Drug treatments for Alzheimer’s disease

While we don’t yet have any drugs that can cure Alzheimer’s disease, there are some that can lessen the symptoms of this condition. And some may even slow the rate at which it develops.

That doesn’t mean that you should discount these drugs. They form a part of the treatment for Alzheimer’s, alongside advice from your specialist medical team, occupational therapy, cognitive behavioural therapy, and talking therapies such as counselling.

Two different types of medication are used to treat Alzheimer’s disease. They work in different ways, so once you’ve been assessed your specialist will know which type of drug is best for you.

Related: Symptoms of Alzheimer's disease

Cholinesterase inhibitors

Cholinesterase inhibitors, (short for acetylcholinesterase inhibitors)

The drugs donepezil, galantamine and rivastigmine are all cholinesterase inhibitors.

Your doctor may prescribe one of these drugs for you, but they may come with a different name. For instance, the patent name for donepezil was originally Aricept, but it is now commonly available as donepezil.

The patent name for Rivastigmine was Exelon, but this is now available under a number of other names, including its generic name, rivastigmine.

The same applies to Galantamine, which is still available as galantamine, and also as the brand names Reminyl XL, and Acumor XL, among others.

If you are at all confused by the names on your medicine packs, whether you are a carer, or someone with Alzheimer’s disease, check with your doctor or nurse. They should be able to explain which drug you’re taking, and why you‘ve been prescribed this particular one.

We all have a chemical called acetylcholine in our brains. This helps the brain send messages between different nerve cells. People with Alzheimer’s disease have lower levels of acetylcholine. They also have a continuing loss of the nerve cells that acetylcholine connects with. Progressive loss of the acetylcholine and the nerve cells are linked with worsening Alzheimer’s symptoms.

The drugs donepezil, rivastigmine and galantamine work by stopping the enzyme – acetylcholinesterase – from breaking down acetylcholine in our brains. By doing this, the drugs may reduce or stabilize some of the Alzheimer’s symptoms, for a while.

Donepezil, rivastigmine and galantamine all work in much the same way, but the side effects may vary, so one of these drugs might work better for you or the person you care for, than the others. This is something to ask your medical team about.

If you or the person you care for has early to mid-stage Alzheimer’s disease, and the doctor thinks that one of these drugs may help, they may prescribe one of them.

Only specialists such as psychiatrists, neurologists and physicians whose area of expertise is caring for older people, can prescribe these drugs.

Memantine

The other type of drug is NMDA receptor antagonists. The NMDA receptor antagonist used to help Alzheimer’s patients is memantine. This operates in a different way to the cholinesterase inhibitors mentioned above. The chemical glutamate also helps to send messages between nerve cells. However, when Alzheimer’s disease causes damage to the brain cells too much glutamate is released, which then causes even more damage to the brain cells.

Memantine works by blocking the damage that excessive amounts of glutamate can cause. A doctor may prescribe memantine for people who are at the mid-stage of Alzheimer’s, and who can’t be prescribed cholinesterase inhibitors because of the side effects, or for those who are in the later stages of the disease.

Your medical team may suggest other, non-medical treatments to help with some of the symptoms of Alzheimer’s disease. These can include relaxation therapy and cognitive behavioural therapy, to help if you are feeling depressed or anxious, or have more serious symptoms, such as delusional behaviour.

If you - or someone who cares for you – feel that your medication isn’t helping, or is causing bad side-effects, it’s important to talk to your specialist medical team. They may suggest trying a different drug or an alternative therapy.