What to Expect From Alzheimer’s Disease Treatment, According to Experts
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There’s so much to process after an Alzheimer’s diagnosis. Whether it’s you or a loved one who has this disease, you’re likely working through piles of complicated information, an avalanche of difficult emotions, and a slew of sensitive conversations about what happens next.
Alzheimer’s disease doesn’t have a cure, meaning no treatment can reverse the damage that’s already occurred in the brain. But that doesn’t mean life has to come to a screeching halt. There are ways to manage symptoms so people with Alzheimer’s can still have fulfilling lives and caregivers can continue to have meaningful experiences with their loved ones, Katherine Ornstein, PhD, MPH, director of the Center for Equity in Aging at the Johns Hopkins School of Nursing, tells SELF.
While Alzheimer’s symptoms progress over time, on average, people live between four and eight years after their diagnosis—sometimes up to 20 years after the fact, depending on factors like when symptoms first manifested, how severe the disease is, and whether it’s responsive to treatment, Dr. Ornstein says. That last factor is particularly significant, so it’s essential to understand the options. Here’s what experts want you to know about treating Alzheimer’s, whether you’re experiencing early symptoms yourself or caring for someone with the disease.
Several medications may ease Alzheimer’s symptoms or temporarily slow the disease’s progression.
The FDA-approved therapies for Alzheimer’s fall into two camps: medications that may temporarily improve symptoms (like impaired memory and thinking) and drugs that aim to slow the rate of cognitive decline. The former targets chemicals that carry messages between the brain’s nerve cells, while the latter goes after the underlying biology of the disease.
To recommend the right drug for you or your loved one, a neurologist will determine whether the disease is in a mild, moderate, or severe stage and evaluate each treatment’s potential efficacy and safety risks based on symptoms and medical history. Ultimately, you should feel empowered to ask about the possible benefits, risks, time commitment, and costs associated with each treatment to ensure you make the decision that’s right for you (or help your loved one choose what’s best for them), says Irina Skylar-Scott, MD, a clinical assistant professor in the Center for Memory Disorders at the Stanford Department of Neurology and Neurological Sciences.
Cholinesterase inhibitors
Alzheimer’s disease hijacks the brain by slowly destroying its nerve cells, which triggers a cascade of cognitive turmoil like gradually escalating forgetfulness, difficulties with planning or organizing, and an uptick in confusion or moodiness. As these nerve cells diminish, so do levels of a chemical messenger called acetylcholine, a key player in memory, language, and thought-processing skills.
That’s where cholinesterase inhibitors can come in. Drugs like donepezil (commonly sold under the brand name Aricept), galantamine (Razadyne), and rivastigmine (Exelon) thwart the breakdown of acetylcholine, upping the amount available to healthy nerve cells. These treatments are typically taken in pill form; rivastigmine can also be applied as a skin patch.
Research suggests cholinesterase inhibitors can drive a modest improvement in cognitive symptoms ranging from mild to severe, but they won’t alter disease progression. Even while a person is taking these medications, Alzheimer’s will continue impacting the brain’s nerve cells and acetylcholine levels, making the drugs less effective over time. The medications also come with a fair share of potential side effects, from nausea and diarrhea to muscle cramps and weight loss, and may not be safe for everyone, particularly those with a history of abnormal heart rhythms.
Anti-amyloid immunotherapies
People with Alzheimer’s tend to have an abnormal buildup of two proteins in their brains: amyloid and tau. These sticky proteins form plaques and tangles that cause severe damage to nerve cells’ vital functions, ultimately triggering dementia symptoms.
Certain forms of amyloid are especially destructive, so researchers set their sights on creating anti-amyloid treatments designed to clear the protein from the brain. In the last couple of years, the FDA has approved two anti-amyloids, lecanemab (brand name Leqembi) and donanemab (Kisunla), after clinical trials showed they could slow the progression of cognitive decline in people with early-stage Alzheimer’s.
However, the buzz surrounding the medications comes with big caveats. Most notably, these immunotherapies are only approved for people with mild dementia symptoms, and they might cause potentially serious side effects, including brain bleeding and swelling. They also require intravenous infusions every few weeks for treatment and ongoing monitoring to ensure they aren’t causing any harm. The medication and tests can be pretty expensive, too, even if your insurance covers some of the costs.
“Not everyone in the field agrees with the utility of these new drugs,” Dr. Skylar-Scott tells SELF. But for the right person, they can be worth a shot, she says. “The overall benefit is modest, but people on these therapies can stay at a lower level of severity for longer before progressing to the next stage.” In other words the medications can delay new or worsened symptoms, which Dr. Skylar-Scott says means a lot to many patients. It gives them more time to get their affairs in order, do things they enjoy, or spend precious moments with their families and friends.
Other meds your doctor may recommend
For moderate to severe Alzheimer’s, your or your loved one’s doctor may also prescribe a glutamate regulator called memantine (often sold under brand names like Namenda and Valios). Glutamate is an abundant chemical messenger that has a substantial influence on brain-cell functions, including the learning and retention of information and short- and long-term memory. People with Alzheimer’s can experience abnormal glutamate activity that harms nerve cells, but memantine helps stunt that impact, potentially slowing symptoms that make day-to-day life more challenging. The downsides are that the medication comes with possible side effects (like headaches, confusion, or dizziness) and may take three months or longer to produce noticeable benefits.
An atypical antipsychotic may also be prescribed. This class of drugs is traditionally used to stabilize mental health conditions like bipolar disorder and schizophrenia but can also be helpful when a person with dementia is experiencing mood-related symptoms. Right now brexpiprazole (brand name Rexulti) is the only FDA-approved option for managing Alzheimer’s-related agitation. Other atypical antipsychotics are sometimes prescribed off-label to help with symptoms like hallucinations, aggression, or delusions. But this is often a last resort due to potentially serious adverse effects, including a higher risk of death in older adults with dementia-related psychosis.
Lifestyle adjustments can also help improve your quality of life.
Medication is just one piece of the puzzle. Dr. Ornstein says it’s also critical for health care providers and caregivers to ask, “What does this person genuinely need? What do they like to do? And what’s the safest way to keep them engaged in daily life?” This conversation helps shape a care plan that can give people with Alzheimer’s a sense of autonomy, comfort, and community.
It’s all about focusing on a person’s cognitive strengths instead of their cognitive weakness, Dr. Skylar-Scott points out. For example, say your mom never skips her morning walk in the park, loves to cook with vegetables from her garden, and joins her friends for breakfast at the local diner every Sunday. After an Alzheimer’s diagnosis her care team might encourage her to keep doing those things for as long as she’s able and then modify them as symptoms progress—say, going on walks with the company of her caregiver, having family tend to her garden alongside her, or inviting a friend over for coffee at home.
Additionally, small behavioral changes can help keep a person with Alzheimer’s engaged in the day-to-day, ultimately setting them up for a healthier, more fulfilling life. That’s why experts also recommend lifestyle adjustments as part of a treatment plan, including:
Getting regular exercise: Daily movement may slow cognitive decline, support other aspects of brain health, improve emotional well-being, and reduce the risk of life-threatening falls. It can also help you or your loved one feel physically independent.
Eating nutritious meals: Dr. Skylar-Scott recommends the Mediterranean diet. While there’s not enough evidence to say conclusively that it improves Alzheimer’s symptoms, it’s one of the most widely studied eating patterns linked to brain health benefits.
Leaning into hobbies: It’s unclear if mentally stimulating activities like puzzles or crosswords actually stave off further cognitive changes. But if you or your loved one are big on games, watercolors, pottery, reading, playing music, or practicing another hobby, stick with it. It keeps the brain busy, supports mental health, and can help build or sustain connections with others.
Staying social: Surround yourself with people who want to see you thrive or make sure your loved one with Alzheimer’s maintains a solid support system. Strong relationships go a long way in boosting a person’s happiness and resilience.
While these strategies won’t turn back the clock in the brain of someone with Alzheimer’s, Dr. Ornstein says they make a difference by tamping down stress, a common trigger that can exacerbate symptoms of the disease.
Experts are optimistic about the future of Alzheimer’s treatment.
There’s still so much we don’t know about Alzheimer’s, but scientists are continuing to unravel what contributes to its development, Dr. Ornstein says. That’s exciting because the more we know about the risk factors we can directly influence, the better our chances are of detecting the disease earlier or possibly preventing it. For example, researchers have established a significant link between hearing loss and cognitive decline in the last few years. Discoveries like this are a big deal because they’re actionable; in this case one potential route is to make hearing aids more accessible for older adults, according to Dr. Ornstein.
Then there’s the winding path to pinpointing new treatments that are safe and effective. According to an analysis published last year, at least 164 clinical trials explored 127 potential Alzheimer’s drug developments in 2024. But it takes a lot of time to do this work—on average, 13 years to advance from the research phase to FDA review, the analysis found. Still, recent advancements have fueled optimism. “Many experts in the field are hopeful that lecanemab and donanemab are just the beginning of an era of breakthroughs in Alzheimer’s therapy,” Dr. Skylar-Scott says.
Globally, scientists are working to expand anti-amyloid therapies, and several drugs in this category are in clinical trials. Whereas drugs like lecanemab and donanemab are administered through infusions, some of the medications currently undergoing testing are delivered via injection, which would make them more accessible and less time-consuming for patients to take. Researchers are also homing in on tau by actively testing treatments that could remove abnormal clusters of these proteins in mice, as well as methods that might potentially prevent tau from tangling up in the brain to begin with.
Scientists are also studying other aspects of the Alzheimer’s process to develop medications that could, say, repair dementia-related brain damage or protect cells from the molecular onslaught of the disease. And there are lots of questions about how other health conditions, including cardiovascular disease and insulin resistance, could spur changes in the brain. Looking into medications aimed at those health markers could theoretically be a means of slowing dementia progression, but the jury’s still out.
Dr. Skylar-Scott tries to reassure her patients and their families by reminding them of these ongoing efforts: “I tell them that many of us get up every day thinking about how to identify new treatments.”
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Related:
How to Provide Quality Care for Someone You Love With Alzheimer’s
What’s the Difference Between Normal Age-Related Memory Decline and Signs of Dementia
Originally Appeared on Self
