Although current medications cannot cure Alzheimer’s or stop it from progressing, they may help lessen symptoms, such as memory loss and confusion, for a limited time.
The U.S. Food and Drug Administration (FDA) has approved two types of medications — cholinesterase inhibitors (Aricept, Exelon, Razadyne, Cognex) and memantine (Namenda) — to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer's disease.
As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. While current medications cannot stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain's nerve cells. Doctors sometimes prescribe both types of medications together. Some doctors also prescribe high doses of vitamin E for cognitive changes of Alzheimer's disease.
Learn more: How Alzheimer’s Medications Work
All of the prescription medications currently approved to treat Alzheimer’s symptoms in early to moderate stages are from a class of drugs called cholinesterase inhibitors. Cholinesterase inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes.
Medication safetyBefore beginning a new medication, make sure your physician and pharmacist are aware of all medications currently being taken (including over-the-counter and alternative preparations). This is important to make certain medications will not interact with one another, causing side effects.
Learn more: Taking Medication Safely
- Prevent the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical messenger important for learning and memory. This supports communication among nerve cells by keeping acetylcholine levels high.
- Delay worsening of symptoms for 6 to 12 months, on average, for about half the people who take them.
- Are generally well tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements.
Three cholinesterase inhibitors are commonly prescribed:
- Donepezil (Aricept) is approved to treat all stages of Alzheimer's.
- Rivastigmine (Exelon) is approved to treat mild to moderate Alzheimer's.
- Galantamine (Razadyne) is approved to treat mild to moderate Alzheimer's.
Tacrine (Cognex) was the first cholinesterase inhibitor approved. Doctors rarely prescribe it today because it's associated with more serious side effects than the other three drugs in this class.
A second type of medication, memantine (Namenda) is approved by the FDA for treatment of moderate to severe Alzheimer’s.
Memantine is prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. It can be used alone or with other Alzheimer’s disease treatments. There is some evidence that individuals with moderate to severe Alzheimer’s who are taking a cholinesterase inhibitor might benefit by also taking memantine. Donepezil (Aricept) is the only cholinesterase inhibitor approved to treat all stages of Alzheimer’s disease, including moderate to severe.
- Regulates the activity of glutamate, a different messenger chemical involved in learning and memory.
- Delays worsening of symptoms for some people temporarily. Many experts consider its benefits similar to those of cholinesterase inhibitors.
- Can cause side effects, including headache, constipation, confusion and dizziness.
Ultimately, the path to effective new treatments is through clinical trials. Right now, at least 50,000 volunteers are urgently needed to participate in more than 100 actively enrolling clinical trials about Alzheimer's and related dementias. Trials are recruiting people with Alzheimer's and mild cognitive impairment (MCI), as well as healthy volunteers to be controls.
Find out more about participating in a clinical study through the Alzheimer’s Association TrialMatch service , a free tool for people with Alzheimer's, caregivers, families and physicians to locate clinical trials based on personal criteria (diagnosis, stage of disease) and location.
Doctors sometimes prescribe vitamin E to treat cognitive Alzheimer's symptoms. No one should take vitamin E to treat Alzheimer’s disease except under the supervision of a physician.
Vitamin E, also known as alpha tocopherol, is an antioxidant. Antioxidants may protect brain cells and other body tissues from certain kinds of chemical wear and tear. Its use in Alzheimer’s disease was initially based chiefly on a 1997 study showing that high doses delayed by several months both loss of ability to carry out daily activities and placement in residential care. That study was conducted by the Alzheimer’s Disease Cooperative Study (ADCS), the clinical research consortium of the National Institute on Aging (NIA). Since the ADCS study was carried out, scientists have found evidence in other studies that high-dose vitamin E may slightly increase the risk of death, especially for those with coronary artery disease. And a study published in 2005 found vitamin E to be ineffective in people with mild cognitive impairment.
In 2014, results of a study published in the Journal of the American Medical Association showed that individuals with mild-to-moderate Alzheimer’s disease who received high doses of vitamin E had a 19 percent slower rate of functional decline than study volunteers who received a placebo. Functional decline includes problems with daily activities such as shopping, preparing meals, bathing, eating, planning, and traveling. Study participants were followed up for an average of a little more than two years. Participants in the study who received both vitamin E and the FDA-approved Alzheimer’s drug memantine did not show the same benefit as participants who received vitamin E alone. None of the four study groups — participants receiving placebo, vitamin E, memantine, or vitamin E and memantine — showed cognitive benefits (benefits in thinking ability and memory). While the results of the 2014 study are encouraging, more research is needed before changes to clinical practice should be considered based on this study.
No one should take vitamin E to treat Alzheimer’s disease except under the supervision of a physician. Vitamin E — especially at the high doses — can negatively interact with other antioxidants and medications, including those prescribed to keep blood from clotting or to lower cholesterol.
|Generic||Brand||Approved For||Side Effects|
|donepezil||Aricept||All stages||Nausea, vomiting, loss of appetite and increased frequency of bowel movements.|
|galantamine||Razadyne||Mild to moderate||Nausea, vomiting, loss of appetite and increased frequency of bowel movements.|
|memantine||Namenda||Moderate to severe||Headache, constipation, confusion and dizziness.|
|rivastigmine||Exelon||Mild to moderate||Nausea, vomiting, loss of appetite and increased frequency of bowel movements.|
|tacrine||Cognex||Mild to moderate||Possible liver damage, nausea, and vomiting.|
|vitamin E||Not applicable||Not approved||Can interact with antioxidants and medications prescribed to lower cholesterol or prevent blood clots; may slightly increase risk of death.|