Anticipated Approaches to Alzheimer's Disease Therapies, as Perceived by Professionals
Managing Alzheimer's: Exploring Treatment Options and Lifestyle changes
Alzheimer's disease brings a flurry of complexities, whether affecting the diagnosed individual or a loved one. Dealing with a multitude of intricate information, overwhelming emotions, and sensitive discussions about the future is the norm.
Alzheimer's disease, for which no cure exists, does not stop life from moving forward. While the progression of symptoms is inevitable, ways to manage them abound, allowing those with the disease to enjoy fulfilling lives and caregivers to maintain meaningful connections. Katherine Ornstein, PhD, MPH, director of the Center for Equity in Aging at the Johns Hopkins School of Nursing, explains this on our website.
Each person's journey with Alzheimer's is unique, with factors like symptom severity and responsiveness to treatment determining how long they may live after diagnosis. On average, people live between four and eight years post-diagnosis, occasionally surviving for up to 20 years. Dr. Ornstein elaborates on the importance of understanding available treatment options.
Two categories of FDA-approved Alzheimer's therapies exist. The first category targets chemicals responsible for message transmission between brain cells, aiming to temporarily improve symptoms such as impaired memory and thinking. The second category targets the underlying biology of the disease, with medications aimed at slowing cognitive decline.
A neurologist will consider the disease's stage and weigh the potential effectiveness and safety risks of each treatment when making recommendations. Being well-informed about the benefits, risks, time commitment, and costs associated with each treatment allows for making well-informed decisions or helping loved ones make the right choices. Irina Skylar-Scott, MD, a clinical assistant professor in the Center for Memory Disorders at the Stanford Department of Neurology and Neurological Sciences, underscores this importance to our website.
Alzheimer's affects the brain by gradually destroying nerve cells, triggering cognitive turmoil marked by escalating forgetfulness, difficulties with planning or organizing, and increased confusion or moodiness. As nerve cells diminish, chemical messenger levels, particularly acetylcholine, decrease, contributing to memory, language, and thought-processing difficulties.
Cholinesterase inhibitors counteract the breakdown of acetylcholine, increasing its availability to healthy nerve cells. Drugs like donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) are commonly used. Though they can drive a modest improvement in cognitive symptoms, they won't halt disease progression. The drugs' effectiveness decreases as Alzheimer's continues to impact the brain, and side effects like nausea, diarrhea, and muscle cramps are possible.
People with Alzheimer's have an abnormal accumulation of two proteins in their brains: amyloid and tau. These proteins form plaques and tangles that severely damage nerve cells, eventually leading to dementia symptoms. Anti-amyloid treatments like lecanemab (Leqembi) and donanemab (Kisunla) have been FDA-approved for early-stage Alzheimer's, potentially slowing cognitive decline progression. However, these immunotherapies require intravenous infusions every few weeks, may cause serious side effects like brain bleeding and swelling, and come with high costs.
For moderate to severe Alzheimer's, memantine (Namenda, Valios) may be prescribed to help modify abnormal glutamate activity that harms nerve cells, slowing symptoms that make day-to-day life more challenging. Other atypical antipsychotics, such as brexpiprazole (Rexulti), may be used off-label to manage symptoms like agitation, hallucinations, aggression, or delusions, although their use is typically a last resort due to potential serious adverse effects.
Lifestyle adjustments can make a significant difference in adding quality to life. Focusing on a person's cognitive strengths instead of weaknesses and creating a care plan tailored to individual needs can provide a sense of autonomy, comfort, and community. Daily exercise, nutritious meals, engaging in hobbies, staying social, and managing stress are also essential aspects of a treatment plan.
Although no definitive cure for Alzheimer's exists, experts remain optimistic about future developments. Ongoing research aims to uncover risk factors directly influencable, potentially leading to earlier diagnosis or even prevention strategies. The link between hearing loss and cognitive decline has recently been established, and making hearing aids more accessible for older adults could be a potential solution.
Recent advancements have fueled hope among experts that lecanemab and donanemab are mere beginnings of breakthroughs in Alzheimer's therapy. Global researchers are expanding anti-amyloid therapies, with some medications in clinical trials deliverable through injections, making them more accessible and time-efficient for patients. Exploring tau-targeting treatments and connections between other health conditions like cardiovascular disease and insulin resistance could potentially lead to slowing dementia progression.
Experts encourage patients and their families by assuring them of ongoing efforts to identify new treatments. As Dr. Skylar-Scott puts it: "Many of us wake up every day thinking about how to identify new treatments."
- Managing Alzheimer's involves exploring treatment options and making lifestyle changes to help those affected enjoy fulfilling lives.
- Understanding available treatment options, including their benefits, risks, time commitment, and costs, is crucial for making well-informed decisions.
- Cholinesterase inhibitors increase the availability of acetylcholine to healthy nerve cells, serving as one of the two FDA-approved Alzheimer's therapies.
- Anti-amyloid treatments like lecanemab and donanemab have been FDA-approved for early-stage Alzheimer's, potentially slowing cognitive decline progression.
- Lifestyle adjustments, such as focusing on cognitive strengths and creating personalized care plans, can provide a sense of autonomy, comfort, and community for those with Alzheimer's.
- Experts remain optimistic about future advancements in Alzheimer's therapy, with ongoing research aimed at identifying new treatments and potential preventive strategies.
