Treating Alzheimer’s Symptoms

Given the complex nature of the condition, there is no one-size-fits-all treatment to cure Alzheimer’s disease (AD).^1,2 Rather, Alzheimer’s treatment should be individualized based on each person’s symptoms, response to the treatment, and associated side effects.^1,3 While there is no cure, the overall goals of treatment involve treating the underlying disease process, helping people preserve their mental capacity for longer, and managing behavioral symptoms.⁴

Just as with early detection and diagnosis of AD, starting treatment as early as possible can help improve quality of life and preserve daily functioning.^2,5 Available pharmacologic treatments include interventions that can either temporarily treat symptoms of AD related to memory or thinking, or those that treat the underlying cause for disease.^6,7

Non-pharmacologic interventions do not change the underlying disease course; however, these interventions are often implemented to help maintain or improve cognitive function as well as reduce behavioral symptoms.⁸ Such intervention can include cognitive stimulation, music-based therapy, psychological treatment (ie, cognitive behavioral therapy), physical therapy/exercise, and a healthy diet.⁸^,9

Medications That Treat Alzheimer's Symptoms

Prescription cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, are among the first drugs prescribed to people with AD.³ These drugs work by affecting neurotransmitters, special chemicals responsible for communication between nerve cells in the brain.^1,11 By improving nerve cell communication, these drugs can help preserve mental function.¹¹ However, they don’t work for everyone and since they don’t address the underlying disease process, they may only help for a limited amount of time.^6,11

Medications Targeting Alzheimer's Disease Progression

Another class of drugs, called monoclonal antibodies, may help improve the underlying disease process in AD.⁶ These medications targeting Alzheimer’s work by decreasing amyloid deposits in the brain.^6,12-14 Aducanumab, donanemab and lecanemab have received FDA approval for the treatment of mild cognitive impairment (MCI) and early (mild) stage of AD, while others like gantenerumab are in the research pipelines.^6,11,16,22 It should be noted that aducanumab is being discontinued in 2024. Although no longer available through clinical trial, the manufacturer, Biogen has stated that patients receiving aducanumab via prescription from their treating physicians will have it available until Nov. 1, 2024.⁸

Caring for people with AD is a team effort.^17-20 Caregivers and medical providers work together to find the best treatment options and develop care plans as Alzheimer’s Disease progresses.^20,21 Often caregivers will coordinate with their medical care team, which often includes doctors, nurses, therapists, pharmacists, and supportive care.¹⁷ This can also include elder law attorneys and geriatric care managers.¹⁷ Using a multidisciplinary approach to care can help both caregivers and patients achieve the best quality of life and health outcomes.

References

Behl T, Kaur I, Sehgal A, et al. The road to precision medicine: Eliminating the “One Size Fits All” approach in Alzheimer’s disease. Biomed Pharmacother. 2022;153:113337.
National Institute on Aging (NIA). Alzheimer’s Disease Fact Sheet. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet
Alzheimer’s Association^®. Medications for memory, cognition and dementia-related behaviors. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
Alzheimer’s Association^®. Management. https://www.alz.org/professionals/health-systems-medical-professionals/management
Alzheimer’s Association^®. Early detection and diagnosis. https://www.alz.org/professionals/public-health/public-health-topics/early-detection-diagnosis
Alzheimer’s Association^®. Treatments and research. https://www.alz.org/help-support/i-have-alz/treatments-research
National Institute on Aging (NIA). How is Alzheimer’s Disease Treated. https://www.nia.nih.gov/health/how-alzheimers-disease-treated
2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 2023;19(4):1598-1695.
Kumar A, Sidhu J, Goyal A, et al. Alzheimer Disease. StatPearls. 2022. https://www.ncbi.nlm.nih.gov/books/NBK499922/
Behera S. Cognitive behavior therapy: Introduction, methodology and benefits of CBT. 1/9/2014. https://www.online-therapy.com/blog/cognitive-behavior-therapy-introduction-methodology-benefits-cbt/
Press, D & Buss, SS. Treatment of Alzheimer Disease. UpToDate. https://www.uptodate.com/contents/treatment-of-alzheimer-disease
Sims JR, Zimmer JA, Evans CD, et al. Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023;330(6):512-527.
Swanson CJ, Zhang Y, Dhadda S, et al. A randomized, double-blind, phase 2b proof-of-concept clinical trial in early Alzheimer’s disease with lecanemab, an anti-Aβ protofibril antibody Alzheimers Res Ther. 2021;13:80.
Klein G, Delmar P, Voyle N, et al. Gantenerumab reduces amyloid-β plaques in patients with prodromal to moderate Alzheimer’s disease: a PET substudy interim analysis. Alzheimers Res Ther. 2019;11:101.
Tampi RR, Forester BP, Agronin M. Aducanumab: evidence from clinical trial data and controversies. Drugs Context. 2021;10:2021-7-3.
Lecanemab (Leqembi^®) Prescribing Information. January 2023. https://www.leqembi.com/-/media/Files/Leqembi/Prescribing-Information.pdf?hash=3d7bf1a2-5db2-4990-8388-81086f415676
Ellison JM. Understanding the healthcare team in Alzheimer’s disease. 8/11/2021. https://www.brightfocus.org/alzheimers/article/understanding-health-care-team-alzheimers-disease
Jurkowski CL. A Multidisciplinary Approach to Alzheimer’s Disease: Who Should Be Members of the Team? Am J Med. 1998;104(suppl 1);13S-16S.
UCSF Department of Radiology & Biomedical Imaging. Radiology’s Role in Determining the Impact of Amyloid PET Imaging on Real-World Alzheimer’s Disease and Dementia Care. 6/19/2019. https://radiology.ucsf.edu/blog/radiologys-role-determining-impact-amyloid-pet-imaging-real-world-alzheimers-disease-and
Alzheimer’s Association^®. Caregiving. https://www.alz.org/help-support/caregiving
Alzheimer’s Association^®. Working with care providers. https://www.alz.org/help-support/caregiving/care-options/working-with-care-providers
News release 7/2/24 (https://investor.lilly.com/news-releases/news-release-details/lillys-kisunlatm-donanemab-azbt-approved-fda-treatment-early). Accessed 7/9/24.