Semin Neurol 2019; 39(02): 227-240
DOI: 10.1055/s-0039-1678581
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current and Future Treatments in Alzheimer's Disease

Alireza Atri
1  Banner Sun Health Research Institute, Banner Health, Sun City, Arizona
2  Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
29 March 2019 (online)

Abstract

The foundation of current Alzheimer's disease (AD) treatment involves pharmacological and nonpharmacological management and care planning predicated on patient-centered psychoeducation, shared goal-setting, and decision-making forged by a strong triadic relationship between clinician and the patient-caregiver dyad. Food and Drug Administration (FDA) approved AD medications, cholinesterase-inhibitors (ChEIs), and the N-methyl-d-aspartate (NMDA) antagonist memantine, when utilized as part of a comprehensive care plan, while generally considered symptomatic medications, can provide modest “disease course-modifying” effects by enhancing cognition, and reducing loss of independence. When combined, pharmacologic and nonpharmacologic treatments can meaningfully mitigate symptoms and reduce clinical progression and care burden. AD pharmacotherapy first involves identification and elimination of potentially harmful medications and supplements. First line treatment for neuropsychiatric symptoms and problem behaviors is nonpharmacological and involves psychoeducation, trigger identification, and implementation, iterative evaluation, and adjustment of behavioral and environmental interventions. Intensive research efforts are underway to develop more accurate and practical AD diagnostic biomarkers and clinical tools and better therapeutics. Ongoing research studies for primary and secondary prevention of AD and clinical trials evaluating symptomatic and disease-modifying treatments in symptomatic AD are directed at diverse therapeutic targets including neurochemicals, amyloid and tau pathological processes, mitochondria, inflammatory pathways, neuroglia, and multimodal lifestyle interventions.

Financial Disclosures

Dr. Atri has no equity, shares, or salary from any pharma company and is not a member of any pharma speakers' bureau. He has received honoraria for consulting, educational lectures/programs/materials or advisory boards from AbbVie, Allergan, Alzheimer's Association, Biogen, Eisai, Grifols, Harvard Medical School Graduate Continuing Education, Lundbeck, Merck, Oxford University Press (medical book-related revenues), Sunovion, Suven, and Synexus. Dr. Atri's institution (Banner Health) has investigational observational study/trial related funding from Novartis. Dr. Atri's previous institution (California Pacific Medical Center) had contracts or received investigational clinical trial related funding from The American College of Radiology, AbbVie, Avid, Biogen, Lilly, Lundbeck, Merck, and vTV.