Medication Treatment Options

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How is AD treated?

What drugs are currently available to treat AD?

Managing behavior symptoms


How is AD treated?

There is no cure for AD, and no treatment has been proven to stop the disease. However, drugs are available that may help manage the cognitive (thinking) symptoms of AD, which affect memory, language, judgment, planning, ability to pay attention, and other thought processes. Medicines can't stop the disease, but they can slow the progression of symptoms for a limited time in some people.


What drugs are currently available to treat AD?

The Food and Drug Administration (FDA) has approved two types of medicines to treat the cognitive symptoms of AD.

  1. One type of medicine, called cholinesterase inhibitors, prevents the breakdown of acetylcholine, a brain chemical important for memory and thinking. These drugs may help delay or prevent cognitive symptoms from becoming worse for a limited time and may help control some behavioral symptoms. No published study directly compares these drugs. Because they work in a similar way, it is not expected that switching from one of these drugs to another will produce significantly different results. However, a person with AD may respond better to one drug than another.
    • Aricept® (donepezil) is approved to treat all stages of AD.
    • Razadyne®, previously known as Reminyl® (galantamine) is approved to treat mild to moderate AD.
    • Exelon® (rivastigmine) is approved to treat mild to moderate AD.
  2. Another type of medicine is believed to work by regulating glutamate, another important brain chemical that, when produced in excessive amounts, may lead to brain cell death. There is only one drug in this class approved for AD.
    • Namenda® (memantine) is approved to treat moderate to severe AD.
    • Namenda® has been shown to delay progression of some of the symptoms of moderate to severe AD, which may allow a person to maintain certain daily functions a little longer.

Because the two types of drugs work very differently, they can be used in combination.


Managing Behavior Symptoms

In addition to cognitive symptoms, many people with AD also experience behavioral or psychiatric symptoms. Like cognitive symptoms, behavioral symptoms in AD are due to progressive destruction of brain cells. However, medicines, environmental factors, and some medical conditions can also cause behavioral symptoms or make them worse. A person who develops behavioral symptoms — especially if they appear suddenly — should receive a thorough medical exam to identify any treatable conditions that are contributing to the behavior.

In early stages of AD, behavioral symptoms can include anxiety, irritability, or depression. In later stages of AD, symptoms may include:

  • Sleeplessness
  • Agitation
  • Wandering
  • Physical or verbal outbursts
  • General emotional distress
  • Restlessness
  • Pacing
  • Hallucinations (seeing, hearing or feeling things that are not really there)
  • Delusions (believing things are real when they are not)

For both patients and their families, these symptoms often are the most challenging and distressing. There are two approaches to managing behavioral symptoms: (1) non-drug strategies, and (2) medications. Non-drug approaches should always be tried first. Check out the Resource Links for more information on non-drug strategies.

Non-Drug Interventions for Behavior Symptoms

For the management of many behavior symptoms, non-drug interventions — such as use of appropriate communication techniques, home or environmental modifications, or involvement in therapeutic activities — should be tried first. In general, steps to managing behaviors include:

  1. Identifying the behavior
  2. Understanding the cause of the behavior
  3. Addressing the underlying cause, including strategies such as adapting the environment to remedy the situation

A variety of resources are available for understanding and managing behavior symptoms, including:

Medications for Behavior Symptoms

If non-drug approaches fail, drug therapy may be appropriate for persons with severe symptoms or who have the potential to harm themselves or others. However, medicines must be used carefully and are most effective when combined with non-drug approaches.

Currently, there are no drugs specifically approved by the U.S. Food and Drug Administration for the treatment of behavioral and psychiatric symptoms in persons with dementia. Physicians may prescribe medicines for “off label” use – a different purpose than the ones for which the drug is approved. Some medicines have been used to help address behavior symptoms.

The use of a medicine should target a specific symptom or symptoms so the drug's effectiveness can be monitored. It may be useful to keep a diary of the specific behavior symptom, when it occurs, and how often. The risks and potential benefits of a drug should be carefully assessed and discussed with the physician. Persons taking medicines for behavior symptoms must be closely monitored for adverse effects from the medicine.

The following are examples of medicines that have been used to treat behavioral and psychiatric symptoms of Alzheimer's disease.

Antidepressant medicines for depression:
Celexa® (citalopram)
Prozac® (fluoxetine)
Paxil® (paroxetine)
Zoloft® (sertraline)
Desyrel® (trazodone)
Anxiolytics (anti-anxiety medicines) for anxiety, restlessness, verbally disruptive behavior, and resistance to care:
Ativan® (lorazepam)
Serax® (oxazepam)
Antipsychotic medicines for distressing hallucinations or delusions, aggression, agitation, and hostile behaviors:
Abilify® (aripiprazole)
Haldol® (haloperidol)
Zyprexa® (olanzapine)
Seroquel® (quetiapine)
Risperdal® (risperidone)

The decision to use an antipsychotic drug needs to be considered with extreme caution. Studies have reported that older persons with dementia who are treated with antipsychotic drugs are at an increased risk of death. The FDA now requires manufacturers to include a “black box” warning about the risks and a reminder that antipsychotics are not approved to treat dementia symptoms.