Evidence-Based Alzheimer's Treatment Options

According to the Alzheimer’s Association, more than 6 million people are living with Alzheimer’s disease in the United States. Alzheimer’s disease is a condition that typically affects an individual’s cognition, their memory, and eventually their ability to care for themselves. Whether you’re a caregiver for someone with Alzheimer’s or have the condition yourself, know that there are treatment options available. In this article, we’ll explore different evidence-based treatments that have shown promise in assisting those living with Alzheimer’s. 

What is Alzheimer's disease? 

Alzheimer's is a common cause of dementia (a nonspecific term for memory loss and degradation of cognitive function). It’s most common among older adults. According to the Alzheimer’s Association, , though early-onset Alzheimer’s can occur in younger adults.  

Alzheimer's is a progressive brain disorder, which means it tends to worsen over time. The disease typically interferes with memory formation, thinking, and behaviors as clumps (called “amyloid plaques”) and tangled fiber bundles (called “tau tangles”) develop in the brain and kill brain cells. During the early stages of the disease, amyloid plaques and tau tangles occur in areas of the brain associated with memory formation, and later, Alzheimer’s disease typically affects areas of the brain that are responsible for reasoning, social behaviors, and language processing. As Alzheimer’s develops, many areas of the brain become affected.  

Symptoms of Alzheimer's disease

Since Alzheimer's is a progressive disorder, symptoms may change and/or become more severe over time. Additionally, symptoms can vary from person to person, particularly depending on what stage of the disease they’re in. Alzheimer's is classified into four stages: preclinical, mild, moderate, and severe. The following are some common symptoms at these stages

Preclinical Alzheimer’s disease:

Preclinical Alzheimer’s is typically defined by early tau bundle and amyloid deposit development. During this stage, individuals may begin to experience mild behavioral changes, such as increased apathy and irritability. 

Mild Alzheimer’s: 

During the mild stage of Alzheimer’s, people are often able to complete daily activities, such as driving, working, and completing chores. However, symptoms of memory problems and/or repetitiveness may become noticeable as well as:

• Poor judgment and decision-making 
• Reduced initiative
• Memory loss that interrupts daily functioning 
• Confusion about dates, new information, and/or physical location
• Difficulty handling money, solving problems, and completing tasks 
• Increased irritability, aggression, and/or anxiety
• Personality changes 
• A tendency to misplace items
• Repetition of questions

Moderate Alzheimer’s: 

Middle-stage or moderate Alzheimer’s is typically characterized by symptoms that become increasingly apparent. While symptoms can vary, they may include: 

• Increasing memory loss, such as difficulty remembering events, personal history, and occasionally loved ones 
• Language challenges, such as difficulty reading or writing 
• Increasing social withdrawal
• Inability to learn new things
• Reduced attention span or ability to cope with change 
• Changes in wake/sleep cycle, such as sleeping during the day and experiencing sleep disruption at night 
• Difficulty with tasks with multiple steps, such as getting dressed
• Delusions and/or impulsivity 
• Increased irritability, anxiety, fear, wandering behaviors, and/or agitation
• Repetitiveness in movement or conversation

Severe Alzheimer's disease: 

Late-stage Alzheimer’s is the last stage of the disease. People with severe Alzheimer’s typically require intensive caregiving and may display the following symptoms:   

• Unawareness of surroundings 
• Little interest in food and accompanying weight loss
• Lack of communication
• Physical health problems, such as becoming prone to skin infections or pneumonia
• Seizures 
• Difficulty swallowing
• Lack of bladder and bowel control 

Alzheimer’s treatment options: Pharmaceuticals  

Clinical trials are currently underway to find new ways to treat Alzheimer's disease. While there is currently no cure, there are treatment options available that can improve individuals’ quality of life. Pharmaceutical treatments can generally be broken down into those that target behavioral symptoms, cognitive symptoms, and disease progression. It’s recommended that you always consult a doctor before taking a new medication or stopping a current one. 

Medications prescribed to slow the progression of the disease include: 

• Anti-amyloid medications: Anti-amyloid treatments work by targeting the cause of Alzheimer’s itself instead of just treating the symptoms. Alzheimer’s disease is believed to be caused by an abnormal build-up of proteins called beta-amyloids in the brain. These build-ups tend to form harmful plaques and tangles around brain cells and create a loss of connection between vital neurons. Anti-amyloids target and destroy the clumps of proteins in the brain. With a reduction in the amount of beta-amyloid in the brain, the clumps may be less likely to form and disrupt communication between neurons. This may contribute to the healthy functioning of an individual’s brain cells, allowing them to work longer.

There are also some medications that are used to treat the cognitive symptoms associated with Alzheimer’s disease. These include:

• Cholinesterase inhibitors: People with mild to moderate Alzheimer's symptoms are often prescribed cholinesterase inhibitors by a healthcare provider to address changes in the brain. Cholinesterase inhibitors can temporarily improve nerve function and reduce symptoms. 
• Glutamate regulators: These medications work by targeting glutamate, a chemical in the brain that aids in learning and memory. Glutamate regulators may be prescribed for people with moderate to severe Alzheimer’s as a treatment for cognitive decline. 

Finally, medications used to treat behavioral symptoms include: 

• Antipsychotics: Some antipsychotic medications can be appropriately prescribed if a person with Alzheimer’s is experiencing psychosis, presents a danger to themselves or others, or is experiencing distress or serious difficulty receiving care. However, these medications can increase the risk of serious cardiovascular problems (especially in those with preexisting cardiovascular disease) and death in older people with dementia. 
• Anti-anxiety drugs and antidepressants: According to research published in the Journal of Alzheimer’s Disease Reports, approximately . Additionally, Johns Hopkins estimates that . While anti-anxiety medications may increase the risk of falls, antidepressants may reduce symptoms of anxiety and depression in some people.
• Insomnia medications: Individuals living with Alzheimer's may experience sleep disturbances, changes in sleep-wake cycles, or “sundowning.” Medications may be prescribed to alter biological signals that impact wakefulness and contribute to higher-quality rest. 

Non-drug treatment options

While medications are often prescribed for cognitive and behavioral changes associated with Alzheimer's disease, there are non-pharmacological options that may be effective when used as an alternative to—or in combination with—medications. These include the following:

Reality orientation exercises 

Studies support the use of orientation exercises, which may help cue individuals with Alzheimer’s into their surroundings, improve cognitive functioning, and improve self-esteem in those with mild to moderate Alzheimer’s. However, memory orientation is not shown to improve behavior or mood, and it can cause distress in some people. Orientation exercises should be guided by the way people with Alzheimer’s respond to them. The following are some tips for caregivers and loved ones with regard to orientation exercises, which may only work at certain stages of Alzheimer’s:

• Use people’s names frequently
• Mention the time of day, date, day of the week, and season
• Utilize signs and labels on objects
• Ask questions about memorable items or photographs

Validation therapy

Validation therapy may help caregivers and loved ones communicate with people with Alzheimer’s disease and related dementia diagnoses more compassionately. Unlike reality orientation, validation therapy tends to emphasize the emotions behind behaviors rather than factual reality. By providing an opportunity to communicate feelings, validation therapy may reduce emotional distress. 

To practice validation therapy, you might try the following: 

• Take a deep breath before engaging.
• Join the person in their experience by matching their expression. 
• Let them know you see them by rephrasing their feelings. 
• Ask compassionate questions about their memories. 

Research suggests that validation therapy can decrease stress levels and reduce behavioral disturbances.

Increased activity during the day

Sleep difficulties can worsen symptoms and accelerate disease progression. However, exercise and activity throughout the day may improve sleep and quality of life. One study found that walking weekly with relatives could improve sleep quality and reduce the occurrence of sundowning in those with Alzheimer’s. Another study suggests that exercise can prevent or delay the development of behavioral problems in those with dementia. 

For individuals who may be unable or unwilling to exercise, sitting outside or by a light-facing window may help regulate their sleep-wake cycle. Additionally, avoiding large meals or naps late in the day may help improve sleep quality. 

Listening to music

Areas of the brain associated with music listening tend to be less affected by Alzheimer’s disease, which makes music a type of interaction in which many can effectively engage. A 2019 review published in Frontiers in Neuroscience found that music can provide clinical benefits like inducing relaxation, providing social opportunities, and reducing behavioral concerns and symptoms of depression. 

Caregiver training

Caregiver education and training can improve both the mental and physical health of individuals with Alzheimer’s. Training can also reduce loss of income and burnout among caregivers. UCLA Health created a free Dementia Caregiver Training Video Guide to help caregivers and loved ones develop a safe and healthy environment for people with dementia. Video topics cover common behavioral challenges, such as wandering, aggressive behaviors, harsh language, agitation, refusal to bathe or take medication, repetitive questions, and sleep disturbances.  

Time with animals

A 2019 study found that animal-assisted therapy with dogs may be an effective complementary treatment for the behavioral and psychological symptoms experienced by those with Alzheimer’s. According to the Alzheimer’s Association, pets can provide nonjudgmental companionship, comfort, increased opportunities for physical activity, and calming stimulation. 

For individuals who cannot care for a live animal, robotic pets may be a useful alternative. A 2017 study published in the Journal of Alzheimer's Disease found that robotic pets can decrease stress and anxiety and reduce the need for pharmaceutical interventions.  

Social activities 

Social activities could include art classes, music, volunteer events, exercise groups, or gardening. Research suggests that socializing can improve quality of life of those with Alzheimer’s and reduce their need for care. It can also give individuals with Alzheimer’s the chance to form meaningful connections with other people. 

Online therapy for caregivers

There are many treatment options available to directly improve the cognitive and behavioral symptoms in individuals with Alzheimer’s. However, by addressing the mental health of caregivers, both people with Alzheimer’s and caregivers can benefit. Therapists may be able to help caregivers reframe unhelpful thoughts and develop healthy coping mechanisms. Additionally, they can aid caregivers in providing compassionate care to people with dementia, which may reduce the occurrence of behavioral challenges.

For some caregivers, attending in-person therapy can pose a significant burden, especially when they’re providing Alzheimer’s care at home. In these cases, online therapy may be more useful. With online therapy, caregivers can connect with a therapist from anywhere they have an internet connection and at a time that’s convenient for them. This means they can still devote themselves to their caregiving responsibilities while also receiving mental health support in a way that’s convenient for them. Caregivers can connect with a licensed therapist via audio, video, or live chat, in addition to using in-app messaging if they have questions in between therapy sessions.

The efficacy of online therapy for caregiver burnout 

A review of 12 randomized controlled trials found that cognitive behavioral therapy (CBT) can effectively reduce emotional burdens, anxiety, and depressive symptoms in caregivers. In addition to the convenience of internet-based therapy, research has found that online CBT can reduce behavioral and psychological symptoms of dementia and the resulting distress of caregivers. CBT is a type of therapy that focuses on changing the thought patterns that are contributing to unwanted behaviors. As an individual shifts their thoughts, they may also be able to alter their emotional and behavioral responses. 

Takeaway

Alzheimer’s disease is a progressive type of dementia caused by the development of tau tangles and amyloid plaques in the brain. Depending on the stage of the disease, symptoms can range from mild to severe. Individuals with Alzheimer’s typically experience psychological and behavioral challenges that can be addressed with medication or non-drug interventions, such as increased activity, socializing, music, and validation therapy. 

Individuals with Alzheimer’s may also benefit if their caregivers use self-care strategies and/or therapy for themselves. Research suggests that online cognitive behavioral therapy (CBT) can reduce depression and anxiety symptoms in caregivers while simultaneously improving behavioral and psychological symptoms in those they care for. If caregivers don’t have time for in-office therapy, online therapy can provide a convenient way to get support without neglecting their role. To learn more about how online therapy may help individuals with Alzheimer’s and their caregivers, reach out to BetterHelp today.