Alzheimer’s is a complex disease. Its symptoms vary from person to person, and it develops at different rates depending on one’s overall physical health, mental engagement, and living environment — along with a wide range of additional factors. That means finding the most effective medical interventions can often involve a process of trial and error.
But while there’s no definitive cure for Alzheimer’s, modern medicine has made remarkable progress in treating its symptoms. In June 2021, the U.S. Food and Drug Administration (FDA) accelerated the approval of a brand-new drug that may slow the disease’s progress; and a number of other prescriptions are already FDA-approved for early- and middle-stage Alzheimer’s. Even some over-the-counter (OTC) medicines may be helpful.
Let’s take a closer look at the most promising medicines for people suffering from Alzheimer’s — and see which are most effective, and how they work.
Several FDA-approved medications can help slow the progress of Alzheimer’s.
A key cause of many Alzheimer’s symptoms, including memory loss, is a decrease in levels of a brain chemical called acetylcholine. In a healthy brain, acetylcholine carries chemical messages between nerve cells, playing a central role in keeping us awake, aware, and able to remember and think clearly. Alzheimer’s causes acetylcholine to break down more rapidly than usual, making it harder for the brain to process thoughts and store memories.
Doctors often prescribe a class of drugs called cholinesterase inhibitors to increase levels of acetylcholine in the brains of people with Alzheimer’s. For example, Donepezil (Aricept) can be used to treat all stages of the disease, and is taken as a once-a-day pill. Galantamine (Razadyne) works for mild to moderate Alzheimer’s, and can be taken as a pill or an extended-release capsule. Rivastigmine (Exelon) is also approved for the disease’s mild and moderate stages, and comes in the form of a pill or a skin patch.
While cholinesterase inhibitors like these are proven to strengthen memory and cognition, it’s also important to note that they can’t prevent Alzheimer’s from destroying brain cells. As the number of active nerve cells decreases, so does the brain’s ability to create and use acetylcholine — which means these drugs will have less of an impact as the disease progresses. However, they can significantly slow cognitive decline; especially with the help of a loving caregiver and a mentally stimulating environment.
Other prescriptions can help preserve cognitive function in later-stage Alzheimer’s.
As the symptoms of Alzheimer’s worsen, your doctor may recommend transitioning to a class of drugs known as glutamate regulators. As their name suggests, these medicines help control levels of glutamate — a brain chemical that’s crucial for memory, attention, logical thinking and language. By supporting this chemical’s activity, glutamate regulators enhance the brain’s ability to process and organize information.
One of the most widely prescribed glutamate regulators is Memantine (Namenda), which has been FDA-approved to treat the moderate and severe stages of Alzheimer’s. It can be taken as a pill or a syrup. Another common prescription is Namzeric, which combines a glutamate regulator with a cholinesterase inhibitor. Alternatively, some doctors prescribe a combination of Memantine and Donepezil (mentioned in the section above), which also work together to boost acetylcholine levels and regulate glutamate activity at the same time.
In recent months, the FDA has approved preliminary clinical trials for a new drug called aducanumab, which may slow the progression of Alzheimer’s in a completely different way: by helping break down amyloid plaque deposits that form on the brain cells of people with the disease. Although aducanumab has not yet been proven to improve mental function or slow cognitive decline, the early evidence is promising — and depending on your situation, it may be worth asking your doctor if the current clinical trials have open slots available.
Some OTC medicines may protect against certain Alzheimer’s symptoms.
You may want to consider one surprising over-the-counter (OTC) therapy for Alzheimer’s. Ibuprofen, more widely known by the brand name Advil, may reduce the inflammatory reactions that cut off blood supply to brain cells. Several clinical studies indicate that a dose of 800mg of ibuprofen per day can reduce inflammation, slow the formation of amyloid plaque deposits, and keep brain cells healthy longer in people with Alzheimer’s.
Omega-3 fatty acids could also reduce inflammation in brain tissue — though the evidence is less compelling than with ibuprofen. Most studies on omega-3s have focused not on brain cells, but on cells found in other types of body tissue; and many have used lab animals rather than humans. Some researchers have found that a diet rich in omega-3 acids reduces amyloid plaque formation in mice, while others say omega-3s make no difference. In short, omega-3 fatty acids probably don’t do any harm, but it’s unclear whether they help or not.
Curcumin, a natural substance produced by a ginger-like plant (and a key ingredient in the spice turmeric), has also drawn a lot of scientific attention for its anti-inflammatory effects. Some studies have reported that curcumin reduces the formation of amyloid plaques, and delays the decay of brain cells in animals with Alzheimer’s symptoms. However, a team of neuroscientists who reviewed these studies’ findings concluded that the evidence was shaky, and that more research is needed to determine whether curcumin is truly effective against Alzheimer’s.
As you research OTC therapies, you may also come across supplements like Prevagen, which contain various combinations of proteins and vitamins that may provide some benefit for people with Alzheimer’s. It’s important to note that these ingredients are chosen based on limited evidence — and while many supplements may be harmless, they haven’t been tested by the FDA, and are not approved for clinical treatment of any form of dementia.
Work with your doctor, and your loved one, to find the right medicinal fit.
When choosing a treatment for Alzheimer’s, what’s most important is to talk with your doctor, and make sure you clearly understand the reason for each prescription, as well as the dose, schedule and potential risks and side effects. Keep all medications clearly labeled, in a secure location, to prevent anyone from taking them by accident.
If your loved one misses a dose, that may not be a big deal — just make sure they take the next one. But never double a dose, or try to force the person in your care to take medication they’re refusing. If they refuse several doses in a row, consult with your doctor, who may be able to help you find a more workable solution. And of course, watch for any side effects. If your loved one reports dizziness, nausea, or any other unusual symptoms, tell your doctor right away.
With careful research and clear communication, you and your doctor should be able to work together to find the right medication regimen for the person in your care. There may be no cure for Alzheimer’s yet, but you may have more options than you think — and some of those options can significantly improve your loved one’s quality of life.