Medications to treat Alzheimer’s disease can slowly the leads to a cognitive decline or also symptoms such as changes in language, thinking ability and movement.
There is no cure and progression can be slow or rapid. The goal of treatment is to achieve improvement within the possible and a better quality of individual life and obviously sexual relationships included.
Each drug has a brand and generic name.
Aricept™ (brand name) or Donepezil (generic name).
Reminyl ER™ (brand name) or Galantamine (generic name)
Exelon™ (brand name) o Rivastigmine (generic name)
Ebixa® (brand name) or Memantine (generic name)
For the purpose of treatment, it does not matter if the medication is brand name or generic, their effects are the same.
The latest potential drug to treat Alzheimer’s disease, aducanumab, which is not yet approved for use in all countries. For questions about aducanumab and/or the treatment of Alzheimer’s disease and other dementias, we recommend that you speak with a neurologist.
Depending on the severity of symptoms and how quickly the disease progresses, different medications may be appropriate.
Medications for mild to moderate Alzheimer’s disease:
Medications for moderate to advanced Alzheimer’s disease:
How do these medications work?
Three of them may help prevent learning and memory impairment
Three of the drugs, donepezil (Aricept™), galantamine (Reminyl™) and rivastigmine (Exelon™), are cholinesterase inhibitors. These drugs can prevent the breakdown of a brain chemical called acetylcholine.
Learn more about acetylcholine:
Acetylcholine is a chemical in the brain that is thought to be important for learning and memory.
A person with Alzheimer’s has lower levels of acetylcholine than someone without the disease.
By providing a higher concentration of acetylcholine, these medications can temporarily relieve or stabilize some of the symptoms of Alzheimer’s disease.
These medications may be useful for two to three years, possibly longer. Eventually, the nerve endings die and the drugs are no longer effective. Therefore, they are only useful for people in the mild to moderate stages of dementia.
One of them can protect your brain cells.
The other drug, memantine (Ebixa®), is an NMDA receptor antagonist. This drug is thought to work by affecting another brain chemical called glutamate.
Learn more about glutamate:
Glutamate helps send messages between brain cells.
Glutamate is released in excess amounts when brain cells are damaged by Alzheimer’s disease.
Memantine can protect brain cells by blocking the effects of excess glutamate.
Some specialists recommend adding memantine to one of the cholinesterase inhibitors once a person with Alzheimer’s has progressed from the early and middle stages to the middle and late stages.
Memantine may be prescribed for people in middle and late stages who cannot tolerate the side effects of a cholinesterase inhibitor.
See our downloadable brochure for more information: Alzheimer’s Disease Medications:
How can you tell if a medication is helping or hurting?
Improvements are often subtle and can be hard to detect, even for your doctor. It may also take several months to see benefits. Some people will benefit more than others.
Improvements may include:
Modest cognitive changes: The person living with Alzheimer’s notices improvements iern memory, concentration and language.
Subtle behavioral changes: The person living with Alzheimer’s is calmer, more involved in daily activities (such as cooking, bathing and using appliances), more motivated and more communicative.
Some people will not show significant improvement, but may stabilize over a period of time.
Possible side effects
Medications are usually started at the lowest dose available, which can help minimize side effects. If the person tolerates the medication, the dose is usually increased slowly to maximize the benefits of treatment.
If the patient experiences any of these side effects, contact with, as soon as possible.
To difference vascular demencial desesase of alzheimer desease it is useful computed tomography (CT),magnetic resonance (MR). Maybe useful so, to elucidate the diagnosis definitely do a lumbar puncture to see if there is TAU protein in other pathologies do not exist.
Side effects of donepezil, galantamine and rivastigmine:
Gastrointestinal side effects, such as nausea, vomiting, diarrhea, or loose stools,
Loss of appetite and subsequent unintentional weight loss,
Decreased heart rate,
Side effects of memantine:
Caution is also required when prescribing memantine to people who have kidney problems.
Because Alzheimer’s is a progressive disease that worsens over time, noticing no change in a person’s daily function and behavior for six months to a year after starting the medication is a positive outcome and a sign that the medication is working.
If the medications are discontinued, the person may lose the benefits and may decline at a faster rate than expected.
When should you start taking these medications?
If there are no other health conditions that would make taking these medications dangerous for you, the specialist usually recommend starting a trial of one of the cholinesterase inhibitors immediately after diagnosis.
If your family physician is uncomfortable or reluctant to prescribe one of these medications, consider requesting a consultation with a geriatric specialist to get another opinion.
How long should these medications be taken?
If you are benefiting from the medication and can tolerate the side effects, it is often recommended that you continue taking the medication until the end stages.
In other cases, when there is no clear benefit, if there is a safety issue, the side effects are too difficult, or you simply do not like taking the medication, then it may be time to stop treatment. Each experience is unique: we must consult an specialist to decide what is best.
Are these medications effective for other types of dementia?
Cholinesterase inhibitors (donepezil, galantamine and rivastigmine) were originally developed to treat only Alzheimer’s disease, not for other types of dementia and similar conditions, such as mild cognitive impairment (MCI).
However, there may be some cases in which these drugs are effective, depending on the type of dementia:
Cholinesterase inhibitors, particularly donepezil and rivastigmine, are also commonly used to treat dementia with Lewy bodies and have been reported to reduce visual hallucinations.
Rivastigmine has also been approved to treat dementia caused by Parkinson’s disease.
There is not enough evidence to support the use of cholinesterase inhibitors or memantine in people living with vascular dementia or frontotemporal dementia.
However, for people with a combination of Alzheimer’s disease and vascular dementia (known as mixed dementia), cholinesterase inhibitors can be used when Alzheimer’s disease is the primary cause, but not to treat vascular dementia alone.
In the case of MCI, these drugs are generally not effective. They do not reduce the risk of mild cognitive impairment progressing to Alzheimer’s disease or another type of dementia.
Important to know:
Dementia affects each person differently. A treatment that works for one person may not work for another.
Drug coverage varies from state to state and individuals may be required to cover some of the costs associated with these medications.
You must meet specific criteria in you state to be eligible to have the drugs paid for by your provincial health coverage plan. Check with your provincial health plan to see if you are covered.
Medications may also be covered by many private insurance plans.
What other treatment options are available?
Medications should only be a part of your overall care. Consider your treatment options:
Some alternative treatments (such as music therapy, aromatherapy, pet therapy and massage) may be beneficial for people with dementia. However, the lack of research-supported evidence prevents us from determining their effectiveness.
There are potential treatments that may be effective in treating not only the symptoms of Alzheimer’s disease, but also in halting cognitive decline altogether. However, much research and testing is needed to validate their results. It may still be years before these new treatments are available to the public.
The most effective treatment that doesn’t involve medication? Follow a brain-healthy lifestyle. Participating in physical and social activities, challenging your brain and making healthy choices are vital to living well with dementia.
For a complete list of treatment options currently available to you, read our printable brochure.
Knowing accurate information and realistic expectations about the potential benefits and possible side effects of these medications, you can consult with your doctor or pharmacist.
More useful links and resources
Alzheimer’s disease medications: Are they right for you? Alzheimer’s Society of Canada. Get all the information you need about current drugs approved to treat the symptoms of Alzheimer’s disease, including their potential benefits and risks.
Approval process for drugs to treat Alzheimer’s disease. Alzheimer’s Society of Canada. Get a complete picture of how a drug is approved for public use in Canada, including a list of currently approved drugs that can treat the symptoms of Alzheimer’s disease.
Treatment options. Alzheimer’s Society of Canada. This downloadable brochure provides an overview of all the treatment options for Alzheimer’s disease that are available to you.
Canadian Provincial Health Plans. Special Benefit Insurance Services. This page is a helpful summary of the health services covered in each province, with links to each plan on each respective province’s government website.
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