Alzheimer's Disease: Understanding Your Treatment Options

Alzheimer’s disease is the most common cause of dementia in the United States. An estimated 7.4 million Americans aged 65 and older are living with Alzheimer’s dementia in 2026 , according to the Alzheimer’s Association. Chances are, you know someone whose life has been impacted by this progressive condition.

Unfortunately, treatment options remain limited. Although several medications are available, they differ in their purpose, effectiveness, and potential risks.

Current medications generally fall into two categories: those that help manage symptoms and those designed to slow the progression of the disease.

1. Medications That Manage Alzheimer’s Symptoms

Several medications are used to help manage cognitive symptoms, such as memory loss and difficulties with thinking and reasoning. While these treatments may provide symptomatic benefits, they do not stop the underlying progression of Alzheimer’s disease.

Cholinesterase inhibitors include Aricept (donepezil), Razadyne (galantamine), Exelon (rivastigmine), and Zunveyl (benzgalantamine). These medications work by increasing the availability of acetylcholine, a chemical messenger involved in memory and learning.

Potential side effects include nausea, vomiting, diarrhea, dizziness, headache, and loss of appetite.

Another medication, Namenda (memantine), regulates glutamate activity in the brain and is used to manage symptoms of moderate to severe Alzheimer’s disease.

Potential side effects include headache, constipation, dizziness, and confusion.

Other medications may be prescribed to address specific symptoms associated with Alzheimer’s disease, including sleep disturbances and agitation related to dementia.

• Belsomra (suvorexant) is approved to treat insomnia. Potential side effects include next-day drowsiness, impaired alertness and coordination, sleep paralysis, and other sleep-related effects. Breathing-related precautions may be important for certain patients.
• Rexulti (brexpiprazole) is approved to treat agitation associated with dementia due to Alzheimer’s disease. It is not specifically approved to treat Alzheimer’s-related psychosis. Potential side effects include weight gain, sleepiness, and dizziness. It also carries a boxed warning regarding an increased risk of death in older adults with dementia-related psychosis.

These medications may help manage selected symptoms, but they do not cure Alzheimer’s disease.

2. Medications Designed to Slow Alzheimer’s Progression

Two medications currently approved in the United States to slow the progression of early Alzheimer’s disease are Kisunla (donanemab) and Leqembi (lecanemab).

Both are administered by intravenous infusion and target beta-amyloid, a protein associated with plaque formation in the brain.

Clinical trials have demonstrated that these medications can slow cognitive and functional decline in certain patients with early symptomatic Alzheimer’s disease. However, they do not reverse the disease, restore lost cognitive abilities, or stop its progression entirely.

What Are the Potential Risks?

Both medications can cause infusion-related reactions, including headache and other symptoms that may range from mild to severe.

A more serious concern is amyloid-related imaging abnormalities (ARIA) , which can include:

• Brain swelling (ARIA-E): Fluid accumulation or swelling in the brain.
• Brain bleeding (ARIA-H): Small areas of bleeding or other blood-related abnormalities in the brain.

Although some cases are asymptomatic, ARIA can sometimes cause serious neurological complications and, rarely, death.

People who carry the APOE ε4 genetic variant, particularly those with two copies, have an increased risk of developing ARIA while taking these medications. Genetic testing and MRI monitoring are important considerations when evaluating treatment eligibility and safety.

Making an Informed Decision About Alzheimer’s Treatment

Choosing an appropriate treatment requires careful consideration of the potential benefits, risks, costs, and individual health circumstances.

Some patients may benefit from medications designed to slow disease progression, while others may prioritize symptom management or require a different approach based on their medical history and risk factors.

 Are you already taking some of these medications and concerned about potential side effects? Have you been prescribed one of these medications and want to better understand your options?

At Valley Integrative Health, we offer early screening, comprehensive assessment, and evidence-informed care for individuals concerned about Alzheimer’s disease and cognitive health.

Our goal is to help patients better understand their health, explore appropriate options, and make informed decisions in collaboration with their healthcare providers.