Which Drugs Can Improve the Clinical Symptoms of Alzheimer's Disease

Although no drug can yet cure Alzheimer's disease, some drugs can improve patients' clinical symptoms. Of course, treating Alzheimer's is not only about medication; more importantly, family members need some knowledge of the disease and daily caregiving skills. Many non-pharmacological methods can ease symptoms—such as helping patients with reminiscence therapy, validation therapy, and reorientation therapy—which may even improve quality of life more than drugs. But these require certain professional skills and some training, which may be difficult for many families.

So which drugs can reduce patients' clinical symptoms? This requires understanding the cause of Alzheimer's. The most important cause is marked brain atrophy: the brain shrinks to a small volume and is light in weight. The sulci on the brain surface become deep and wide, while the gyri become narrow and shrunken. Autopsy, with brain tissue sliced and examined under the microscope, shows widespread senile plaques and neurofibrillary tangles in the cerebral cortex, subcortical structures, and basal ganglia; the number of neurons is markedly reduced, as are their synapses and branches.

Senile plaques and neurofibrillary tangles in the cortex, subcortical structures, and basal ganglia are the main diagnostic criteria for Alzheimer's, but this examination cannot be performed in life and is done only after death. Clinical diagnosis today therefore rests mainly on doctors' experience. The main component of neurofibrillary tangles is hyperphosphorylated tau protein, an important biomarker in the cerebrospinal fluid of Alzheimer's patients. Tangles relate to the total amount of acetylcholine in the brain. In addition, about 80% of Alzheimer's patients have cerebrovascular problems, and female patients are additionally affected by estrogen.

So current drugs for Alzheimer's mainly fall into three categories: first, cholinesterase inhibitors; second, drugs improving cerebrovascular function (mainly herbs that activate blood and resolve stasis and soften hard masses); and third, drugs regulating estrogen.

Current Western medication regimens by severity are roughly as follows: mild cases may use cerebral metabolic activators such as donepezil, rivastigmine, and galantamine; moderate cases may use donepezil, rivastigmine, galantamine, or memantine hydrochloride; severe cases may use donepezil or memantine hydrochloride.

If the patient also has hypertension, antihypertensives are needed; diabetes calls for hypoglycemics; coronary heart disease calls for anticoagulants such as statins; and chronic obstructive pulmonary disease requires COPD medication. Female patients with osteoporosis and declining estrogen may consider hormone replacement therapy, but must weigh the possible breast- and cervical-cancer risks of estrogen. The Chinese medicine Ginkgo biloba capsules and some common patent medicines for stroke sequelae can also improve symptoms.

Alzheimer's patients often have hallucinations, believing family members are impostors and that giving them medicine is harming them; their medication adherence is very low, and reasoning does not help. In such cases, families sometimes need to mix the medication into food or drink so the patient takes it unknowingly.