What Medications Are Used to Treat Cognitive Symptoms of Alzheimer's Disease?

Alzheimer's disease is an irreversible brain disorder that progressively impairs memory and cognition. It causes plaques and tangles in the brain, as well as destroys nerve cell communication.¹ Treating Alzheimer’s disease is multi-pronged, and involves managing behavioral symptoms, providing supportive care, and helping maintain mental functioning and slowing of symptoms. Medication can be one of these treatments.

There are some medications approved by the Food and Drug Administration (FDA) to alleviate the symptoms of Alzheimer's disease, but these drugs are not a cure and do not stop the disease from progressing.

Different medications are approved for different stages of the disease, and many drugs are most effective in the early or middle stages of Alzheimer's.² These drugs can help to slow down the progression of cognitive symptoms but do not prevent the disease from getting worse.

Types of Alzheimer's medications

To treat the cognitive symptoms of Alzheimer's disease, the FDA has approved the following medications:³

• Cholinesterase inhibitors
• Memantine (brand name Namenda)
• Memantine + donepezil (brand name Namzaric)

Ergoloid mesylates are also used to treat cognitive symptoms, but aren't widely used and prescribed.

Cholinesterase inhibitors

Cholinesterase inhibitors are most effective in early to moderate Alzheimer's because they help to slow down or stop the breakdown of a chemical called acetylcholine, which helps cell communication and aids in memory and cognition.² These medications are less effective as Alzheimer's disease becomes more widespread because as the condition progresses, there is less acetylcholine produced in the brain, so inhibiting the breakdown of acetylcholine does not have as much an effect.

Cholinesterase inhibitors include:

• Donepezil (Aricept)
• Galantamine (Razadyne)
• Rivastigmine (Exelon)

These are all prescription-only drugs. People with Alzheimer's might respond better to one medication versus another, so if one drug is not effective, don't give up hope.

Memantine

Memantine (Namenda) is usually prescribed for moderate to severe Alzheimer's disease. Memantine works on glutamate, which is a chemical involved in information processing. Memantine can help to regulate glutamate, which helps to reduce symptoms.

Memantine + donepezil

Namzaric is a combination of donepezil, a cholinesterase inhibitor, and memantine, an NMDA antagonist. This medication is also usually prescribed for moderate to severe Alzheimer's disease.

Side effects

As with any kind of medication or supplement, there may be side effects when taking these approved medications for Alzheimer's disease. Medications are usually started at low doses, and as your body gets used to them, the dosage is gradually increased to a dose where it has been shown to be most effective. Some of the common side effects from these drugs for Alzheimer's include nausea, vomiting, changes in appetite (usually loss of appetite), increased bowel movements, constipation, and headache.^2,3 Many of the side effects will resolve over time, but patients should let their doctor know about any side effects or abnormal symptoms that they may be experiencing.

Medications are just one part of treatment for Alzheimer's disease, but can be an important aspect of treating the condition. Some other medications may be used to treat behavioral aspects of Alzheimer's disease, such as antidepressants, but should be used with caution. This is especially true of medications used to address cognitive symptoms because some of those drugs may make cognitive symptoms worse. Talk with the doctor about whether medication is appropriate and safe, and if so, which one might be best.

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