What to expect from Alzheimer’s Medicines

There’s not a hard-and-fast rule to know whether to start or stop meds for Alzheimer’s disease.

Patients and families often want to try anything to help dementia but it’s important to help set realistic expectations up front…to limit false hope.

Cholinesterase inhibitors (donepezil, etc) are modestly effective at best…and many patients won’t benefit.

About 1 in 12 Alzheimer’s patients may have a SMALL improvement…but an EQUAL number will have significant side effects (nausea, diarrhea, bradycardia, etc).

Plus there’s not good evidence that Alzheimer’s meds can keep patients at home longer, improve quality of life, or limit caregiver burden.

And meds aren’t likely to help agitation or aggressive behaviors.

Alzheimer’s meds for mild cognitive impairment or “pre-Alzheimer’s”…are not recommended as they’re not shown to prevent progression.

If treatment for mild to moderate Alzheimer’s is desired, lean toward donepezil. It’s dosed once daily and seems more tolerable than oral galantamine or rivastigmine.

Memantine has few side effects…but doesn’t help mild Alzheimer’s. Switching to memantine for moderate to severe disease if a cholinesterase inhibitor isn’t tolerated may be a good idea.

Combining memantine PLUS a cholinesterase inhibitor isn’t likely to add much benefit…and adds cost.

Check in at about 3 to 6 months to re-evaluate med use.

Think of stopping meds if the benefit is questionable…side effects are a problem…or if the patient has progressed to advanced dementia.

Generally it’s a good idea tapering meds over 4 weeks to limit possible discontinuation symptoms, such as agitation or insomnia.

Continue to stay alert for anticholinergic meds that may worsen symptoms…antihistamines, overactive bladder meds, tricyclics, etc.