Standard Prescriptions for Alzheimer’s

Cholinesterase Inhibitors

All of the prescription medications currently approved by the U.S. Food and Drug Administration (FDA) to treat cognitive Alzheimer symptoms are in a class of drugs called cholinesterase (KOH-lean-STE-raise) inhibitors. These drugs are designed to prevent the breakdown of acetylcholine (pronounced a-SEA-til-KOH- lean), a chemical messenger in the brain that is important for memory and other thinking skills. The drugs work to keep levels of the chemical messenger high, even while the cells that produce the messenger continue to become damaged or die. About half of the people who take cholinesterase inhibitors experience a modest improvement in cognitive symptoms.

Three cholinesterase inhibitors are commonly prescribed: donepezil (Aricept®), approved in 1996; rivastigmine (Exelon®), approved in 2000; and galantamine (Reminyl®), approved in 2001. Tacrine (Cognex®), the first drug in this class, was approved in 1993 but is rarely prescribed today because of associated side effects, including possible liver damage.

Vitamin E

Vitamin E supplements are often prescribed as a treatment for Alzheimer’s disease because they may help brain cells defend themselves from “attacks.” Normal cell functions create a byproduct called a free radical, a kind of oxygen molecule that can damage cell structures and genetic material. This damage, called oxidative stress, may play a role in Alzheimer’s disease. Cells have natural defenses against this damage, including the antioxidants vitamins C and E, but with age some of these natural defenses decline. Research has shown that taking vitamin E supplements may offer some benefit to people with Alzheimer’s.

Most people can take vitamin E without side effects. However, any change in medications should first be discussed with a primary care physician because all medication can cause side effects or interactions with other medications. A person taking “blood-thinners,” for example, may not be able to take Vitamin E or will need to be monitored closely by a physician.