Treatment of Alzheimer’s disease

Abstract

Alzheimer’s disease is the most common, irreversible, progressive neurodegenerative disease of the central nervous system leading to dementia. Despite very intensive and multidirectional research efforts toward finding an effective form of therapy, the current approach remains primarily focused on symptomatic treatment. The effectiveness of procognitive drugs (acetylcholinesterase inhibitors and memantine) is limited to a minor contribution to improving cognitive abilities, but the drugs do not stop or slow the progression of the disease. Laboratory experiments and clinical trials conducted on the efficacy of monoclonal antibodies against various forms of beta-amyloid, the deposits of which are found in large amounts in the brains of people with Alzheimer’s disease, have led in recent years to the registration by the US Food and Drug Administration of two drugs (aducanumab and lecanemab) that potentially modify the course of the disease in patients with mild cognitive impairment or in the early stages of Alzheimer’s dementia. The efficacy of both antibodies in clinical trials, however, fell far short of the expectations that were anticipated at the trial design stage. Evaluation of lecanemab by the European Medicines Agency is expected in the coming months. Dementia in Alzheimer’s disease, in addition to cognitive decline, is also associated with the presence of behavioural and mood disorders. Their treatment involves a number of drugs, originally approved for other indications, whose efficacy in dementia varies. This article discusses current pharmacotherapy options for treating cognitive and behavioural disorders in patients with dementia in Alzheimer’s disease.