Treatments for Alzheimer’s disease

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At the moment, we neither have a cure nor any treatment that can stop the advance of Alzheimer’s disease. However, certain interventions have proven effective in terms of delaying the cognitive and functional impairment and preventing or minimising the complications associated with Alzheimer’s. In this regard, the disease must be approached from different perspectives: drug therapy, physical and cognitive intervention programmes, and social protection measures for the patient.

Non-drug therapy

Different studies have shown that programmes involving cognitive intervention, physical activity, and activities of daily living have a beneficial effect on patients with Alzheimer’s disease.

Ejercicio persona mayor

There are different types of intervention available but there is not enough evidence to support recommending one over the others. These activities have a positive effect depending on their frequency: two weekly sessions for cognitive intervention programmes and three hours a week for physical activities. The stage of the disease must also be considered as not all programmes are appropriate for all stages.

Dieta adecuada, pirámide de la alimentación

Patients should follow healthy lifestyle habits and control risk factors associated with cardiovascular disease. Nevertheless, there is no scientific evidence that these elements have a direct benefit in terms of disease progression once it has established itself. On the other hand, support and educational programmes for the patient’s caregiver also have a positive effect, both on the carer’s health and the management of the patient with Alzheimer’s.

Drug therapy

There are currently four drugs marketed specifically for the treatment of Alzheimer’s disease. They all have a symptomatic effect, in other words, they act on the consequences of the neurodegenerative process, such as the cognitive and behavioural problems, but they do not address the causes. There are two groups of drugs available:

Pills with green and white stripes

Acetylcholinesterase inhibitors (AChEI). These increase the concentration of acetylcholine in the brain, which is a neurotransmitter substance whose levels are known to decline in patients with Alzheimer’s. The drugs in this group are donepezil, rivastigmine and galantamine and they have shown to be modestly effective in reducing both the loss of cognitive function, such as the ability to complete day-to-day activities, and the level of altered behaviours in patients with mild to moderately severe Alzheimer’s disease. The three drugs have a similar effect and the main difference is the route of administration (whether orally or transdermally). The main side effects are concerned with digestive problems (nausea, diarrhoea, weight loss, abdominal discomfort).

Blue, white and green pills

The fourth drug is an N-methyl-D-aspartate (NMDA) receptor antagonist called memantine. This medication has also proven effective as it improves cognition, overall function, activities of daily living and behaviour in patients in a moderate to severe stage of the disease.

round pills, vasodilators

Some Alzheimer’s patients go through stages that cause symptoms such as mood disorder, irritability, disturbed sleep, etc., which require drug therapy. These symptoms are managed with drugs that are commonly used to treat psychiatric disorders, although often at lower doses to avoid side effects.

New therapies

Different lines of research into new therapies for Alzheimer’s disease are currently being studied.

The majority of activity is focused on developing a drug that, unlike those currently available, can modify the evolution of the disease, i.e., a drug capable of stopping or slowing the progression of the pathological changes occurring in the brain and therefore delaying the symptoms and preserving the patient’s independence and quality of life for as long as possible. 

As such, different drugs are currently being tested with the aim of eliminating or decreasing the amounts of pathological proteins, primarily the β-amyloid or tau proteins, that accumulate in the brains of people with Alzheimer’s, whether by eliminating those which have already accumulated, decreasing their production or inhibiting their aggregation. Although these effects have already been confirmed in test animals, it remains to be seen whether cleaning up proteins in the human brain improves the clinical progression, which is the final objective. 

Other lines of research aim to discover drugs that can preserve the remaining neurons and prevent further neurodegeneration, modify the inflammatory activity, etc. 

Meanwhile, other researchers continue to study symptomatic treatment with potential new drugs that are more effective than those currently available or which can be co-administered to produce a greater beneficial effect. 
 

Treatment complications

In general, the treatments specific to Alzheimer’s disease are well tolerated.

The most common side effects of the group of drugs known as acetylcholinesterase inhibitors (AChEI), comprised of donepezil, rivastigmine and galantamine, are gastrointestinal problems. They may initially give rise to nausea, vomiting, diarrhoea or weight loss, and these symptoms may be temporary or long-lasting. The dose is usually increased progressively to minimise the appearance of side effects. Administration via transdermal patches can also reduce the level of these symptoms. Other less common side effects are headache, nightmares, muscle cramps and urinary urgency. Some rare but potentially severe effects are slowing of the heartbeat and bronchospasm, so they must be prescribed with precaution in patients with irregular heartbeat or severe asthma.

Regarding memantine, the most common side effects are dizziness, headache, confusion or nervousness. Memantine is not recommended in patients with severe liver problems or epilepsy because it can aggravate these conditions.

Neuroleptic drugs (quetiapine, risperidone, haloperidol), which are used to control altered behaviour and disturbed sleep, can also produce side effects, particularly when they are administered at high doses and over prolonged periods. The most frequent side effect is drowsiness, followed by muscle stiffness, slow movements and tremors. Therefore, patients and caregivers must monitor for their appearance in order to reduce the dose or even withdraw the drug if necessary.

Substantiated information by:

Neus Falgas Martínez
Raquel Sanchez del Valle Díaz
Soledad Barreiro Gigan

Published: 9 April 2018
Updated: 9 April 2018

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