From the Guidelines
The most recent and effective medications for Alzheimer's disease are the anti-amyloid monoclonal antibodies, including lecanemab (Leqembi) and aducanumab (Aduhelm), which have shown promise in targeting and removing amyloid plaques in the brain, although the provided evidence does not directly mention these newer treatments. Given the available evidence from studies such as 1, it's clear that cholinesterase inhibitors like donepezil, rivastigmine, and galantamine, as well as the NMDA receptor antagonist memantine, have been the mainstay of treatment for Alzheimer's disease, providing modest improvement in symptoms and temporary stabilization of cognition. However, these studies are older and do not reflect the most current treatment options. The dosages for these medications are as follows:
- Donepezil: 5-10 mg daily
- Rivastigmine: 1.5-6 mg twice daily
- Galantamine: 4-12 mg twice daily
- Memantine: 10 mg twice daily It's essential to note that treatment decisions should be individualized based on disease stage, potential benefits, risks, and patient preferences, considering the most recent clinical guidelines and evidence available. In clinical practice, the choice of medication and the decision to treat should be guided by the latest research findings and clinical experience, prioritizing the patient's quality of life, morbidity, and mortality outcomes. Given the lack of direct information on the newer anti-amyloid therapies in the provided evidence, it's crucial to consult the most recent medical literature and guidelines for the latest recommendations on Alzheimer's disease management.
From the Research
New Alzheimer's Medications
- Lecanemab is a novel anti-amyloid-beta (Aβ) monoclonal antibody approved for the treatment of Alzheimer's disease with mild cognitive impairment or mild dementia 2, 3.
- It is administered intravenously and has been found to be efficacious in reducing the accumulation of beta-amyloid and slowing down cognitive decline 2.
- The most common treatment-emergent adverse events associated with lecanemab are headache, infusion-related reactions, and amyloid-related imaging abnormalities-edema 2.
- Other medications such as memantine, donepezil, rivastigmine, and aducanumab have also been used in the treatment of Alzheimer's disease, with varying degrees of success 4, 5.
- Current research is focused on developing new therapeutic strategies that target multiple pathological processes, including neuroinflammation, neurotransmitter dysregulation, and oxidative stress 5, 6.
Mechanism of Action
- Lecanemab targets large and soluble Aβ protofibrils, which has shown evidence of slowing clinical decline in Alzheimer's disease patients 3.
- Memantine and donepezil work by reducing β-amyloid plaque, affecting N-Methyl-D-aspartate (NMDA) receptors, and diminishing glutamate and elevated acetylcholine 4.
- Aducanumab targets beta-amyloid and has received rapid approval from the FDA, but its long-term safety and tolerability require further monitoring and confirmation 5.
Future Therapeutic Strategies
- Researchers are exploring new therapeutics that regulate neurotransmitters, inflammation, lipid metabolism, autophagy, microbiota, circadian rhythm, and disease-modified genes for Alzheimer's disease 6.
- Early diagnosis and multiple-target intervention may provide a promising outcome for Alzheimer's disease treatment 6.
- The development of new drugs is focused on overcoming the bottlenecks encountered in previous drug development, including excessive clinical side effects and poor efficacy 5.