Treatment for Alzheimer's Disease and other Dementias

There are numerous causes of memory and thinking difficulties. Many, including Alzheimer's disease, are treatable and some may be reversible including depression, thyroid disease, vitamin deficiencies or medication side effects. Treatment options are identified and explained to patients so they may make well-informed decisions about their care. If a diagnosis of Alzheimer's is made, regardless of the severity of the disease, treatment options are available.

Three medications are FDA-approved to treat mild to moderate Alzheimer's disease: Donepezil (Aricept), Rivastigmine (Exelon) and galantamine (Reminyl). Memantine (Namenda) is FDA-approved for the treatment of moderate to severe Alzheimer's disease.

These medications are not cures nor do they restore normal cognitive functioning. They may improve a person’s cognitive functioning modestly or stabilize cognitive and functional abilities. 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 and day to day functioning indicates that your medication is working.

Poor memory and medication side effects may affect the patient’s ability to follow a medication regimen. Having a dependable person to help the patient with medication management is ideal.  Alzheimer’s medicines need to reach the right dose to work, so side effects or other issues should be addressed quickly. If someone can't tolerate a medicine because of side effects, another medication should be considered. Medication may be providing benefits which are not readily apparent until that medication is stopped.  

Of note, there have been no head-to-head, double-blind, placebo-controlled studies comparing the effectiveness of donepezil, rivastigmine and galantamine, 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.

The ADMDC is proud to offer treatment with two medications approved by the FDA that slow the progression of Alzheimer’s disease.  Both are antibodies created to trigger the removal of amyloid protein deposits (plaques) from the brain and are administered intravenously:  

• Lecanemab (Leqembi) was approved by the FDA in 2023 for mild cognitive impairment due to Alzheimer’s disease and mild Alzheimer’s disease. Medicare requires patient data submission to a clinical registry to receive the medication.
• Donanemab (Kisunla) was approved by the FDA in July 2024 for mild cognitive impairment and mild Alzheimer’s Disease. Clinical registry participation is also required for Medicare coverage of donanemab.

Both lecanemab and donanemab require the patient have evidence of amyloid deposits in their brains. These deposits can only be detected reliably with an amyloid PET scan or spinal fluid analysis (via spinal tap/lumbar puncture).

Both lecanemab and donanemab have potential side effects including infusion reactions and amyloid related imaging abnormalities (ARIA) that consist of areas of edema (swelling) or hemorrhage (bleeding) in the brain. People who have one or two copies of the Apolipoprotein E4 gene are at higher risk for ARIA with people with two copies (“E4 homozygotes”) at especially high risk.  ARIA often occurs without symptoms but can sometimes cause headaches, confusion, dizziness or more serious complications.

Neither lecanemab nor donanemab improve symptoms of Alzheimer’s disease, they are only shown to modestly decrease the rate of progression.