The goals in treating Alzheimer's disease are to:
- Slow progression of the disease
- Manage behavior problems, confusion, and agitation
- Change the home environment to be safe
- Support family members and other caregivers
- There is no cure for Alzheimer's. The most promising treatments include lifestyle changes and medications.
Studies show the following lifestyle changes may help improve behavior in people with Alzheimer's disease:
- A regular walk with a caregiver or trusted companion may improve communication skills and reduce the chance of wandering.
- Bright light therapy may reduce insomnia and wandering.
- Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
- Pets can sometimes help people improve behavior.
- Relaxation training and other exercises that require focused attention may help boost social interaction and make it easier to do tasks.
- The Safe Return Program, implemented by the Alzheimer's Association, encourages identification bracelets, wallet cards, and clothing labels for people with Alzheimer's. Information is stored in a national database and given to authorities when a person is reported missing.
Several drugs are available to try to slow the progression of Alzheimer's and possibly improve mental function.
- Cholinesterase inhibitors -- increase the amount of acetylcholine in the brain. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes:
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne, formerly called Reminyl)
Memantine (Namenda) -- This drug works by regulating a chemical messenger called glutamate, which is involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness. It is the only drug approved for treatment of moderate-to-severe Alzheimer’s disease.
The following medications may also ease the symptoms related to Alzheimer’s:
- Selective serotonin reuptake inhibitors (SSRIs) increase activity of a brain chemical called serotonin. They are used to treat depression that often occurs in the early stages of Alzheimer's.
- Methylphenidate (Concerta) is a stimulant that is often prescribed for attention deficit hyperactivity disorder. It is sometimes used to treat withdrawal and apathy in people with Alzheimer's.
- Carbamazepine is an anti-seizure drug that stabilizes sodium levels in the brain. It is sometimes used to treat agitation in people with Alzheimer's.
Nutrition and Dietary Supplements
People with Alzheimer's may need help with their diet. They often forget to eat and drink and can get dehydrated.
Follow these tips for a healthy diet:
- Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
- Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains, dark leafy greens (such as spinach and kale), and sea vegetables such as kelp and dulce.
- Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
- Avoid refined foods such as white breads, pastas, and especially sugar.
- Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
- Use healthy oils in foods, such as olive oil
- Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
- Don’t smoke.
- Drink 6 - 8 glasses of filtered water daily.
- Exercise at least 30 minutes daily, 5 days a week.
Some supplements may interact with certain medications and may have negative side effects. Always tell you doctor about any herb or dietary supplement you are taking. These supplements may help with some symptoms of Alzheimer's, although further study is needed:
- Phosphatidylserine, 100 mg three times per day, shows promise in several studies. Phosphatidylserine is a substance that occurs naturally in the brain. It may raise levels of brain chemicals that deal with memory, according to several studies. It may work best in people with mild symptoms, and may lose its effect after about 16 weeks. Do not take phosphatidylserine if you are taking blood thinners such as warfarin (Coumadin). Use caution if taking it with ginkgo. In both cases, your risk of bleeding may increase. Phosphatidylserine may cause sleeplessness in some people. It may interact with other medications for Alzheimer’s and glaucoma. Ask your doctor before taking it.
- Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some, but not all, studies, vitamin E (400 - 800 IU per day) combined with Aricept seemed to slow mental decline in people with Alzheimer’s disease. Another antioxidant, coenzyme Q10 (10 - 50 mg three times per day), may help the brain get more oxygen. Coenzyme Q-10 might help the blood clot. By helping the blood clot, coenzyme Q-10 might decrease the effectiveness of warfarin (Coumadin). The skins of dark berries also provide valuable antioxidants. Try eating half a cup of frozen blueberries daily -- freezing makes the antioxidants in the berries' skin more easily absorbed.
- Vitamins: biotin (300 mcg); B1 (50 - 100 mg), B2 (50 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folic acid (400 - 1,000 mcg). No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often high in Alzheimer's patients. Shots of B12 may work better than pills.
- Zinc (30 - 50 mg per day) is often low in elderly people, and may help improve memory.
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.
- Ginkgo (Ginkgo biloba), standardized extract, 40 - 50 mg three times per day, shows some evidence for treating early Alzheimer's disease and vascular dementia. However, one large randomized, double-blind, placebo-controlled study found that ginkgo did not prevent Alzheimer’s or dementia. If you are taking blood-thinning medication such as warfarin (Couamdin) or aspirin, don’t use ginkgo without your doctor’s supervision.
- Huperzine A, a chemical made from the plant Huperzia serrata, may improve memory in both vascular and Alzheimer's dementia, according to several studies in China. However, more studies are needed to know for sure. The usual dose is 200 mcg twice a day. Do not take huperzine A if you have liver disease or if you are about to have anesthesia. Talk to your doctor before taking huperzine A if you already take medication to treat Alzheimer’s.
- American ginseng (Panax quinquefolium) improves blood flow to the brain. Use with caution if you have high blood pressure, and talk to your doctor before combining ginseng with gingko.
- One study showed that lemon balm (Melissa officinalis), 60 drops per day, helped improve mental function in people with mild-to-moderate Alzheimer's. Lemon balm may have some sedating effects.
- Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might work for dementia. One study found that 300 mg per day for 12 weeks seemed to improve cognition in healthy people.
- Vinpocetine (isolated from Vinca minor), 10 - 40 mg twice daily, may increase blood flow to the brain and help the brain better use oxygen. However, most of the studies done so far have been of poor quality. More research is needed. Vinpocetine may interact with blood thinning medications such as warfarin (Coumadin) and aspirin.
Small studies have shown that transcutaneous electrical nerve stimulation (TENS), a technique used in physical therapy and certain types of acupuncture, may improve memory and daily living skills in people with Alzheimer's. More studies are needed.
Massage and Physical Therapy
People with Alzheimer's disease become frustrated and anxious because they cannot communicate well with language. Using touch, or massage, as a form of nonverbal communication may help. In one study, people with Alzheimer's who received hand massages and were spoken to in a calming manner had lower pulse rates and didn’t engage in as much inappropriate behavior. Health care professionals think that massage may help not only because it is relaxing, but because it provides a form of social interaction.
Music therapy -- using music to calm and heal -- cannot slow or reverse dementia. But it may improve quality of life for both a person with Alzheimer's disease and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that promote sleep and ease anxiety. Mood also got better after listening to the music.
Support for the Caregiver
Studies suggest that caregivers who receive emotional support have better quality of life, which also benefits the people they care for.
Akhondzadeh S, Abbasi SH. Herbal medicine in the treatment of Alzheimer's disease. Am J Alzheimers Dis Other Demen. 2006;21(2):113-8.
Begum AN, Jones MR, Lim GP, Morihara T, Kim P, Heath DD, et al. Curcumin structure-function, bioavailability, and efficacy in models of neuroinflammation and Alzheimer's disease. J Pharmacol Exp Ther. 2008 Jul;326(1):196-208.
Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol. 2006;100(4):1164-70.
Bone K. Botanical therapies for Alzheimer's disease. Presented at: Clinical Practice and Assessment Skills. American Herbalist Guild Symposium 2000; October 20-22, 2000; Mount Madonna, Watsonville, Calif.
Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.
Christen Y. Oxidative stress and Alzheimer disease. Am J Clin Nutr. 2000;71(suppl):621S-629S.
Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L, Veland PM. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998;55:1449-1455.
DeKosky ST, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62.
Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil. 2000;81:669-678.
Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of double-blind, placebo-controlled trials. Clin Drug Invest. 1999;17:301-308.
Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview. Can J Nurs Res. 1998;30:67-86.
Gwyther LP. Social issues of the Alzheimer's patient and family. Am J Med. 1998;104(4A):17S-21S.
Hendrie HC, Ogunniyi A, Hall KS, et al. Incidence of dementia and Alzheimer disease in 2 communities. JAMA. 2001;285(6):739-747.
Heo JH, Lee ST, Chu K, Oh MJ, Park HJ, Shim JY, Kim M. An open-label trial of Korean red ginseng as an adjuvant treatment for cognitive impairment in patients with Alzheimer's disease. Eur J Neurol. 2008 Aug;15(8):865-8.
Jiang H, Luo X, Bai D. Progress in clinical, pharmacological, chemical and structural biological studies of huperzine A: a drug of traditional Chinese medicine origin for the treatment of Alzheimer's disease. Curr Med Chem. 2003;10(21):2231-52.
Kelley BJ, Knopman DS. Alternative medicine and Alzheimer disease. Neurologist. 2008 Sep;14(5):299-306.
Kidd PM. Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Altern Med Rev. 2008 Jun;13(2):85-115.
Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Altern Med Rev. 1999;4:144-161.
Kim EJ, Buschmann MT. The effect of expressive physical touch on patients with dementia. International Journal of Nursing Studies. 1999;36:235-243.
Koger SM, Brotons M. Music therapy for dementia symptoms (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
Kumar AM, Tims F, Cruess DG, et al. Music therapy increases serum melatonin levels in patients with Alzheimer's disease. Altern Ther Health Med. 1999;5:49-57.
Le Bars PL, Katz MM, Berman N, et al. A placebo controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. JAMA. 1997;278:1327-1332.
Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind, placebo-controlled trial of the Ginkgo biloba extract EGb761 in dementia. Dement Geriatr Cogn Disord. 2000;11:230-237.
Lee ST, Chu K, Sim JY, Heo JH, Kim M. Panax ginseng enhances cognitive performance in Alzheimer disease. Alzheimer Dis Assoc Disord. 2008 Jul-Sep;22(3):222-6.
Lim GP, Yang F, Chu T, et al. Ibuprofen suppresses plaque pathology and inflammation in a mouse model for Alzheimer's disease. J Neurosci. 2000;20(15):5709-5714.
Limpeanchob N, Jaipan S, Rattanakaruna S, Phrompittayarat W, Ingkaninan K.Neuroprotective effect of Bacopa monnieri on beta-amyloid-induced cell death in primary cortical culture.J Ethnopharmacol. 2008 Aug 5. (Epub ahead of print)
Little JT, Walsh S, Aisen PS. An update on huperzine A as a treatment for Alzheimer's disease. Expert Opin Investig Drugs. 2008 Feb;17(2):209-15.
McDaniel MA, Maier SF, Einstein GO. "Brain-specific" nutrients: a memory cure? Nutrition. 2003;19(11-12):957-75.
Masaki KH, Losonczy KG, Izmirlian G. Association of vitamin E and C supplement use with cognitive function and dementia in elderly men. Neurology. 2000;54:1265-1272.
Mantle D, Pickering AT, Perry AK. Medicinal plant extracts for the treatment of dementia: a review of their pharmacology, efficacy and tolerability. CNS Drugs. 2000;13:201-213.
Morris MC, Beckett LA, Scherr PA, et al. Vitamin E and vitamin C supplement use and risk of incident Alzheimer disease. Alzheimer Dis Assoc Disord. 1998;12:121-126.
Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol. 1998;55:1409-1415.
Orr SK, Bazinet RP. The emerging role of docosahexaenoic acid in neuroinflammation. Curr Opin Investig Drugs. 2008 Jul;9(7):735-43.
Ott BR, Owens NJ. Complementary and alternative medicines for Alzheimer's disease. J Geriatr Psychiatry Neurol. 1998;11:163-173.
Pettegrew JW, Levine J, McClure RJ. Acetyl-L-carnitine physical-chemical, metabolic, and therapeutic properties: relevance for its mode of action in Alzheimer's disease and geriatric depression. Mol Psychiatry. 2000;5:616-632.
Pitchumoni SS, Doraiswamy M. Current status of antioxidant therapy for Alzheimer's disease. J Am Geriatr Soc. 1998;46:1566-1572.
Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin. 2001;17(1):239-47.
Sano M, Ernesto C, Thomas RG, et al. A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. N Engl J Med. 1997;336:1216-1222.
Scherder EJ, Bouma A, Steen AM. Effects of short-term transcutaneous electrical nerve stimulation on memory and affective behaviour in patients with probable Alzheimer's disease. Behav Brain Res. 1995;67(2):211-219.
Scherder EJ, Van Someren EJ, Bouma A, vd Berg M. Effects of transcutaneous electrical nerve stimulation (TENS) on cognition and behavior in aging. Behav Brain Res. 2000;111(1-2):223-225.
Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.
Singh M, Arseneault M, Sanderson T, Murthy V, Ramassamy C. Challenges for research on polyphenols from foods in Alzheimer's disease: bioavailability, metabolism, and cellular and molecular mechanisms. J Agric Food Chem. 2008 Jul 9;56(13):4855-73. Review.
Snowdon DA, Tully CL, Smith CD, Riley KR, Markesbery WR. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr. 2000;71:993-998.
Spagnoli A, Lucca U, Menasce G, et al. Long-term acetyl-L-carnitine treatment in Alzheimer's disease. Neurology. 1991;41:1726-1732.
Szatmari SZ, Whitehouse PJ. Vinpocetine for cognitive impairment and dementia. Cochrane Database Syst Rev. 2003;(1):CD003119.
Tabet N, Birks J, Grimley Evans J. Vitamin E for Alzheimer's disease (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
Thal LJ, Carta A, Clarke WR, et al. A 1-year multicenter placebo-controlled study of acetyl-L-carnitine in patients with Alzheimer's disease. Neurology. 1996;47:705-711.
Thompson C, Briggs M. Support for carers of people with Alzheimer's type dementia. Cochrane Database Syst Rev. 2000;(2):CD000454.
van Marum RJ. Current and future therapy in Alzheimer's disease. Fundam Clin Pharmacol. 2008 Jun;22(3):265-74. Review.
Wang J, Ho L, Zhao W, Ono K, Rosensweig C, Chen L, Humala N, et al. Grape-derived polyphenolics prevent Abeta oligomerization and attenuate cognitive deterioration in a mouse model of Alzheimer's disease. J Neurosci. 2008 Jun 18;28(25):6388-92.
Wettstein A. Cholinesterase inibitors and ginkgo extracts -- are they comparable in the treatment of dementia? Phytomed. 2000;6:393-401.
Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.
Zhang HY, Zheng CY, Yan H, Wang ZF, Tang LL, Gao X, Tang XC. Potential therapeutic targets of huperzine A for Alzheimer's disease and vascular dementia. Chem Biol Interact. 2008 Sep 25;175(1-3):396-402. (Epub 2008 May 13)