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Treatment of Cognitive and Behavioral Symptoms associated with Alzheimer's Disease

Carrie Steckl, Ph.D., edited by Natalie Staats Reiss, Ph.D.

Treatment of Cognitive Symptoms

Two kinds of medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of cognitive symptoms of Alzheimer's disease. It is extremely important to understand that these medications do not cure the disease or reverse someone's symptoms. However, these medications can help some people function at a higher level for a longer period of time.

pills spilling from bottleSome caregivers that using an Alzheimer's medication will only be prolonging a loved one's suffering. In other words, caregivers sometimes fear that their loved ones will live longer with a terrible disease if they use these medications. However, there is no evidence that life is actually prolonged by taking medications for Alzheimer's Disease.

Cholinesterase inhibitors increase levels of acetylcholine (a neurotransmitter that plays a key role in memory and learning; for more information, see the previous section on Causes of Alzheimer's Disease in the brain. Cholinesterase inhibitors postpone the worsening of symptoms for approximately 6-12 months in about half of the people who take them. They are usually prescribed for individuals with mild to moderate AD (except for donepezil, see below). Cholinesterase inhibitors are generally well tolerated. If side effects do occur, they are usually related to digestion (e.g., nausea, vomiting, decreased appetite, changes in bowel movements). Individuals taking cholinesterase inhibitors should be monitored closely by a physician so that dosages and/or other medications can be adjusted in case side effects occur.

Tacrine (Cognex®) was the first cholinesterase inhibitor made available to the public. It was approved in 1993, but it is rarely used anymore because of associated side effects, including potential liver damage. The cholinesterase inhibitors most commonly prescribed now include donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®). Donepezil is also FDA-approved for the treatment of severe Alzheimer's Disease.

Memantine (Namenda®) is a different kind of Alzheimer's medication that regulates glutamate (a neurotransmitter that plays a key role in the processing of information; for more information, see the previous section on Causes of Alzheimer's Disease) in the brain. Memantine is used to treat moderate to severe AD and may delay the worsening of symptoms in some people. Side effects of memantine can include headaches, dizziness, constipation, and confusion.

Treatment of Behavioral Symptoms

Behavioral symptoms of Alzheimer's Disease are often the most challenging for caregivers and can include agitation, aggression, suspicion, delusions, hallucinations, wandering, sundowning, sleep disturbances, and repetition (each of these behaviors is described in more detail in a later section, click here to go there now). Sometimes, medications are useful for treating these behavioral symptoms.

For instance, anti-anxiety medications (which are typically used to treat anxiety disorders) have been used successfully to treat agitation and restlessness in individuals with AD, and anti-psychotic medications (which are typically used to treat disorders like schizophrenia) are sometimes effective in reducing delusions and hallucinations. However, negative side effects (e.g., dizziness, drowsiness, muscle stiffness, tremors, seizures) and/or medication interactions (when two or more drugs interact and produce negative effects) are common when these types of medications are used. There is also some research showing that antipsychotic medications may cause increased communication difficulties in individuals with AD. Any medication to treat behavioral symptoms should be used with caution and only in close consultation with a psychiatrist who specializes in the treatment of individuals with this illness.

Often, a combination of appropriate medications and behavioral management strategies works best. Behavior management entails identifying what might be triggering a difficult behavior and then devising an intervention that either changes the person's environment or the caregiver's reaction to the behavior. Behavior management is explained in more detail in the section on caregiver coping strategies (click here to go there now).