In our experience, treatment of Alzheimer’s disease and other causes of memory loss and dementia is best carried out in a partnership between the patient, his or her caregiver(s), and the clinician. As with most diseases, when the diagnosis of Alzheimer’s disease is made, the first question that is asked is “What can be done?” As we explain to our patients and families, there are many aspects to treatment ranging from counseling and education to medications that, when skillfully combined, lead to the best outcomes.
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Treatment of Alzheimer’s disease and other causes of memory loss and dementia is best carried out in a partnership between patient, caregiver, and clinician.
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Current FDA-approved treatments can help improve or maintain the patient’s cognitive and functional status by “turning back the clock” on memory loss.
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New, disease-modifying treatments are being developed and may be available soon.
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Families and other caregivers are helped by treatments that improve the behavioral and psychological symptoms of dementia.
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Non-pharmacological strategies can also help compensate for memory loss.
Talking About Treatments for Alzheimer’s Disease
Patients for whom we prescribe a cholinesterase inhibitor such as donepezil (Aricept), memantine (Namenda), or a combination of the two often ask how these medications work and what else can be done. We typically have a discussion with these patients and their families that attempts to incorporate the following points.
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Alzheimer’s disease is a brain disease. In the most basic sense, brain cells are dying. As you lose brain cells, the abilities to which these cells contribute are also lost. For example, early in the course of the disease individuals with Alzheimer’s disease lose cells in a brain structure called the hippocampus. The hippocampus is critical to the formation of new memories and this is why one of the first signs of Alzheimer’s disease is difficulty remembering new information. (We sometimes show a photograph or a model of the brain with the hippocampus (such as in Figures 4-5 and 4-12 ) and we generally show the patient their CT or MRI scan and indicate the hippocampus and other regions of atrophy to show where brain cells have been lost.)
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Unlike many other organs in the body, brain cells do not typically regenerate, so, once a brain cell is lost, it is gone forever.
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As more brain cells die, the disease progresses and more abilities are lost.
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The goal of treatment is to treat with medications that will help the remaining brain cells—even those that may be diseased—function more efficiently. This improved efficiency can help to compensate for the ongoing loss of brain cells.
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The two most commonly used types of medication to accomplish this goal are cholinesterase inhibitors such as donepezil (Aricept) and memantine (Namenda).
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These medications do not stop the death of brain cells or even slow it down, but they do help to improve the symptoms of the disease. (We often show or draw them a figure similar to Figure 15-1 to help them understand what “symptomatic benefit” means.)
Related posts:
Approach to the Patient with Memory Loss, Mild Cognitive Impairment, or Dementia
Jakob-Creutzfeldt Disease
Progressive Supranuclear Palsy
Legal and Financial Issues in Memory Loss, Alzheimer’s Disease, and Dementia
Vitamins, Herbs, Supplements, and Anti-inflammatories for Memory Loss, Alzheimer’s Disease, and Dementia
Other Disorders That Cause Memory Loss or Dementia
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