Alzheimer's Disease — Medications and Other Therapies are Improving Quality of Life

Most of us have misplaced our keys or forgotten what we went into another room for. Losing things or being forgetful happens to everyone. If you’re stressed, short on sleep, or in a hurry, you may notice even more lapses.

When do we chalk forgetfulness up to a hectic life, and when should we be concerned?

Let’s look at normal brain function as you age vs. Alzheimer’s disease and then dive into the stages, causes, treatments, and ways to save on prescription medications, including the only disease-modifying medication used to treat Alzheimer’s disease.

Alzheimer’s disease isn’t just normal aging

It can be difficult to know if early lapses in memory or occasional poor choices signal the beginning of Alzheimer’s disease. How can you tell the difference between normal aging and Alzheimer’s disease? Taking a self-assessment may be a place to start but should never replace a medical evaluation.

Here are some reasons to visit your healthcare provider:

• You lose track of time, the day, or the season.
• You have trouble navigating to a place you often visit.
• When you lose something, you can’t retrace your steps and find it.
• You can no longer manage your finances.
• You have trouble keeping up with a conversation.
• You have difficulty following a recipe, remembering how to operate the TV remote, or recalling the rules of a card game.
• You forget what an object is called or call it by the wrong name.
• Your loved ones notice you repeatedly ask the same questions.

Alzheimer’s disease in a nutshell

Alzheimer’s disease is the most common form of dementia. It primarily affects people 65 years old or older, although up to 10% of people develop Alzheimer’s disease at a younger age.

Alzheimer’s disease worsens progressively, but the rate at which it worsens varies by individual. Alzheimer’s disease has several stages once symptoms begin.

Early Stage

With early or mild Alzheimer’s disease, you may live independently, work, and drive. However, you have:

• Trouble remembering a word or someone’s name
• Misplaced things of actual or sentimental value that you’d normally safeguard
• Trouble planning or organizing
• Difficulty learning something new or remembering something you’ve just read
• Feelings of depression and anxiety

Middle Stage

The middle stage or moderate Alzheimer’s disease lasts the longest. Your memory and decision-making decline, and your personality and behavior begin to change. You need some help with daily activities and:

• Forget your personal details and personal history, such as an address, phone number, and where you went to high school
• Get lost or have trouble finding a place you’ve been to before
• Forget the day and season
• Begin to have trouble recognizing loved ones
• Have paranoia, delusions, or compulsive behavior

Late Stage

During the late stage or severe Alzheimer’s disease, you are significantly impaired:

• You need around-the-clock help with daily activities of living, such as dressing and grooming.
• You are unable to have a conversation.
• You are unaware of the passage of time.
• You forget what common objects are, such as a clock or a pencil.
• You don’t recognize loved ones, or you call them the wrong name.
• You become unaware of your surroundings.
• You have difficulty walking and sitting.
• You can’t swallow properly. Food and liquids enter your lungs and cause pneumonia.

Although some people with Alzheimer’s disease may live 20 years after the diagnosis, most die within four to eight years. The leading causes of death with Alzheimer’s disease are pneumonia, malnutrition, and dehydration.

Currently, there’s no cure, although early treatment with medication and therapy may slow the disease’s progression.

Causes of Alzheimer’s disease

The exact cause of Alzheimer’s disease remains a mystery and may vary from individual to individual. Here are some factors that contribute to Alzheimer’s disease:

• Advanced age — About a third of those over 85 years of age have Alzheimer’s disease.
• Genetics — If you have a parent with Alzheimer’s disease, you are at greater risk of developing the disease, often at a younger age.
• Lifestyle — Social isolation, a lower level of education, inadequate sleep, and poor nutrition may contribute.
• Other medical conditions — Heart disease, high blood pressure, strokes, and diabetes may increase your risk of Alzheimer’s disease.

Although the causes of Alzheimer’s disease are still being studied, the changes that occur in your brain are known. Proteins accumulate within and between your brain cells. The proteins form neurofibrillary tangles in the brain cells and amyloid plaques between the cells that interfere with normal brain function.

With Alzheimer’s disease, your brain also fails to clean house. Waste products from metabolism, toxins, and amyloid plaques build up and cause chronic inflammation.

Diagnosing Alzheimer’s disease

No single test exists to diagnose Alzheimer’s disease. Your healthcare provider will obtain a medical history and perform a physical exam. Suppose a loved one accompanies you to the visit. In that case, they will probably be asked about your memory, judgment, difficulties with daily living activities, and any change in your personality. Your healthcare provider will test your memory by asking a series of standard questions or referring you for a computer-based test. If you are younger than 60, you may have a genetic test looking for inherited Alzheimer’s disease.

With the medical history, physical exam, blood tests, and brain imaging, your healthcare provider will be looking for other reasons for memory loss, such as:

• Depression
• Abnormal blood pressure
• Abnormal blood sugar levels
• Severe vitamin deficiencies
• An underactive thyroid
• Abnormalities in your brain (tumors, excess fluid, bleeding, or a stroke)

Even if your memory loss doesn’t stem from a treatable medical condition, early treatment can slow the progression of Alzheimer’s disease.

Mood and behavior changes with Alzheimer’s disease

Along with memory loss, you are very likely to have behavior changes from the damage caused by amyloid plaques and tangles. Early in Alzheimer’s disease, depression, anxiety, and irritability are common. As the disease progresses, behavior changes include:

• Anger
• Aggression
• Agitation
• Physical or verbal outbursts
• Restlessness, fidgeting, pacing
• Delusions — believing in something that isn’t true, such as insisting something has been stolen rather than misplaced
• Hallucinations — hearing, seeing, or feeling things that aren’t there

Medications for Alzheimer’s disease

The Food and Drug Administration (FDA) has approved many drugs to relieve the symptoms of Alzheimer’s disease. But so far, only one drug is approved to treat the anatomical changes seen in your brain. That drug is aducanumab (Aduhelm).

Medication to Treat an Underlying Cause of Alzheimer’s Disease

Aducanumab (Aduhelm) reduces amyloid plaque and is the first drug to treat an underlying cause of Alzheimer's disease. The FDA approved Aduhelm early so people with mild Alzheimer's disease could enter clinical drug trials and reap the potential benefits. Ongoing studies are looking at how much Adulhelm reduces cognitive decline and improves day-to-day functioning.

If you've been diagnosed with early Alzheimer's disease, you may be qualified to participate in Aduhelm studies.

Medications to Treat Cognitive Impairment

Other FDA-approved medications target the symptoms rather than the cause of Alzheimer’s disease. Medications for cognitive improvement include:

• Donepezil (Aricept) — used for all stages of Alzheimer’s disease
• Rivastigmine (Exelon) — for mild to moderate disease
• Galantamine (Razadyne) — for mild to moderate disease
• Memantine (Namenda)
• Donepezil and memantine (Namzaric)

Medications for Sleep Disturbances

Insomnia frequently affects people with Alzheimer’s disease. Inadequate or poor sleep can make thinking and reasoning more difficult and worsen your mood. Suvorexant (Belsomra), a sleep aid, may break this vicious cycle and promote better sleep.

Medications for Mood, Anxiety, and Behavior Changes

Depression and anxiety frequently accompany early Alzheimer’s disease. Symptoms may be reduced or relieved by non-medication therapies (see below). If depression doesn’t improve with non-medication therapy, antidepressants can help. Antidepressants include:

• Citalopram (Celexa)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)
• Sertraline (Zoloft)
• Trazodone (Desyrel)

Medications used to treat anxiety, restlessness, pacing, and verbal outbursts include:

• Lorazepam (Ativan)
• Oxazepam (Serax)

An anti-seizure medication, carbamazepine (Tegretol), may be prescribed for aggressive behavior that is hard for caregivers to manage. Likewise, antipsychotic medications, such as aripiprazole (Abilify), olanzapine (Zyprexa), or risperidone(Risperdal), may be prescribed for agitation, paranoia, hallucinations, and aggression. Both classes of drugs have significant side effects in people with Alzheimer’s disease so non-medicine approaches to modifying behavior should be tried first.

Saving on Alzheimer’s disease medications

Normally Medicare covers FDA-approved medications. In an unprecedented move, Medicare added stipulations to its coverage of aducanumab (Aduhelm). For Medicare recipients, the prescription drug plan pays 80% of the Aduhelm’s cost only if you are enrolled in a clinical study using this medication.

If you aren’t part of an aducanumab study, Medicare won’t pay. And the medication can be prohibitively expensive if it isn’t covered by your health insurance.

Here’s how ScriptSave® WellRx can help. WellRx allows you to compare prescription prices at pharmacies near you by entering the prescription drug’s name and your zip code. If you are paying for aducanumab out of pocket, finding the lowest prescription price means more money left in your wallet.

To learn about how prescription discount cards work, compare your prescription and over-the-counter medication prices, claim your free Rx savings card, and receive coupons for medications, visit WellRx.

Non-medication therapies for Alzheimer’s disease

A variety of therapies may be part of a comprehensive treatment plan to improve quality of life and slow the progression of Alzheimer’s disease.

Art Therapy

Art projects can stimulate brain function, boost your mood, allow for creativity, and promote social interaction.

Travel Therapy

Actual and virtual travel can bring joy and improve the symptoms of Alzheimer’s disease. Planning and anticipation, followed by experiencing the sights and sounds of a new environment and spending time with loved ones, can improve your quality of life and stimulate your brain.

Reminiscence Therapy

Reminiscence therapy may improve depression and quality of life by remembering loved ones and pleasant events from the past. This may help a person with Alzheimer’s disease focus on what they can remember rather than dwell on what they can’t recall.

Music Therapy

Memories triggered by listening to music and singing can reduce agitation and aggressive behavior in the middle and late stages of Alzheimer’s disease.

Support for caregivers

If you are a caregiver for a loved one with Alzheimer’s disease, you are in good company. In 2021, more than 11 million Americans provided upwards of 16 billion unpaid hours of care to loved ones with Alzheimer’s disease and other forms of dementia.

As Alzheimer’s disease progresses, behavior changes become more apparent and may make caregiving even more difficult. It’s important to remember that this is a manifestation of the disease, not a personal attack. Some coping strategies include:

• Recognize a person with Alzheimer’s disease may lash out because they can’t tell you what’s bothering them or that their needs aren’t being met
• Make sure your loved one gets plenty of rest
• Have your loved one wear her glasses and hearing aids while their awake to avoid further isolation
• Keep a security or comfort object on hand
• Avoid confrontation
• Keep the home environment calm and quiet without a lot of background noise
• Enjoy the good days
• Reminisce about the people and pleasant times in the past

Support groups and resources can help you with the caregiving journey. Those who’ve cared for loved ones with Alzheimer’s disease will tell you not to forget about caring for the caregiver. Please be sure to schedule time away for your emotional and physical well-being.

Teresa Otto, MD, is a freelance medical writer on a mission to inform readers about the positive impact of good nutrition and a healthy lifestyle. She is a retired anesthesiologist who practiced in Billings, Montana, for most of her career. She graduated from the University of Washington School of Medicine in Seattle and did her anesthesia residency and fellowship at New York University and Columbia-Presbyterian in New York.

Resources:

1. https://www.nia.nih.gov/health/what-causes-alzheimers-disease
2. https://wexnermedical.osu.edu/brain-spine-neuro/memory-disorders/sage
3. https://www.alz.org/alzheimers-dementia/stages
4. https://www.medicalnewstoday.com/articles/315123#stage-1
5. https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet
6. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet#:~:text=As%20Alzheimer's%20worsens%2C%20people%20experience,and%20personality%20and%20behavior%20changes.
7. https://www.nia.nih.gov/health/what-happens-brain-alzheimers-disease#:~:text=Neurofibrillary%20tangles,-Neurofibrillary%20tangles
8. https://www.nia.nih.gov/health/memory-forgetfulness-and-aging-whats-normal-and-whats-not
9. https://www.alz.org/alzheimers-dementia/10_signs
10. https://www.alz.org/media/Documents/suspect-packet.pdf
11. https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests
12. https://www.health.harvard.edu/blog/screening-at-home-for-memory-loss-202203302716
13. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/diagnosis-treatment/drc-20350453
14. https://www.alz.org/alzheimers-dementia/treatments/aducanumab
15. https://www.bmj.com/content/374/bmj.n1682
16. https://www.alz.org/alzheimers-dementia/treatments
17. https://www.cms.gov/newsroom/press-releases/cms-finalizes-medicare-coverage-policy-monoclonal-antibodies-directed-against-amyloid-treatment
18. https://www.nia.nih.gov/health/alzheimers-disease-research-centers
19. https://www.alzinfo.org/articles/prevention/how-art-can-aid-people-with-alzheimers/
20. https://www.seasons.com/could-your-next-vacation-also-help-treat-dementia/2614854/
21. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/music-and-alzheimers/faq-20058173
22. https://www.alz.org/alzheimers-dementia/facts-figures
23. https://www.ucsfhealth.org/en/education/coping-strategies-for-alzheimers-disease-caregivers
24. https://www.alz.org/help-support/community
25. https://www.alz.org/help-support/caregiving

https://www.alz.org/help-support/caregiving/care-options/respite-care