A few weeks ago, we uploaded a blog post about the treatment options that are available in the UK for someone with depression and we received some good feedback. If you have not read the blog post yet, you can read it here. Since our topic of the month is Alzheimer’s Disease, we decided that we would write another blog post informing people about all the UK treatment options that are available for it. Whether you are the one that has been diagnosed with Alzheimer’s Disease, or someone close to you has been diagnosed, you will know that there is currently no cure, but there are ways to reduce the symptoms.
A number of medicines may be prescribed for Alzheimer’s disease to help temporarily improve symptoms. It is important that we highlight that these improvements are temporary, since there is no cure and it is ultimately a debilitating disease. It is also extremely important that you consult with your GP first who will talk you through the medications we have described and make suggestions. It is possible that your GP will refer to a specialist, usually an Old Age Psychiatrist or neurologist, for further testing and medicine prescription.
The most common medications are:
Acetylcholinesterase (AChE) inhibitors:
Although we do not currently know the aetiology of Alzheimer’s Disease, it is characterized by a loss of cholinergic neurotransmission, therefore cholinesterase inhibitors have become the mainstream treatment for patients with mild to moderate Alzheimer’s Disease. Acetylcholine helps nerve cells communicate with each other and this type of medication increases the levels in the brain. This type of medication can only be prescribed by specialists but can be prescribed by your GP if advised by the specialist or if they have expertise in this themselves.
Under this umbrella, there are some specific medications that are prescribed including donepezil, galantamine and rivastigmine. These are usually prescribed for people with early-to-moderate Alzheimer’s Disease; however, the latest guidelines recommend that they should be continued in the later, severe stages of the disease. There is no difference in how well each of the 3 different AChE inhibitors work but it is clear that some people respond better or have less side effects from certain ones.
Memantine has been prescribed to patients with advanced Alzheimer’s Disease and is taken in addition to the cholinesterase inhibitors described above. Memantine works by blocking the effects of an excessive amount of chemical in the brain called glutamate.
It is important that you discuss these options with GP or specialist because not all medications are effective for all patients and ultimately do not change the course of the disease. According to the National Institutes of Health Report (2015), these drugs may help only for a limited period of time and cause a range of side effects, such as nausea, vomiting, and diarrhoea. However, for many, the side effects will subside after 2 weeks. If not, you should consult your GP.
Medications are not only prescribed to temporarily improve the most classic symptoms of Alzheimer’s Disease but also to treat some of the challenging behaviours. In the later stages of dementia, a significant number of people will develop behavioural and psychological symptoms of dementia (BPSD). Symptoms include increased agitation, anxiety, wandering, aggression and delusions and hallucinations. These changes in behaviour can be very distressing for both the person with Alzheimer’s Disease and the person who cares for them. In this situation, you must consult your GP for further advice.
It is possible that you will be recommended some coping strategies. We will briefly list a few here:
- Keeping a diary to discover triggers and to document the time of day and environment during episodes of challenging behaviour.
- Get them involved in activities. For some information, read one of our previous blog posts here. Please note that this blog post was written well in advance of COVID-19 so should be interpreted accordingly.
- Provide reassurance and a quiet, calming environment. To try and create a ‘dementia friendly’ home, see our blog post here.
If these coping strategies do not work, a specialist may prescribe medication.
These include risperidone or haloperidol and can be prescribed for those who show persistent aggression or extreme distress. These are the only medicines licensed for people with moderate to severe Alzheimer’s Disease where there is a risk to themselves or others. Risperidone is usually prescribed at its lowest dose and for the shortest time possible due to the possibility of experiencing quite serious side effects. Haloperidol may only be prescribed if no other treatment has helped. Additionally, antidepressants may be prescribed if depression is suspected as an underlying cause of anxiety.
There are also some ‘off-label’ medications that may be recommended to treat specific symptoms of BPSD (by ‘off-label’ we mean not specifically indicated for BPSD). It would be up to the doctor to review symptoms and prescribe accordingly, however, they must provide reasoning for using these medications.
There are other treatments that are advised alongside medications.
This includes the more holistic treatments, such as gingko biloba, curcumin or coconut oil. We cannot say for certainty that these remedies are effective, and research is sparse. Even though a lot of these are available over the counter, it is usually best to consult a doctor first. Also, remember that these are not a substitute for medication.
Cognitive stimulation therapy (CST):
This involves taking part in group activities and exercises that are designed to improve memory, problem-solving skills and language skills. Evidence suggests that this benefits people from mild to moderate dementia. In the early stages, it is thought to help cope with the condition. There are different types of CST:
This technique involves working with a training professional, usually an occupational therapist, to achieve a personal goal. This might include practising everyday tasks that they get stuck on or getting used to something new, for example a new oven. This type of therapy works by getting the person to use the parts of their brain that are working to help the parts that are not. It is important that a carer continues this outside of appointments.
Since people with dementia suffer considerably with memory, cognitive training for dementia methods focus abilities on abstract memory. We have written a blog post all about cognitive training and whether it works, you can read it here.
Reminiscence work involves talking about things and events from the past and props, such as photos, personal possessions or music, are used to enhance this experience.
Life story work:
This involves compiling photos, notes, keepsakes from their childhood to the present day and talking it through them. It is obviously easier to do this digitally, however, if the person is not familiar with digital methods, it is best to keep it traditional and make a physical book.
Often life story work and reminiscing are combined.
Repetitive Transcranial Magnetic Stimulation (rTMS) with Cognitive Training:
Transcranial magnetic stimulation (TMS) is a non-invasive technique that generates an electric current inducing modulation in cortical excitability. Depending on the location and parameters of the stimulation and the physiology of the underlying cortical tissue, varying changes in behaviour may be seen, including enhancement of or interference with cognitive performance. Some convincing data supporting improvement in some cognitive functions (including executive, learning, memory and attention) after rTMS have been reported.
A treatment, that we offer in our clinic, combines rTMS with cognitive training and has been shown to alter mild to moderate symptoms of Alzheimer’s Disease. Whilst not every patient will have the same response from rTMS-COG – patients, carers and doctors have reported the following improvements, classically after about 6 weeks from the end of therapy: Better language, name and face recognition, greater independence and social interaction, noticeable improvements in attention and focus and improvement in memory, mood, and overall daily living. To read more about the procedure, click here.
Disclaimer: This blog post was not written by a doctor and is therefore not advising on which treatment options are the most effective or providing any recommendations for the reader. If you would like to seek a diagnosis, please consult your GP first. If you would like to discuss any of these treatment options or make any changes to your current treatment plan, please consult your GP or psychiatrist. Although we offer some of these services or treatment options, we are not mentioning them based on this.