What to Expect from Treatment for AD
or Another Dementia
There are numerous causes of memory and thinking difficulties. Many, including Alzheimer's disease, are treatable. Others, such as depression, thyroid problems, severe nutritional deficiency, or medication interaction, may be reversible. Patients who are evaluated through the ADMDC should expect to have their options for treatment identified and explained to them so that they may make a well informed decision about their care. If a diagnosis of AD is made, regardless of the severity of the disease, treatment options are available.
Treatments for the symptoms of AD have been available for some time. Initially, the only medications available were treatment for the non-cognitive or behavioral symptoms of AD which may or may not develop during the course of illness. In 1993, the Food and Drug Administration approved the first medication intended to treat the cognitive symptoms of AD. That drug was Cognex. Cognex is no longer prescribed due to difficult side effects and the development of better tolerated medications. The FDA has since approved three drugs for the treatment of mild to moderate AD: Donepezil (Aricept) was approved in 1996, Rivastigmine (Exelon) was approved in 2000, and galantamine (Reminyl) was approved in 2001. In October, 2003, the FDA approved Memantine (Namenda) for the treatment of moderate to severe AD.
Presently, none of the five FDA approved medications for Alzheimer's disease are capable of curing the disease or restoring normal cognitive functioning or memory. The medications are not expected to improve a person's functioning, although this may occur for some time in some cases. Rather, medications for Alzheimer's disease are intended to stabilize cognitive and functional abilities from the point the medication is started. For most, an initial stabilization period is followed by periods of restabilization or slowed progression through medication adjustment or the possible addition of other medications. If you are trying to determine whether a medication is working, remember that no change or a slower than expected change in cognition or day to day functioning indicates that your medication is working.
There are several important things to know about these drugs, which may help you and your doctor select the best option. Effective treatment depends on several factors, including getting an accurate diagnosis, reaching a therapeutic dose on medication, and ongoing monitoring of the patient's response to medication. If a condition worsens over time or additional symptoms develop, your doctor may want to adjust or add a medication.
Keep in mind that a patient's ability to tolerate a medication may affect his or her compliance in taking the medicine. Poor memory, coupled with the absence of a reliable person to serve as a medication manager, can also compromise compliance. Since medications for AD are unlikely to benefit a patient if a minimum therapeutic level is not reached, factors which could interfere with reaching the minimum dosage must be addressed. If someone can't tolerate a medicine because of side effects, another medication should be tried, and the time between stopping one medication and beginning another kept to a minimum. If, on the other hand, someone is tolerating a medication well, switching to another medication must be carefully considered. A medication may be providing benefits which are not readily apparent until that medication is stopped. Even if restarted, a patient may not regain the same level of cognitive or functional ability as before.
When deciding on a medication, you should further keep in mind that there have been no head to head, double-blind, placebo controlled studies comparing the effectiveness of the current cholinesterase inhibitors, or comparing cholinesterase inhibitors to Memantine. In other words, no drug has been shown to be better than another in maintaining thinking ability or daily functioning. You should speak to your doctor about the potential side effects of each medication, and consider practical issues such as the number of times a medication must be taken each day when making your decision. If a spouse, family member, or trusted other is available to oversee the administration of medications, the frequency of dosing may not be a significant issue.
Persons seeking treatment for memory or thinking problems must establish realistic expectations for treatment, and a clear understanding of the goals of therapy.
To make an informed decision about treatment, you should discuss your expectations and goals for treatment fully with your doctor. In preparation for talking with your doctor, consider contacting the Alzheimer's Association or the Alzheimer's Disease Education and Referral Center www.alzheimers.org for a listing of all medications currently approved by the FDA for treating Alzheimer's disease.