What medication and dietary management options are available to help those with Alzheimer’s disease?
Anyone living with a loved one who has Alzheimer’s disease knows all too well how the condition can rob them of their cognitive function, ability to complete daily tasks and even their identity.
What the family members of people with Alzheimer’s may not know, however, is that while there’s currently no cure for the condition, there are a variety of medications and treatments that can assist people at different stages of the disease.
According to Michael Woodward director of the Aged Care Research and Memory Clinic at Austin Health “in the pre-clinical stage, which lasts about 20 years, people with Alzheimer’s typically show a build-up of a toxic protein called amyloid-beta in their brain. There are no symptoms at this stage of Alzheimer’s and medication isn’t effective.
The prodromal or mild cognitive impairment stage is the second phase of the disease, and while people may experience symptoms such as memory loss, they’re essentially still able to function independently. Studies show the drugs don’t work at this stage of the condition.
The final stage is the dementia stage, which is where medication has been shown to have a modest efficacy in reducing symptoms. It would be a standard of practice to offer these medications at that stage”.
Options for the early stages
For people who have been diagnosed with early Alzheimer’s disease but who are still in the prodromal stage where medications aren’t effective, Souvenaid® – a food for special medical purposes that is taken daily can nutritionally support memory loss– can be used.
“Souvenaid® is a food,” Woodward says. “Food has a number of chemicals in it, all of which in combination have a beneficial effect. The whole purpose of Souvenaid® is to slow down that progression to dementia.”
Souvenaid® works by supporting the development of new synapses in the brain and helps support memory function for those living with Alzheimer’s by providing nutrients that are important for brain health and memory.
Medications for the later stages
In the dementia stage, the medications Woodward mentions – known as cholinesterase inhibitors – are prescribed for a limited time to offer relief of symptoms in some people living with Alzheimer’s . These medications include donepezil (sold under the brand name Aricept), galantamine (sold as Reminyl in Australia and Razadyne in the US) and rivastigmine (also sold as Exelon).
These drugs all work similarly by aiming to stop acetylcholine – a chemical that acts like a ‘spark plug’ to allow the brain’s cells to communicate with each other – from breaking down as rapidly to give it the best chance of moving between cells to temporarily improve memory, psychological and behavioural symptoms and thinking skills.
People with early Alzheimer’s experience damage in the basal forebrain nucleus, a part of the brain that’s fundamental in making acetylcholine. When this happens, the brain becomes deficient in acetylcholine, which can lead to a decline in cognitive function and the onset of other Alzheimer’s symptoms. “We replace that chemical (acetylcholine) or boost the levels of that chemical with the drugs that are currently available,” Woodward explains. “Whilst they’re not curing the disease or getting rid of the underlying pathology, they’re certainly helping with the symptoms of the disease in some people.”
The three drugs are available on the Pharmaceutical Benefits Scheme to people who’ve had a specialist diagnose dementia or Alzheimer’s. The medications can, however, come with side effects such as a reduced heart rate, diarrhoea, nausea, disturbed sleep and lowered blood pressure. In these cases, patients may be advised to stop taking the medication completely or to try a different drug within the class inhibitors.
“They will generally severely affect about one in five patients treated with these drugs,” Woodward warns. “Some people will lose weight, not just because of obvious tummy upsets but they just lose their appetite. Some people will develop a slight tremor, some people can get, paradoxically, a little agitated.”
Experts typically recommend a six-month trial for cholinesterase inhibitors and if there’s a clinically significant response such as improved memory in the patient, will continue prescribing the medication for an indefinite period of time – usually even when a person is in the advanced stages of dementia.
In these more advanced stages, a drug called Memantine (sold under brand names Ebixa, Memanxa, and APO-Memantine) may be offered in addition to the cholinesterase inhibitors to ensure nerve cells communicate with each other more efficiently.
For people who use Souvenaid® in the earlier stages of Alzheimer’s disease, there is no need to give it up once they are prescribed medication. Souvenaid® can also be used safely alongside these medications.
If you have a loved one who lives with Alzheimer’s disease, it’s important to ensure their GP, specialist or health professional talks to them about the possibility of medication for their condition. While Souvenaid® is not medication it should be consumed under medical supervision.
Content created in consultation with dementia expert Associate Professor Michael Woodward.