Alzheimer Disease (cont.)

Even though Alzheimer's disease is not reversible, treatment can slow the progression of symptoms in some people. Relieving symptoms can improve function significantly. Some of the important treatment strategies in dementia are described here.

Nondrug treatments

Behavior disorders such as agitation and aggression may improve with various interventions. Some interventions focus on helping the individual adjust or control his or her behavior. Others focus on helping caregivers and other family members change the person's behavior. These approaches sometimes work better when combined with drug treatment.

Drug treatment

The symptoms of Alzheimer's disease can sometimes be relieved, at least temporarily, by medication. Many different types of medications have been or are being tried in dementia. The medications that have worked the best so far are the cholinesterase inhibitors.

• Cholinesterase is an enzyme that breaks down a chemical in the brain called acetylcholine. Acetylcholine acts as an important messaging system in the brain. Brain acetylcholine level is low in most people with Alzheimer's disease.
  
  
• Cholinesterase inhibitors, by stopping the breakdown of this neurotransmitter, increase the amount of acetylcholine in the brain and improve brain function.
  
  
• These drugs not only improve or stabilize cognitive functions, they may also have positive effects on behavior and activities of daily living.
  
  
• They are not a cure, but they do slow down the rate of decline in some people. In many people the effect is modest, and in others, the effect is not noticeable.
  
  
• The effects are temporary, since these drugs do not change the underlying cause of the dementia.

Another drug, memantine, is showing promise in Alzheimer's disease. This new drug works by blocking brain damage caused by another brain chemical called glutamate.

Certain drugs are being used on a trial basis in people with Alzheimer's disease. Experts think these drugs might help based on what we know from research about Alzheimer's disease. None of these drugs have yet achieved widespread acceptance as treatment for the disease.

• Anti-inflammatory drugs are being tried on the premise that inflammation is one cause of senile plaques and neurofibrillary tangles.
  
  
• The antioxidant tocopherol (vitamin E) is believed by some to counteract damage in brain cells, which may have a role in causing Alzheimer's disease or its progression.
  
  
• Hormone replacement therapy has been given to some women who have been through menopause and have Alzheimer's disease, but this approach has been questioned by many experts. The rationale is that the loss of estrogen at menopause takes away one line of protection from the disease.

Other drugs are used to treat specific symptoms or behavior changes.

• Mood swings and emotional outbursts may improve with antidepressant or mood stabilizing drugs.
  
  
• Agitation, anger, and disruptive or psychotic behavior are often relieved by antipsychotic medication or mood stabilizers.