Update on Alzheimer’s Treatment Options in 2022
Until 1996, the main “treatment” for Alzheimer’s disease involved a range of practices that did not involve medications. Then in 1996 the FDA approved the first of two families of drug treatments — known as “acetylcholinesterase inhibitors” — and in 2003 approved a second, known as “NMDA antagonists”. Notably neither of these drugs “cure” Alzheimer’s disease, but instead are designed to slow the progression of the illness. These drugs have been shown to reduce the pace of progression of the disease in about 40-50% of people who take the drug. Some additional benefits to mood and maintaining function have been discovered as additional benefits of the medications since they were first approved.
Recently, some exciting new avenues for treatment options have been developed, including a new class of medication. In June 2021, the FDA approved a new kind of drug, known as a “monoclonal antibody” for the treatment of mild cognitive impairment and early-stage Alzheimer’s disease.
The agency’s approval was controversial, however, because some researchers regarded the evidence of the drug’s benefit as limited at the time it was approved. However, the approval was unique in that the FDA requires the company to continue researching the drug’s benefits and risks while it is being used. This research requirement comes amid a significant uptick in clinical trials underway exploring the benefits of other drug options, as well as changes in diet and lifestyle and other non-pharmacologic interventions. The result is that patients receiving an Alzheimer’s diagnosis will have a broader range of options to consider now and in the near future.
FDA approved agents for Alzheimer’s Disease
1996 - Acetylcholinesterase inhibitors:
These drugs block the normal breakdown of the central nervous system chemical known as “neurotransmitter acetylcholine”. This class of drugs include:
Donepezil (Aricept)
Galantamine (Exelon)
Rivastigmine (Razadyne)
These are drugs that are taken orally once a day. The drug Exelon also comes in a patch that can be applied daily to the skin.
The main side effects of the drug are nausea, loss of appetite, loose bowels, weight loss, lowering of heart rate, and in rare cases, fainting.
2003 - NMDA receptor antagonists:
These drugs block a part of the brain known as the “NMDA receptor,” and decreases the effects of a chemical called glutamate which can be harmful. This class of drugs includes Memantine Namenda), which is taken orally twice daily. The drug’s main main side effects are headaches, elevated blood pressure, temporary increased confusion, and a change in bowel patterns.
FDA approval for drugs to treat Mild Cognitive Impairment or Early-Stage Alzheimer’s Disease
June 2021 - Monoclonal Antibody
Antibodies are part of the human immune system that attack various elements that can cause disease. In this treatment, the antibody is directed at an abnormal protein known as Amyloid, which is thought to contribute to the nerve damage that occurs as part of Alzheimer’s disease. This treatment is not a cure, however; but it does appear to slow the progression of the disease. The treatment is called Aducanumab (Aduhelm), and it is administered via intravenous infusion every 4 weeks until the disease progresses to a “moderate stage” illness. The main side effects of the treatment include, in some instances, brain hemorrhages and swelling, which in most cases were asymptomatic and reversible.
Clinical Trials
There are a number of important new theories about the cause of Alzheimer’s disease, and as a result there are some new treatments that are being tested in human volunteers.
The website https://clinicaltrials.gov/ is home to the National Institute of Health’s database of all active research. Searching for “Alzheimer’s disease” will show you active trials in your area.
I applaud anyone who chooses to volunteer for a clinical trial. It is the only way to find cures for illnesses like Alzheimer’s disease. Participation in clinical trials, however, is not for everyone. Most trials include the possibility that some of the volunteers will receive the placebo or sham pill. There can also be multiple and lengthy visits and diagnostic tests. On the other hand, some people enjoy the process and value the early access to possible beneficial medications.
If you are interested in learning more, start with the clinical trials site https://clinicaltrials.gov/; then ask your NAN Navigator for a referral to the best clinical trials company in your area.
