Treatment and Management of Alzheimer's Disease

A successful treatment plan should include several different components. It is important for caregivers to learn as much as possible about the illness and its effects on behavior, ability to communicate and ability to accomplish tasks.

This information will help caregivers develop effective strategies in the day -to-day effort to reduce anxiety in the person with Alzheimer's, to preserve his or her sense of self-worth, and to keep the frequency of behavioral problems as low as possible.

Medical Therapy
Special types of medications, called cholinesterase inhibitors (for example, donepezil and tacrine), are currently the only medications that have been approved by the United States Food and Drug Administration (FDA) for symptomatic (functional) improvement in people with Alzheimer's disease. These medications may help to improve memory, but it is more likely that they will only work to improve the ability to accomplish everyday tasks. The medications inhibit the breakdown of the neurotransmitter acetylcholine and, thus, prolong its duration of activity in the brain. Because donepezil needs only to be given once a day and does not have any adverse effects on the liver, it is usually preferred over tacrine. It is likely that additional drugs with similar mechanisms of action will become available in the near future.

Both vitamin E and selegiline have been shown to be effective in slowing the rate of decline in those who are moderately impaired by Alzheimer's disease. There is no benefit to taking both, compared to taking either one alone. Because it is less expensive and readily available, high dose vitamin E is often recommended. The mechanism by which vitamin E produces this benefit is not known for sure, but it is believed that it may be related to the vitamin's ability to protect nerve cell membranes from oxidative damage.

There is a major research effort currently under way to discover drugs that will have a more powerful effect in slowing the rate of decline. These same drugs may also prove useful in delaying the onset of dementia symptoms in individuals in the earliest stage of this illness.

Behavioral Management Therapy
Hypnotic, anti-anxiety, and anti-psychotic medications reduce the intensity and frequency of the behavioral problems experienced by many people with Alzheimer's disease. These behavioral problems include disrupted and fragmented sleep patterns, agitation, paranoia, hallucinations, delusions, and aggression. These medications should be tried only when all efforts at non-medicine behavioral management strategies have failed.

When medication is used, it is important to start with the lowest dose of the gentlest medication and only increase it when necessary. It is also a good general rule to always try to keep both the dose and frequency as low as possible to maintain adequate control of the behavior.

Alternative/Complementary Therapies
There have been few studies that have researched traditional alternative therapies. In one large-scale trial in the United States, Gingko biloba (an extract of various parts of the Gingko tree) was shown to slow the rate of decline in people with Alzheimer's disease. The benefit was modest and the results have not yet been confirmed in a second study. The drug used in the study was prepared in Germany and is not available in the United States. However, various Gingko biloba preparations sold as dietary supplements are available in many local communities.

Alternative therapies have the potential to aid in the management of those with Alzheimer's disease. Although there are few studies demonstrating their benefit, strategies which use music therapy, reminiscent therapy, and aroma therapy may have a calming influence, bring pleasure, and simply improve the quality of life for both people with Alzheimer's disease and their caregivers.

Future Potential (Research)
Alzheimer's disease research is one of the most active areas of investigation in the neurosciences; the problem is being attacked at every level. Basic scientists are trying to unravel how Alzheimer's disease causes brain cells to die. Epidemiologists are searching for environmental and nutritional factors which may contribute to the risk of developing the disease. Molecular geneticists are looking for new gene mutations that can cause the disease. Clinical geneticists are trying to identify genetic susceptibility factors. Clinicians and pharmacologists are looking for treatments that can delay the onset, slow the progression, improve the symptoms, and perhaps eventually even cure the disease. Equally important research is being done to determine how to improve the quality of life for people who have the disease and for their caregivers while they wait for scientists to discover a cure.