Alzheimer’s disease is multifaceted, so there is no single treatment option that will be successful for every person living with the disease.1 However, researchers are making steady progress in their understanding of Alzheimer’s and are developing new medications to treat the disease, some of which are in late-stage clinical trials.
While new drugs are in development, the U.S. Food and Drug Administration (FDA) has previously approved several medications to help manage the symptoms of Alzheimer’s disease.1 Most of these medications work best in the early or middle stages of the disease. However, there currently is no cure for Alzheimer’s.
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Treatments for Mild to Moderate Alzheimer’s Disease
The goal of treating mild to moderate Alzheimer’s is to help maintain a comfortable and independent quality of life for as long as possible.1 Galantamine, rivastigmine, and donepezil are medications that may help reduce or control some cognitive and behavioral symptoms. These agents prevent the breakdown of acetylcholine — a chemical believed to regulate memory and thinking — in the brain. The brain produces less acetylcholine as Alzheimer’s disease progresses, so these medications eventually lose their effect. People with Alzheimer’s who use these agents may find that they respond better to one of them than the others. However, switching a person from one drug to another in this class usually does not produce significant results.
In June 2021, the FDA approved the newest Alzheimer’s medication, aducanumab (Aduhelm®), and classified it as a disease-modifying agent.2 Aducanumab removes beta-amyloid deposits in the brain. Beta-amyloid is a protein fragment that forms plaques within the brain.3 These plaques seem to have toxic effects on nerve cells in the brain and disrupt communication between them. While aducanumab has not yet been shown to slow the progression of Alzheimer’s, researchers continue to study how it affects the rate of cognitive decline over time.1
Doctors may run positron emission tomography (PET) scans or test cerebrospinal fluid before prescribing aducanumab to find out whether amyloid deposits are present in the brain. Magnetic resonance imaging (MRIs) are also used in conjunction with aducanumab. MRIs are recommended before starting a patient on aducanumab, during the process of determining the best dose for a particular patient, and at any time a patient’s symptoms suggest amyloid-related imaging abnormalities.6 People taking aducanumab may need an MRI to check for swelling or bleeding in the brain during treatment.
Treatments for Moderate to Severe Alzheimer’s Disease
Memantine is an FDA-approved treatment for moderate to severe Alzheimer’s.1 It works by blocking the effects of glutamate in the brain. Glutamate is a neurotransmitter, a chemical that sends messages between nerve cells in the brain.4 Although it is important for brain function, too much glutamate may cause the death of brain cells in Alzheimer’s.1
The main effect of memantine is that it reduces the symptoms of Alzheimer’s, allowing some people to keep doing certain daily activities for a longer time than if they didn’t take the medication.1 For however long it lasts, this is beneficial both to the person with Alzheimer’s and their caregiver(s).
In addition to memantine, the donepezil tablet and the rivastigmine patch have been approved by the FDA to treat moderate to severe Alzheimer’s.1 There is also a combination of memantine and donepezil in an extended-release capsule that is approved for this use.
General Advice About Using Alzheimer’s Medications
People who get treatment for Alzheimer’s typically start with low doses of medications, eventually working up to higher doses based on symptom relief and the side effects they experience.1
While some people may benefit from higher doses of Alzheimer’s medications, this also increases the risk for side effects. The most common side effects of these medications include nausea, vomiting, diarrhea, allergic reactions, and loss of appetite. Doctors should carefully monitor their patients when prescribing Alzheimer’s medications. Patients should take their medications exactly as prescribed, promptly report any unusual symptoms to their doctor, and let the doctor know before adding or making changes to medications.
Medications to Be Used With Caution in People With Alzheimer’s Disease
Not all medications are safe for people with Alzheimer’s.1 These include sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics.
- Sleep aids are useful for people with insomnia, but they increase the risk of confusion and falling for people with Alzheimer’s.
- Anti-anxiety drugs treat agitation, but they can cause people with Alzheimer’s to become sleepy, dizzy, and confused and may increase their risk of falling.
- Anticonvulsants help to prevent seizures, but they cause sleepiness, dizziness, mood swings, and confusion in people with Alzheimer’s.
- Antipsychotics treat paranoia, hallucinations, agitation, and aggression, but they can increase the risk of death in people with Alzheimer’s.
Despite these concerns, doctors may choose to use these medications in patients with Alzheimer’s if the possible benefits outweigh the risks. However, people with Alzheimer’s and their caregivers should be aware of these side effects and risks and tell their doctor immediately if they occur.
Managing Behavioral Symptoms of Alzheimer’s Disease
The progressive deterioration of brain cells is the main cause of behavioral changes in people with Alzheimer’s.5 This is the most troubling aspect of the disease for both patients and caregivers. The earliest behavior changes may be irritability, anxiety, or depression. Later symptoms tend to be more severe and may include aggression, anger, physical/verbal outbursts, hallucinations (seeing, hearing, or feeling things that are not real), and delusions (firmly held belief in things that are not true).
Behavioral changes can be triggered by certain events or changes in surroundings for people with Alzheimer’s.5 Specific situations that can affect a person’s behavior include new or different living arrangements, a change in caregiver(s), misinterpreted threats, and embarrassing situations such as needing assistance to bathe or change clothes. Identifying a person’s trigger(s) is helpful in finding the best way to deal with behavior changes.
It is important to conduct a thorough medical evaluation in people with Alzheimer’s who develop sudden behavioral changes.5 Even though Alzheimer’s is usually the main cause, tests may show that there are other contributing factors. Side effects from medications, uncorrected problems with hearing or vision, and discomfort from infections or other conditions may cause changes in behavior aside from the effect of Alzheimer’s on brain function. People with advanced Alzheimer’s may be unable to tell their needs to caregivers, such as pain or bladder/bowel issues, which tends to increase their anxiety.
Successful management of behavioral symptoms in people with Alzheimer’s requires careful observation of how a certain symptom may relate to the person’s experience.5 Caregivers should make whatever changes are necessary to increase comfort, security, and peace of mind for people with Alzheimer’s.
Creating a Safe and Supportive Environment
Making adaptations for people with Alzheimer’s disease is essential.2 Such steps include always keeping personal items in the same place. Keep a daily schedule and check completed items off the list, including records of daily medication doses. When away from home, always have the person with Alzheimer’s carry personal identification and a cell phone with important numbers programmed into it. Prevent falls by installing sturdy handrails on stairways and in bathrooms, and make sure that shoes and slippers are comfortable and have anti-slip soles.
How Caregivers Can Help Alzheimer’s Patients Cope
Caregivers who use coping strategies can make life much easier for themselves as well as people with Alzheimer’s.5 Being aware of mealtimes, room temperature, and regular bathroom visits helps to ensure their comfort. Maintaining a calm environment and avoiding confrontation helps to prevent anxiety. Allowing for rest after busy periods or stimulating activities also helps to people with Alzheimer’s calm. Most importantly, caregivers should look for reasons behind unusual behaviors and never take personal offense. The Alzheimer’s Association offers an online community for caregivers at ALZConnected.
Use of Medications for Behavioral Symptoms
Sometimes prescription medications may be needed to treat the behavioral symptoms of Alzheimer’s disease, especially if the person might harm themselves or others.5 When this is the case, caregivers must work closely with the doctor to learn about the possible risks and benefits of each medication. They also should target specific symptoms and start with the lowest effective dose while monitoring carefully for side effects.
Suvorexant (Belsomra®) is an FDA-approved insomnia (sleeplessness) treatment for people with mild to moderate Alzheimer’s disease.5 Certain medications that are often used to treat depression may be needed in people with Alzheimer’s who are irritable and have low moods. These include citalopram, fluoxetine, paroxetine, sertraline, and trazodone. Other medications that are often used for anxiety, such as lorazepam or oxazepam, can be used in people with Alzheimer’s for anxiety, restlessness, and verbally disruptive behavior.
Hallucinations, delusions, aggression, agitation, and hostility require antipsychotic treatment.5 Medications that are useful for these symptoms include aripiprazole, clozapine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone. It is important to note that antipsychotic medications should not be used to sedate or restrain persons with dementia. When needed, the lowest dose should be used for the shortest length of time possible.
Sometimes, a doctor may see the need for carbamazepine — a seizure medication used as a mood stabilizer — in people with Alzheimer’s who are agitated. The use of each of these medications should be closely monitored for side effects.
Resources for Alzheimer’s Disease Treatments
- NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center: The NIA ADEAR Center offers information and free print publications about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.
- Alzheimers.gov: Explore the Alzheimers.gov portal, posted by the federal government, for information and resources on Alzheimer’s and related dementias.
- National Library of Medicine’s MedlinePlus: Use this online library from the National Institutes of Health to research a broad range of health topics, including hundreds of articles on Alzheimer’s disease and resources for caregivers.
- ACL.gov’s Eldercare Locator : Find services for older adults and their families using this public service of the U.S. Administration on Aging.
