Treating Alzheimer's Disease: the Good, the Bad and the Future

An Introduction by Harvey Gilbert, MD: Dr. Fillit’s contribution to Gilbert Guide’s expert corner has been long awaited. Dr. Fillit is a clinical professor of geriatrics and medicine, and a professor of neurobiology at the Mount Sinai Medical Center in New York. He is the co-editor of Textbook of Geriatric Medicine and Gerontology, a leading textbook on geriatric medicine and gerontology. He is also an internationally recognized expert on Alzheimer’s disease and executive director of the Alzheimer’s Drug Discovery Foundation.

In this post, he summarizes the current treatment options for Alzheimer’s disease and gives us an idea of what the future holds.

The four drugs on the market today for the treatment of Alzheimer’s disease are safe and modestly effective for treating the symptoms of the disease. Cholinesterase inhibitors (Aricept, Exelon, and Razadyne) are recommended for all patients newly diagnosed with mild to moderate Alzheimer’s disease. Patients with moderate to severe Alzheimer’s can be started on NMDA antagonist memantine (Namenda). Combination therapy (combining both cholinesterase inhibitor and memantine) is recommended for patients with moderate to severe disease because some clinical trials have demonstrated added benefit with the combined use.

Do Supplements or Alternative Medicines Help?

I, along with my fellow medical experts in the field of Alzheimer’s treatment, do not recommend any supplements or alternative medicines. None have been proven effective. There are no drugs currently on the market that modify the underlying disease process, and the drugs mentioned above only treat the symptoms of Alzheimer's.

Are We Making Progress in Treating Alzheimer’s?

There is much in the pipeline to be hopeful about. Drug discovery and development for Alzheimer’s disease is changing rapidly. As recently as five years ago, there were few, if any, drugs in clinical development to change the course of the disease. Today there are many. In fact, most of the major pharmaceutical companies are now involved in developing new drugs for Alzheimer’s disease. A few new disease-modifying “compounds” (they are not called “drugs” until they are approved by the FDA) are in late-stage development, and announcements on the results from a few companies are due in the coming weeks to months. These drugs act by several mechanisms. Some prevent the deposition of an abnormal protein called amyloid that is toxic to neurons (brain cells), or protect the neurons from injury. If successful, they will be the first disease-modifying drugs for Alzheimer’s disease.

What Does the Future Look Like for Alzheimer’s Treatment?

Several more potential blockbuster drugs are in earlier stages of clinical development. The medical community holds great hope that, within the next five years, there will be effective drugs available to not only treat the underlying process of Alzheimer’s disease, but to actually prevent it.

Posted in: Treating Symptoms, Treatment

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