Drug and Non-drug Treatments to Manage AD Symptoms

At the present time, there is no “cure” for AD.42,43 Treatment approaches include drug and non-drug interventions to treat the cognitive, behavioral, and psychological symptoms of the disease. Treatment approaches that collectively utilize drug and non-drug treatments are optimal.42 Figure 4 summarizes the primary goals of treatment. A comprehensive list of medications to manage AD symptoms is listed in Table 2. This table includes information about medication indications, interactions (with other drugs, alcohol, supplements, antacids, and foods), and common adverse effects. Individuals diagnosed with AD should not take anticholinergic drugs.44

Figure 4. Primary goals for AD treatment.35,42
  • Maintain quality of life
  • Maximize function in daily activities
  • Enhance cognition, mood and behavior
  • Foster a safe environment
  • Promote social engagement, as appropriate

In the U.S. four medications are available to improve memory and potentially delay the progression of AD symptoms. Two of the medications are appropriate for mild to moderate disease, one is appropriate for mild to severe disease, and one is appropriate for moderate to severe disease. These medications can be used alone or in conjunction with other medications. The main effect of these drugs is to delay symptom progression and allow individuals to maintain activities of daily living.45,46 Some of the most common adverse effects include gastrointestinal disturbances, headache, nausea, diarrhea, dizziness, confusion, and cardiac arrhythmias. The most common oral adverse effect is vomiting.

Medications are also used to treat behavioral symptoms of AD. Antidepressants are used to treat changes in mood, irritability, and sleep disturbances. Anxiolytics are used to manage anxiety, restlessness, disruptive behavior, and sleep disturbances. Antipsychotics are used to manage hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, uncooperativeness, and sleep disturbances. Medications for insomnia, seizures, and ADHD can also be helpful. The most common adverse effects of these medications are headache, drowsiness, dizziness, and nausea. The most common oral adverse effect is xerostomia. Many of these drugs are known to interact with epinephrine to prolong the QT interval leading to potential ventricular tachyarrhythmia. Thus, the use of local anesthetics containing epinephrine must proceed with caution.

Table 2. Medications to Treat Alzheimer’s Disease Symptoms.46-48
Medication Indications Interactions Adverse Effects
*effects that affect the provision of oral health care in bold
Acetylcholinesterase Inhibitors
*drugs that prevent the breakdown of acetylcholine
Razadyne®
(galantamine)
Mild to moderate disease None Nausea, vomiting, diarrhea, loss of appetite, weight loss, confusion
Exelon®
(rivastigmine tartrate)
Mild to moderate disease None Nausea, vomiting, diarrhea, loss of appetite, weight loss, confusion, muscle weakness, dizziness, abdominal pain, headaches, cardiac arrhythmia
Aricept®
(donepezil)
Mild to severe disease None Nausea, vomiting, diarrhea, dizziness, headaches, insomnia, agitation
N-methyl D-aspartate (NMDA) antagonist
*Regulates the activity of glutamate
Namenda®
(memantine)
Moderate to severe disease None Dizziness, headache, constipation, confusion
Antidepressants
Celexa®
(citalopram)
Low mood and irritability Caution with alcohol; avoid valerian, St John’s wort, tryptophan, kava May prolong QT interval (caution/use local anesthesia without vasoconstrictor), somnolence, insomnia, nausea, xerostomia, sweatiness
Prozac®
(fluoxetine)
Low mood and irritability Caution with alcohol; avoid valerian, St John’s wort, tryptiphan, kava May prolong QT interval (caution/use local anesthesia without vasoconstrictor), xerostomia, taste perversion, increased bleeding, nausea, insomnia, somnolence, anxiety, nervousness, vomiting, muscle weakness or tremor
Paxil®
(paroxetine)
Low mood and irritability Caution with alcohol, avoid valerian, St John’s wort, tryptophan, kava Xerostomia, postural hypotension, abnormal taste, bruxism, impaired platelet aggregation, somnolence, insomnia, headache, sweatiness
Zoloft®
(sertraline)
Low mood and irritability Caution with alcohol; avoid valerian, St John’s wort, tryptiphan, kava Caution with local anesthetic, xerostomia, impaired platelet aggregation
Desyrel®
(trazodone hydrochloride)
Low mood and irritability, sleep disturbances Caution with alcohol, avoid valerian, St John’s wort, tryptophan, kava Sedation, headache, dizziness, fatigue, xerostomia, nausea, blurred vision
Pamelor™
(nortriptyline)
Low mood and irritability, sleep disturbances Caution with alcohol, avoid valerian, St John’s wort, tryptophan, kava Drowsiness, xerostomia, constipation, anxiety
Anxiolytics
*Antianxiety
Ativan®
(lorazepam)
Anxiety, restlessness, verbally disruptive behavior and resistance, sleep disturbances Caution with alcohol, avoid valerian, St John’s wort, tryptophan, kava Drowsiness, respiratory depression
Serax®
(oxazepam)
Anxiety, restlessness, verbally disruptive behavior and resistance, sleep disturbances Caution with alcohol, avoid valerian, St John’s wort, tryptophan, kava Drowsiness
Xanax®
(alprazolam)
Anxiety, restlessness, verbally disruptive behavior and resistance, sleep disturbances Smoking may increase levels, avoid alcohol, valerian, St John’s wort, tryptophan, kava Drowsiness, depression, lightheadedness, memory impairment, somnolence, sedation, appetite changes, xerostomia
BuSpar®
(buspirone)
Avoid alcohol, valerian, St John’s wort, tryptophan, kava Drowsiness, xerostomia
Antipsychotic
Abilify®
(aripiprazole)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, and uncooperativeness Avoid alcohol, avoid high-fat meal, avoid valerian, St John’s wort, kava Drowsiness, rigidity, headache, insomnia, agitation, anxiety, and unusual movements
Clozaril®
(clozapine)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, and uncooperativeness None listed Tachycardia, insomnia, sialorrhea, weight gain, abdominal discomfort, drowsiness, rigidity, and unusual movements
Haldol® Decanoate
(haloperidol)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, uncooperativeness, and sleep disturbances None listed May prolong QT interval (caution/use local anesthesia without vasoconstrictor), xerostomia, orthostatic hypotension, drowsiness, rigidity, and unusual movements
Zyprexa®
(olanzapine)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, and uncooperativeness None listed Somnolence, dizziness, headache, fatigue, insomnia, drowsiness, rigidity, and unusual movements
Seroquel®
(quetiapine)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, uncooperativeness, and sleep disturbances Avoid alcohol, avoid valerian, St John’s wort, kava May prolong QT interval (caution/use local anesthesia without vasoconstrictor), xerostomia, increased blood pressure, somnolence, headache, agitation, drowsiness, rigidity, and unusual movements
Risperdal®
(risperidone)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, uncooperativeness, sleep disturbances Avoid alcohol, tea/cola, valerian, St John’s wort, kava May prolong QT interval (caution/use local anesthesia without vasoconstrictor), drowsiness, rigidity, and unusual movements
Geodon®
(ziprasidone)
Hallucinations, delusions, paranoia, aggression, agitation hostility, confusion, and uncooperativeness none listed May prolong QT interval(caution/use local anesthesia without vasoconstrictor), xerostomia, orthostatic hypotension, dysphagia, headache, somnolence, dizziness, drowsiness, rigidity, and unusual movements
Insomnia Medications
Ambien®
(zolpidem tartrate)
Treatment of insomnia Avoid alcohol, grapefruit juice, avoid valerian, St John’s wort, kava Xerostomia, headache, somnolence, dizziness
Sonata®
(zaleplon)
Treatment of insomnia Avoid alcohol, avoid valerian, St John’s wort, kava, high-fat diet Headache, xerostomia
Other
Tegretol®
(carbamazepine)
Agitation, mood stabilizer Avoid alcohol, avoid valerian, St John’s wort, kava, evening primrose Xerostomia, headache, dizziness, somnolence, nausea, vomiting, constipation
Concerta®
(methylphenidate)
apathy Administer 30-45 min before meals, avoid ephedra and yohimbe Hypertension