Treating Cognitive and Behavioral Issues in Alzheimer's

FDA-approved Medications and Strategies to Treat Symptoms in Alzheimer's Disease

Aricept pills, Eisai Co.'s alzheimers drug, are arranged for a photograph. Credit: Bloomberg / Contributor / Getty Images

Although there is currently no cure for Alzheimer's disease, researchers are making encouraging advances in Alzheimer's treatment, including medications to treat the cognitive symptoms, and non-drug approaches to managing behavioral symptoms. 

How are Thinking and Memory Problems Treated in Alzheimer's Disease?

Cognitive symptoms include problems with thought processes like memory, language, and judgment.

Five medication have been approved by the U.S. Food and Drug Administration for treatment of the cognitive symptoms of Alzheimer's disease:

  • Cholinesterase inhibitors increase the levels of acetylcholine in the brain, which plays a key role in memory and learning. Cholinesterase inhibitors that are approved by the FDA for use in Alzheimer's disease include Aricept (donepezil HCL), Exelon (rivastigmine), and Razadyne (galantamine). Exelon (rivastigmine) and Aricept (donepezil) are used to treat all stages of Alzheimer's disease, whereas Razadyne (galantamine) may be prescribed for mild to moderate Alzheimer's. Because of varying side effects and possible interactions with other medications, doctors may try different cholinesterase inhibitors until the most effective one is found for the individual.
  • Namenda (memantine) regulates glutamate in the brain, which plays a key role in processing information, learning, and memory. This drug is used to treat moderate to severe Alzheimer's disease.

    Sometimes, memantine and a cholinesterase inhibitor are taken simultaneously during the moderate to severe stage of Alzheimer's disease. In 2014, the FDA approved Namzaric, which is a combination of Aricept (donepezil) and Namenda (memantine).

    It's important to know that while these medications may improve the symptoms of Alzheimer's disease, they do not delay the progression of the disease.


    How are Behavioral Problems Treated in Alzheimer's Disease?

    Often the most challenging for caregivers, behavioral symptoms include agitation, suspicion, and depression. Although caregivers may be personally affected by the behaviors exhibited toward them, it's important to remember that behavioral symptoms are just as much a result of damage to brain cells as are cognitive symptoms.

    Some medications are useful for managing behavioral symptoms. For instance, anti-anxiety medications can treat agitation and aggression, and antipsychotic medications have been used to address suspicion and paranoia. However, the risk of drug reactions and/or interactions runs high among those with Alzheimer's, so caution should be used when medications are prescribed to manage behavioral issues. A combination of drug and non-drug treatments often works best.

    Non-drug treatments involve analyzing the behavior, identifying what may have triggered it, and devising an approach that either changes the person's environment or the caregiver's reaction to the behavior.

    For example, excessive noise can worsen agitation in individuals with Alzheimer's. Simply creating a calmer environment may eliminate the behavior.

    Likewise, when caregivers become angry in response to a difficult behavior, this usually only upsets the person with Alzheimer's and increases the behavior's frequency. Reacting in a calm, controlled manner can reduce the tension long enough to distract the person to a more pleasant activity, such as looking at a family photo album or listening to a favorite kind of music.

    Also, consider other sources for a person with Alzheimer's disease distressing behavior. Scheduling an appointment with their doctor may uncover an infection, like a urinary tract infection. Or a source of pain that is not visible to the caregiver may be the culprit.


    What Should I Do?

    If you are a caretaker or a loved one of someone with Alzheimer's disease, speak with your doctor about effective behavior management strategies. Connecting with others caregivers or loved ones of those with Alzheimer's disease support groups and online support networks may also be helpful. 


    Alzheimer's Association. (2015). Current Alzheimer's Treatments. Retrieved November 19th, 2015. 

    Alzheimer's Association. (2015). Basics of Alzheimer’s disease: What it is and what you can do. Retrieved November 19th, 2015. 

    Alzheimer's Association. (2015). Behaviors. Retrieved November 19th, 2015. 

    Galimberti D & Scarpini E. Disease-modifying treatments for Alzheimer's disease. ​Ther Adv Neurol Disord. 2011 Jul;4(4):203-16.

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