Better Memory from a Pill? Some Drugs May Slow the Progress of Dementia

A diagnosis of Alzheimer’s disease (AD) can be devastating news, but if discovered in its early stages, AD can often be slowed and its symptoms managed with the help of medications.

There are currently five FDA-approved medications for Alzheimer’s disease. Three of them are cholinesterase inhibitors: donepezil (Aricept) for all stages of Alzheimer’s; rivastigmine (Exelon) for mild-to-moderate Alzheimer’s; and galantamine (Razadyne) for-mild to-moderate Alzheimer’s.

Two other drugs are approved for moderate-to-severe Alzheimer’s: memantine (Namenda), which is the most commonly prescribed; and a combination of memantine and donepezil (Namzaric), which together may have an additive effect.

Memantine can improve memory, attention, language, and simple task performance, says David Mischoulon, MD, PhD, director of the Depression Clinical and Research Program at Massachusetts General Hospital.

He adds that it can be prescribed alone or in combination with other anti-dementia drugs.

“In general, the earlier the treatment begins, the better the outcomes,” Dr. Mischoulon explains. “These drugs are prescribed at the first sign of dementia symptoms that cannot be explained by any other cause. There is not a lot of long-term study data on these drugs. They are not a cure, nor do they reverse dementia symptoms, but they can gradually alter the course of the illness, which is progressive by its nature.”

How Memory Meds Work

AD medications help control symptoms by acting on the brain chemicals directly.

The cholinesterase inhibitors prevent the enzyme acetylcholinesterase from breaking down the neurotransmitter acetylcholine, which plays a role in attention, learning memory and other functions. Neurotransmitters are brain chemicals that help deliver impulses between neurons.

By increasing acetylcholine levels, cholinesterase inhibitors may help lessen the cognitive symptoms of Alzheimer’s. “The disease results in less acetylcholine being produced over time, and consequently these medications may not work as well as the illness progresses,” Dr. Mischoulon explains. “Side effects of cholinesterase inhibitors may include nausea, vomiting, loss of appetite, and increased frequency of bowel movements. Some people find the side effects intolerable and may not be good candidates for them.”

Memantine regulates activity of glutamate, a chemical involved in information processing, storage, and retrieval. Increasing glutamate activity can help slow down the progression of Alzheimer’s. Memantine is well tolerated, Dr. Mischoulon says, though he notes common side effects can include confusion or agitation, dizziness, drowsiness, headaches, insomnia, and hallucinations. Less common side effects include nausea and vomiting, anxiety, muscle stiffness, bladder infections, and increased libido. “Again, some people may not be able to tolerate side effects if they are too severe,” he says.

As the disease advances, there will come a point when the patient is not likely to obtain any further benefit, but without adequate long-term studies we do not know what that critical point may be. Patients and their families should discuss with the prescribing doctor what time course might be appropriate for treatment, and periodically ask whether the medication should be discontinued, particularly if no further benefit is being obtained. In some cases, however, discontinuing the drug may be followed by a worsening of cognitive symptoms, Dr. Mischoulon says.

Regardless of what medication you take, it’s important to tell your doctor about any change in your symptoms or side effects as they develop. Let your family members know to be on the lookout for changes, too.

Other Drugs and Supplements

While not specifically designed to improve memory, sometimes stimulant drugs can be prescribed when the patient reports poor concentration and lack of focus, Dr. Mischoulon says. “This may present in many adults who do not have dementia per se, but may be suffering from adult attention deficit hyperactivity disorder or residual symptoms of depression or other psychiatric disorders. Atypical antipsychotics may help reduce aggression and psychosis in people with Alzheimer’s disease, but they may have bothersome side effects, including movement difficulties or excessive sedation, as well as increased mortality if used for the long-term.”

Certain supplements may be helpful for better brain function, but you should use them with caution and be sure to tell your doctor before taking them. “Ginkgo biloba is the best studied of the natural over-the-counter remedies with regard to boosting memory,” Dr. Mischoulon says. “The body of evidence overall is supportive of efficacy, and its tolerability is good.”

He adds that gingko biloba can be combined safely with cholinesterase inhibitors, with demonstrated synergistic effects and good tolerability. Elderly people are vulnerable to B vitamin deficiencies, including B12 and folic acid. These deficiencies have been associated with mood disorders and cognitive problems, so it is a good idea to check blood levels of these vitamins and replenish them in cases of deficiency, Dr. Mischoulon says.

On the Horizon

The prospect of new memory drugs, though encouraging, isn’t likely to materialize soon. National political leaders have encouraged medical science to attain full prevention or effective treatment of Alzheimer’s by 2025. However, while many drugs are in early stages of development, very few actually will be approved by this time, cautions Dr. Mischoulon.

One example of a drug currently in development is posiphen, an inhibitor of production of amyloid precursor protein, which reduces amyloid buildup and may delay Alzheimer’s onset or slow the progression of the illness. “There is an ongoing clinical trial to evaluate the safety and efficacy of three different doses of posiphen in older adults with early Alzheimer’s,” Dr. Mischoulon says. “The study is expected to be completed by the end of 2019, so the results may be known soon.

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