Frequently Asked Questions

Currently, there is no cure for Alzheimer's disease (AD). However, there are medications that can help control its symptoms. In addition, treatments are also available to help manage agitation, depression, or psychotic symptoms (hallucinations or delusions), which may occur as the disease progresses. Consult a physician before taking any medications.

FDA-Approved Drugs

There are five Food and Drug Administration (FDA)-approved drugs that can control symptoms and slow the progression of AD. Four, called cholinesterase inhibitors, Cognex® (tacrine), Aricept® (donepezil), Exelon® (rivastigmine), and Razadyne® (galantamine), slow the metabolic breakdown of acetylcholine, an important brain chemical involved in nerve cell communication. These drugs make more of this chemical available for communication between cells. This slows the progression of cognitive impairment and can be effective for some patients with AD. These four medications are all approved for the treatment of mild to moderate symptoms of Alzheimer’s disease. In 2006, the FDA approved Aricept for the management of severe AD symptoms. The fifth medication, Namenda® (memantine), is approved for the treatment of moderate to severe AD. Namenda appears to protect the brain's nerve cells against excess amounts of glutamate, a messenger chemical released in large amounts by AD-damaged brain cells.

The effectiveness of these drugs varies from person to person, and some drugs may be better tolerated than others by certain individuals. Side effects include nausea, dizziness, headache and fatigue. All medications are taken orally. However, in 2007, the FDA approved the ExelonPatch (rivastigmine transdermal system) to deliver this drug through the skin. Cognex, though effective, has more adverse side effects and although still available, is now rarely prescribed.

Medications to Control Depression, Anxiety and Psychotic Symptoms

For patients in the middle stages of AD, there are also medications to control depression, anxiety and psychotic behavior, including paranoid thoughts, delusions and hallucinations. These individuals can also exhibit aggression, hyperactivity and combativeness. Medications for these symptoms are considered when non-medication alternatives have failed and/or these symptoms put the AD patient or others in danger.

Potential Treatments for AD

Many potential AD treatments are being investigated in laboratories and tested in human clinical trials. Scientists continue basic research on therapies that could potentially clear the protein plaques in the brain. The safety and efficacy of possible treatments are being tested on humans, including drugs that could remove plaques, immunotherapy with beta amyloid antibodies, non-steroidal anti-inflammatory drugs (NSAIDs) and statins (drugs used to lower cholesterol). The protective effects of estrogen, antioxidants (Vitamins A, C and E), ginkgo biloba and omega 3 fatty acids (found mainly in fish such as tuna and salmon) are also being tested in trials. To date, no consistent results have emerged from various studies, but further research and future results from rigorous trials should help clarify the benefit of these and other treatments.

Immunotherapy

In 1999, studies revealed that injection of beta amyloid itself, called active immunization, caused laboratory mice to produce antibodies against the protein and reduced its accumulation. Spurred on by the potential of immunotherapy, some pharmaceutical companies started human clinical trials in 2001. However, in 2002, the trials were halted when about six percent of participants developed a potentially serious side effect, acute encephalitis (inflammation in the brain). Autopsies of several participants who died of other causes revealed that a large amount of beta amyloid had been cleared from their brains, their brain volume was lower, and lower levels of tau, another protein related to AD, were found in their spinal fluid. Further, for the living trial participants who developed antibodies, there was evidence of better memory, attention and concentration. More recently, some pharmaceutical companies have begun further human trials using passive immunotherapy, in which antibodies to a protein rather than the protein itself are given to the recipient.

NSAIDs (non-steroidal anti-inflammatory drugs)

Studies suggest that brain inflammation may play a role in damage due to Alzheimer’s disease, and early observations indicated that NSAIDs could potentially slow disease progression. However, studies and human clinical trials have produced conflicting results.

A large trial of three NSAIDs, Aleve® (naproxen), Vioxx® (rofecoxib) and Celebrex® (celecoxib) showed that these drugs did not delay the advance of the disease. Trials of naproxen and Celebrex were suspended before completion due to concerns about an elevated risk of stroke and heart attack for participants.

In early 2008, researchers examining data from the U.S. Veterans Affairs Health Care System found that long-term (5-year) NSAID use, particularly the use of ibuprofen, appeared to protect against Alzheimer’s. Another study looking at results from six previous investigations suggested that naproxen, ibuprofen and aspirin may reduce the risk of Alzheimer’s disease.

More recently, a 2009 study published in the journal Neurology showed that NSAIDs do not prevent Alzheimer's disease or other forms of dementia. In fact, the risk of developing dementia in the study's very elderly population was 66 percent higher among heavy users of NSAIDS than among people who used little or no NSAIDs.

Each of these studies was performed in unique clinical populations including differences in sizes of the study and ages of the participants. More clinical trials will be necessary to fully understand how NSAIDs impact Alzheimer’s disease. While additional studies are underway, individual patients should continue to consult with their doctors on the relative benefits and risks of treatments involving NSAIDs.

Statins

Several clinical trials are underway to test whether statins, cholesterol-lowering drugs, may help slow progression of AD.

Estrogen

Research suggests that estrogen taken to manage the symptoms of menopause may also protect the brain. Therefore, scientists have been interested in whether estrogen could reduce the risk or slow the advance of AD. However, clinical trials of those already diagnosed with AD, showed that estrogen had no impact on its progression. Other studies indicate that women who begin using estrogen after age 60 to 65 are at increased risk of developing dementia, as well as heart attack and stroke. Estrogen is now only recommended for short term use to treat menopausal symptoms. Recent research has helped clarify the neuroprotective role of estrogen taken by younger women before menopause. According to a study published in August 2007, scientists from the Mayo Clinic found that women who had one or both ovaries removed prior to menopause had an increased long-term risk of dementia or cognitive impairment. However, those who underwent ovary removal, but also had estrogen treatment until at least age 50 did not experience this higher risk. These findings suggest that if taken before menopause, the neuroprotective benefits of estrogen may outweigh the risks of side effects, such as heart problems, stroke and cognitive impairment. Women of any age should consult with a physician about the individual risks and benefits of undergoing or considering hormone replacement therapy.

Antioxidants

Vitamin E may offer some protection against cell damage caused by free radicals. However, research has produced conflicting results and further rigorous scientific study will be needed to clarify the role of this antioxidant. Ongoing clinical trials are investigating whether vitamins E and C can slow the progression of AD. Another clinical trial is examining whether Vitamin E and/or selenium can prevent AD or cognitive decline. In April of 2005, the New England Journal of Medicine published results of a study that compared the use of vitamin E, Aricept (donepezil - an Alzheimer's disease treatment) and a placebo in delaying progression from mild cognitive impairment (MCI) to Alzheimer’s disease. People with MCI experience memory problems, but are able to function independently; however, MCI is often a transitional stage that leads to the serious cognitive decline of Alzheimer's disease. The study found that over the course of three years, none of the treatments affected the advance of the disease.

Ginkgo biloba

Ginkgo biloba, an extract from the leaves of the ginkgo tree, is said to have antioxidant and anti-inflammatory properties. It may also increase blood flow in the brain. However, the results of a large multicenter clinical trial led by the University of Pittsburgh School of Medicine, and published in the Journal of the American Medical Association in November of 2008, found that Ginkgo biloba does not reduce the risk of developing Alzheimer’s disease or dementia in either healthy older individuals or in those with mild cognitive impairment. A similar clinical trial is underway in Europe.

Omega-3 fatty acids

Omega-3 fatty acids are found mainly in “oily” fish such as salmon and albacore tuna, but are also present in certain nuts and oils. Scientists believe they may have a protective effect on the brain. Clinical trials are underway to test whether these fatty acids can slow the both cognitive and functional decline in those with mild to moderate AD.

Before taking any medications, over-the-counter drugs, supplements or herbs, visit a physician for a full medical evaluation. The American Health Assistance Foundation does not endorse any medications, vitamins or herbs. A qualified physician should make an informed decision based on each person's medical history and current prescriptions.

Aricept (donepezil), an Alzheimer's disease treatment appears to have a slowing effect—though limited—on the progression from mild cognitive impairment (MCI) to Alzheimer's disease, according to a study published in April 2005 by the New England Journal of Medicine. Those with MCI, such as the study participants, experience memory problems, but are able to function independently; however, MCI is often a transitional stage that leads to the serious cognitive decline of Alzheimer's disease. Over the first year of the three-year trial, MCI patients treated with Aricept had a reduced risk of progressing to Alzheimer's disease compared to patients who took a placebo, an inactive pill. The study found the effect of the Aricept treatment lasted longer (up to two to three years) in those patients carrying the ApoE4 gene. Previous studies have shown that those with the ApoE4 gene have a higher risk of developing Alzheimer's than the general population. Source: Mayo Clinic, Rochester and the National Institute on Aging

Dementia is a progressive deterioration of intellectual function due to the death of brain cells. Dementia can be caused by medical conditions such as hypothyroidism or stroke, drug toxicity or brain injury. Some conditions are treatable, and others cause irreversible brain damage. Alzheimer’s disease (AD) is irreversible, and in western countries, it accounts for more than half of dementia cases. Currently, the only way to diagnose AD definitively is through a brain autopsy. However, on living patients, physicians can correctly diagnose AD about 90 percent of the time based on mental and behavioral symptoms, a physical examination, and neuropsychological and laboratory tests.

A physician will normally take a history of mental and behavioral symptoms, using information provided by the patient and the family. In nearly 75 percent of cases, AD starts with the inability to remember recent events and to learn and retain new information. Early stage AD patients experience memory problems that interfere with daily living and steadily worsen. Other early AD symptoms can include difficulty managing money, driving, orientation, shopping, following instructions, abstract (conceptual) thinking and finding the right words. There may also be other problems, such as poor judgment, emotional instability and apathy. AD can be distinguished from other types of dementia in part by the symptoms exhibited, the extent to which these symptoms occur and the speed with which the disease progresses.

A physical examination will be performed to help identify and rule out other potential causes of dementia. This exam will normally include a general physical, blood tests and urinalysis. Through a blood test, for example, the physician can measure thyroid function; hypothyroidism or failure to produce sufficient thyroid hormones is common in the elderly and can cause dementia. Dementia may also be the result of a vitamin B12 deficiency which is common in the elderly, and can be measured through blood tests. Physicians may use brain scans (such as magnetic resonance imaging or MRI) to rule out other possible causes of dementia, including brain tumors, stroke, blood accumulation on the brain surface or other conditions. In addition, brain scans can show characteristic structural changes present in AD. Physicians may administer an electroencephalogram (EEG) to measure the electrical activity in the brain. Occasionally, spinal fluid may be tested through a lumbar puncture.

Neuropsychological tests identify behavioral and mental symptoms associated with brain injury or abnormal brain function. The neuropsychological tests used will depend on the symptoms and the dementia’s state of advancement. Usually, physicians start with a brief screening tool, such as the Mini-Mental Status Examination (MMSE), to help confirm that the patient is experiencing problems with intellectual functions. The MMSE includes tests of memory, attention, mathematical calculation and language. If a patient has severe dementia, further neuropsychological testing beyond the MMSE is usually not necessary. However, for patients with mild intellectual deficits, more tests may be needed to determine whether the patient is simply showing signs of advanced age or is developing AD. The patient may be referred to a neuropsychologist, who will administer a battery of tests to identify more specific deficits.

There are three general stages of Alzheimer's disease:

Stage 1 (Mild): Early in the illness, those with Alzheimer’s tend to be less energetic and spontaneous. They exhibit minor memory loss and mood swings, and are slow to learn and react. They may become withdrawn, avoid people and new places and prefer the familiar. Individuals become confused, have difficulty organizing and planning, get lost easily and exercise poor judgment. They may have difficulty performing routine tasks, and have trouble communicating and understanding written material. If the person is employed, memory loss may begin to affect job performance. They can become angry and frustrated.

Stage 2 (Moderate): In this stage, the person with Alzheimer’s is clearly becoming disabled. Individuals can still perform simple tasks independently, but may need assistance with more complicated activities. They forget recent events and their personal history, and become more disoriented and disconnected from reality. Memories of the distant past may be confused with the present, and affect the person’s ability to comprehend the current situation, date and time. They may have trouble recognizing familiar people. Speech problems arise and understanding, reading and writing are more difficult, and the individual may invent words. They may no longer be safe alone and can wander. As Alzheimer’s patients become aware of this loss of control, they may become depressed, irritable and restless or apathetic and withdrawn. They may experience sleep disturbances and have more trouble eating, grooming and dressing.

Stage 3 (Severe): During this final stage, people may lose the ability to feed themselves, speak, recognize people and control bodily functions. Their memory worsens and may become almost non-existent. Constant care is typically necessary. In a weakened physical state, the patient may become vulnerable to other illnesses and respiratory problems, particularly when bedridden.

First, visit your regular family physician. The physician will probably do a variety of tests to determine the probability of Alzheimer's. Specialists such as neurologists, gerontologists and geriatric psychiatrists may also be involved in the evaluation process.

If you visit a new doctor, bring your medical records; for any doctor, bring a list of over the counter and prescription medicines you are currently taking. If you don't know the names of the drugs, bring the pill bottles with you. A medication or a combination of medications can sometimes cause symptoms that resemble Alzheimer's disease. Also make a list of current medical problems. It's a good idea to show the doctor a list of symptoms, behaviors and any problems carrying out routine activities (for example, paying bills) in yourself or your loved one that concern you.

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On average, patients with Alzheimer's disease live for 8 to 10 years after diagnosis. However, this terminal disease can last for as long as 20 years.