To this day, there is no cure for Alzheimer’s disease. However, several pharmaceuticals are developing and bring hope. The therapeutic approaches, which are currently in the research stage, aim to tackle the pathological process of the disease in the hope of curing or halting it. In addition, there are drugs that reduce the symptoms and which improve cognitive functioning to some extent.

The effectiveness of the treatments is evaluated by the doctor after 3 to 6 months. If necessary, the treatments are then modified. At the moment, the benefits of the treatments are modest and the drugs do not prevent the disease from progressing.³⁰.

The Foundation for Medical Research estimates that in 2016 there were nearly 900 people affected by Alzheimer’s disease in France. (see the infographic)

pharmaceuticals

The pharmaceuticals following are available on prescription. We cannot know a priori which will best suit the patient. Sometimes it takes a few months to find the appropriate treatment. According to studies, after 1 year of medication, 40% of people see their condition improve, 40% have a stable condition and 20% feel no effect.

Cholinesterase inhibitors

They are mainly used to treat mild or moderate symptoms. This family of drugs helps increase the concentration in acetylcholine in certain regions of the brain (by reducing its destruction). Acetylcholine allows the transmission of nerve impulses between neurons. It has been noticed that people with Alzheimer’s disease have lower amounts of acetylcholine in the brain because the destruction of their nerve cells reduces the production of this neurotransmitter.

On the Canadian market, there are currently 3 inhibitors of cholinestérase (the enzyme that destroys acetylcholine):

• Le donepezil or E2020 (Aricept®). It is taken in the form of tablets. It alleviates mild, moderate and advanced symptoms of the disease;
• La rivastigmine (Exelon®). Since February 2008, it has also been offered in the form of a skin patch: the drug is absorbed slowly by the body over 24 hours. Rivastigmine is suitable for patients who have mild or moderate symptoms;
• Le bromhydrate de galantamine (Reminyl®). It is sold as a tablet taken once a day for mild or moderate symptoms.

These drugs lose their effectiveness over time, as neurons still produce less and less acetylcholine. They can also cause side effects, such as nausea and vomiting, loss of appetite and stomach pain. In this case, it is important to see your doctor again, who will adjust the dose as needed.

In the United States and France, tacrine (Cognex®) is used as an inhibitor of cholinestérase. However, it can cause serious side effects and is not approved in Canada.

NMDA receptor antagonist

Since 2004, memantine hydrochloride (Ebixa®) has been given to relieve moderate or severe symptoms of disease. This molecule acts by binding to NMDA (N-methyl-D-aspartate) receptors located on neurons in the brain. It thus takes the place of glutamate which, when it is present in large quantities in the environment of neurons, contributes to the disease. There is no indication, however, that this drug slows down the degeneration of neurons.

Ongoing research

Significant efforts are being invested in the search for new drugs. The main objectives are:

• Destroy beta-amyloid protein plaques, thanks to the injection of antibodies capable of suppressing them. These plaques are, in fact, one of the most important brain lesions in the disease. Such an antibody has been developed (the name of the molecule is bapineuzumab) and is under clinical evaluation in people with the disease. This approach is called a “therapeutic vaccine”. Another solution tested would be to activate certain brain cells (microglia) so that they eliminate the plaques in question;
• Replace neurons. The scientific community places great hope on the replacement, with the help of a transplant, of the neurons destroyed by the disease. Nowadays, researchers are able to create cells that resemble neurons from stem cells obtained from human skin. However, the method is not quite developed. It does not yet make it possible to create neurons which have all the properties of “natural” neurons.

Physical exercise

Doctors strongly encourage people with Alzheimer’s disease to takeexercise. It improves strength, endurance, cardiovascular health, sleep, blood circulation and mood, and increases dynamism and energy levels. In addition, physical exercise has particularly beneficial effects for people with this disease:

• it helps to maintain motor skills;
• it gives an impression of meaning and purpose;
• it has a calming effect;
• it maintains the level of energy, flexibility and balance;
• it reduces the risk of serious injury in the event of a fall.

People who care for the sick can kill two birds with one stone by exercising at the same time as their patients¹⁷.

Social support

Considered a component of treatment, the social support brought to the sick is crucial. Doctors advise various strategies to family and caregivers patients.

• Make regular visits to patients to offer them support, according to their needs;
• Provide them with memory aids;
• Create a stable and calm living structure in the house;
• Establish a bedtime ritual;
• Make sure that their immediate environment presents little danger;
• Make sure they always have a card (or bracelet) in their pocket with an indication of their state of health, as well as phone numbers in case they get lost.

Associations also offer support in various forms. See the Sites of Interest section.