Treatment Options

Anti-amyloid therapies for Alzheimer’s disease

Over the past two years, two new drugs – Aduhelm® (aducanumab) and Leqembi® (lecanemab) have become available for infusion-based treatments.  So far, a small number of our patients have completed 18 months of treatments, while more are in the process of receiving or will be receiving these new drugs.  We have developed a thoughtful process to determine who may best benefit from these drugs, including:

• Confirmation of Alzheimer’s disease pathology by CSF biomarkers or amyloid/tau PET (NOTE: we do not accept blood tests as confirmation of Alzheimer’s disease)
• Review of clinical/functional status consistent with mild deficits
• Review by a panel of Rutgers neurologists and geriatricians experienced in monitoring patients on these drugs

Medicare will consider paying for these drugs on a case-by-case basis, and many private insurance carriers do not pay for these drugs.  If your insurance plan denies coverage for these drugs, you may be eligible for Patient Assistance Programs offered by Biogen or Eisai.

If you have been diagnosed by your physician with MCI or mild Alzheimer’s disease dementia, you can obtain a spinal fluid test through the Division of Cognitive Neurology by calling 732-235-7733.  You will be asked to obtain from your regular physician a recent MMSE test score and a brain MRI before we can proceed with the spinal fluid test.

 

Other pharmacological options

Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)

These drugs improve the level of one chemical (acetylcholine) in the brain by preventing its breakdown.  It is quite effective in Lewy body dementia/disease and somewhat effective in MCI and mild Alzheimer’s disease dementia.  This medication can sometimes be associated with side effects such as GI symptoms, leg cramps, vivid dreams.

Memantine

This drug blocks the action of another chemical in the brain.  It is somewhat effective in Alzheimer’s disease, and can be associated with headaches.

Psychiatric medications

Depending on symptoms of dementia, some psychiatric medications for mood, anxiety, and irritability may be helpful.

 

Non-pharmacological options

Exercise

What is good for the heart is probably good for the brain, and exercise has been shown to improve brain health.  The CDC recommends 60 minutes of aerobic exercise three times a week, and strength/resistance training of 150 minutes a week.

Quality sleep

Sleep is when the brain gets rid of the toxic proteins from the brain.  Make sure you get at least 6-7 hours of sleep every night.  If you have sleep apnea or suspected sleep apnea, you may need to see a sleep specialist for treatment.

Adequate light exposure

Light during the day is important for regulating your internal clock and helping you sleep better at night.  We generally recommend getting 10-12 hours of light exposure (natural light through the window or bright lamps) a day.

Combined social and cognitive activities

Research has shown that playing games only or socialization only is not enough to improve brain health.  However, doing both at the same time can be beneficial to the brain.  An example of this is volunteering, and some cities are having Volunteer Corps to help older adults with their brain health.