For the more than 5.2 million Americans living with Alzheimer's, there is no cure for the brain disease.
But there are medications available that may help lessen symptoms, including memory loss, confusion and problems with thinking and reasoning, for a short time.
According to Dr. Oscar Lopez, director of the University of Pittsburgh Alzheimer's Disease Research Center, five drugs approved by the U.S. Food and Drug Administration are available to treat the cognitive symptoms. Four of the drugs – Aricept, Reminyl, Exelon and Cognex (which is rarely prescribed today) – are called cholinesterase inhibitors. They work by slowing the breakdown of a chemical in the brain called acetylcholine, which facilitates communication among nerve cells and is important for memory.
Another drug, Namenda, is prescribed for the treatment of moderate to severe Alzheimer's. It works by reducing the amount of glutamate in the brain, which is important because excess levels of glutamate contribute to the death of brain cells in people with Alzheimer's.
Most people on Namenda also take one of the cholinesterase medications, and this combination seems to work best.
Dr. Judith Black, a geriatrician, medical director for senior products at Highmark Inc. and a clinical associate professor of medicine at the University of Pittsburgh, said the current medications for Alzheimer's modestly slow the progression of cognitive symptoms that impact activities of daily living, such as bathing, dressing and feeding (which affects caregivers because it can delay, for months, the need to place an Alzheimer's patient into a nursing home) and may help behavior problems.
But they don't work for everyone – at least half of the people who take the drugs don't respond to them – and they improve symptoms only temporarily, between six and 12 months in most cases, according to the Alzheimer's Association.
And all of the medications have possible side effects ranging from dizziness and vomiting to loss of appetite and diarrhea.
“That's why we need to really talk with the patient and their family about what their goals of care are, because these medications are not for everyone,” Black said. “It's really important that early on you have in-depth conversations with the patient, the family and the doctor about what the medications will and will not do for you, and to make shared decisions if they want to take those medications.”
Alzheimer's medications are not cheap, either. While a generic version of Aricept is available, a majority of dementia medications have no generic option and cost, on average, from $177 to more than $400 per month.
Dr. Heidi Weinhold, a naturopathic physician in Peters Township, said her father, Fred, who died from Alzheimer's in 2008, suffered from anorexia, a rare side effect of Aricept, after he was prescribed the medication to treat Alzheimer's symptoms.
He stayed on Aricept for about a month and Namenda for less than three months (he suffered side effects from that medication, too) before Weinhold and her mother decided to discontinue the medications.
Instead, Weinhold turned to homeopathic remedies aimed at making her father comfortable and reducing his agitation, anxiety and hallucinations.
“Once those neuron connections are gone in Alzheimer's patients, there's no getting them back. Once you have those large gaps between the neurons, you can't rebuild them. In many cases, the medications available only delay the progression of cognitive loss for a short time, and we didn't think it was worth it,” Weinhold said. “I chose to give my dad homeopathic remedies. They are safe and gentle, and they helped with his anxiety. There are a lot of herbal things that are helpful and won't interfere with other medications, but some can. Often Alzheimer's patients are also taking medications for other health conditions.”
Both Weinhold and Black advised caregivers to consult with a physician before using any alternative treatments, including herbal remedies.
Among the alternative treatments that Weinhold administered to her father were homeopathic baryta carbonica, Bach flower Rescue Remedy, turmeric and phospahtidlylserine.
Since research indicates some links between cardiovascular disease and Alzheimer's, doctors recommend adopting healthy lifestyles to do everything possible to reduce the risk of developing Alzheimer's.
That means, said Black, keeping blood pressure under control, not smoking and limiting alcohol consumption.
“I'm a firm believer in the connection between cardiovascular disease, diabetes and Alzheimer's,” said Weinhold, who recommends people eat healthy foods and exercise, take B6, B12 and sources of Omega-3 fatty acids and avoid exposure to aluminum and metals that can be found in products ranging from cans, cosmetics and antacids to food additives and kitchenware.
Weinhold said her father, a restaurateur who owned Freddie's Grill, Freddie's II and the former Freddie's III in Peters Township, was a “jovial guy, very social; he loved people. But he was very noncompliant when it came to his diet. He loved to eat, and he didn't eat healthy foods.”
It has been more than a decade since a new medication was approved by the FDA to treat Alzheimer's, Lopez said.
But intensive research and clinical trials are being conducted at the ADRC and research facilities throughout the country, although Lopez believes more funding should be available for Alzheimer's research. In fact, in 2013, the National Institutes of Health spent nearly seven times as much on HIV/AIDs research as it did on Alzheimer's, even though there are five times as many people with Alzheimer's as with HIV/AIDs.
In the meantime, Alzheimer's patients and their caregivers wait for a breakthrough.
“It's a journey for anybody who goes through it, and my heart breaks for any family whose loved one has Alzheimer's,” said Weinhold. “Nancy Reagan was right when she called Alzheimer's 'the long goodbye.' That's exactly what it is.”