Alzheimer Disease: Current and New Advances in Treatment

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.¹ The greatest risk factor for Alzheimer is increasing age, with the majority of cases being diagnosed in patients 65 years of age and older.¹

It is estimated that 44 million people currently live with dementia worldwide.² Based on these statistics, the occurrence of Alzheimer is predicted to more than triple by the year 2050 if a cure is still unavailable.²

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).

Current Treatment Options

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.³

Drug Name

Drug type

Dose

Possible AEs

Aricept (donepezil)

Cholinesterase inhibitor

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

Exelon (rivastigmine)

Cholinesterase inhibitor

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

Namenda (memantine)

N-methyl D-aspartate (NMDA) antagonist

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

Oral solution: Same as above*

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

Namzaric (memantine and donepezil)

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

Extended release capsule:

28 mg memantine/10 mg donepezil once a day if stabilized on memantine and donepezil

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

Razadyne (galantamine)

Cholinesterase inhibitor

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 Treated³

New Treatment

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.

Alzheimer disease is characterized by the build-up of beta amyloid plaques and neurofibrillary tangles in the brain.⁴ This accumulation of plaques leads to the progression of neurodegeneration and synaptic dysfunction.

Aducanumab is a human monoclonal antibody that targets beta amyloid plaques and selectively disperses the build-up of these plaques in Alzheimer disease.⁴ The effects of aducanumab in breaking up the excess beta amyloid plaques in the brain has shown promise in multiple clinical trials.^4-6

If approved, aducanumab could be extremely beneficial to patients suffering from Alzheimer disease. As of July 8, 2020, Biogen has announced that they have completed license applications and submitted the drug to the FDA.⁷

If successful, aducanumab would be the first drug on the market found to reduce the clinical decline of Alzheimer disease by selectively targeting and removing amyloid beta plaques.⁷

This would provide hope for an improved quality of life among the many patients suffering from this horrible disease.

About the Author

Alec Williams is a PharmD candidate at Shenandoah University’s Bernard J. Dunn School of Pharmacy, anticipated to graduate in Spring 2021.

Jonathan Ogurchak, PharmD, CSP, is the founder and CEO of STACK, a pharmacy compliance management software, and serves as preceptor for a virtual Advanced Pharmacy Practice Experiential Rotation for specialty pharmacy, during which this article was composed.

References

• What is Alzheimer’s Disease. https://www.alz.org/alzheimers-dementia/what-is-alzheimers. Accessed: 07 22, 2020.
• Lane CA, Hardy J, Schott JM. Alzheimer's disease. Eur J Neurol. 2018;25(1):59-70.
• NIH: National Institute on Aging. How is Alzheimer’s Disease Treated? https://www.nia.nih.gov/health/how-alzheimers-disease-treated. Revised: 04 01, 2018. Accessed: 07 20, 2020.
• Sevigny J, Chiao P, Bussière T, et al. The antibody aducanumab reduces Aβ plaques in Alzheimer's disease. Nature. 2016;537(7618):50-56.
• Vaillancourt DE. Aducanumab reduces Aβ plaques in Alzheimer's disease. Mov Disord. 2016;31(11):1631.
• Briggs R, Kennelly SP, O'Neill D. Drug treatments in Alzheimer's disease. Clin Med (Lond). 2016;16(3):247-253.
• Stewart J. Aducanumab Approval Status. https://www.drugs.com/history/aducanumab.html. Updated: 07 08, 2020. Accessed: 07 22, 2020.