PHARMACOLOGIC AND MEDICAL MANAGEMENT

Management of patients with Alzheimer’s dementia primarily addresses symptoms, including treatment of behavioral disturbances, environmental manipulations to support function, and counseling regarding issues of safety (discussed later in this course). However, some FDA-approved medications can help improve or maintain the patient’s cognitive and functional status and help lessen symptoms such as memory loss and confusion. Some medicines also improve behavioral and psychological symptoms and can be used in addition to nonpharmacologic strategies (Alzheimer’s Association, 2021b).

FDA-approved medications for treating the cause of Alzheimer’s disease include:

• Aducanumab (Aduhelm), an anti-amyloid antibody intravenous infusion therapy given once a month
• Lecanemab (Leqembi), an anti-amyloid antibody intravenous infusion therapy given every two weeks
  (Alzheimer’s Association, 2023)

Treating Cognitive and Memory-Related Symptoms

As Alzheimer’s progresses, the following medications may help temporarily lessen or stabilize symptoms related to memory and thinking by affecting chemicals involved in carrying messages among and between the brain’s nerve cells (Alzheimer’s Association, 2021b). These include:

• Cholinesterase inhibitors donepezil, rivastigmine, and galantamine, for treating symptoms related to memory, thinking, language, judgment, and other thought processes
• Glutamate antagonist memantine, for moderate to severe Alzheimer’s disease, to improve cognition and global assessment of dementia, but with only small effects that are not of clear clinical significance
• Antioxidant vitamin E (alpha-tocopherol), for modest benefit in delaying progression of functional decline in patients with mild to moderate Alzheimer’s, but with no measurable effect on cognitive performance
  (Press & Buss, 2021)

Treating Behavioral and Psychological Symptoms

Behavioral and neuropsychiatric symptoms are common in dementia patients and are often more problematic than memory impairment.

Suvorexant (Belsomra) is approved by the FDA to address insomnia in those with dementia. Other medications are used “off label” and include the following:

• Selective serotonin reuptake inhibitors (SSRIs), for the management of agitation and paranoia
• Benzodiazepine anti-anxiety medications, for anxiety, restlessness, verbally disruptive behaviors, and resistance
• Antipsychotic agents in low doses, for short-term use to manage symptoms, including hallucinations, delusions, aggression, agitation, hostility, and uncooperativeness
• Analgesics, for pain control in order to improve behavior and function
  (Alzheimer’s Association, 2021a; Press & Alexander, 2021)