Do Alzheimer’s Medications Really Work?

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While Alzheimer’s disease currently has no cure, there are a handful of medications that are FDA-approved to help manage the symptoms. But if you or a loved one has Alzheimer’s, you might be wondering: Do the medications really work?

Alzheimer’s medication options

It’s important to note that drugs aren’t always the logical first step to help treat someone with Alzheimer’s.

“Medications are not the only way and in many cases not the best way to treat people with [Alzheimer’s disease],” says Steven DeKosky, MD, a Fellow of the American Academy of Neurology and a professor of Alzheimer’s Research at the University of Florida College of Medicine. “Activities, social events, music, art, depending on the level of severity of their impairment, are all wonderful ways to support, calm, and elevate the feelings of people with dementia.”

However, if your loved one’s doctor determines that he or she might benefit, there are two types of drugs approved by the Food and Drug Administration to help manage symptoms of the disease: cholinesterase inhibitors (also called acetylcholinesterase inhibitors and abbreviated as AChEI or AChEIs) and memantine. These drugs can’t stop or reverse the cognitive decline that comes with Alzheimer’s, but they may help stabilize the symptoms for a while.

Cholinesterase inhibitors (AChEIs)

Cholinesterase inhibitors block the breakdown of a key neurotransmitter, acetylcholine (ACh), “so that it stays around in the brain connections longer,” DeKosky says. This neurotransmitter is very important for memory function. But in a person with Alzheimer’s disease, the cells that produce an enzyme critical to the synthesis of ACh are dysfunctional and slowly degenerate. “As the cells disappear, the brain can’t make [that enzyme] any longer as effectively,” DeKosky explains. “So whatever you can do to prolong the ACh that IS made, we want to do.”

To sum it up: AChEIs work to reduce the brain’s routine breakdown of an important neurotransmitter, acetylcholine, that is essential for turning thoughts into memories.

The three AChEI medications currently approved by the FDA are donepezil, rivastigmine, and galantamine. According to DeKosky, all three medications have side effects, with major symptoms being nausea, vomiting, and diarrhea. “However, those symptoms usually resolve in a short time if the dose is started at a low level, and increased slowly,” he says.

Do cholinesterase inhibitors work?

In clinical trials, people with mild to moderate Alzheimer’s who took any of the three types of AChEIs had better cognition and function than those taking a placebo. A study published in 2012 in the New England Journal of Medicine reported that donepezil may improve cognition in the moderate to severe stages of Alzheimer’s as well.

But those improvements aren’t necessarily life-changing. In a 2008 review of previous research, researchers from McMaster University in Canada found that while the effects of both AChEIs and memantine were statistically significant, they weren’t clinically relevant in terms of cognition and a global assessment of dementia.

In simpler terms: the medications can work well in theory, but may not result in noticeable real-life effects. It’s also impossible to know what a person’s symptoms would have been like if they hadn’t ever taken medication. However, each case of Alzheimer’s is unique, as is the effect of the medications on the person taking them.

Memantine

Memantine, the second type of drug that treats Alzheimer’s, is usually prescribed in the moderate to severe stages of the disease. It works by regulating the activity of a receptor in the brain that is activated by a neurotransmitter called glutamate.

“I generally start patients on an AChEI, and do not put them on memantine unless they are at a moderate or severe level of impairment,” DeKosky says. “Many doctors, however, put patients on memantine as soon as they diagnose them, no matter what level of severity they are. Although it has been tried, I do not believe anyone has shown that memantine has an effect in people with mild Alzheimer’s disease.”

So how effective is memantine for patients in the later stages of Alzheimer’s?

“A lot depends on expectation,” DeKosky says. “It’s clear that if you give the drug to a population of patients they are better off than if they were not given it—how long that lasts, we do not know. That improvement is better than nothing, especially now that the medications are available in a generic. [But] if your expectation is a Lazarus-like recovery from cognitive impairment, you’ll be disappointed.”

Summary

Both cholinesterase inhibitors and memantine can help improve the symptoms of Alzheimer’s, although it might only be a minor improvement. They can also be used together safely, DeKosky says.

“These medications were the first to be developed for AD, and they address symptomatic aspects,” DeKosky says.

Looking ahead, drugs are being created to tackle the disease from a different angle—rather than working to manage systems, they aim to reduce or stop the memory decline altogether.

“Most of the newer medications are being developed as disease modifying drugs to actually slow down or stop the neurodegeneration,” DeKosky says. “We hope they will add to our power to stop or slow down the disease.”

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