Medications to Treat Cognitive Symptoms of Alzheimer's Disease

Alzheimer's disease is a chronic brain condition. “Plaques” and “tangles” of proteins form in the brain. They block communication between brain cells. This causes cells to die. Cells dying causes memory and cognition to worsen over time.^1,2

There are many medicines approved for treating Alzheimer's. Several of them can treat cognitive symptoms. These drugs will not prevent Alzheimer’s disease from getting worse. But they can lessen or stabilize symptoms for a short time. Talk to your doctor about the right treatment options for you.²

Why is treating cognitive symptoms important?

People with Alzheimer’s often have cognitive symptoms, including problems with:¹

• Memory
• Thinking
• Language
• Judgment
• Reasoning

Medicine can improve or stabilize symptoms for a limited time. This can provide more comfort, dignity, and independence for a longer period of time. It can also reduce the burden on caregivers. But this will not cure Alzheimer’s or prevent disease progression.²

Treatments for cognitive symptoms do not work the same for all people. Some people may:³

• Seem much better
• Get better in small ways
• Stay the same
• Get worse over time, but slower than expected
• Not change for some time and then get worse as expected

What causes cognitive symptoms in Alzheimer’s?

Scientists are studying the exact brain changes that happen in Alzheimer’s disease. Changes in the brain may start 10 to 20 years before symptoms start. During the early stages, 2 proteins start to clump and build up in the brain:¹

• Amyloid, which forms “plaques” outside brain cells
• Tau, which forms “tangles” inside brain cells

These plaques and tangles cause healthy brain cells to stop working. They lose connections with other brain cells and die. This interferes with brain chemicals that affect memory and learning. For example, people with Alzheimer’s have problems with the chemicals acetylcholine and glutamate.¹

Early damage happens to parts of the brain involved in forming memories. As Alzheimer’s progresses, more brain cells die. This starts to affect parts of the brain that control language, reasoning, and thinking. Memory loss gets worse and daily tasks become difficult.¹

Examples

Several types of medicine treat the cognitive symptoms of Alzheimer's disease. Medicines are sometimes grouped into “classes” by how they work and their effect on the body. The US Food and Drug Administration (FDA) has approved drugs in the following classes:^2,4

• Cholinesterase inhibitors
• Glutamate regulators
• Combination treatments

Cholinesterase inhibitors

Cholinesterase inhibitors work by reducing the breakdown of acetylcholine. Acetylcholine is a brain chemical important for memory and learning. Blocking acetylcholine breakdown helps brain cells communicate. This supports cognition.^2,5,6

These drugs work best in mild-to-moderate Alzheimer’s disease. As Alzheimer’s progresses, the brain produces less acetylcholine. Blocking the breakdown of acetylcholine no longer has a large effect.^2,5

Cholinesterase inhibitors approved to treat Alzheimer’s disease include:^2,3,7,8

• Aricept^® (donepezil)
• Razadyne^® (galantamine)
• Exelon^® (rivastigmine)

Switching between cholinesterase inhibitors may not change results. But some people may respond better to a certain drug.^2,5

Glutamate regulators

Glutamate regulators work by adjusting the activity of glutamate. Glutamate is a brain chemical that activates certain proteins, including the NMDA (N-methyl-D-aspartate) receptor. This helps maintain learning and memory functions.^2,5,9

Excess glutamate can cause too much NMDA receptor activation. This leads to brain damage and cognitive problems in Alzheimer’s. Glutamate regulators maintain normal levels of NMDA receptor activation. This can help improve:^2,5,9,10

• Memory
• Language
• Other thought processes

The only glutamate regulator approved to treat Alzheimer’s is Namenda^® (memantine). Namenda is prescribed for moderate-to-severe Alzheimer's disease.^2,5,10,11

Combination drugs

Combination drugs combine a cholinesterase inhibitor with a glutamate regulator. The only combination treatment approved by the FDA to treat Alzheimer’s is Namzaric^® (donepezil and memantine).^2,5,12

Namzaric is prescribed for moderate-to-severe Alzheimer's disease.²

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking.

Side effects of cholinesterase inhibitors are rare but possible. They include:^2,5

• Nausea
• Diarrhea
• Vomiting
• Loss of appetite
• Not sleeping well
• Feeling tired

The most common side effects of Namenda include:^2,5,10,11

• Headache
• Constipation
• Confusion
• Dizziness

The most common side effects of Namzaric include²

• Headache
• Nausea
• Diarrhea
• Dizziness
• Loss of appetite

These are not all the possible side effects of medicines to treat cognitive symptoms in Alzheimer’s. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking these drugs.

Other things to know

Doctors usually start people with Alzheimer's disease at low doses of medicines and slowly increase the dosage based on how well they tolerate the drug. Some people with Alzheimer's may do better on higher doses, but that increases the chances of unwanted side effects.¹³

Medications to treat cognitive symptoms are just one part of treatment for Alzheimer's disease. Other medicines to address common Alzheimer's symptoms like mood changes and sleep issues are also often used. Talk with your or your loved one's doctor about what medicines will be most effective for your situation.¹

Before beginning treatment for Alzheimer’s disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

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