Treatment

Cholinesterase Inhibitors

A group of medications known as cholinesterase inhibitors are the primary treatment for mild to moderate Alzheimer's disease. Acetylcholine is a chemical found in the brain that helps it function properly. There is less of this chemical found in the brains of patient's with Alzheimer's. Cholinesterase Inhibitors prevent acetylcholine from breaking down, allowing the brain to function better. These medications treat symptoms, but do not cure Alzheimer's or stop disease progression. Family members frequently report improvement in some symptoms, slowed progression in others and no difference in still others. People commonly report that their loved one ?seems to be like their old selves', an indication that the treatment is worthwhile for as long as it provides some benefit. Although these medications work in a similar way they have different side effects and patients often respond to one better than another, so if one is poorly tolerated it is worth trying another from this same group.

These medications appear to work more effectively at higher doses and therefore many physicians will try to increase the dosage after being on the medication for a month, even if it is effective. Increases in dosages should be done gradually to minimize side effects.

Donepezil HCL - Aricept, Aricept ODT

• Indicated for treatment of symptoms of mild to moderate Alzheimer's
• Its once daily dosing is an advantage when patients may have trouble remembering to take the medication or a caregiver must be present to give the medication.
• Once daily dosing is a disadvantage when one wishes to increase the dosage if side effects are uncomfortable.
• This medication may be taken on a full or empty stomach, with or without food
• Take this medication at bedtime, unless it interferes with your sleep
• ODT is an oral disintegrating tablet that will dissolve on the tongue. Be sure hands are dry before handling and drink a glass of water after taking.

Rivastigmine Hydrogen Tartrate - Exelon

• Indicated for treatment of symptoms of mild to moderate Alzheimer's
• Twice daily dosing may be a disadvantage when patients have trouble remembering their medications or caregivers must be present to administer the medication
• Twice daily dosing is an advantage when it comes to increasing the dosage, as it can be done more slowly, minimizing the side effects
• Take this medication with food
• Take morning and evening, at regularly spaced times daily.

Galantamine HBr - Razadyne, Razadyne ER (U.S.), Reminyl, Reminyl ER (Canada),

• Indicated for the treatment of symptoms of mild to moderate Alzheimer's
• This medication is available in a once daily form that should be taken with the morning meal and in twice daily forms that should be taken with the morning and evening meals.

Memantine HCL - Namenda(U.S.), Ebixa (Canada)

• Indicated for treatment of moderate to severe Alzheimer's
• This medication can be taken with or without food
• Dosage should begin at 5 mg once daily and increase to twice daily dosing. Dosage increases should be spaced at least a week apart to minimize side effects.

Antipsychotic Medications - As Alzheimer's disease progresses patients sometimes begin to exhibit behavioral difficulties. They may become paranoid, agitated, psychotic, restless, irritable and combative. They may become lost easily and are at risk for wandering off during the night.

Antipsychotic medications are often necessary to bring these symptoms under control. Newer antipsychotics, though more expensive, tend to have fewer side effects and are therefore the preferred choice. The elderly can be very sensitive to anti-psychotic medications and therefore should be started on very low doses. Antipsychotics commonly used today include:

• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)

Side effects: Patients taking anti-psychotics may experience stomach upset, difficulty sleeping or constipation. Contact the physician if the medication causes any rigid or unusual movements in the face or limbs.

Antidepressants - Depression is sometimes seen in patients suffering from Alzheimer's disease even before the disease is diagnosed. However, major depression is not always an indication of Alzheimer's, and people with depression often have poor memory and some of the other symptoms found in Alzheimer's. The group of antidepressants, known as SSRIs, particularly those that are mild and do not stay in the body too long, such as citalopram (Celexa) or sertraline (Zoloft) are useful in relieving symptoms of depression associated with this disease. People suffering from Alzheimer's disease often need to be on an antidepressant for a longer period of time before the benefits can be seen. If a patient does not respond to an SSRI, a tricyclic antidepressant (TCA) such as desipramine or nortriptyline may be useful. It is preferable to avoid most TCAs since they can cause the blood pressure to drop on standing, resulting in increased falls in the elderly. They also have a tendency to cause drowsiness, and constipation.

Anti-anxiety medications - Benzodiazepines such as Xanax, Ativan, Serax, and BuSpar can be useful for calming agitated patients and are frequently used for this purpose. They can cause drowsiness which is advantageous at bedtime but may be a disadvantage during the day. They also worsen symptoms related to cognition (knowing) such as memory, problem solving, learning new things and performing tasks.