Dear NP

Dear NP,

My 69-year-old mother is becoming more than just forgetful. She recently got lost in a town she has lived in her whole life. She has been diagnosed with Alzheimer’s and offered a lot of medications to help with the symptoms. Can you tell me about some of these medications? L. S.

Dear L. S.,

First of all, so many of us know all too well what it is like to see a parent struggle with Alzheimer’s. I hope the advice in this column will make things easier for you and for her.

Unfortunately, the medications for Alzheimer’s currently available can only manage symptoms. They cannot cure the underlying disease. The symptoms of Alzheimer’s are caused by both a loss in neurons (brain and nerve cells), as well as a decrease in neurotransmitters (the chemical messengers between neurons). Neurons are some of the slowest cells to regenerate, which makes Alzheimer’s a difficult disease to treat.

There are currently five FDA-approved drugs for the direct symptoms Alzheimer’s disease: donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly Reminyl), tacrine (Cognex) and memantine (Namenda). Except for memantine, all of these are cholinesterase inhibitors.

These drugs work by raising the level of acetylcholine in the brain, which is an important neurotransmitter that is often low in Alzheimer’s patients. Patients at any stage of Alzheimer’s may benefit from a cholinesterase inhibitor, so these are likely the types of medications your mother was offered.

Memantine is for later-stage Alzheimer’s and is often paired with a cholinesterase inhibitor. This medication works by blocking glutamate, which is a neurotransmitter that can destroy neurons in large amounts.

Though those are the only FDA-approved medications that address the direct neurological symptoms of Alzheimer’s, these are not the only medications prescribed to Alzheimer’s patients.

Alzheimer’s patients frequently struggle with mental health issues like anxiety and depression. Late stage Alzheimer’s patients may also hallucinate or have other symptoms of psychosis. So, these patients may also be offered antidepressants, sedatives, or antipsychotics depending on the extent of the symptoms.

Patients with Alzheimer’s often benefit from antidepressants as far as maintaining social function and energy. Anti-anxiety medications are often good for patients who struggle with sundowning (the tendency of symptoms to get worse in the evening) or insomnia.

Antipsychotics are usually not required in early-stage Alzheimer’s patients. These are for patients who frequently lose touch with reality or hallucinate. These medications can help manage behavior for people who experience these episodes.

As your mother’s caregiver, make sure you know whether the health care providers are offering medication for neurological symptoms or mental health symptoms. Both treatments are valid, and patients may benefit from a combination of treatments.

Starting medication for a new illness is always about trial and error. Just remember that your mother may need your help making these choices now or at some point down the line. Communicate openly with her as well as the health care providers, and don’t be afraid to advocate for her if need be.

It is difficult to say whether there will ever be a cure for Alzheimer’s disease, though so many of us wish there were one. There has been a lot of progress in understanding the causes and s one. There has been a lot of progress in understanding the causes and symptoms of Alzheimer’s.

We now understand that there are biomarkers that emerge years before symptoms begin, but this knowledge has not translated into a way to cure the disease or reverse the damage it has done. Until the research catches up, medications to relieve symptoms are all that are available. But these medications can do wonderful things for patients, helping them live longer and more happily.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]