Fast Five Quiz: Test Your Knowledge on Key Aspects of Alzheimer's Disease

Amy Kao, MD; Helmi L. Lutsep, MD; Aimee L. Pierce, MD; Shaheen E. Lakhan, MD, PhD, MS, MEd


February 09, 2023

Prior to 2021, approved treatments for Alzheimer's disease have been for Alzheimer's dementia only. These treatments target the neurochemical communication pathways involved in learning and memory instead of the disease itself. However, aducanumab, an amyloid beta that has demonstrated to prevent beta-amyloid from forming plaques and also remove them from the brain, has recently been approved for the treatment of early Alzheimer's disease. Patients receiving treatment with aducanumab exhibited significant dose- and time-dependent reduction of amyloid beta plaques, per three large randomized controlled drug trials. Post-FDA approval clinical trials are required to verify whether reduction in amyloid beta plaques translate to clinical benefit.

Secondary symptoms of Alzheimer's disease (eg, depression, agitation, aggression, hallucinations, delusions, sleep disorders) can be problematic. Behavioral symptoms in particular are common and can exacerbate cognitive and functional impairment. These classes of psychotropic medications have been used to treat these secondary symptoms:

  • Antidepressants

  • Anxiolytics

  • Antiparkinsonian agents

  • Beta-blockers

  • Antiepileptic drugs (for their effects on behavior)

  • Neuroleptics

Although the usefulness of ChEIs was originally expected to be limited to the early and intermediate stages of Alzheimer's disease (because the cholinergic deficit becomes more severe later in disease and because fewer intact cholinergic synapses are present), ChEIs can also be beneficial in advanced disease. ChEIs are also beneficial in patients who have Alzheimer's disease with concomitant infarcts and in patients who have dementia with Lewy bodies. Alzheimer's disease and dementia with Lewy bodies is a common form of mixed dementia—a condition sometimes referred to as the Lewy body variant of Alzheimer's disease.

Several studies have demonstrated that memantine, an NMDA antagonist, can be safely used in combination with ChEIs. The combination of treatment with memantine and a ChEI has been shown to treat neuropsychiatric symptoms more effectively than a ChEI alone, and it is suggested that the combination may delay institutionalization.

Learn more about the treatment of Alzheimer's disease.


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