Treatments: Best Practices
The cause of Alzheimer’s disease (AD) is essentially still unknown, although less than 5% of cases can be attributed to genetic mutations that predispose individuals to Alzheimer’s. There is currently no cure for AD, but there are treatments to slow its progression, mprove cognition and quality of life.
Commonly Prescribed Drugs
● Donepezil: this drug is an acetylcholinesterase inhibitor (ChEI) marketed under the name Aricept. It acts by inhibiting the enzyme acetylcholinesterase, an enzyme responsible for metabolizing the neurotransmitter acetylcholine. Acetylcholine is vital to thought, memory, decision making and other cognitive processes. Inhibition of acetylcholinesterase causes the concentration of acetylcholine to increase in the brain. This helps improve cognitive ability in a patient with Alzheimer’s.
● Rivastigmine: another ChEI that is marketed under the name Exelon. It acts by the same mechanism as donepezil, although its effects may lessen as the disease progresses as fewer cholinergic neurons remain functionally intact. In addition, in vivo studies have shown that combination with NMDAs such as memantine does not affect its performance as a ChEI.
● Galantamine: a ChEI marketed under the name Razadyne. Very similar to both donepezil and rivastigmine and acts by the same mechanism.
● Memantine: this drug is in a class called N-methyl-D-aspartase (NMDA) receptor antagonists. Memantine functions by binding to the NMDA receptor and modulating the concentrations of glutamate. This is an important pathway to modulate since glutamate is involved in long-term potentiation, a process vital to learning and memory, as well as preventing calcium buildup, which can lead to cell death. NMDA receptor agonists are commonly coupled with CHEIs (donepezil) as adjuvants. It is sold under the name Namenda.
Centers of Excellence
● National Institute of Aging – Alzheimer’s Disease Center, 30 centers in 19 states
○ These centers seem to be at the forefront of Alzheimer’s research.
● Mary S. Easton Center for Alzheimer’s Disease Research – UCLA School of Medicine
● Johns Hopkins School of Medicine – Alzheimer’s Disease Research Center