Health

How Exactly Do Different Kinds of Alzheimer’s Medications Work?

Whether you just started medications to manage Alzheimer's disease symptoms or you're caring for someone with the condition, understanding a bit more about Alzheimer's treatment makes it less mysterious and, ultimately, helps you feel a bit more in control.

First, let's review a little bit about Alzheimer's disease.

Alzheimer's disease is a neurodegenerative condition caused by multiple things that aren't totally understood, Zaldy Tan, M.D., medical director of the UCLA Alzheimer’s and Dementia Care Program, tells SELF. But, he says, the prevailing hypothesis is that the accumulation of beta-amyloid proteins forms a type of plaque in the brain that causes damage. Additionally, tau protein threads collect to form "tangles" that affect brain cells’ ability to transport nutrients and other compounds.

Initially this occurs in areas of the brain associated with short-term memory, which leads to cell death and corresponding neurological symptoms, Dr. Tan explains. So, the first symptoms that are noticeable are those related to memory, like forgetting where you left something or feeling lost in a familiar place.

But as those plaques and tangles spread throughout the brain and cause more damage, people develop other symptoms, like difficulty swallowing, repetitive movements, wandering, and hallucinations.

There are two major classes of Alzheimer's medications, which are FDA-approved to treat symptoms at specific stages of the disease.

There aren't any treatment options out there right now that can affect the proteins believed to be at the root of Alzheimer's disease progression, Dr. Tan explains. But we do have several medications available that can help patients manage their symptoms. Rather than targeting those proteins, these medications alter the way neurotransmitters function in the brain.

There are two major types of medications:

Cholinesterase inhibitors:

These medications include galantamine (Razadyne), donepezil (Aricept), and rivastigmine (Exelon). They're FDA-approved to treat the symptoms of mild to moderate dementia symptoms associated with Alzheimer's disease, and they affect acetylcholine, a chemical that plays a role in muscle activity, attention, learning, and memory.

But, rather than acting directly on acetylcholine receptors or by just supplying more acetylcholine, they inhibit the actions of cholinesterase, an enzyme that normally breaks down acetylcholine. This ends up leaving more acetylcholine intact, Dr. Tan says, which may help improve a patient's memory.

It takes about six weeks to see if the medication is working or not, he explains, and it doesn't work for everyone. Even for those it does help, "it’s a very modest response," he says. "The best case scenario is that the patient’s memory and cognitive function may improve slightly to what it was six months to a year ago—it's not going to turn back time."

As with all medications, these can come with some side effects that may be a deterrent for some people. The most common ones include nausea, vomiting, diarrhea, and very vivid dreams, Dr. Tan says. Some patients also develop a decreased heart rate, so these aren't drugs that someone who already has an irregularly slow heart rate should try. But having another heart condition doesn't necessarily mean they're off limits, he says.

Memantine:

Memantine (Namenda) works on the neurotransmitter glutamate, which is involved in many brain functions, rather than acetylcholine.rather than acetylcholine. Patients with dementia show an overstimulation of glutamate NMDA receptors—"Nobody knows why," Dr. Tan says—so, the idea is that blocking those receptors will prevent that overstimulation and could restore some memory functions. Memantine is approved only for moderate to severe symptoms of Alzheimer's disease.

It's not uncommon for patients to start with a cholinesterase inhibitor and, as their disease progresses, have memantine added into their regimen. As with cholinesterase inhibitors, it takes about four to six weeks to notice any differences after starting memantine. And the effects, again, are moderate at best.

Dr. Tan says patients are usually able to tolerate memantine pretty well, but it can come with side effects such as confusion and constipation.

There is also one drug, Namzeric, which is a combination of donepezil (a cholinesterase inhibitor) and memantine, that is FDA-approved for moderate to severe dementia associated with Alzheimer's.

Unfortunately, these drugs don't cure Alzheimer's disease, they just help manage the symptoms. So it's important to keep your expectations reasonable.

Although these medications can help counteract some symptoms of Alzheimer's disease through neurotransmitter functions, they don't stop brain cell death, Dr. Tan says. Even then, they may be able to help with other symptoms of dementia, such as hallucinations or delusions. "It's possible that, these medications, while not so effective in improving memory and cognitive function, may help with some of the behaviors associated with dementia," he explains.

Current research is looking into the possibility of directly targeting amyloid proteins in patients who may be predisposed (due to family history) to develop Alzheimer’s in order to prevent the onset of symptoms, Dr. Tan says. But those options aren’t close to being available yet.

So, if you or someone you're caring for is taking these medications, it's important to talk to a doctor to help weigh the potential risks and benefits as the disease progresses.

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