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Cognitive symptoms: Drug treatments
Behavioral symptoms: Causes and treatments


Currently, there is no cure for Alzheimer's. But drug and non-drug treatments may help with both cognitive and behavioral symptoms.

Cognitive symptoms: Drug treatments

Cognitive symptoms affect memory, awareness, language, judgment and other thought processes. The U.S. Food and Drug Administration (FDA) has approved two types of drugs to treat cognitive symptoms of Alzheimer's disease.

  1. Cholinesterase (KOH-luh-NES-ter-ays) inhibitors prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. By keeping levels of acetylcholine high, these drugs support communication among nerve cells.

    Three cholinesterase inhibitors are commonly prescribed:
    • Donepezil (Aricept), approved to treat all stages of Alzheimer's disease.
    • Rivastigmine (Exelon), approved to treat mild to moderate Alzheimer's.
    • Galantamine (Razadyne), approved to treat mild to moderate Alzheimer's.
  2. Memantine (Namenda) works by regulating the activity of glutamate, a different messenger chemical involved in learning and memory. It is approved to treat moderate to severe Alzheimer's disease.

Behavioral symptoms: Causes and treatments

Many people find changes in the person's behavior the most challenging and distressing effect of the disease. These include anxiety, agitation, aggression and sleep disturbances. The chief underlying cause of behavioral and psychiatric symptoms is the progressive damage to brain cells. Other possible causes of behavioral symptoms include:

  • Drug side effects
    Side effects from prescription medications may be at work. Drug interactions may occur when taking multiple medications for several conditions.
  • Medical conditions
    Symptoms of infection or illness, which may be treatable, can affect behavior. Pneumonia or urinary tract infections can bring discomfort. Untreated ear or sinus infections can cause dizziness and pain.
  • Environmental influences
    Situations affecting behavior include moving to a new private residence or residential care facility; misperceived threats; or fear and fatigue from trying to make sense of a confusing world.

Drug treatments for behavior
There are two types of treatments for behavioral symptoms: non-drug treatments and prescription medications. Non-drug treatments should be tried first.

Non-drug treatments for behavior
Steps to developing non-drug treatments include:

  1. Identifying the symptom
  2. Understanding its cause
  3. Changing the caregiving environment to remove challenges or obstacles

Identifying what has triggered behavior can often help in selecting the best approach. Often the trigger is a change in the person's environment, such as:

  • New caregivers
  • Admission to a hospital
  • Presence of houseguests
  • Being asked to bathe or change clothes

Prescription medications can be effective in managing some behavioral symptoms, but they must be used carefully and are most effective when combined with non-drug strategies. Medications should target specific symptoms so that response to treatment can be monitored.

Prescribing any drug for a person with Alzheimer's is medically challenging. Use of drugs for behavioral and psychiatric symptoms should be closely supervised by a doctor and the family of the person with Alzheimer's.

Next: Clinical Trials

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