Treatments that can improve the lives of Alzheimer’s patients

Dementia cannot be cured, but drug treatment can improve symptoms and slow their progression. If treatment begins when symptoms are still mild, the patient’s functional capacity will be significantly improved.

Treatment of mild symptoms of Alzheimer’s disease

Cholinesterase inhibitors are prescribed for the treatment of mild to moderate symptoms of Alzheimer’s disease. This type of medication can help delay symptoms or prevent them from worsening for a limited time. They may also help control some behavioral symptoms.

For example, one of the symptoms they can moderate is memory loss, as they slow down the breakdown of acetylcholine, a chemical compound important for memory. As Alzheimer’s disease progresses, the brain produces less and less acetylcholine and these drugs increase its levels.

Treatment of severe Alzheimer’s symptoms

A drug known as Memantine is prescribed for the treatment of moderate to severe symptoms of Alzheimer’s disease. Its main effect is to delay the progression of some of the symptoms and to allow patients to maintain their daily functions (ability to go to the bathroom independently) for a longer time than they would have without using the drug.

This drug works by regulating glutamate, an important chemical in the brain, which when produced in excessive amounts can lead to brain cell death.

Dosage and side effects of treatment

Patients are started on a low dose of the drug and the dose is gradually increased, taking into account the patient’s response. The higher the dose, the higher the likelihood of side effects.

Monitoring patients when they start taking a drug is essential.

Other unproven pharmacological options

Vitamin E and selegiline have shown some benefit, due to their anti-oxidant properties, on the rate of disease progression. But they may have significant adverse effects, so their widespread use is not recommended.

Ginkgo biloba extract may be useful in some patients, but has had conflicting results, so it is not possible to determine the precise indications for its use.

Estrogen hormone supplementation may improve cognitive performance in women with menopausal symptoms, but not in other circumstances.

Alzheimer’s Treatment Considerations

Generally speaking, anticholinesterases delay cognitive decline in patients by about half a year, and the benefit is usually sustained over the long term.

It may happen that the improvement does not show up in the neuropsychological tests administered in consultation, but it does show up in the activities of daily living (level of attention and participation).

The recommended duration of treatment for Alzheimer’s disease is not agreed upon by specialists, but in general it tends to be maintained as long as the patient’s tolerance is good, even in the advanced stages.

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Treatment of psychotic disorders

Neuroleptics treat psychotic symptoms (hallucinations, delusions and false perceptions), which appear when dementia is moderate.

The most relevant adverse effect of neuroleptics is the symptomatology similar to that observed in Parkinson’s disease: tremor, rigidity, dyskinesias, dystonia, akathisia…

Treatment of Anxiety

Anxiety is frequent in Alzheimer’s patients, so benzodiazepines are usually used to control it. However, the use of these drugs should be reserved for specific moments, due to their sedative effect, the worsening of gait they produce or the risk of physical dependence.

Anticholinergic drugs and memantine, used in the treatment of cognitive symptoms, have shown benefits in behavioral disorders, and may reduce the need for other types of drugs.

Treatment of Depression

The causes of mood disorders in Alzheimer’s patients may be varied and may be related to the disease process itself or to other factors such as the patient’s own perception of cognitive and functional impairment.

Classical antidepressants may have a negative effect on cognitive level, so nowadays the tendency is to avoid them.

At present, selective serotonin reuptake inhibitors are generally used, with moderate efficacy and good tolerance. Trazodone also has an anxiolytic effect and reduces behavioral problems at night.

Treatment of sleep disorders

The alteration in the biological rhythms experienced by patients is due to multiple causes, so their approach must be adapted and varied. Benzodiazepines, trazodone and melatonin have been beneficial in some studies.

Non-pharmacological therapies

Cognitive rehabilitation seeks to stimulate those functions related to the degenerative process of Alzheimer’s disease, while developing compensation strategies through the use of preserved cognitive resources, in order to maintain the highest degree of functionality and independence possible. It is common for Alzheimer’s patients to have low self-esteem. In this context, praising their daily achievements improves the patients’ mood and their degree of motivation in the face of new challenges or tasks.

Likewise, adapting the activities performed by patients to their functional capacity reduces the level of stress they usually endure, and helps to avoid behavioral problems. To this end, it is essential to know precisely the specific condition of each patient, by means of a sufficiently broad neuropsychological evaluation.

On the other hand, regular physical exercise has been shown to slow cognitive decline in people with Alzheimer’s disease. Occupational therapy also improves motor performance and the ability to carry out daily activities.

There are also other therapies designed primarily to improve psychomotor agitation, such as music therapy, aromatherapy, massage, or assisted toilet training.