Your Options for Managing Alzheimer’s Disease

According to the Alzheimer's Association, as of 2021, more than 6 million people in America had Alzheimer's disease. Estimates are that this number will more than double by 2050, with more than 13 million people dealing with the disease. 

According to the Centers for Disease Control and Prevention, no known cure for Alzheimer's disease exists in 2021, and the likelihood of a complete cure in near-future years is not high. That's due in part to how complex of a disease Alzheimer's is. One medication or treatment is unlikely to have a positive impact across the entire spectrum of symptoms associated with the condition, and without a clear understanding of how Alzheimer's occurs, medical researchers are a ways off from developing final cures.

That doesn't mean, however, that Alzheimer's isn't treatable. Alzheimer's treatments can help individuals maintain cognitive health (and memories) longer, especially when treatments begin as early as possible. Treatments can also help slow the progression of the disease and manage some of the behavioral symptoms associated with the condition.

Research on the condition is constant and aggressive, too, and new treatments and potential options for developing a future cure arise all the time. For those facing the diagnosis of Alzheimer's for themselves — or who have a loved one with the condition — understanding treatment options is important. 

First, knowing which treatments are available helps you communicate with medical care teams about options for yourself or your loved one. Patients who are actively involved in their own care — or who have loved ones advocating for them — tend to have more positive outcomes on average than others.

Another reason to stay up-to-date with Alzheimer's treatment options and research is hope. Knowing treatments are an option for delaying disease progression and that people are constantly working on new research for treatments and cures provides hope for the future.

This guide provides a summary of some of the treatments currently available for Alzheimer's patients, along with information about outcomes, side effects and costs.

Aducanumab, which is the generic name for Aduhelm, is an exciting new treatment option for Alzheimer's. The FDA approved using the drug for treating the disease in June 2021.

This is the first time the FDA has approved any drug to treat the underlying biology associated with Alzheimer's disease. The drug has been shown to positively impact amyloid beta plaques in the brain, which are believed to contribute to Alzheimer's disease because they are found in the brains of people with the diagnosis.

The reason this fast-track approval from the FDA is exciting is that aducanumab is the first medication approved specifically to treat the disease itself and not the conditions of the disease. While the FDA appears positive but very cautious about the impact of this treatment on the disease overall, the medication does present a step in the direction toward a possible future cure.

Success Rate of Aducanumab

The treatment is very new and not without controversy, particularly when it comes to whether it's effective. Biogen, the company that brought the medication to the FDA for approval, conducted a number of clinical trials in 2019 that were halted. Reasons for stopping the trials included that the trials, as structured, weren't meeting primary goals.

However, Biogen subsequently gathered and conducted more research about the drug and brought it to the FDA for successful approval. One of the data points in that research was that people who had a high-dose of the drug experienced 22% less clinical decline associated with Alzheimer's over a period of approximately 18 months.

Potential Side Effects of Aducanumab

The National Institutes of Health note that potential side effects of aducanumab might include:

• Headache
• Diarrhea
• Confusion
• Dizziness or falls
• Fluid buildup in the brain
• Brain bleed

Cost of Aducanumab

According to Biogen, the annual cost for the medication would be $56,000. That's the cost for a maintenance dose; Biogen notes that the first year's cost would likely be cheaper as patients were worked up to a stronger dose.

Whether insurance companies will kick in to help cover this treatment remains to be seen in 2021. Many insurance companies are hesitant to cover new drugs, so patients should contact their insurance companies to ask about coverage.  

Helpful Links:

• Biogen's media statement about Aduhelm
• Press release about patient service lines and potential help paying for the treatment
• FDA information on Aduhelm
• Centers for Medicare and Medicaid Services tracking of coverage analysis (the process that helps decide whether Medicare will cover the drug in the future)

Cholinesterase inhibitors are often used in treating someone with mild to moderate Alzheimer's. The goal of using these drugs is to minimize or delay some of the cognitive and behavioral symptoms associated with progression of the disease. 

Researchers noted that in individuals with advanced stage Alzheimer's, some nerve cells in the brain didn't communicate well because they weren't as active. Brain signals either took longer to be sent and received or weren't sent or received at all, which is likely associated with some cognitive dysfunction.

Cholinesterase inhibitors help improve the activity of those nerve cells. Drugs such as rivastigmine, donepezil and galantamine are approved for this purpose and for use in treating people in mild or moderate stages of the disease. 

Success Rate of Cholinesterase Inhibitors

According to a study originally published in Dementia & Neuropsychologia, cholinesterase inhibitors have a "good rate of clinical response." The study indicates that for those with mild forms of dementia, 37% had positive clinical results taking the medication after three months. For those with moderate forms of the disease, the clinical response rate was just over 20%.

The takeaway for patients and loved ones is that cholinesterase inhibitors do work for some people and are more likely to provide noticeable results when used early in the disease process. Other studies have indicated that this is likely to be true as well.

Potential Side Effects of Cholinesterase Inhibitors

The potential side effects of these types of medications can include:

• Diarrhea
• Loss of appetite
• Vomiting or nausea
• Dizziness

Typically around 30% of people taking the medications report some nausea or related symptoms, but side effects tend to be more common with higher doses.  

Cost of Cholinesterase Inhibitors

According to GoodRX, prices for these types of medications range from $13 to $97, but that's often reflecting a discount or coupon.

These medications have been around for some time and are used to treat a range of cognitive conditions. That makes it more likely that your insurance company will cover the drugs, reducing your costs even more. If you have Medicare Part D prescription drug coverage, whether cholinesterase inhibitors are covered may depend on your formulary.

Glutamate receptors help mediate the fast exchange of information between areas of the nervous system in the brain. When glutamate receptors aren't working properly, learning, memory and other cognitive functions can decline. This can be the case with some people with Alzheimer's disease.

Glutamate regulators are medications that help ensure these receptors are working as well as possible. This can help delay some of the cognitive decline associated with memory disease. One common glutamate regulator prescribed for Alzheimer's is memantine.

Success of Rate of Glutamate Regulators 

One study indicates that memantine was able to delay cognitive decline in around 10% of patients. More recent studies in this area of pharmacology indicate that there may be hope for better results with other forms of glutamate regulators, but more research needs to be done. 

Side Effects of Glutamate Regulators 

Some side effects reported by people using memantine include:

• Headache
• Depression
• Confusion
• Dizziness
• Nausea or vomiting
• Constipation or diarrhea
• Unexplained pain in the body
• Cough
• Weight loss

Cost of Glutamate Regulators 

GoodRx reports a range of cost for memantine between $30 and $130 on average with a discount or coupon. Glutamate regulators have been around long enough that they may also be covered by insurance companies, so patients and family caregivers should always check with their plans.

Not all treatment options for Alzheimer's are related to medication. There's some belief that cognitive behavioral therapy may be effective at helping to delay symptoms of the disease. CBT is a popular form of talk therapy that works, among other things, to retrain the brain to react to outside stimuli in more positive ways. 

This same type of "brain training" may be useful in helping to forge better cognitive connections and support memory, learning and focus. Even more to the point, CBT may be able to help those with Alzheimer's cope with symptoms such as anxiety and depression.

Success Rate of CBT

Recent research indicates that the use of CBT is at least as effective in treating symptoms as antidepressants and antipsychotics, which are prescribed at high rates among populations of patients with Alzheimer's. 

Potential Side Effects of CBT

Cognitive behavioral therapy is considered very safe and does not have known side effects. The closest you might get to side effects with this type of treatment is that talk therapy may uncover old psychological wounds that may need to be addressed.

Cost of CBT

Licensed therapists typically charge by the hour or session for cognitive behavioral therapy. The Anxiety & Depression Association of America notes that costs can be $100 per hour or more. However, CBT is covered by most insurance companies, which can substantially reduce the cost for patients and caregivers.

These are some of the most common treatments for Alzheimer's. However, this is a complicated disease, and the guide above does not present an exhaustive list. What might be right for you or your loved one can be different from the best options for anyone else. So, talk to your doctor about your treatment options.

The following resources can help you or your loved one prepare for and manage life with Alzheimer’s disease.

• The National Institutes of Health offers a list of resources links for caregivers.
• The Alzheimer's Association has a resource page you can browse.
• The CDC offers a resource page on healthy aging and Alzheimer's.
• You can find a wealth of information from the National Alzheimer's and Dementia Resource Center.