By Dr. Gerard Muraida,
As we age, most of our bodily functions slow down, and at some point, begin to fail. We have all seen heart failure, kidney failure and liver failure. We should include memory failure, or cognitive decline. There are many varieties of cognitive decline, the most diagnosed being Alzheimer’s disease.
In 1906, this condition was first identified as a disease by a German psychiatrist and neuropathologist Alois Alzheimer. He cataloged one of his patient’s symptoms and, upon her death, examined her brain. He discovered the plaques and tangles we understand to characterize the disease today. The abnormal protein buildup interferes with brain cell communication and eventually leads to cell death.
Symptoms of Alzheimer’s disease include forgetfulness, word-finding difficulty, repetitive questions, getting lost in familiar places, and difficulty managing finances or planning. As the disease progresses, symptoms get worse. Eventually, people may struggle to recognize their loved ones, lose the ability to speak or walk, and need full-time care.
While a definitive cause of Alzheimer’s remains unknown, the mainstay of treatment has been a group of medications called cholinesterase inhibitors. These drugs prevent the breakdown of acetylcholine, a neurochemical messenger important for nerve cell communication. The theory is that if there is more acetylcholine present, the better the inter-cellular communication. Thus, symptoms related to memory, thinking, language, and judgment may improve. The most common cholinesterase inhibitors include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl).
Donepezil use has been approved for all stages of Alzheimer’s disease. Galantamine has been approved for mild to moderate Alzheimer’s disease. Rivastigmine has been approved for mild to moderate Alzheimer’s and Parkinson’s disease dementia. It is available as an oral capsule and a transdermal patch.
There have been some major developments in Alzheimer’s research recently. In the last few years, drugs like lecanemab (Leqembi) and donanemab (Kesunla) have been approved for early Alzheimer’s. These treatments target amyloid plaques and have been shown to modestly slow the disease in some people. They are not cures, but they offer hope for delaying progression when used early.
Early detection may be the key to successful treatment of Alzheimer’s. Blood tests that look for biomarkers (such as abnormal proteins) are becoming more accurate and accessible. This could allow people to get treatment earlier, which is when it’s most effective.
An ounce of prevention is worth a pound of cure. Prevention is associated with regular exercise, a healthy diet (like the Mediterranean diet), and staying socially and mentally active. Managing stress and treating medical conditions like high blood pressure or diabetes can also lower the risk of developing Alzheimer’s or slow its progression.
Begin your discussion with your health care provider to assess your risk and determine the next steps.
