Should I take medications to treat Alzheimer's disease?

Introduction

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This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Deciding whether and when to treat Alzheimer's disease with medicines can be a difficult decision. Taking a careful look at how bad your condition is can help you decide whether medicines are right for you. Consider the following when making your decision:

• Your symptoms interfere with your daily living and are more bothersome than the potential side effects of the medicines, so taking medicines may be a good choice for you.
• Disruptive behaviors may be manageable without medicines. If behavior problems can be managed in other ways, you may be able to avoid treatment with medicine and the side effects and costs that come with it.
• Treatment with a cholinesterase inhibitor may reduce the burden on caregivers by producing small improvements in your memory and general ability to function.^{1 2} For example, you may be able to remember friends' names better and be able to dress yourself with less difficulty.
• Doctors don't know for sure that cholinesterase inhibitors help with behavior problems in people who have Alzheimer's disease.³ Some studies show that these medicines do help, which can mean less burden on caregivers.² But other studies show that these medicines do not help.^{4 5}
• Medicines for Alzheimer's disease do not work for everyone who takes them, and their effectiveness is not always dramatic. Even if they do initially reduce your symptoms, the medicines eventually will no longer control the progressive symptoms of memory problems, behavioral and personality changes, and thinking problems caused by Alzheimer's disease.
• Medicines can relieve your symptoms and restore your ability to function. You can temporarily improve your physical and mental health by taking medicines.
• Although medicines may improve your Alzheimer's symptoms—thinking and memory problems, and personality changes—they will not completely eliminate the symptoms nor will they prevent the disease from progressing.
• Medicines may be expensive.

Medical Information

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What is Alzheimer's disease?

Alzheimer's disease is a progressive condition that damages areas of the brain involved in memory, intelligence, judgment, language, and behavior. It is the most common form of mental decline, or dementia, in older adults. Symptoms include having:

• Significant memory loss, such as forgetting how to drive or how to tell time.
• Problems with language, such as not being able to think of words.
• Personality changes, such as becoming aggressive when your personality is non-aggressive.
• Confusion or becoming disoriented, such as not knowing where you are or not recognizing family members or friends.
• An inability to perform daily tasks, such as not being able to unload a dishwasher or pay the bills.

What medicines are used to treat Alzheimer's disease?

The medicines most often used to treat moderate symptoms of Alzheimer's disease are cholinesterase inhibitors such as donepezil (Aricept) and galantamine (Razadyne). Memantine (Namenda) can be used to treat moderate to severe symptoms of confusion and memory loss from Alzheimer's disease. It works differently than cholinesterase inhibitors. But like cholinesterase inhibitors, it does not prevent Alzheimer's disease from progressing.

Other medicines, such as tranquilizers, may be used to reduce anxiety, agitation or hostile behavior, sleep problems, or other similar symptoms.

What are the side effects of these medicines?

In general, most people seem to tolerate the medicines very well. The most common side effects of cholinesterase inhibitors are nausea, diarrhea, vomiting, indigestion, abdominal pain, loss of appetite, and weight loss. Less common side effects include insomnia, fatigue, and muscle cramps. Side effects tend to be mild and usually go away within a few weeks after starting treatment with the medicine.

Common side effects of memantine are mild and include dizziness, confusion, headache, and constipation. Memantine should not be used by people who have kidney problems.

Tranquilizers can sometimes cause drowsiness.

Close monitoring and regular reevaluation of the severity of Alzheimer's symptoms are very important during treatment with medicine. As the disease progresses and symptoms change, your medication needs often change. If you are a caregiver for someone with Alzheimer's disease, be alert for adverse drug reactions or side effects that further impair the person's ability to function.

How can behavior problems be treated without medicines?

Before deciding to manage behavior problems with a medicine, try to figure out what is causing the behavior. Some behaviors, such as agitation, wandering, and becoming restless and agitated in the early evening (sundowning), do not always respond well to treatment with medicine. Understanding what is causing the behavior and taking steps to manage or change it can sometimes be helpful. It is worthwhile to explore the cause of behavior problems both before and during the time you are taking medicine.

If you need more information, see the topic Alzheimer's Disease.

Your Information

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Your choices are:

• Treat Alzheimer's disease symptoms with medicines for as long as they are effective.
• Try other means to reduce anxiety and agitation and to improve thinking and memory abilities. For example, a caregiver can label all the items in your room for you and list your daily activities to remind you what to do.

The decision about whether to take medicines to treat your Alzheimer's disease takes into account your personal feelings and the medical facts.

Deciding about medicines for Alzheimer's disease

Reasons to take medicines

Reasons not to take medicines

You can tolerate the side effects of the medicines. The benefits of the medicines outweigh the side effects and costs. You want to try to delay the start of Alzheimer's for as long as you can. The medicines relieve your current symptoms and improve your quality of life. The burden on your caregivers has increased, and medicines may reduce your agitation and other symptoms. Are there other reasons you might want to take medicines for Alzheimer's disease?

Your symptoms are still manageable without medicines. The side effects are too bothersome, and the medicines are too expensive. You've tried medicines, but they do not work for you. You're at an advanced stage of the disease, and medicines are no longer helpful. Your caregiver knows you well and can help you through a disruptive or confusing episode without medicines. Are there other reasons you might not want to take medicines for Alzheimer's disease?

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking medicines to treat Alzheimer's disease. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am in the early stages of Alzheimer's disease and my symptoms are mild.	Yes	No	Unsure
The medicine's side effects are tolerable.	Yes	No	Unsure
The disease is starting to interfere with my daily activities.	Yes	No	Unsure
I am really bothered when I feel confused or forget the names of people I know.	Yes	No	NA*
So far, the quality of my life is okay and symptoms are not too significant.	Yes	No	Unsure
I have people living with me or people are available to check in on me throughout the day.	Yes	No	Unsure
My caregiver can usually talk me out of an episode of confusion or agitation.	Yes	No	NA
I've tried the medicines, and they don't work for me.	Yes	No	NA
It will be hard for me to afford the medicines.	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers on the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use medicines to treat Alzheimer's disease.

Check the box below that represents your overall impression about your decision.

Leaning toward taking medicines

Leaning toward NOT taking medicines

Return to the topic Alzheimer's Disease.

References

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Citations

1. Bentham P, et al. (2004). Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): Randomised double-blind trial. Lancet, 363(9427): 2105–2115.

2. Trinh NH, et al. (2003). Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: A meta-analysis. JAMA, 289(2): 210–216.

3. Sink KM, et al. (2005). Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence. JAMA, 293(5): 596–608.

4. Raina P, et al. (2008). Effectiveness of cholinesterase inhibitors and memantine for treating dementia: Evidence review for a clinical practice guideline. Annals of Internal Medicine, 148(5): 379–397.

5. Howard RJ, et al. (2007). Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine, 357(14): 1382–1392.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Peter J. Whitehouse, MD - Neurology
Last Updated	November 10, 2008