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Alzheimer’s Disease Medications for Memory

Alzheimer’s Disease Medications for Memory

Blog, Dementias, Progressive Neurological Diseases

Dementia Treatments

Alzheimer’s Disease Medication

Introduction 

People are increasingly interested in the latest advancements in Alzheimer’s disease medications as they seek to safeguard their brain health through the most cutting-edge scientific developments. Alzheimer’s disease, a progressive neurodegenerative disorder characterized by memory loss, cognitive decline, and behavioral changes, poses significant challenges for both patients and their loved ones. As awareness of Alzheimer’s grows and its prevalence rises, there is a growing sense of urgency to explore all available options for prevention, treatment, and management.

Leqembi

+ Leqembi is an IV medication for early-stage Alzheimer’s, targeting and removing beta-amyloid from the brain.

+ While not a cure, it’s the first FDA-approved treatment addressing Alzheimer’s biology, aiming to slow down cognitive decline and maintain independence.

+ It’s only for those with confirmed elevated beta-amyloid levels and hasn’t been tested for advanced stages or those without symptoms.

More Information

Aduhelm

Aducanumab

+ Aducanumab (Aduhelm®) has gained accelerated FDA approval for treating early Alzheimer’s and Mild Cognitive Impairment (MCI) due to Alzheimer’s Disease.

+ It’s the first therapy to demonstrate that reducing beta-amyloid in the brain can slow cognitive and functional decline in early-stage Alzheimer’s by targeting and removing specific forms of beta-amyloid plaques.

+ Administered via intravenous infusion every 4 weeks, Aducanumab aims to reduce beta-amyloid accumulation, potentially aiding other brain functions in memory, thinking, learning, and behaviors.

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Aricept

Donepezil

Donepezil (Aricept) : Approved to treat all stages of Alzheimer’s Disease. Its primary mechanism of action involves inhibiting an enzyme called acetylcholinesterase. This enzyme normally breaks down acetylcholine, a neurotransmitter involved in memory and learning. By inhibiting acetylcholinesterase, Aricept increases the levels of acetylcholine in the brain, temporarily improving communication between nerve cells.

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Exelon

Rivastigmine

Rivastigmine (Exelon): Approved for mild-to-moderate Alzheimer’s disease and mild-to-moderate dementia associated with Parkinson’s disease. This is another medication used to treat Alzheimer’s disease. Its mechanism of action is similar to Aricept but extends to inhibiting both acetylcholinesterase and butyrylcholinesterase enzymes. By doing so, Rivastigmine increases the levels of acetylcholine in the brain, supporting improved communication between nerve cells. This helps alleviate cognitive symptoms in individuals with Alzheimer’s, providing symptomatic relief without modifying the underlying progression of the disease.

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Razadyne

Galantamine

Galantamine (Razadyne): Approved for mild-to-moderate stages of Alzheimer’s disease. Its mechanism of action involves acting as a reversible acetylcholinesterase inhibitor, similar to Aricept and Rivastigmine. By inhibiting the breakdown of acetylcholine, a neurotransmitter crucial for memory and learning, Galantamine temporarily increases its levels in the brain. This enhancement of acetylcholine communication between nerve cells aims to alleviate cognitive symptoms associated with Alzheimer’s disease.

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Namenda

Memantine

Memantine (Namenda): Approved for moderate-to-severe Alzheimer’s disease. Unlike acetylcholinesterase inhibitors, Memantine works by modulating the activity of glutamate, an excitatory neurotransmitter in the brain. It acts as an NMDA receptor antagonist, helping regulate the activity of glutamate and preventing excessive stimulation. This mechanism aims to protect nerve cells from damage caused by overstimulation, which is implicated in the progression of Alzheimer’s. Memantine provides symptomatic relief by addressing a different aspect of neurotransmission compared to acetylcholinesterase inhibitors, offering a complementary approach in the treatment of Alzheimer’s disease.

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Namzaric

Donepezil and memantine (Namzaric): Approved for moderate-to-severe Alzheimer’s disease. Namzaric is a combination medication that includes both donepezil and memantine. Each component targets different aspects of Alzheimer’s disease to provide a comprehensive treatment approach. Together, the combination of donepezil and memantine in Namzaric aims to enhance cognitive function and provide symptomatic relief in individuals with moderate to severe Alzheimer’s disease. It represents a synergistic strategy by targeting both acetylcholine and glutamate to address different aspects of the disease’s underlying pathology.

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Stages of Alzheimer’s Disease

Stages of Alzheimer’s Disease

Dementias

“Memories are the threads that weave the fabric of our lives, shaping who we are and who we become.” – Elizabeth Loftus

    Stages of Alzheimer’s Disease

    Alzheimer’s disease is a complex condition that affects millions of individuals worldwide, impacting not only those diagnosed but also their families and caregivers. Understanding the progression of Alzheimer’s is crucial for providing appropriate care and support at each stage of the disease. In this article, we’ll explore the seven stages of Alzheimer’s Disease, highlighting the areas of the brain affected, common symptoms experienced, and available treatments for each stage.

    Stage 1 – No Impairment

    Area of the Brain: No noticeable changes.

    Symptoms: No memory problems or cognitive decline.

    Treatments: Focus on maintaining a healthy lifestyle, including regular exercise, a balanced diet, and mental stimulation.

    Stage 2 – Very Mild Decline

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    More Examples

    Area of the Brain: Minimal changes, primarily in the hippocampus.

    Symptoms: Occasional forgetfulness, such as misplacing keys or forgetting names.

    Treatments: Continued emphasis on lifestyle factors, along with memory aids and cognitive exercises.

    Stage 3 – Mild Decline

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    More Examples

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    More Examples

    Area of the Brain: Further deterioration in the hippocampus and other regions involved in memory and learning.

    Symptoms: Noticeable memory lapses, difficulty finding the right words, and challenges with planning and organization.

    Treatments: Introduction of medications such as cholinesterase inhibitors to help manage cognitive symptoms, along with support from caregivers and memory care programs.

    Stage 4 – Moderate Decline

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    More Examples

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    More Examples

    Area of the Brain: Significant damage in multiple brain regions, including the frontal and temporal lobes.

    Symptoms: Increased memory loss, difficulty performing tasks independently, mood swings, and confusion about time and place.

    Treatments: Additional medications, such as memantine, may be prescribed to manage cognitive symptoms. Occupational therapy and support services become more important for daily functioning.

    Stage 5 – Moderately Severe Decline

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    More Examples

    Area of the Brain: Extensive damage throughout the brain, affecting communication between neurons.

    Symptoms: Severe memory impairment, inability to recall personal details, challenges with basic activities of daily living, and behavioral changes.

    Treatments: Intensive support from caregivers, including assistance with personal care and supervision. Behavioral interventions and communication strategies are crucial.

    Stage 7 – Very Severe Decline

    Area of the Brain: Severe neuronal loss and widespread brain damage, resulting in complete dependence on others for care.

    Symptoms: Loss of verbal communication, minimal responsiveness, and severe physical impairment.

    Treatments: End-of-life care focuses on comfort and dignity, with a focus on pain management and emotional support for both the individual and their loved ones.

    Stage 6 – Severe Decline

    Area of the Brain: Severe atrophy and damage in all brain regions, leading to profound cognitive and physical decline.

    Symptoms: Loss of awareness of surroundings, difficulty recognizing familiar faces, incontinence, and limited mobility.

    Treatments: Palliative care focuses on maximizing comfort and quality of life. Supportive therapies, such as music and art therapy, can provide comfort and stimulation.

    Bottom Line:

    Understanding the stages of Alzheimer’s disease is essential for navigating the challenges and providing appropriate care and support throughout the journey. While there is currently no cure for Alzheimer’s, early diagnosis and intervention can help manage symptoms and improve quality of life for individuals and their families. With ongoing research and advancements in treatment, there is hope for a future where Alzheimer’s is more effectively managed and ultimately cured.

    Warning Signs of Dementia

    Warning Signs of Dementia

    Dementias

    “Memory is the diary that we all carry about with us.” – Oscar Wilde

    Warning Signs of Dementia

    Memory changes as we age can be unsettling, leaving many of us wondering if what we’re experiencing is just a normal part of getting older or something more serious, like dementia. It’s important to recognize that there’s a subtle overlap between age-related memory changes and the warning signs of dementia. In this article, we’ll explore these warning signs in a way that’s easy to understand.

    Consider the following symptoms of Dementia: 

    Working Memory

    Working Memory

    Do you find it challenging to remember things you just learned or heard? This could be a sign of dementia.

    More Examples

    Episodic Memory

    Episodic Memory

    Trouble remembering specific events or experiences from your past.

    More Examples

    Immediate Recall Difficulty

    Immediate Recall Difficulty

    Struggling to remember information right after learning it.

    More Examples

    Slower Retrieval and Rapid Forgetting

    Slower Retrieval and Rapid Forgetting

    Finding it takes longer to recall information, and forgetting things more quickly.

    More Examples

    Prospective Memory Challenges

    Prospective Memory Challenges

    Difficulty remembering to perform tasks in the future without external reminders.

    More Examples

    Autobiographical Memory Changes

    Autobiographical Memory Changes

    Memories across your lifespan become less detailed and more vague.

    More Examples

    What can ‘offset’ these changes or help you cope with them?

    Intelligence, expertise, and using compensatory strategies can help cope with memory changes.

    Examples: 

    • Using tools like calendars or setting reminders on your phone to help remember important dates or tasks.
    • Using mnemonic devices to remember important information.
    • Writing notes to yourself to remember tasks or appointments.
    • Creating a daily routine to help remember daily tasks and activities

    Note: Memory specialists are trained with information that greatly exceeds these very simple everyday strategies found on the internet. Clinical oversight is recommended if you feel some of these symptoms have described you. 

     

    Bottom Line:

    If you or a loved one are experiencing these warning signs of dementia, it’s essential to seek help from a local memory specialist. While it can be challenging to confront these changes, getting an evaluation and discussing options early on can lead to better outcomes and quality of life. Remember, you’re not alone, and there are resources available to support you through this journey.

    References

    Baddeley, A. D., Kopelman, M. D., & Wilson, B. A. (2004). The essential handbook of memory disorders for clinicians. Chichester, West Sussex, England ;: J. Wiley.

    Cohen, C., Culver, C., Gomberg, D., Magai, C., & Malatesta, C. (1996). Emotional Expression During Mid- to Late-Stage Dementia. International psychogeriatrics, 8(3), 383-395. doi:10.1017/S104161029600275X

    Early Memory Loss and Confusion

    Early Memory Loss and Confusion

    Conditions We Treat, Dementias, Neurological Rehabilitation, Progressive Neurological Diseases

    Early Memory Loss and Confusion

    Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

    Symptoms of Early Memory Loss and Confusion You Should Take Seriously

    If you are experiencing signs and symptoms of early memory loss, it is important to take them seriously. Although there are a variety of factors why you would be having difficulty remembering information, any brain changes should be a concern.

    Some symptoms of early memory changes include:

    • Word-finding difficulties to items you should know 
    • Forgetting details of what was said in a conversation or phone call that took place less than 10 minutes ago
    • Frequently forgetting why you entered a room (more than 3 times a day) 
    • Getting lost when driving to locations you have frequently visited 
    • Personality changes (lethargic, increased desire to be alone, irritable, short-tempered)
    • Sleeping more
    • Harder time managing finances and appointments
    • Increasing difficulty managing tasks you are used to managing (multi-tasking) 
    • Work performance is being affected at your place of employment

    Causes of Early Memory Loss and Confusion

    • Stress
    • Alcohol and Drugs Misuse
    • Anxiety and Depression
    • Prescription side-effects
    • Neurodegenerative Illness
    • Stroke
    • Traumatic Brain Injury 
    • Oxygen Loss
    • Brain Infections

    Neurodegenerative Illnesses

    • Alzheimer’s disease
    • Vascular cognitive impairment
    • Dementia with Lewy bodies 
    • Stroke
    • Frontotemporal dementia
    • Parkinson’s disease
    • Huntington’s disease
    • Traumatic brain injury

    Find out more specific information about your diagnosis:

    How can occupational therapy benefit you if you are having early memory loss? 

    Occupational therapy can greatly benefit you if you are concerned about specific symptoms. Early memory loss is a sign that something somewhere in your brain is not functioning as optimally as it could. Just as you would not ignore your right arm if you were having difficulty raising it, you should not ignore memory loss. With the right early intervention strategies, you can improve your symptoms. You will also have a healthcare professional to monitor your confusion each year in order to provide early intervention if the need arises.

      Occupational Therapy Interventions to Improve Your Memory

      What type of intervention is used by a neuro-centered rehabilitation team?

      Helpful Page Definititions

      Instrumental Activities of Daily Living (IADLs)

      Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

      Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

      Cleaning -   The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc. 

      Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

      Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time. 

      Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time. 

      Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

      Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house. 

      Activities of Daily Living

      Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.  

      ADLs include:

      • Bathing and showering
      • Getting dressed
      • Going to the bathroom
      • Walking and getting up and down from a chair or car
      • Eating and swallowing
      • Feeding 
      • Sexual activity 
      • Personal hygiene and grooming
      • Being able to use personal care devices like adaptive equipment and durable medical equipment 
      Progressive Neurological Disorders (PND)

      Progressive Neurological Disorders (PNDs) are diagnoses that are progressive in nature and cause a decline in function throughout their progression. They are also known as neurodegenerative diseases. The decline can be seen over decades, years, months, or even weeks. 

      Some common examples of PNDs include Multiple Sclerosis, Parkinson's disease, Lewy Body Dementia, Lou Gerhig's Disease, Alzheimer's disease, Motor Neuron Disease, and Huntington's disease. 

      Early intervention for any neurodegenerative disease is critical to maintaining function for as long as possible. Restoration in early stages and maintenance throughout a disease progression can benefit your quality of life and reduce caregiver burden. 

      Neuromuscular Re-education

      NMRE is used by neurocentric occupational therapists to improve communication between your muscular system and nervous system. By promoting this stream of communication, you close the circle of recovery. Without NMRE, you can have the biggest muscles in the world and still experience mobility deficits due to poor reaction time, coordination, and mixed signals. 

      Heavy Work

      Heavy work is also known as resistance training and can utilize isometric and isotonic movements with or without external weights while focusing on eccentric and concentric muscle contractions. By partnering heavy work with visual perceptual tasks and neural recruitment visualization, increased carryover and recovery is experienced. 

      Neurodevelopmental Techniques (NDT)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Proprioceptive Neuromuscular Facilitation (PNF)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Cross Crawl Techniques

      A cross-crawl technique is used in movement and mobility training of both upper body and lower body. By recruiting both sides of your brain using opposite movement patterns we strengthen the communication across the two sides of your brain known as your corpus collosum. 

      Neurocognitive Strategies

      When combining neurcogitive skills and functions with motor elements, true cognitive rehabiliation can take place (memory, recall, sequencing, etc.). We include the domains of neurocognition like language, calculation, executive functioning, complex attention, perceptual-motor, and reasoning while training your body in order to increase neural plasticity and neural re-patterning. 

      Comprehensive Evaluation

      Occupational therapists treat the entire person. Much like your primary care physician, we were required to learn elements of the entire body so that we could treat holistically (a one stop shop). Because of this, your outpatient rehabilitation specialist will perform an evaluation that assesses the following things: 

      • Personal history
        • Who are you? What do you do? What makes you tick? Why are you seeking outpatient therapy?
      • Physical function (upper body and lower body)
        • Strength, range of motion, and flexibility 
      • Neuromuscular function (brain to muscle communication)
        • Coordination, speed, agility, and reaction time 
      • Cognitive and Mind health
        • Short term memory, recall, information processing, and perception of illness 
      • Occupational Inventory (Activity and role inventory)
        • Roles you play like a caregiver, spouse, parent, employee, etc. 
        • Mobility inventory like the places you need to go 
        • IADL inventory and what activities are required for you to be independent 
        • Other activities that are important to you
      Dementia Diagnosis

      Dementia Diagnosis

      Conditions We Treat, Dementias, Neurological Rehabilitation, Progressive Neurological Diseases

      Dementia Diagnosis

      Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

      What do I do if I just received a dementia diagnosis?

      ‘Dementia’ is a general term for memory deficits or memory changes. It is important to note that ‘dementia’ is not a synonym for any other word. For example, if you have been given a dementia diagnosis, this does not mean you have Alzheimer’s disease (AD) or another specific progressive neurological disease (PND). It does, however, mean your brain’s ability to recall and use some important executive functions is impaired. Whether you are just seeing the beginnings of early memory changes or you have been diagnosed with a specific disorder, early intervention is key and imperative to keeping as much function and brain activity as possible. Seeking out therapists who are specialized in neurological approaches and can follow you throughout the progression of your dementia is vital to protecting your quality of life. 

      What types of diagnoses cause dementia?

      • Alzheimer’s disease
      • Vascular cognitive impairment
      • Dementia with Lewy bodies 
      • Stroke
      • Frontotemporal dementia
      • Parkinson’s disease
      • Huntington’s disease
      • Traumatic brain injury

      Find out more specific information about your diagnosis:

      What are my options after receiving a dementia diagnosis?

      Although there are neurocognitive enhancement medications, one of the most important things you can do for yourself is to seek out a team of therapists as early as possible. With the right early intervention strategies you can improve your symptoms and/or control the speed at which you experience decline.

      What type of intervention is used by a neuro-centered rehabilitation team?

      How can outpatient occupational therapy help after a dementia diagnosis?

      • Once given a dementia diagnosis, we can ‘stage’ your dementia progression through specific screens and assessments so that you always feel in control of your circumstances.
      • Make recommendations for adaptive equipment, durable medical equipment, and mobility aids throughout each stage
      • Provide a hybrid approach to rehabilitation and maintenance grounded in neurocentric principles offering you an inclusive rehab program.

      Helpful Page Definititions

      Instrumental Activities of Daily Living (IADLs)

      Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

      Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

      Cleaning -   The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc. 

      Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

      Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time. 

      Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time. 

      Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

      Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house. 

      Activities of Daily Living

      Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.  

      ADLs include:

      • Bathing and showering
      • Getting dressed
      • Going to the bathroom
      • Walking and getting up and down from a chair or car
      • Eating and swallowing
      • Feeding 
      • Sexual activity 
      • Personal hygiene and grooming
      • Being able to use personal care devices like adaptive equipment and durable medical equipment 
      Progressive Neurological Disorders (PND)

      Progressive Neurological Disorders (PNDs) are diagnoses that are progressive in nature and cause a decline in function throughout their progression. They are also known as neurodegenerative diseases. The decline can be seen over decades, years, months, or even weeks. 

      Some common examples of PNDs include Multiple Sclerosis, Parkinson's disease, Lewy Body Dementia, Lou Gerhig's Disease, Alzheimer's disease, Motor Neuron Disease, and Huntington's disease. 

      Early intervention for any neurodegenerative disease is critical to maintaining function for as long as possible. Restoration in early stages and maintenance throughout a disease progression can benefit your quality of life and reduce caregiver burden. 

      Neuromuscular Re-education

      NMRE is used by neurocentric occupational therapists to improve communication between your muscular system and nervous system. By promoting this stream of communication, you close the circle of recovery. Without NMRE, you can have the biggest muscles in the world and still experience mobility deficits due to poor reaction time, coordination, and mixed signals. 

      Heavy Work

      Heavy work is also known as resistance training and can utilize isometric and isotonic movements with or without external weights while focusing on eccentric and concentric muscle contractions. By partnering heavy work with visual perceptual tasks and neural recruitment visualization, increased carryover and recovery is experienced. 

      Neurodevelopmental Techniques (NDT)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Proprioceptive Neuromuscular Facilitation (PNF)

      NDT is a hands-on approach used by occupational therapists to provide deep pressure to key parts of your body during repeated movements. Your movement mixed with repetition and deep pressure creates and stores new motor patterns in your brain in order to re-establish mobility and speed up recovery. 

      Cross Crawl Techniques

      A cross-crawl technique is used in movement and mobility training of both upper body and lower body. By recruiting both sides of your brain using opposite movement patterns we strengthen the communication across the two sides of your brain known as your corpus collosum. 

      Neurocognitive Strategies

      When combining neurcogitive skills and functions with motor elements, true cognitive rehabiliation can take place (memory, recall, sequencing, etc.). We include the domains of neurocognition like language, calculation, executive functioning, complex attention, perceptual-motor, and reasoning while training your body in order to increase neural plasticity and neural re-patterning.Â