Who Does Alzheimers Disease Affect
Alzheimers disease mainly affects people over age 65. The higher your age over 65, the more likely youll develop Alzheimers.
Some people develop Alzheimers disease before age 65 typically in their 40s or 50s. This is called early-onset Alzheimers disease. Its rare. Less than 10% of AD cases are early-onset.