From Alzheimer's drugs, to therapeutic interventions, to home design modifications, here's expert-backed guidance on managing the symptoms of Alzheimer's disease.
Alzheimer’s disease is a progressive neurodegenerative condition that affects more than one in every nine Americans over the age of 65. Managing its symptoms can help improve the quality of life for people living with Alzheimer’s and their loved ones, and help patients remain independent for longer.
What are the symptoms of Alzheimer’s disease?
Alzheimer’s can look different in different people. While people with Alzheimer’s will progress through its seven stages, there is no definite, set timeline for the disease. It shares symptoms with other forms of dementia (for example, vascular dementia) but here’s a list of its most common symptoms.
The key signs and symptoms of Alzheimer’s include:
- Memory loss that affects your daily life (i.e. forgetting to turn off the oven)
- Trouble remembering dates or directions
- Repeating questions over and over
- Trouble remembering newly learned information
- Misplacing or losing objects
- Difficulty with complex cognitive tasks and planning
- Personality changes
- Increased anxiety, irritation, or depression
- Difficulty with language
- Changes in sleeping patterns
Some of these may sound familiar — and they aren’t always cause for alarm. Learn more about the difference between signs of “normal” cognitive aging and neurodegenerative diseases like Alzheimer’s here.
How do you manage Alzheimer’s symptoms?
Drugs and supplements for Alzheimer’s disease’s cognitive and behavioral symptoms
There are two FDA-approved drugs that may slow the course of the disease — Leqembi and Aduhelm, designed for people in the earliest stages of the disease. Many people don’t get a diagnosis early enough to qualify for these drugs, but most live between five to 20 more years with the disease — and for many of those years, with good management of Alzheimer’s symptoms, they may still live relatively independent lives.
While there are only two drugs out there that can treat the disease itself, there are a number of FDA-approved drugs for the disease’s symptoms, like memory loss, difficulty learning new information, and trouble with spatial awareness. Managing symptoms throughout the course of the disease can help people live independently for longer.
There are two different types of symptom-management drugs available for treating the later stages of Alzheimer’s.
Cholinesterase inhibitors for Alzheimer’s
Aricept, Excelon and Razadyne are cholinesterase inhibitor drugs while Namenda is an NMDA receptor inhibitor. Cholinesterase inhibitors work by prolonging the activity of an important brain signaling molecule called acetylcholine.
NMDA receptor inhibitors for Alzheimer’s
NMDA receptor inhibitors help prevent brain cells from firing too often and damaging themselves.
Through these effects, both types of drugs boost cognitive function, making it easier for people with Alzheimer’s to go about their daily lives. Some of these treatments also come as patches that are applied to the skin. This helps reduce unpleasant side effects like nausea and diarrhea.
Alzheimer’s drugs in development
There are also new drugs being developed to address other unmet needs. These drugs aren’t cholinesterase inhibitors or NMDA receptor inhibitors. Rexulti may soon be approved by the FDA for treating agitation. There are other drugs, including liraglutide which is used to treat diabetes being tested for their effects on Alzheimer’s. Another drug in development is hoping to turbocharge the effect of Aricept to boost its cognitive benefits.
Antipsychotics for Alzheimer’s?
Alert: Certain prescription drugs carry special risks for people living with dementia and may not help their symptoms, but many doctors are prescribing them anyway. In fact, one study found that 75 percent of older adults living with dementia were being given prescription medications that were unhelpful or even dangerous.
While some antipsychotics are prescribed off-label for the behavioral symptoms of Alzheimer’s, scientists recommend limiting their use. This is because these drugs come with many side effects and lead to an increased risk of mortality, stroke, and hallucinations. Nursing homes in the U.S. are currently under investigation for inappropriately prescribing antipsychotics to Alzheimer’s and dementia patients.
Cannabis for Alzheimer’s — marijuana and CBD
As cannabis becomes legal in more states and the CBD market thrives, can these herbal drugs treat people with Alzheimer’s and dementia?
“Medical cannabis [is an] emerging research field,” Zhibin Liang, a Glenn Postdoctoral Fellow in Cellular Neurobiology Laboratory and The Paul F. Glenn Center for Biology of Aging Research at Salk Institute for Biological Studies, told Being Patient. “Phytocannabinoids from the cannabis plant are well known for acting on the cannabinoid receptors in the brain, in the central nervous system, or in the peripheral nervous systems, and it’s well known that this kind of compounds, especially tetrahydrocannabinol [THC] have pharmacological effects.”
So far, research on the benefits of THC for people living with Alzheimer’s is extremely limited. Research in lab mice linked tetrahydrocannabino to improvements in memory and a reduction of the brain plaque found in Alzheimer’s brains — though findings from mouse studies rarely translate to humans.
While cannabis is frequently turned to for pain relief — hence the rise of “medical marijuana” — there is conflicting research on its efficacy. One study recently found that cannabis did not stand up to a placebo when it came to pain relief.
“Factors such as patients’ expectations of relief are likely to play a role in the analgesic effects associated with cannabis-based treatments,” Karin Jensen, a pain neuroimaging researcher at Stockholm’s Karolinska Institutet, told CNN.
Despite the hype around this hopeful cure-all, it is just as unfounded. Some neurologists are skeptical of the social media traction CBD products have gained, even calling CBD vendors “snake oil salesmen” who are taking advantage of people who may confuse relief from CBD oils, rubs, creams, gummies, and other products with the placebo effect.
In one study released in 2021 by the National Library of Medicine, researchers say CBD does have real potential — this time as a therapy to help curb cognitive decline and alleviate some Alzheimer’s symptoms through changing the chemistry in the brain. However, this study was also conducted only in mice, and again, there is no guarantee these results would translate to humans.
In the meantime, regulators and researchers warn of safety issues with CBD products: States have differing restrictions on the production of CBD products. According to a report from the Pew Center, not only are the health benefits of cannabidiol unclear, but there is no guarantee that products are produced in clean, regulated facilities, nor tested for toxic pesticides, heavy metals and bacteria, according to state officials.
More research is underway, but it will be a while before findings are considered conclusive, and in the meantime, it’s important to remember that (1) these substances may be legal state by state, but they are not federally legal; and (2) their production is unregulated and that factor may introduce safety risks.
Diet and dietary supplements for brain health and Alzheimer’s
Even though there are strong links between a healthy diet and Alzheimer’s disease, researchers haven’t yet shown that changing your diet will slow cognitive decline or treat the symptoms. Similarly, while the keto diet and fasting are trendy, we still lack scientific evidence that they will treat Alzheimer’s or dementia. That isn’t to say that healthy eating isn’t good for you — a Mediterranean-style diet rich in fruits, vegetables, fish, and whole grains is effective in supporting heart health.
According to data from 2017 to 2018, more than half of Americans are taking dietary supplements. This includes the natural supplements, brain boosting pills, beneficial microbes, and other products crowding the shelves in the health food store. Many of these products contain off-label ingredients and don’t require rigorous research to prove their health claims. This suggests that instead of providing health benefits these supplements may actually harm you, or at best provide no benefit.
Managing symptoms with dementia-inclusive design
As people progress to the later stages of Alzheimer’s disease, it becomes harder to keep safe at home. Beyond medications, there are environmental modifications, from home modifications to community-wide dementia-inclusive design that can help people with Alzheimer’s live independently for longer.
These simple changes that help reduce confusion, agitation, and disorientation.
Try the following expert-recommended strategies:
- Clearing floor clutter to prevent falls
- Installing guardrails
- Using clear labels for rooms and important objects to reduce confusion
- Improving lighting and contrast in the home
Grant Warner, who specializes in designing senior living spaces for the architectural firm HKS suggests starting with kitchen safety. People may forget to turn off the stove for hours on end, which causes smoke or fires, he told Being Patient. Automatic shut-off options and fire extinguishing systems, for example, can help protect people living with Alzheimer’s and allow them to live on their own for longer. See more of his advice here.
Meanwhile, supermarkets, museums, public transportation systems, and even whole communities are being designed with dementia awareness in mind. Dementia-inclusive design reduces social isolation and stigma, and increases the community support system for people living with dementia.
Activities to ease Alzheimer’s symptoms
A number of other science-based activities can help boost a person’s mood and may have a small impact on their cognitive symptoms. These activities include:
Listening to music
Did you know that musical memories are often the last to go in Alzheimer’s? Music is a powerful emotional cue that helps people tap into their memories and remember events from their life.
Organizations like Music & Memory coach families on how to use music to help ease the symptoms for people living with Alzheimer’s and other dementias, even in the disease’s late stages.
Art and dance therapy
Other forms of creative expression like painting or dancing may also help people unlock past memories. Read art therapy in practice for dementia here.
Bringing in trained dogs (or using robotic pets) helps reduce loneliness for people with Alzheimer’s and keeps them moving. This intervention may reduce some of the behavioral symptoms of the condition.
As a practice, horticultural therapy can benefit people with disabilities, injuries, diseases in many different settings, including hospitals, veteran centers and nursing homes, to name a few. Some research suggests that HT may help people with dementia as well, reducing apathy (a common symptom of the disease) and improving cognitive function after 10 weeks.
Read more about a small study on horticultural therapy — which includes activities like planting, handicrafting, eating, drinking and cooking plants — and how it worked for people living with Alzheimer’s and other forms of dementia.
Sensory loss — including loss of smell — and neurodegeneration, including Alzheimer’s disease, are linked. Some research shows that it’s possible to tap into what’s left of a person’s sense of smell to connect with memories and emotions of past experiences.
In her “smell therapy” sessions in long-term care facilities with aging adults, including adults living with dementia, “scent guru” Ruth Sutcliffe has found that because of the unique nature of our sense of smell, a guided scent-driven journey through memory can be full of emotion. Here’s more about Sutcliffe’s forays into smell therapy for dementia.
Cognitive behavioral therapy
About a third of people living with dementia have depression, and as many as half of people with Alzheimer’s and other forms of dementia suffer from anxiety.
According to Sunil Bhar, professor of psychology at Swinburne University of Technology, people with dementia who are depressed may feel that they are losing touch of who they are, as they begin to lose their memories in the early stages of dementia.
“They no longer feel a sense of mastery over their environment and identity,” Bhar, who is also the co-director of the Wellbeing Clinic for Older Adults, told Being Patient.
Research is underway to measure the benefits of cognitive behavioral therapy. CBT is widely used and proven to be effective in the treatment a host of mental health disorders from addiction to eating disorders. Learn more about that research and the way CBT is being applied to treat dementias like Alzheimer’s here.
The bottom line on managing Alzheimer’s symptoms
In the later stages of Alzheimer’s disease, memory loss and other types of cognitive impairment become more severe. Fortunately, there are science-backed approaches that help people live independently for longer, and as research continues to reveal more about the disease, how it progresses through the brain, and how to treat and manage it, options to improve the quality of life for people with a diagnosis are continuing to expand.
This guide was written by reporter Simon Spichak and managing editor Alexandra Marvar