What Is the Future of Alzheimer’s Disease Treatment?

Other research suggests that less invasive approaches also may be beneficial. In 2011, Bentwich et al administered daily sessions of transcranial magnetic stimulation (TMS) to eight patients with probable Alzheimer’s disease for six weeks. TMS was associated with significant improvements on Alzheimer Disease Assessment Scale-Cognitive and Clinical Global Impression of Change tests. In a 2009 study, researchers administered three 30-minute sessions of transcranial direct-current stimulation to 10 patients with Alzheimer’s disease. Stimulation significantly improved visual recognition memory, compared with sham stimulation, but did not affect attention.

Treating Behavioral Symptoms

Neurologists have many options for treating the behavioral symptoms of Alzheimer’s disease, but should keep abreast of current data. For example, atypical antipsychotics are the subject of a growing number of warnings about increased risks of stroke, heart attack, and mortality. But atypical antipsychotics may be “justified if they keep people in their homes, rather than in an institution,” said Dr. Kirshner. Neurologists should avoid phenothiazines and haloperidol because they have more potential for extrapyramidal side effects such as parkinsonism or tardive dyskinesia, and even greater evidence of long-term harm. Benzodiazepines are addictive, worsen memory loss, and cause falls in elderly people.

Trazodone and mirtazapine can improve sleep, but diphenhydramine should be avoided because it is anticholinergic and worsens memory loss. Drugs for bladder dysfunction such as oxybutynin have similar side effects. Cognitive behavioral therapy may improve behavioral symptoms, “but I would say it’s not easy [to administer],” said Dr. Kirshner.

Hope for Future Therapies?

“At the moment we still have only symptomatic treatments [for Alzheimer’s disease],” Dr. Kirshner continued. “We haven’t proved any neuroprotective therapy yet. The antiamyloid therapies have been very disappointing, but perhaps we’ve been trying them too late [in the disease course]. We’re trying to address that now. There are breakthroughs promised, so keep tuned.”

—Erik Greb