Should We Try the Medications for Alzheimer's Disease?
Anytime a new medication is considered, it is critical to think about the potential benefits as well as the possible side effects and other risks. Ideally only medications that are effective and free of side effects would be used. Since there are currently no available medications that are a definitive cure for Alzheimer’s disease the decision is a bit more complicated from the start. In such situations when we cannot cure an illness, the last thing we want to do is reduce the patient’s quality of life with side effects. With this as our starting point, let’s look at what is currently available.
Four medications have now been given FDA approval for use, including donepezil, memantine, and the newest, aducanumab and Lecanemab. While none cure the illness, they each have some activity against some of the symptoms. In addition to possibly slowing down the progression of the disease process, donepezil and memantine have been shown to reduce abnormal moods, behaviors, and hallucinations, along with increasing the time before having to resort to a nursing home placement.
These less common, but important effects can sometimes make a big difference in the quality of life for a loved one and their caregiver. Too often you will hear healthcare professionals, including doctors, say these medications are not worth using. Sadly, they are focusing on the progression of illness and ignoring the potential real benefit to reducing other aspects of Alzheimer’s disease that can be so distressing to patients and families.
The risks of these medications are typically mild and occur no more frequently than prescription medications such as antibiotics or high blood pressure medications. All of these side effects are fully reversible when the medication is stopped.
For donepezil the most common side effects are upset stomach, loose bowels, and loss of appetite. Some patients have sleep disturbance and/or leg cramps. The most dangerous effects are related to changes in heart rhythm, including slowing of the heart rate or skipping beats and creating a tendency to faint.
Memantine has its own profile of side effects including mild elevations of blood pressure, headache, bowel changes of constipation or diarrhea, and temporary increased confusion.
Aducanumab and Lecanemab have the most serious of the possible side effects. A type of brain bleeding called ARIA-H and brain swelling called ARIA-E can happen. For most patients there are no symptoms associated with this side effect — it has to be detected on a routine brain MRI. Other patients taking these drugs have experienced headaches, increased confusion, and nausea.
Most of the time these side effects resolve with time, but since these are new medications the full range of possible effects is not known. In part due to these risks, there are a set of unique requirements for taking these medications. If you are interested in any of these medications speak with your loved one’s personal providers.
I hope you feel more comfortable discussing this issue with your loved one’s treating providers.
If you do decide to use one of the medications with your loved one, please be sure to follow closely your loved one’s reactions, and note any side effects that create distress. Keeping in mind the goal is to lessen distress for your loved one, not increase it, you may be in the best position to decide whether their using a medication is in their best interest.
A final word about currently available medications. Now more than ever there are pharmaceutical companies working towards the cure for Alzheimer’s disease. The research needed to achieve FDA approval are called “clinical trials.” These research studies include people with Alzheimer’s disease from across the country who volunteer to participate.
Often being part of a clinical trial is the best way to gain access to cutting-edge treatments. In many cases your Loved one could be on the FDA approved medications donepezil and/or memantine AND participate in a trial of a new drug. Use of aduhelm, however, may disqualify patients from entering future clinical trial studies.
Your treating provider should be able to direct you to the local research clinic. Information about specific trials can be found on clinicaltrials.gov website.
Please talk with your own/loved one’s healthcare provider before using any of this information.
