I wish I could tell you we had a magic pill to treat memory impairment, but we don’t. Variables known to contribute to healthy brain aging include: diet, exercise, sleep, cognitive stimulation, social stimulation, and decreased stress. So, in all circumstances, these lifestyle factors are important.
Numerous conditions can cause or mimic the symptoms of dementia (global cognitive decline), only some of which may be reversible, such as vitamin B12 deficiency or an underactive thyroid (hypothyroidism). There are also a number of prescription and over-the-counter medications taken for other conditions that may interfere with or cause loss of memory. Alcohol, tobacco, sleep deprivation, depression and stress, head injury, stroke, and other neurodegenerative diseases may also affect memory. Getting the right diagnosis is important for treatment and planning. Also, it is common for there to be more than one cause of impairment, and therefore, each should be recognized and addressed.
Alzheimer’s disease is the most common cause of dementia in the elderly. As Alzheimer’s progresses, brain cells die and connections between cells are lost. This causes cognitive symptoms, such as memory loss, confusion, and problems, with thinking and reasoning. Although current medications cannot cure Alzheimer’s or stop it from progressing, these drugs may lessen some symptoms for some people for a period of time.
There are two types of medications that have been approved by the FDA to treat memory and other forms of cognitive impairment caused by underlying Alzheimer’s disease. These are cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda). Namzaric, the newest medication is a combination of both types of medicines.
Cholinesterase inhibitors work by stopping the enzyme cholinesterase from clearing acetylcholine from the synapses, or space between neurons. The idea is that by maintaining more acetylcholine in the brain, memory functioning will be better preserved since acetylcholine is known to be important to memory functioning. Cholinesterase inhibitors are commonly prescribed, even for people with very mild symptoms, tend to have a low side effect profile, and may offer some benefit for a period of time. Patients are prescribed only one of these three options at a time.
| Generic | Brand | Stage Severity | FDA-Approval Year |
|---|---|---|---|
| donepezil | Aricept | All stages | 1996 |
| rivastigmine | Exelon | All stages | 2000 |
| galantamine | Razadyne | Mild to Moderate | 2001 |
| memantine | Namenda | Moderate to Severe | 2003 |
| Donepezil and memantine | Namzaric | Moderate to Severe | 2014 |
Memantine is an NMDA receptor antagonist and works by preventing calcium from entering the neuron and causing a cascade of damaging events. Since this medication works by a different mechanism, patients may be prescribed memantine in addition to a cholinesterase inhibitor as symptoms progress. Memantine also has a low side effect profile and may offer some modest benefit to patients.
Unfortunately, none of the medications currently available are known to help prevent the underlying disease process of plaque and tangle formation in the brain that occurs in Alzheimer’s disease. So, even as a patient takes these medications, symptoms will continue to progress. Although less common, some of these drugs may also produce side effects such as agitation, dry mouth, drowsiness, tremors, falling or constipation. Before beginning any new medication, it is important that your physician and pharmacist are made aware of all the drugs currently being taken, to make certain that the medications do not interact with one another. It is also helpful to review the Medicare Part D plans carefully regarding Alzheimer’s drug-coverage.
There are numerous pharmaceutical companies working on the development and research of potentially new treatments that would halt the progression of plaque and/or tangle formation. Ultimately, the path to effective treatments is through clinical trials. Many of these experimental therapies are aimed at people with mild symptoms and early disease stage but trials for middle and later stage disease are available. We have learned that the earlier we can identify patients for intervention, the greater the likelihood of having an impact on disease progression.
The CRCNJ(CRCNJ) in Springfield offers access into such trials, as well as clinical diagnosis and treatment plans. We are pleased to provide ways of obtaining amyloid PET scans, cutting-edge technology used to determine if amyloid plaques are present in the brain. Most of our services are covered by Medicare, or provided at no cost to patients as part of sponsored research. Contact the CRCNJ: www.thecrcnj.com or 973-850-4622.
