Treatment and medication for Alzheimer's disease. What regimen will help?

The treatment of Alzheimer's dementia is complex, using all available options of symptomatic pharmacotherapy.

However, non-pharmacological treatments also play an important role, including cognitive training, psychosocial interaction, caregiver education, animal therapy, music therapy, aromatherapy and many others.

Pharmacological treatment is divided into "primary" and "secondary" treatment.

• Primary therapy uses so-called cognitive agents. These are drugs for the symptomatic treatment of cognitive deficits in dementia. They slow down the progression of the disease. They include anticholinesterases, memantine and ginkgo biloba extract.
• We refer to other drugs used to manage neuropsychiatric symptoms of dementia, such as depression, as secondary treatments.

A very successful treatment is the inhibition of the enzymes that break down acetylcholine. These are cholinesterase inhibitors, which effectively slow down the progression of the clinical symptoms of dementia.

They are of greatest benefit when introduced in the early stages of dementia. Up to 50% of Alzheimer's patients describe not only improved cognitive function but also maintenance of the pace of daily functioning.

Three cholinesterase inhibitors are often used: donepezil, rivastigmine and galantamine.

Many side effects can occur during treatment:

• bradycardia
• increased gastric acid secretion
• increased irritability of the gastrointestinal tract
• nausea
• diarrhoea
• anorexia (lack of appetite)

Conversely, the advantage is the low burden on the liver and the low risk of drug interactions.

Memantine is the primary drug against the progression of Alzheimer's disease. Its most important mechanism of action is to prevent the release of glutamate. The result is an improvement in cognition, especially memory impairment, but also a slowing of nerve cell loss and thus the progression of dementia.

Memantine tends to be well tolerated by patients, with minimal side effects, which are rare. The most common are dizziness, headache, constipation and drowsiness.

Ginkgo biloba extract has a special position in the treatment of dementia. It improves blood circulation, is neuroprotective, scavenges free radicals and is therefore an antioxidant.

It is mainly used in the treatment of mild cognitive impairment, vascular dementia and the early stages of degenerative dementia. In the treatment of AD, it is more of a supportive therapy, with existing therapy with memantine and cholintransferase inhibitors.

The drug is non-toxic, very well tolerated. Mild side effects include possible antiplatelet effects, i.e. increased risk of bleeding.

Neuropsychiatric support is also an essential treatment. Antidepressants and antipsychotics are used, but their use requires caution, especially in elderly patients.

Prognosis

Alzheimer's dementia is a steadily progressive disease, with no short-term fluctuations. There may be periods without progression, called plateaus, when the clinical condition is stable for a longer period of time.

However, the disease is irreversible and incurable, even fatal.

The average survival time from diagnosis to death is 7-8 years.

There are cases where patients survive for 15 years or more. Survival time depends on several factors. The most important good prognostic factor is early detection and diagnosis of the disease and therefore early initiation of supportive care.