Alec Williams, PharmD Candidate

I wanted to write an article on Alzheimer disease because it affected someone very close and dear to me. I watched both of my grandmothers suffer through this horrible disease. They were physically fit, working in their gardens for hours on end, but were prisoners of their minds.

For some reason, they were stuck in a certain time of their lives when they were younger. It was heartbreaking to see them so confused and frustrated.    

Alzheimer disease is a type of progressive dementia that interferes with the brain’s ability to remember past experiences. These symptoms can become so severe that they interfere with daily living among many of these patients. Working memory and behavior can be altered in patients with Alzheimer, leading to a diminished quality of life.

Alzheimer disease has grown in prevalence in recent years, now accounting for 60% to 80% of all dementia cases.

The greatest risk factor for Alzheimer is increasing age, with the majority of cases being diagnosed in patients 65 years of age and older.

It is estimated that 44 million people currently live with dementia worldwide.

Based on these statistics, the occurrence of Alzheimer is predicted to more than triple by the year 2050 if a cure is still unavailable.

Sadly, there is not a cure for Alzheimer at this time. Current medications for treatment are only approved to improve symptoms and quality of life by slowing the progression of the disease. Current treatments have been used for years with good efficacy and low chances of adverse effects (AEs).

There are 2 main groups of drugs currently in use to slow the progression of Alzheimer disease. The first group consists of Cholinesterase inhibitors, which are typically used for mild to moderate cases. The second group is an N-methyl D-aspartate (NMDA) antagonist used for moderate to severe cases.

Tablet: 5 mg once a day, may increase 10 mg/day after 4-6 weeks if tolerated, then 23 mg/day after at least 3 months

			Orally disintegrating tablet: Same as above*

Nausea, vomiting, diarrhea, muscle cramps, fatigue, weight loss

Capsule: 3 mg/day, may increase to 6 mg/day, 9 mg/day, and 12 mg/day at 2-week intervals if tolerated

			Patch: 4.6 mg once a day, may increase to 9.5 mg once a day and then 13.3 mg once a day at 4 week intervals if tolerated

Nausea, vomiting, diarrhea, weight loss, indigestion, muscle weakness

Tablet: 5 mg once a day, may increase to 10 mg/day, 15 mg/day, and 20 mg/day at 1-week intervals if tolerated

			Extended release capsule: 7 mg once a day, may increase to 14 mg/day, 21 mg/day, and 28 mg/day at 1 week intervals if tolerated

Dizziness, headache, diarrhea, constipation, confusion

N-methyl D-aspartate (NMDA) antagonist plus cholinesterase inhibitor

			28 mg memantine/10 mg donepezil once a day 

			7 mg memantine/10 mg donepezil once a day, may increase to 28 mg memantine/10 mg donepezil in 7 mg increments at 1-week intervals if tolerated 

for patients only stabilized on donepezil

Headache, nausea, vomiting, diarrhea, dizziness, anorexia

Tablet: 8 mg/day, may increase to 16 mg/day, and 24 mg/day at 4-week intervals if tolerated

			Extended-release capsule: Same as above but taken once daily*

Nausea, vomiting, diarrhea, decreased appetite, dizziness, headache

*Table information referenced from National Institues of Health: How is Alzheimer’s Disease Treated

Current available treatments are only indicated to slow the progression of Alzheimer disease. However, a new and exciting drug has emerged that has shown efficacy in studies. This new drug, aducanumab, is currently working its way through FDA review.

Articles

There are two main groups of drugs currently in use to slow the progression of Alzheimer disease.