Treatment

How is Alzheimer’s disease treated?

Alzheimer’s is complex, and it is therefore unlikely that any one drug or other intervention will successfully treat it in all people living with the disease.

Scientists are exploring many avenues to delay or prevent the disease as well as to treat its symptoms. In ongoing clinical trials, scientists are developing and testing several possible interventions. Under study are drug therapies aimed at a variety of disease interventions, as well as nondrug approaches such as physical activity, diet, cognitive training, and combinations of these. Just as we have many treatments for heart disease and cancer, we will likely need many options for treating Alzheimer’s. Precision medicine — getting the right treatment to the right person at the right time — will likely play a major role.

Current approaches to treating Alzheimer’s focus on helping people maintain mental function, treating the underlying disease process, and managing behavioral symptoms.

Medications to maintain mental function in Alzheimer’s disease

Several medications are approved by the U.S. Food and Drug Administration (FDA) to treat symptoms of Alzheimer’s. Donepezil, rivastigmine, and galantamine are used to treat the symptoms of mild to moderate Alzheimer’s. Donepezil, memantine, the rivastigmine patch, and a combination medication of memantine and donepezil are used to treat moderate to severe Alzheimer’s symptoms. All of these drugs work by regulating neurotransmitters, the chemicals that transmit messages between neurons. They may help reduce symptoms and help with certain behavioral problems. However, these drugs don’t change the underlying disease process. They are effective for some but not all people and may help only for a limited time.

Medications to treat the underlying Alzheimer’s disease process

Aducanumab is the first disease-modifying therapy approved by the FDA to treat Alzheimer’s disease. The medication helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimer’s, although it has not yet been shown to affect clinical outcomes such as progression of cognitive decline or dementia. A doctor or specialist will likely perform tests, such as a PET scan or analysis of cerebrospinal fluid, to look for evidence of amyloid plaques and help decide if the treatment is right for the patient.

Aducanumab was approved through the FDA’s Accelerated Approval Program. This process requires an additional study after approval to confirm the anticipated clinical benefit. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.

Several other disease-modifying medications are being tested in people with mild cognitive impairment or early Alzheimer’s as potential treatments.