Alzheimer’s disease is a progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior (WHO, 2023). It is the most common cause of dementia, accounting for 60-80% of cases (WHO, 2023). As healthcare professionals, it’s crucial to stay informed about the intricacies of Alzheimer’s to provide optimal care and support for patients and their families.

Prevalence and Statistics

Alzheimer’s disease affects millions globally. In the United States alone, an estimated 6.7 million people aged 65 and older live with Alzheimer’s in 2023, with the number expected to rise to nearly 13 million by 2050 due to the aging population (Alzheimer’s Association, 2023a). Women are disproportionately affected, comprising almost two-thirds of Americans with Alzheimer’s (Alzheimer’s Association, 2023a). The financial impact is staggering, with costs for Alzheimer’s care projected to reach $1 trillion by 2050 (Alzheimer’s Association, 2023a).

Signs and Symptoms

Alzheimer’s disease typically presents with subtle memory lapses that gradually worsen. Early signs may include difficulty remembering recent conversations, names, or events. As the disease progresses, symptoms extend beyond memory loss (WHO, 2023):

• Confusion and Disorientation: Patients may become lost in familiar places or fail to recognize familiar faces.
• Difficulty with Language: Finding the right words becomes challenging, leading to frustration and communication breakdowns.
• Impaired Judgment and Reasoning: Decision-making abilities decline, and patients may struggle with complex tasks like managing finances.
• Changes in Mood and Behavior: Depression, apathy, anxiety, and aggression can manifest, significantly affecting the patient’s quality of life.

Stages of Alzheimer’s Disease

Understanding the stages of Alzheimer’s can help tailor interventions to the patient’s needs (WHO, 2023):

1. Preclinical Alzheimer’s: No symptoms are evident, but changes in the brain, such as amyloid plaques, begin years before diagnosis.
2. Mild Cognitive Impairment (MCI): Symptoms are mild and often go unnoticed, with slight memory lapses and occasional confusion.
3. Mild Alzheimer’s Disease: Noticeable memory lapses occur, along with difficulty performing everyday tasks. Patients may begin to withdraw from social activities.
4. Moderate Alzheimer’s Disease: Memory loss worsens, and patients may require help with daily activities. Behavioral changes become more pronounced.
5. Severe Alzheimer’s Disease: Patients lose the ability to communicate, require full-time care, and are at risk of complications like infections.

Care Planning for Alzheimer’s Patients

Effective care planning is essential for managing Alzheimer’s disease and enhancing the quality of life for patients and their caregivers (Alzheimer’s Association, 2023b):

• Early Diagnosis and Intervention: Encourage regular cognitive assessments for early detection. Early diagnosis allows for timely intervention, enabling patients to participate in decision-making while they are still able.
• Person-Centered Care: Tailor care plans to the individual’s history, preferences, and abilities. Activities that align with the patient’s interests can promote engagement and well-being.
• Support for Caregivers: Alzheimer’s can be overwhelming for caregivers. Offer resources, such as respite care, support groups, and education on disease management.
• Advance Care Planning: Discuss future care preferences early, including legal and financial considerations, to ensure that the patient’s wishes are respected as the disease progresses.
• Symptom Management: Focus on managing symptoms like anxiety, depression, and sleep disturbances with non-pharmacological interventions and, when necessary, medications.

Common Medications used for Individuals with Alzheimer’s

Currently, there is no cure for Alzheimer’s Disease. However, there are several medications available for the delay and management of Alzheimer’s (Alzheimer’s Association, 2023b). These medications are used in stages of the disease. Once an individual progresses from one stage to another, the medication regimen must be altered or stopped (Alzheimer’s Association, 2023b) (National Institute on Aging, 2023). Below are some of the medications currently available (National Institute on Aging, 2023).

Cholinesterase Inhibitors

Cholinesterase inhibitors work by preventing the breakdown of acetylcholine, a neurotransmitter important for memory and learning. These medications are generally used in the early to moderate stages of Alzheimer’s disease (Alzheimer’s Association, 2023b):

• Donepezil (Aricept)
  • Stage: Mild, Moderate, and Severe Alzheimer’s
  • Use: Approved for all stages of Alzheimer’s disease. It helps to improve cognition and behavior by increasing the levels of acetylcholine in the brain.
• Rivastigmine (Exelon)
  • Stage: Mild to Moderate Alzheimer’s
  • Use: Available in oral and transdermal (patch) forms. It is used to treat mild to moderate Alzheimer’s and is also approved for mild to moderate dementia associated with Parkinson’s disease.
• Galantamine (Razadyne)
  • Stage: Mild to Moderate Alzheimer’s
  • Use: Used to improve cognitive function in mild to moderate Alzheimer’s disease.

NMDA Receptor Antagonists

These medications work by regulating the activity of glutamate, a neurotransmitter involved in learning and memory, which can be harmful when produced in excess (Alzheimer’s Association, 2024).

• Memantine (Namenda)
  • Stage: Moderate to Severe Alzheimer’s
  • Use: Typically prescribed for patients in the moderate to severe stages of Alzheimer’s disease. It can be used alone or in combination with a cholinesterase inhibitor.

Combination Therapy

Combining cholinesterase inhibitors with NMDA receptor antagonists can be beneficial for patients in the moderate to severe stages of Alzheimer’s disease (Alzheimer’s Association, 2024).

• Donepezil and Memantine (Namzaric)
  • Stage: Moderate to Severe Alzheimer’s
  • Use: This combination therapy is used for patients who are already stabilized on donepezil alone but need additional cognitive support in the moderate to severe stages of the disease.

Antipsychotics, Antidepressants, and Anxiolytics

While not specifically approved for Alzheimer’s disease, these medications are often used to manage symptoms such as agitation, depression, and anxiety, which can occur at various stages of the disease (Alzheimer’s Association, 2023b).

• Antipsychotics: May be used in the moderate to severe stages for managing severe behavioral symptoms.
• Antidepressants: Commonly used across all stages to manage depression.
• Anxiolytics: Used as needed for anxiety across all stages.

Anti-Amyloid Antibodies

These are newer therapies targeting amyloid plaques, which are believed to contribute to the disease process (Food and Drug Administration (FDA), 2023) (Alzheimer’s Association, 2024).

• Lecanemab (Leqembi) (Mayo Clinic, 2023) (Food and Drug Administration (FDA), 2023).
  • Stage: Early Alzheimer’s Disease (Mild Cognitive Impairment and Mild Dementia)
  • Use: Approved for early Alzheimer’s disease, it aims to slow disease progression by reducing amyloid plaques in the brain.
• Aducanumab (Aduhelm)
  • Stage: Early Alzheimer’s Disease (Mild Cognitive Impairment and Mild Dementia)
  • Use: Also targets amyloid plaques and is approved for use in the early stages of Alzheimer’s disease, although its use is subject to ongoing debate due to questions about its efficacy.
• Kisunla (donanemab-azbt) (U.S. Food and Drug Administration (FDA), 2024).
  • Stage:  Early Alzheimer’s Disease (Mild cognitive impairment or mild dementia)
  • Use: Also targets amyloid plaques and is approved for use in the early stages of Alzheimer’s disease, although its use is subject to ongoing debate due to questions about its efficacy.

Tau-Targeting Therapies

These therapies are still largely in clinical trials but represent a future direction for treating Alzheimer’s by targeting tau protein tangles (Pluta & Ułamek-Kozioł, 2020) (Ye, Wan, et al., 2024).

These medications are typically part of a comprehensive care plan, including non-pharmacological interventions, that should be personalized to each patient’s needs. It’s essential to monitor patients closely for side effects and adjust treatments as the disease progresses (Pluta & Ułamek-Kozioł, 2020) (Ye, Wan, et al., 2024).

Conclusion

Alzheimer’s disease presents significant challenges, but with informed care strategies and support, healthcare professionals can make a meaningful difference in the lives of those affected. By staying up-to-date on the latest research, maintaining empathy, and fostering strong caregiver support networks, we can provide comprehensive care that addresses the complex needs of Alzheimer’s patients. See the CareerSmart course catalog for courses on Alzheimer’s Disease.

Author: Jennifer Walker, RN, MSN, NPD-BC, GERO-BC, NE-BC

References:

• Alzheimer’s Association. (2023a). Alzheimer’s Disease Facts and Figures. Retrieved from https://www.alz.org/alzheimers-dementia/facts-figures.
• Alzheimer’s Association. (2023b). “Medications for Memory, Cognition, and Dementia-Related Behaviors.” Alzheimer’s Association. Retrieved from https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
• Alzheimer’s Association. (2024).  Accessed from: https://www.alz.org/media/Documents/alzheimers-dementia-fda-approved-treatments-for-alzheimers-ts.pdf
• Food and Drug Administration (FDA). (2023).  FDA Converts Novel Alzheimer’s Disease Treatment to Traditional Approval.  Accessed from: https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval
• Food and Drug Administration (FDA ). (2024). FDA approves treatment for adults with Alzheimer’s disease. Retrieved from: https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-treatment-adults-alzheimers-disease#:~:text=The%20U.S.%20Food%20and%20Drug,studied%20in%20the%20clinical%20trials.
• Mayo Clinic. (2023).  Lecanemab for Alzheimer’s disease: An option for you? Accessed from: https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/lecanemab/art-20548103
• Pluta R, Ułamek-Kozioł M. (2020).  Tau Protein-Targeted Therapies in Alzheimer’s Disease: Current State and Future Perspectives. In: Huang X, editor. Alzheimer’s Disease: Drug Discovery [Internet]. Brisbane (AU): Exon Publications. Chapter 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566118/ doi: 10.36255/exonpublications.alzheimersdisease.2020.ch4
• World Health Organization (WHO). (2023). Dementia. Retrieved from https://www.who.int/news-room/fact-sheets/detail/dementia.

• Ye, Jinwang; Wan, Huali; et al. (2024). Targeting tau in Alzheimer’s disease: from mechanisms to clinical therapy. Neural Regeneration Research 19(7):p 1489-1498.  DOI: 10.4103/1673-5374.385847