The second step in treating Alzheimer's is for the patient, and family, to prepare for and manage the disease as it progresses.
Numerous medications are intended to reduce the symptoms of Alzheimer's, by helping to slow memory loss, control behavior problems, or improve sleep. It is important to work with physicians who have considerable knowledge and experience in using these medications.
In a process called oxidant stress, cells produce free radicals, highly reactive molecules that can overwhelm and damage normal cells. Vitamin E and other antioxidants have been studied in patients who have Alzheimer's disease. The use of Vitamin E is controversial. A physician will determine if Vitamin E is appropriate.
In the brains of people with Alzheimer's, there is a dramatic drop in the level of the chemical acetylcholine, which transmits messages in the brain. This chemical is important for attention and memory. The enzyme acetylcholinesterase rapidly breaks down acetylcholine. The enzyme can be blocked with cholinesterase inhibitors, which may help improve cognitive and neuropsychiatric symptoms and might affect the long-term course of the disease.
Glutamate is a chemical in the brain that acts on receptors known as NMDA receptors. There is evidence that overstimulation of these receptors may be bad for brain cells. The medication memantine, which blocks NMDA receptors, has recently been approved by the U.S. Food and Drug Administration for treatment of patients with moderate to severe Alzheimer's disease. A physician will determine if memantine is appropriate.
Antipsychotics or Neuroleptics
These drugs can help control behaviors caused by Alzheimer's, such as agitation, anger, hallucinations and delusions (seeing and hearing nonexistent things), and insomnia (inability to sleep). Many of these drugs have significant side effects.
Antidepressants and Anxiolytics
Some medications help treat depression and anxiety in patients with Alzheimer's. Because some drugs may increase anxiety or agitation, patients should be closely monitored. The drugs may also cause insomnia, tremors, nausea and other side effects.
As Alzheimer's progresses, a common behavior is to become increasingly agitated, confused and restless toward the end of the day, which is often called "sundowning." Patients with Alzheimer's disease may also wake or even wander at night. If the problem can't be managed through adjusting living environments, patients may benefit from sleep medications. Anti-anxiety medications may also help reduce these symptoms.
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