What Is The Treatment For Alzheimer’s

What Is The Outlook For People With Alzheimers Disease

Alzheimers disease gets worse over time and is ultimately fatal. Persons with Alzheimers disease live, on average, four to eight years after diagnosis. Some patients can live as long as 20 years after diagnosis. The course of the disease varies from person to person.

Last reviewed by a Cleveland Clinic medical professional on 03/18/2019.

References

What Are The Side Effects

The most common side-effects are feeling sick, loss of appetite, tiredness, diarrhoea, muscle cramps and sometimes poor sleep. These may be reduced or avoided by increasing the dose slowly, or taking the medicine after food.

The side-effects usually fade after a few weeks and will go away if the medicine is stopped. More information about side-effects can be obtained from your doctor or by reading the leaflet that comes with the tablets.

The First Treatment For Alzheimers Disease Is Here

Alzheimers disease was first described by Alois Alzheimer in 1906, and now, more than 100 years later, doctors have an effective drug to treat the cognitive disorder.

On June 7, the U.S. Food and Drug Administration approved aducanumab, developed by the U.S.-based biotech Biogen and Japanese pharmaceutical company Eisai. But the drugs approval comes with a caveat. The FDA is requiring Biogen to conduct an additional placebo controlled study of the drug to verify its effectiveness in improving peoples memory and cognitive symptoms.

That request stems in large part from the conclusion of an expert panel convened by the FDA last November, which almost unanimously decided that the evidence presented by the drugs developers did not justify approval. The committees recommendation then went to the FDA, and the agency extended the deadline for making a decision from last March to June 7.

The drugs rocky road of failed and halted clinical trials has generated divided opinions among brain experts about how useful the drug actually is, with some, including the Alzheimers Association, supporting approval as the first treatment for the diseasethe currently approved therapies for Alzheimers only address the symptoms of Alzheimers and not its root causesand others not convinced the data prove that the benefits of the drug outweigh its potential risks.

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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.

Therapies For Prevention And Treatment Of Alzheimers Disease

G. Garcia-Alcocer

1Laboratorio de Investigación Genética, Facultad de Química, Universidad Autónoma de Querétaro, Cerro de las Campanas S/N, Centro Universitario, 76010 Santiago de Querétaro, QRO, Mexico

Abstract

1. Introduction

Alzheimers disease is an age-related, progressive, and irreversible neurodegenerative disorder characterized by cognitive and memory impairment, and it is the most common cause of dementia in older adults. The estimated prevalence of this disease in 2015 was 44 million people throughout the world and it is estimated that this figure will double by 2050 . Most people with AD have sporadic or late-onset AD , a multifactorial disease in which environmental factors and genetic predisposition contribute to the pathology . The other form of AD, familial or early-onset AD , corresponds to less than 5% of the AD population and is due to mutations in any of the three following genes: the amyloid precursor protein gene on chromosome 21, presenilin 1 gene on chromosome 14, and presenilin 2 gene on chromosome 1 . The classification of AD is based on clinical criteria including medical history, physical examination, laboratory tests, neuroimaging, and neuropsychological evaluation .

2. Pathogenesis and Clinical Features in AD

2.1. Risk Factors for LOAD

The main metabolic and nongenetic risk factors include hypercholesterolemia , obesity , hyperhomocysteinemia , hypertension , and type 2 diabetes mellitus .

2.1.1. Genetic Susceptibility to LOAD

4.1. Lifestyle

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Natural Alzheimers Treatment #: Sleep

Research indicates there is a strong link between cognition and sleep. Studies into sleep deprivation show that healthy adults losing even one-third of a normal nights worth of sleep can suffer severe short-term memory loss, comparable to cognitive impairment seen in dementia. Those diagnosed with Alzheimers disease and related dementias can suffer even greater consequences when their sleep is disturbed, making normal dementia symptoms worse. Normally, sleep disturbances are common side effects of dementia, so this problem can be quite complicated for an elder with dementia as well as their caregiver.

Cognitive-behavioral therapy has been shown to improve symptoms of insomnia as well as depression in elders, the main benefit of therapy being education about good sleep hygiene. Elders and their caregivers both benefit from CBT for stress relief and insomnia.

Another useful tool to help regulate our circadian rhythms as we age is bright-light therapy , where bright lights are viewed by the person with insomnia at certain times of day in order to prompt the body into picking up a healthy circadian rhythm. Exercise is also a great way to improve sleep, with research showing that regular aerobic exercise is one of the best ways to naturally regulate sleep.

How Does Dementia Affect The Brain

âDementia-causing diseases can impede communication between neurotransmitters, effectively unplugging the connections in the brain, leading to the eventual destruction of the brain cells themselves.

Alzheimerâs disease begins in the hippocampus and entorhinal cortex, both situated in the temporal lobe, the area of the brain most associated with memory. This is why an early sign of dementia is poor memory. With other types of dementia, or through general progression, the damage begins in or spreads to other areas of the brain. This explains the complex range of symptoms.

Damage to the frontal lobe, the area associated with self-control, organization, and working memory, will impact reasoning, judgment, and behavior. Any damage to the parietal lobe will show weakened language skills, such as difficulty forming long sentences or making sense of conversations heard.

The exact places where dementia first develops can depend on the cause. The symptoms correlated with the locality of the brain impaired. For example, frontotemporal dementia is concerned with the frontal and temporal lobes, impacting executive functions and memory. In contrast, Parkinsonâs disease damages the basal ganglia, an area deeply buried in the brain responsible for motor skills.

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Mori People With Dementia

Mori are 8.5 and 3.3 years younger than Pkeh and Pasifika, respectively when they are diagnosed. Mori understandings of mate wareware differ from the main Western conceptions of dementia. Whnau are generally inclusive of their whnau members changes in their daily functioning and new emerging behaviours. Whnau are crucial for the care of a kaumtua with mate wareware, so they need to be included in treatment discussions and decisions, along with the person with mate wareware.Te oranga wairua has been identified as central to Mori thinking about health, and effective care for someone with mate wareware must therefore include cultural practices to strengthen wairua of the whole whnau.Read more: Dudley M, Menzies O, Elder H, Nathan L, Garrett N, Wilson D. Mate wareware understanding dementia from a Mori perspective NZ Med J. 2019 Oct 4 132.

Approach To The Patient

• References

Guidelines on the treatment of Alzheimer disease are available from a number of organizations , including one developed by the American Academy of Family Physicians, in conjunction with the American College of Physicians.15 All guidelines emphasize the importance of educating patients and their families about the disease process and its expected course. Early referral to local support groups is recommended, and medicolegal issues such as driving and end-of-life planning should be addressed. Recommendations regarding pharmacologic treatment are described in Table 2,2123 and a suggested algorithm for the treatment of Alzheimer disease is presented in Figure 1. The decision to treat with medication should be shared with the patient and caregivers, including a discussion of the modest clinical benefit, adverse effects, and cost. Physicians should consider discontinuing therapy in patients who continue to decline despite maximal therapy.16 The National Institute on Aging and the Alzheimer’s Association have released recommendations on the diagnosis of dementia and mild cognitive impairment from Alzheimer disease however, these guidelines do not address the treatment of Alzheimer disease and do not recommend the clinical use of biomarkers.52,53

Summary of Guidelines for the Treatment of Alzheimer Disease

American Academy of Family Physicians and American College of Physicians15

MMSE = Mini-Mental State Examination.

Information from references 2, and 14 through 20.

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What Newer Medications Are Under Study

All currently approved medications target Alzheimers disease after it develops. Scientists are currently researching ways to stop or slow the progress of Alzheimers disease before it starts.

Some of the drugs in late-stage investigation are called monoclonal antibodies. These drugs target the amyloid protein that builds up in brain cells. They work by attaching to the amyloid proteins as they float in the brain and remove them, before they form into the plaques and tangles that interfere with the brains ability to properly function.

These drugs are still in clinical trials and are several years away from Food and Drug Administration approval in the United States. Early results have been mixed, with some trials showing no improvement in brain function others showing a slight improvement . Despite the mixed results, researchers are excited about this new potential method to modify the disease process.

Mental Activity To Support Cognition

Many patients with normal cognition or those with mild impairment are concerned that they may develop AD. Many experts believe that mentally challenging activities, such as doing crossword puzzles and brainteasers, may reduce the risk in such patients. Whether such activities might slow the rate of disease progression in patients who already have AD is not known. Clinical trials are under way to determine the effect these cognitive activities have on AD progression.

Mental activities should be kept within a reasonable level of difficulty. Activities should preferably be interactive, and they should be designed to allow the patient to recognize and correct mistakes. Most important, these activities should be administered in a manner that does not cause excessive frustration and that ideally motivates the patient to engage in them frequently. Unfortunately, little standardization or rigorous testing has been done to validate this treatment modality.

Some investigators have attempted various forms of cognitive retraining, also known as cognitive rehabilitation. The results of this approach remain controversial, and a broad experimental study needs to be performed to determine whether it is useful in AD.

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How Cholinesterase Inhibitors Work

In Alzheimers disease, nerve cells become damaged and lose their ability to communicate. Cholinesterase inhibitors work by increasing the amount of a chemical called acetylcholine, that helps messages to travel around the brain. These messages are vital to the way we move, think and remember. Cholinesterase inhibitors can reduce the symptoms of Alzheimers for a time.

These treatments are normally given as tablets or capsules, but they are available in a liquid form too. Donepezil is also available as a tablet that dissolves on the tongue, and Rivastigmine is available in patches, where the drug is absorbed through the skin. Your doctor will discuss the most suitable form for you.

Effects Of Cholinesterase Inhibitors

People with Alzheimers may find that their symptoms improve by taking a cholinesterase inhibitor. This could be improvement in thinking, memory, communication or with day-to-day activities. Others may find that their condition stays the same, or that their symptoms do not worsen as quickly as they would have expected. Some people may not notice any effect at all.

As these drugs dont stop the disease from progressing in the brain, symptoms will continue to get worse over time. However, they can help some people to function slightly better than they would do without the drug.

The most common side-effects of cholinesterase inhibitors are feeling or being sick, diarrhoea, having trouble sleeping, muscle cramps and tiredness. These effects are often mild and usually only temporary. Not everyone will experience side-effects. If you are worried about side-effects you can talk about this with your doctor.

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What Is Alzheimer’s Disease

Alzheimers disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with the disease those with the late-onset type symptoms first appear in their mid-60s. Early-onset Alzheimers occurs between a persons 30s and mid-60s and is very rare. Alzheimers disease is the most common cause of dementia among older adults.

The disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps and tangled bundles of fibers .

These plaques and tangles in the brain are still considered some of the main features of Alzheimers disease. Another feature is the loss of connections between nerve cells in the brain. Neurons transmit messages between different parts of the brain, and from the brain to muscles and organs in the body. Many other complex brain changes are thought to play a role in Alzheimers, too.

This damage initially appears to take place in the hippocampus, the part of the brain essential in forming memories. As neurons die, additional parts of the brain are affected. By the final stage of Alzheimers, damage is widespread, and brain tissue has shrunk significantly.

Treatment Of Alzheimer Disease

BRADFORD T. WINSLOW, MD, Swedish Family Medicine Residency, Littleton, Colorado

CHRISTIAN M. STOB, DO, Denver Health Medical Center, Denver, Colorado

KATHLEEN A. HAZLEWOOD, PharmD, University of Wyoming School of Pharmacy, Laramie, Wyoming

Am Fam Physician. 2011 Jun 15 83:1403-1412.

Patient information: See related handout on Alzheimer disease, written by the authors of this article.

• References

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Acetylcholinesterase inhibitors are modestly effective in patients with mild to moderate Alzheimer disease, although limited by their adverse effects.

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What Are Some Risk Factors For Alzheimers Disease

Risk factors for the development of Alzheimers disease include:

• Age. Increasing age is the primary risk factor for developing Alzheimers disease.
• Genetics . There is a certain gene, apolipoprotein E that is associated with late-onset Alzheimers disease. Other genes have been associated with early-onset Alzheimers disease.
• Smoking
• Obesity

Researchers believe the presence of the last five risk factors mentioned above might reduce the clearance of amyloid protein from the brain, which then increases the risk of developing Alzheimers disease. In particular, the presence of a number of these risk factors at the same time and while the person is in his or her 50s is associated with a higher risk of Alzheimers disease.

There may be some ways to reduce the risk of mental decline. In general, living a healthy lifestyle protects the body from strokes and heart attacks and is believed to also protect the brain from cognitive decline. Scientists cant absolutely prove the cause and effect of the following factors, but studies have shown a positive association.

Which Medicines Are Used To Treat Alzheimers Disease

There is no cure for Alzheimers disease, but available medications temporarily slow the worsening of dementia symptoms and help with behavioral problems that may appear during the course of the disease.

Four medications representing two drug classes are currently approved by the Food and Drug Administration to treat the symptoms of Alzheimers disease. These drugs are the cholinesterase inhibitors and a NMDA antagonist.

Cholinesterase inhibitors. The cholinesterase inhibitors are all approved to treat the symptoms of mild to moderate Alzheimer’s disease . Cholinesterase inhibitors include:

• Donepezil
• Rivastigmine and Exelon patch
• Galantamine

These drugs work by blocking the action of acetylcholinesterase, the enzyme responsible for destroying acetylcholine. Acetylcholine is one of the chemicals that helps nerve cells communicate. Researchers believe that reduced levels of acetylcholine cause some of the symptoms of Alzheimer’s disease. By blocking the enzyme, these medications increase the concentration of acetylcholine in the brain. This increase is believed to help improve some memory problems and reduce some of the behavioral symptoms seen in patients with Alzheimers disease.

These medications do not cure Alzheimers disease or stop the progression of the disease. The most common side effects of these drugs are nausea, diarrhea, and vomiting. Some people may have loss of appetite, insomnia or bad dreams.

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