There is no cure for Alzheimer’s and no way to prevent its progression. There are, however, some treatment options that may be effective at slowing it if administered in the early-to-middle stages of disease.

The main treatment option is acetylcholinesterase inhibitors.  This type of drug increases the duration of acetylcholines action at synapses.  Tacrine, the earliest drug of this type to be manufactured, has limited benefit and many side effects, including liver damage (hepatotoxicity). 

Donepezil is a highly selective acetylcholinesterase inhibitor that gives significant improvement in cognitive function and has fewer side effects, so is the first choice in most cases. 

A more recently developed acetylcholinesterase inhibitor, Rivastigmine, has a few side effects but requires more precise dosage than Donepezil and so takes longer to achieve the desired effect.  Other drugs in the same family, such as Aricept, Exelon and Reminyl work by maintaining existing supplies of acetylcholine.

These drugs cannot cure the disease, but may stabilise some of the symptoms for a limited period.  Some patients may suffer from side effects associated with acetylcholinesterase inhibitors such as diarrhoea, nausea, insomnia, fatigue and loss of appetite.

Oestrogen therapy increases acetylcholine concentration as well as having an added antioxidant action, but proof that it can reduce the risk of Alzheimers disease awaits confirmation.

The ability of some anti-inflammatory drugs to improve function in Alzheimers is under investigation.  Antioxidants, including vitamin E and Ginkgo biloba have shown some benefit, improving cognition and delaying progression of the disease, but more studies are required before specific recommendations can be made.

03/06/2009