As our population ages, more families find themselves navigating the challenging terrain of dementia and Alzheimer's disease. With over 55 million people worldwide currently living with dementia and nearly 10 million new cases each year, the impact is substantial.
While research continues to advance our understanding of these conditions, it's crucial to understand that currently, there is no cure for dementia or Alzheimer's disease. However, several medications can help manage symptoms and potentially slow disease progression, offering patients additional months of independence and improved quality of life.
Understanding Dementia and Treatment Options
Dementia is not a single disease but a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer's disease is the most common type, accounting for 60-70% of cases. Other types include vascular dementia (caused by stroke or blood vessel problems), Lewy body dementia, and frontotemporal dementia (affecting the front and side portions of the brain). All forms progressively impact memory, thinking, behavior, and the ability to handle everyday tasks.
Despite the absence of a cure, the medical community has developed several approaches to treating these neurodegenerative conditions. These treatments fall into a few main categories:
Newer amyloid-targeting medications
Traditional cognitive symptom management drugs
Medications for behavioral symptoms
Lifestyle interventions and supportive care
Let's explore what's currently available and what patients and caregivers should know when making treatment decisions.
The Newer Generation: Amyloid-Targeting Medications
Recent advancements have led to the approval of medications that specifically target amyloid proteins in the brain – the plaques that are hallmarks of Alzheimer's disease.
Lecanemab (Leqembi)
Lecanemab works by removing harmful protein buildup in the brain. It was recently approved after studies showed it could slow memory and thinking decline.
According to research from Washington University:
For people with mild memory problems, lecanemab may provide about 10 more months of independent living
For those with more advanced symptoms, it might add up to 26 more months of being able to perform daily activities like dressing and bathing
This medication requires visits to a medical facility every two weeks for treatment through an IV.
Donanemab (Kisunla)
Donanemab works similarly to lecanemab. Studies showed it reduced the risk of worsening symptoms by about 35% over 18 months.
Research suggests:
People with early symptoms might gain about 8 months of independence
Those with more advanced symptoms could get about 19 more months of self-care ability
This treatment requires monthly IV visits rather than every two weeks.
Important Considerations for These Newer Medications
While promising, these medications have important drawbacks:
Side Effects: Both can cause serious side effects, including:
Brain swelling and bleeding that require monitoring with brain scans
About 3% of participants in clinical trials experienced these serious side effects
Several deaths occurred during trials
Other side effects include allergic reactions, confusion, dizziness, heart issues, and severe headaches
Cost: Even with Medicare coverage, annual co-pays can cost thousands.
Monitoring Requirements: Patients must undergo regular brain scans to check for bleeding and swelling.
Genetic Factors: People with two copies of the APOE-4 gene (indicating genetic predisposition to Alzheimer's) face even greater risks of side effects and may not be ideal candidates for these treatments.
Effectiveness Context: As Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases, notes: "These are not miracle drugs... All that happens is that people get less worse over time — instead of declining by three years, they decline by two years."
Traditional Cognitive Medications
Before the newer amyloid-targeting drugs, several medications were (and still are) commonly prescribed for Alzheimer's and dementia:
Memory-Enhancing Medications
Several medications can help with memory and thinking problems:
Donepezil (Aricept) - can be used at all stages of Alzheimer's
Rivastigmine (Exelon) - for early to middle stages of Alzheimer's
Galantamine (Razadyne) - for early to middle stages
These medications work by boosting brain chemicals involved in memory and thinking. Side effects typically include nausea, vomiting, loss of appetite, and digestive issues.
Medications for Advanced Symptoms
Memantine (Namenda) helps with symptoms in the later stages of Alzheimer's
Sometimes combined with donepezil (Namzaric) for better results
Side effects may include dizziness, headache, and constipation.
Medications for Vascular Dementia
For vascular dementia (caused by blood vessel problems in the brain), doctors often prescribe:
Blood pressure medications
Cholesterol-lowering medications
Blood-thinning medications to prevent further strokes
Medications for Mood and Behavior Changes
As dementia progresses, changes in mood and behavior often occur. While no medications are specifically approved for these symptoms, doctors sometimes prescribe:
Antidepressants for low mood and irritability, though these aren't usually the first approach
Anti-anxiety medications for nervousness and restlessness
Strong calming medications for severe agitation or aggression, but only when there's risk of harm
Medical experts emphasize that non-drug approaches should always be tried first. These medications carry extra risks for people with dementia and should be used cautiously.
Make Informed Treatment Decisions with Neurology Associates
When considering medications for dementia or Alzheimer's, patients and families should have thoughtful conversations with healthcare providers. Dr. Sarah Hartz from Washington University explains that these medications should be considered in terms of what matters most to patients: "The purpose is to help people make decisions that are best for themselves and their family members."
At Neurology Associates Neuroscience Center, we specialize in personalized care for patients with dementia and Alzheimer's disease. Our expert neurologists provide comprehensive evaluations and treatment plans tailored to each individual's needs and circumstances. We offer our services at convenient locations in Chandler and Mesa, with telemedicine options available for qualifying patients.
Contact us today to schedule a consultation and learn how our comprehensive neurological services can help you or your loved one navigate the journey of living with dementia or Alzheimer's disease.
IMPORTANT NOTE: The information in this article is intended for educational purposes only. All medications and treatments should be administered under the direct supervision of qualified healthcare professionals to ensure safety and effectiveness.