Alzheimer's Disease (cont.)
Partial glutamate antagonists
Glutamate is the major excitatory neurotransmitter in the brain. One theory
suggests that too much glutamate may be bad for the brain and cause
deterioration of nerve cells. Memantine (Namenda) works by partially decreasing
the effect of glutamate to activate nerve cells. It has not been proven that
memantine slows down the rate of progression of Alzheimer's disease. Studies have demonstrated
that some patients on memantine can care for themselves better than patients on
sugar pills (placebos). Memantine is approved for treatment of moderate and
severe dementia, and studies did not show it was helpful in mild dementia. It is
also possible to treat patients with both AchEs and memantine without loss of
effectiveness of either medication or an increase in side effects.
Non-medication based treatments
Non-medication based treatments include maximizing patients' opportunities for
social interaction and participating in activities such as
walking, singing,
dancing that they can still enjoy. Cognitive rehabilitation, (whereby a patient
practices on a computer program for training memory), may or may not be of
benefit. Further studies of this method are needed.
Treatment of psychiatric symptoms
Symptoms of Alzheimer's disease include agitation, depression, hallucinations,
anxiety, and
sleep disorders. Standard psychiatric drugs are widely used to treat these
symptoms although none of these drugs have been specifically approved by the FDA
for treating these symptoms in patients with Alzheimer's disease. If these behaviors are
infrequent or mild, they often do not require treatment with medication.
Non-pharmacologic measures can be very useful.
Nevertheless, frequently these symptoms are so severe that it becomes
impossible for caregivers to take care of the patient, and treatment with
medication to control these symptoms becomes necessary. Agitation is common,
particularly in middle and later stages of Alzheimer's disease. Many different classes of agents
have been tried to treat agitation including:
Studies are
conflicting about the usefulness of these different drug classes. It was thought
that newer, atypical antipsychotic agents such as clozapine
(Clozaril), risperidone
(Risperdal),
olanzapine (Zyprexa, Zydis), quetiapine
(Seroquel), and ziprasidone
(Geodon) might have advantages over the older
antipsychotic agents because of their fewer and less severe side effects and the
patients' ability to tolerate them. However, more recent studies have not
demonstrated superiority of the newer antipsychotics. Some research shows that
these newer antipsychotics may be associated with increased risk of stroke or
sudden death than the older antipsychotics, but many physicians believe this
question is still not resolved.
Apathy and difficulty concentrating occur in most Alzheimer's disease patients and should not
be treated with antidepressant medications. However, many Alzheimer's disease patients have other
symptoms of depression including sustained feelings of unhappiness and/or
inability to enjoy their usual activities. Such patients may benefit from a
trial of antidepressant medication. Most physicians will try selective serotonin
reuptake inhibitors (SSRIs), such as sertraline
(Zoloft), citalopram (Celexa), or fluoxetine
(Prozac), as
first-line agents for treating depression in Alzheimer's disease.
Anxiety is another symptom in Alzheimer's disease that occasionally requires treatment.
Benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) may be
associated with increased confusion and memory impairment. Non-benzodiazepine
anxiolytics, such as buspirone
(Buspar) or SSRIs, are probably preferable.
Difficulty sleeping (insomnia) occurs in many patients with Alzheimer's
disease at some point
in the course of their disease. Many Alzheimer's disease specialists prefer the use of sedating
atypical antidepressants such as trazodone
(Desyrel). However, other specialists may
recommend other classes of medications. Sleep improvement measures, such as
sunlight, adequate treatment of pain, and limiting nighttime fluids to prevent
the need for urination, should also be implemented.
Next: Potential and future therapies for Alzheimer's disease »
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