Despite the growing rate of incidents of Alzheimer’s disease (AD), there are a number of ways patients and their caregivers can manage and treat the ailment, according to a review published in December in the Annals of Clinical and Translational Neurology.

The authors, including lead author Jeffrey L. Cummings with the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, contend that the disease, the most common form of dementia, affects one in nine adults over the age of 65, two-thirds of which are women.

Additionally, Alzheimer’s disease International estimates that the rate of AD diagnoses will grow by 225 percent by the year 2050. “Clinicians play a key role in the medical management of AD, and provide recommendations and advice to patients and families/caregivers on a broad range of issues, including psychosocial problems, and legal and financial resources,” the Cummings et al wrote.

In the article, the research team looked at current trends in AD research, treatment and drug therapy available to AD patients and caregivers.

Healthy Brains
According to numerous studies, maintaining brain health through diet and exercise shows potential to lessen the risk for patients with certain risk factors of AD.

“The few available studies indicate that physical activity in healthy people is an important factor preventing the development of cognitive impairment and AD,” the authors wrote.

Suggestions included:

• Following a Mediterranean-style diet high in vegetables and fish and limited amounts of meat and dairy
• Consider supplementing the patient’s diet with omega-3, B-complex vitamins and vitamin E
• Limit alcohol intake
• Regular physical activity
• Stay socially engaged
• Educate yourself about AD and find support systems
• Engage in activities like Tai Chi and puzzles that stimulate the brain
• Find ways to integrate music into daily life
• Maintain regular sleep patterns
• Manage stress

Drug Therapy
Food and Drug Administration (FDA)-approved pharmacotherapies may improve AD symptoms and possible help slow decline, though none impact the degenerative process occurring in the brain. Promising new drug therapies include:

• ChEIs - including donepezil, galantamine and rivastigmine, these are targeted for mild-to-moderate AD. All three have demonstrated benefits on cognitive function and global clinical status.
• N-methyl-D-aspartate (NMDA) receptor antagonist - the drug memantine has been indicated for moderate-to-severe AD and has demonstrated efficacy on cognition, global function and ADL performance.
• Medical foods - including caprylidene, cerefolin NAC and vayacog, medical foods have all shown the capacity to increase cognitive function in early clinical trials.

Comorbidities
A recent study has shown that in a population of 679 participants with AD, 61 percent had more than 3 additional medical comorbidities and the number was found to increase with advancing dementia severity.

Common medical comorbidities include cardiovascular disease, thyroid dysfunction, sleep apnea, osteoporosis, glaucoma, cancer, falls, depression, infections, anorexia, rheumatoid conditions and incontinence.

“It is important for clinicians to manage conditions co-morbid to AD (Box 2). This can limit cognitive and functional decline and reduce the risk of hospital admission, which can be disorienting, distressing, and lead to medication discontinuation,” Cummings and team wrote.  “Moreover, medical illness and pain are common triggers for agitation or aggression in patients with AD, so early recognition and treatment of comorbid medical conditions can limit neuropsychiatric and behavioral symptoms.”

Further Considerations
The authors also listed factors like financial impacts associated with caring for AD patients including residential care needs and the high cost of AD-therapy drugs. Additionally, patient’s safety when dealing with AD is extremely important as falls and accidents within the home become more prevalent and dangerous.

“Clinicians responsible for patients with AD should pay attention to several areas that may impact well-being, and not only medication,” they concluded.

The team noted that AD can be one of the most challenging chronic conditions to deal with for both patients, families and caregivers.

“Treatment must be individualized for the symptoms, functional status, comorbidities, behaviors, and the psychosocial situation of each patient, and requires regular reassessments for changes in the patient’s and care-giver’s medical, mental, and psychological states,” Cummings et al concluded.