There is no cure for Alzheimer’s disease (AD), but treatment with certain drugs may help control or reduce some behavioral and cognitive symptoms.
AD is a progressive condition that begins with memory issues and can lead to the loss of someone’s ability to respond to their environment and communicate with others.
The disease affects the parts of the brain that control memory, language, and thought.
This article looks at the goal of medications, first-line drugs, the newest drugs, and medications to treat late stage AD. It also looks at when to discontinue medications and financial help to help cover the cost of treatment.
Below is a table summarizing the medications available to treat AD:
| Drug class | Stage of Alzheimer’s disease | How it works | Common side effects | |
|---|---|---|---|---|
| donepezil (Aricept) | AChE inhibitor | prevents the breakdown of acetylcholine in the brain | • nausea • vomiting • fatigue • diarrhea • muscle cramps | |
| galantamine (Razadyne) | AChE inhibitor | mild to moderate | prevents the breakdown of acetylcholine in the brain | • diarrhea • nausea • vomiting • dizziness • decreased • appetite • headache |
| rivastigmine (Exelon) | AChE inhibitor | mild, moderate, and severe | prevents the breakdown of acetylcholine in the brain | • diarrhea • indigestion • nausea • vomiting • muscle weakness |
| aducanumab (Aduhelm) | disease-modifying drug | mild | removes the buildup of atypical amyloid protein plaques in the brain | amyloid-related imaging abnormalities can cause: • headache • confusion • falls • brain bleeds • dizziness • diarrhea |
| lecanemab (Leqembi) | disease-modifying drug | removes the buildup of atypical amyloid protein plaques in the brain | amyloid-related imaging abnormalities can cause: • headache • confusion • falls • brain bleeds • dizziness • diarrhea | |
| memantine (Namenda) | NMDA antagonist drug | moderate to severe | regulates and blocks the effects of glutamates in the brain | • headache • confusion • constipation • diarrhea • dizziness |
There is no cure for AD, but medical management can help improve a person’s quality of life and may reduce certain symptoms. Treatment can also help improve the quality of life for caregivers of people with AD.
Treatment for the condition aims to address different areas, which
- managing behavioral symptoms, such as wandering, sleeplessness, and aggression
- delaying or slowing symptoms
- helping people maintain their brain health
- providing comfort and dignity
As a first-line treatment for mild to moderate AD, doctors may prescribe an acetylcholinesterase (AChE) inhibitor drug. These include:
- donepezil
- galantamine
- rivastigmine
The
However, they may help prevent the breakdown of a brain chemical called acetylcholine, which may be important to thinking and memory processes.
In people with AD, the brain produces less acetylcholine as the disease progresses, so these medications may gradually become less effective.
The above three AChE inhibitors generally work equally well, although some people may respond better to certain types. Additionally, some types may cause more side effects, which can include loss of appetite, nausea, and vomiting.
New drugs for the treatment of AD include aducanumab and lecanemab.
Aducanumab
Aducanumab is the first disease-modifying drug with
The medication helps reduce the buildup of atypical proteins called amyloid deposits in the brain, which may help slow the progression of AD.
However, researchers have not yet shown that the drug can affect clinical outcomes for the disease, such as the progression of cognitive decline. There is not yet proof that clearing amyloid can protect people from cognitive decline.
The FDA approved aducanumab as part of its
This process requires additional research after approval to confirm the results that the FDA anticipated. If the drug does not show clinical benefits, the agency may withdraw approval.
Before prescribing aducanumab, a doctor will typically perform tests, such as a PET scan, to detect amyloid plaques and decide whether the treatment may benefit the person with AD.
Lecanemab
The FDA approved lecanemab in
Researchers are still investigating the relationship between amyloid proteins and AD and the role of drugs, such as lecanemab, in slowing disease progression.
As with aducanumab, a doctor will typically perform tests, such as a PET scan, to detect amyloid plaques and decide whether the drug may benefit the person.
Doctors may prescribe an N-methyl D-aspartate (NMDA) antagonist drug called memantine to treat moderate to severe, later stage AD.
One such NMDA, memantine, may decrease symptoms, which could prolong a person’s ability to maintain some of their daily functions, in some cases by
Scientists believe the drug works by regulating a brain chemical called glutamate. When the brain produces too much glutamate, it can cause brain cell death. The drug may delay the death of cells, helping prolong functionality and delay cognitive decline.
Doctors may also prescribe the AChE inhibitors donepezil, rivastigmine, or a combination of donepezil and memantine to treat moderate to severe AD.
Caregivers and healthcare workers should regularly review medication. People with AD should receive medication as long as the benefits of the treatment outweigh any side effects and make a noticeable difference to symptoms.
A person with AD or a caregiver should discuss the decision to stop medication with a doctor and should not stop treatment on their own.
A doctor may also decide to stop treatment if someone becomes unable to take the medication in the way the doctor has prescribed.
There are a variety of financial resources that could help cover the cost of some AD medications.
These include:
- Medicare: This is the primary source of healthcare coverage and typically helps cover prescription medications to treat the disease.
- Government assistance: A person with dementia may qualify for various public programs, which can help provide income support, social security income disability, veteran benefits, and Medicaid.
- Private insurance, retiree health coverage, or group employee plan: These mainly apply to people under the age of 65 years.
- Employee benefits: If a person continues to work during the early stages of the disease, benefits may include some payment for out-of-pocket medical expenses.
Currently, the Centers for Medicare & Medicaid Services do not cover aducanumab or lecanemab unless the person has enrolment in an approved clinical trial.
If someone has insurance other than Medicare, they should contact their provider to find out if coverage is available.
There are various medications available to treat AD. There is no cure for the disease, so doctors aim to slow the progression and manage certain behavioral symptoms through treatment.
Doctors may prescribe AChE-inhibiting drugs to prevent acetylcholine breakdown in the brain, which can slow cognitive decline. This may be effective for people with mild, moderate, or severe AD and may delay the progression of the disease by several months.
Doctors may prescribe drugs the FDA has recently approved, such as aducanumab or lecanemab, which remove an atypical protein in the brain called amyloid, which causes plaques. The FDA approved these drugs as part of an accelerated program, though research has not yet proved their clinical significance.
Finally, doctors may prescribe memantine to treat moderate to severe AD. This drug regulates and blocks the effects of glutamates in the brain, a chemical in the brain that causes cell death.