What Medications Are Available To Treat Alzheimer's?
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
While there is no cure yet for Alzheimer’s disease, patients do have a number of medications now available that help treat its symptoms and one that may actually modify the course of the disease itself.
The drugs in the first group, called cholinesterase inhibitors, have been around for several years and work to raise the amount of acetylcholine in the brain, a chemical messenger that is critical to memory formation.
“This group of drugs often help somewhat with memory symptoms, but improvement is modest to moderate,” says Dr. Daniel Press, neurologist at Beth Israel Deaconess Medical Center and assistant professor of neurology at Harvard Medical School.
The medications have brand names such as Aricept, Exelon and Razadyne and are able to help patients at all stages of the disease. “Even before diagnosis, when patients have cognitive impairment that proceeds to Alzheimer’s,” Dr. Press says. “At each stage, patients can get an improvement equivalent on average to six months time. It’s like a car rolling down a hill. The medicine pushes the car back up the hill, but it continues to roll down at the same speed.”
Still, patients can continue taking the medication throughout the course of their disease and “sometimes it can be significant enough that they will have a big improvement in the quality of their lives,” he adds. “I’ve seen patients who couldn’t drive and on the medication they were able to pass a driving test. They may have an easier time remembering conversations, so they don’t repeat the same conversations over and over. They may have an easier time remembering day and location, so it makes them feel more secure.”
Although there are no new drugs available in this category, one of the drugs, Exelon, is now available in patch form, making it more convenient to take and causing fewer side effects, says Dr. Press.
A drug of a different class, Namenda, works on a different chemical messenger, glutamate, which is produced in excessive amounts in Alzheimer’s patients, killing brain cells. The drug blocks the production of glutamate, potentially preventing the destruction of brain cells. “There is a possibility that it actually makes the hill less steep,” says Dr. Press, returning to the analogy he used to describe how the cholinesterase inhibitors work.
Whether or not the drug actually modifies the course of the disease is still unknown and ongoing clinical trials seek to answer that question, he says. But Namenda was approved because advanced patients who took it in trials seemed to progress more slowly than those taking placebo, he notes.
“It really seems to work at the moderate to advanced stages, but not as much at the mild stages,” says Dr. Press. “But it can be taken in conjunction with the other drugs. In any case, people on it seem to buy time. It is useful if they have advanced disease and are still living at home and want to prevent placement in a nursing home. This may push that off for three to six months and that’s no small feat in terms of duress and economics.”
Beyond these approved medications, there are several new drugs in the pipeline that seek to inhibit the buildup of the plaques in the brain that cause the disease to develop in the first place.
These range from a vaccine that generates antibodies to amyloid plaques and uses the patient’s immune system to break up plaques already in the brain to drugs called gamma-secretase inhibitors that inhibit production of an enzyme that causes the production of plaques to drugs that work on inflammation, also thought to be a culprit in the formation of plaques.
“I’m excited about all three approaches,” says Dr. Press. “All three have the potential to be major breakthroughs in the field. The general level of excitement in the field is very high. All of these approaches have the potential to modify the course of the disease.”
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.
Posted December 2008
Beth Israel Deaconess Medical Center Correspondent
While there is no cure yet for Alzheimer’s disease, patients do have a number of medications now available that help treat its symptoms and one that may actually modify the course of the disease itself.
The drugs in the first group, called cholinesterase inhibitors, have been around for several years and work to raise the amount of acetylcholine in the brain, a chemical messenger that is critical to memory formation.
“This group of drugs often help somewhat with memory symptoms, but improvement is modest to moderate,” says Dr. Daniel Press, neurologist at Beth Israel Deaconess Medical Center and assistant professor of neurology at Harvard Medical School.
The medications have brand names such as Aricept, Exelon and Razadyne and are able to help patients at all stages of the disease. “Even before diagnosis, when patients have cognitive impairment that proceeds to Alzheimer’s,” Dr. Press says. “At each stage, patients can get an improvement equivalent on average to six months time. It’s like a car rolling down a hill. The medicine pushes the car back up the hill, but it continues to roll down at the same speed.”
Still, patients can continue taking the medication throughout the course of their disease and “sometimes it can be significant enough that they will have a big improvement in the quality of their lives,” he adds. “I’ve seen patients who couldn’t drive and on the medication they were able to pass a driving test. They may have an easier time remembering conversations, so they don’t repeat the same conversations over and over. They may have an easier time remembering day and location, so it makes them feel more secure.”
Although there are no new drugs available in this category, one of the drugs, Exelon, is now available in patch form, making it more convenient to take and causing fewer side effects, says Dr. Press.
A drug of a different class, Namenda, works on a different chemical messenger, glutamate, which is produced in excessive amounts in Alzheimer’s patients, killing brain cells. The drug blocks the production of glutamate, potentially preventing the destruction of brain cells. “There is a possibility that it actually makes the hill less steep,” says Dr. Press, returning to the analogy he used to describe how the cholinesterase inhibitors work.
Whether or not the drug actually modifies the course of the disease is still unknown and ongoing clinical trials seek to answer that question, he says. But Namenda was approved because advanced patients who took it in trials seemed to progress more slowly than those taking placebo, he notes.
“It really seems to work at the moderate to advanced stages, but not as much at the mild stages,” says Dr. Press. “But it can be taken in conjunction with the other drugs. In any case, people on it seem to buy time. It is useful if they have advanced disease and are still living at home and want to prevent placement in a nursing home. This may push that off for three to six months and that’s no small feat in terms of duress and economics.”
Beyond these approved medications, there are several new drugs in the pipeline that seek to inhibit the buildup of the plaques in the brain that cause the disease to develop in the first place.
These range from a vaccine that generates antibodies to amyloid plaques and uses the patient’s immune system to break up plaques already in the brain to drugs called gamma-secretase inhibitors that inhibit production of an enzyme that causes the production of plaques to drugs that work on inflammation, also thought to be a culprit in the formation of plaques.
“I’m excited about all three approaches,” says Dr. Press. “All three have the potential to be major breakthroughs in the field. The general level of excitement in the field is very high. All of these approaches have the potential to modify the course of the disease.”
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.
Posted December 2008
