A decade ago, the best that doctors could offer Alzheimer's patients and their families was an early diagnosis. Today, doctors have four medications to offer, but there's no agreement on how helpful those drugs are.
None of the medications cure Alzheimer's. But slowing the speed of the diseases' deterioration of the brain is exciting enough to psychiatrist Gary Small, who directs the University of California, Los Angeles Center on Aging, and has done significant research in Alzheimer's medications.
"The families will come back and say the patient seems brighter, more independent," says Small. "They really notice differences in target symptoms."
Small says that after patients take medication for about a month, families report changes. One woman noticed her husband stopped asking the same question again and again, and seemed less agitated and irritable.
Another family noticed that dad would spend more time with the grandkids and would play pool more often with the family. Returning to these fun and familiar activities seemed to help him more.
There's a synergy, says Small, between getting back to a normal routine and the medication.
There are basically two classes of drugs now available. One includes three medications, sold under the brand names Aricept, Exelon and Razadyne. They work by bolstering a neurotransmitter in the brain that helps brain cells communicate.
"These drugs will increase the amount of that brain messenger or that brain transmitter, so that there's better cellular communication," says Small. "They actually benefit memory and other forms of cognition. There's been studies showing they'll even reduce the caregiver burden."
Caregivers report having to spending less time helping Alzheimer's patients once the patients start the medication. The fourth drug, Namenda, also strengthens the brain's cellular-communication system, but it works differently. It essentially cuts down on the "noise" in the brain's communication system so signals get through more effectively.
Both types of medication can be taken simultaneously, which can increase their benefit. But Small cautions that the benefit, while noticeable for certain patients and their families, is small.
Geriatric specialist Tom Finucane agrees. Finucane teaches at Johns Hopkins University School of Medicine. He says that although patients do improve on memory and cognition tests, the improvement is tiny, and most studies show no meaningful, practical change.
Finucane's patients and their caregivers haven't reported a difference, he says.
"There really is no difference between these drugs and placebo." And he's concerned that the cost -- which can be $150 a month -- just isn't worth it.
For his part, Small couldn't disagree more. Doctors have a responsibility to offer patients the best that's available, he says, and right now, that's one drug from each class.