From the Guidelines
The recommended treatments for Alzheimer's disease include both medication and non-medication approaches, with cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine, and memantine being the primary medications used to manage symptoms and slow disease progression, as supported by the most recent evidence from 1.
Medication Approaches
Medications approved for Alzheimer's include:
- Cholinesterase inhibitors such as donepezil (Aricept, 5-10mg daily), rivastigmine (Exelon, 1.5-6mg twice daily or 4.6-13.3mg/24hr patch), and galantamine (Razadyne, 8-24mg daily), which work by increasing acetylcholine levels in the brain to support memory and thinking.
- Memantine (Namenda, 5-20mg daily) may be prescribed for moderate to severe disease, often in combination with a cholinesterase inhibitor.
Non-Medication Approaches
Non-medication approaches are equally important and include:
- Establishing routine daily activities
- Providing a safe environment
- Engaging in regular physical exercise
- Maintaining social connections
- Ensuring good nutrition
- Cognitive stimulation through puzzles, reading, and memory exercises to help maintain function
- Caregivers should also receive support and education to manage behavioral symptoms
Treatment Effectiveness
Treatment effectiveness varies by individual, and early intervention typically yields better outcomes as these medications can temporarily slow symptom progression but cannot reverse the underlying disease process, as noted in 1.
Deprescription
Deprescription of anti-dementia drugs should be considered based on individual patient factors, such as worsening of dementia, lack of benefit, or development of intolerable side effects, as recommended in 1.
From the FDA Drug Label
The effectiveness of donepezil hydrochloride in the treatment of patients with moderate to severe Alzheimer’s disease was established in studies employing doses of 10 mg/day and 23 mg/day The effectiveness of memantine hydrochloride/donepezil treatment was statistically significantly superior to placebo/donepezil.
The recommended treatments for Alzheimer's disease include:
- Donepezil hydrochloride at doses of 10 mg/day and 23 mg/day for moderate to severe Alzheimer’s disease 2
- Memantine hydrochloride in combination with donepezil, which has been shown to be statistically significantly superior to placebo/donepezil 3 Key points:
- Donepezil hydrochloride and memantine hydrochloride are used to treat Alzheimer's disease
- These medications have been shown to improve cognitive function and overall clinical effect in patients with Alzheimer's disease
From the Research
Recommended Treatments for Alzheimer's Disease
The current recommended treatments for Alzheimer's disease include:
- Cholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, which have been shown to improve cognition, behavior, and activities of daily living in patients with mild-to-moderate Alzheimer's disease 4, 5, 6, 7
- N-methyl D-aspartate receptor antagonist, memantine, which has been shown to have a modest effect on cognition and global functioning in patients with moderate-to-severe Alzheimer's disease 5, 7
Efficacy of Cholinesterase Inhibitors
The efficacy of cholinesterase inhibitors has been demonstrated in several studies, including:
- A meta-analysis of 13 randomized, double-blind, placebo-controlled trials, which found that treatment with donepezil, galantamine, or rivastigmine produced improvements in cognitive function, global clinical state, and activities of daily living 6
- A systematic review and meta-analysis of double-blind, placebo-controlled trials, which found that donepezil, galantamine, rivastigmine, and memantine were effective in improving cognition, with donepezil and galantamine also showing benefits in behavior and function 7
Safety of Cholinesterase Inhibitors
The safety of cholinesterase inhibitors has been evaluated in several studies, including:
- A study that found that cholinesterase inhibitors were generally well-tolerated, with side effects that tend to be dose-related and most problematic during dose titration 4
- A meta-analysis that found that more patients left cholinesterase inhibitor treatment groups due to adverse events than left placebo groups, with nausea, vomiting, diarrhea, and dizziness being the most common adverse events 6
Comparison of Cholinesterase Inhibitors
Several studies have compared the efficacy and safety of different cholinesterase inhibitors, including: