Alzheimer disease is a progressive neurodegenerative disease that is characterized by memory loss, cognitive decline, and eventually, functional impairment. The disease’s progression is viewed by experts as a continuum, and defined as mild cognitive impairment in addition to mild, moderate, and severe stages of dementia. The pathological process of the disease—which involves amyloid-beta (amyloid-ß), a protein that accumulates into plaques within the brain, and tau deposition within the brain—can begin about 10 to 20 years prior to observable signs or symptom onset.1
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For patients with Alzheimer disease, their health care professionals may prescribe them a treatment to slow the progression of their cognitive decline. These treatments work by undermining the biology of the disease’s process, targeting amyloid-ß at different stages of plaque formation. Other treatments indicated for mild to moderate Alzheimer disease help decrease the breakdown of acetylcholine and support communication between nerve cells. Although these medications have demonstrated efficacy, some patients may need additional support to see improvement in their symptoms or reductions in disease progression.1,2
Certain patients or their caregivers may not observe significant improvement in cognitive impairment symptoms, leading health care providers and pharmacists to make other recommendations for additional support. One option that may benefit patients is brain supplements. Prevagen (Quincy Bioscience)3 is a dietary supplement and the only product formulated with the ingredient apoaequorin. Additionally, it has been tested in clinical trials to be safe for patients and is the top recommended memory supplement by pharmacists, according to a Pharmacy Times survey of Pharmacists’ OTC Recommendations.1-3
Other supplements, in addition to Prevagen, include ginkgo biloba, omega-3 fatty acids, vitamin E, curcumin, B vitamins, and even probiotics.4,5 Although some trials on natural products have shown modest effects on the prevention of cognitive decline or dementia, experts note that further research is needed to confirm these findings and gather additional evidence.4,5
In addition to supplement recommendations, pharmacists may also recommend or assist patients in the following nonpharmacological changes1,2:
- A brain-healthy lifestyle can help counter Alzheimer symptoms or cognitive decline (e.g. remaining physically and socially active, eating well, managing stress, and challenging the brain)
- Cognitive behavioral therapy, which may support patients as they adjust to their diagnosis (as well as mental health symptoms that may worsen because of a diagnosis) and future planning
- Music therapy, which can aid in patients’ abilities in communication, coordination, expression, and socialization
- Memory- and orientation-based exercises, such as art therapy, aromatherapy, and contact with animals, which may help delay mental ability loss
- Nutritional interventions, including adjustments in diet (e.g. intermittent fasting6), can help with cognition and function
- Environmental modifications can encourage creative solutions to dementia and memory loss symptoms
- Caregiver training for family members, which can help as they adjust to their family member’s diagnosis and learn how to help them
Because pharmacists are health care professionals who frequently interact with patients, they can be key in the detection of Alzheimer-related symptoms, as well as educating and advocating for further interventions. Pharmacists may serve as early screening and identification of mild cognitive impairment or other symptoms (e.g., changes in behavior, memory, or mood) through interactions and can recommend patients seek additional care, whether it is through diagnostic testing or appointments with memory specialists, neurologists, and primary care offices. Additionally, because seeing these specialists may be difficult for patients, a pharmacist’s ability to detect such signs can be crucial to early intervention.1,2
Further, pharmacists can also ensure that patients are receiving correct medications and that there are no potential drug-drug interactions with their treatments and supplements. Additionally, they can provide patients with guidance on their drugs, potential adverse events (as well as how to recognize them), and address concerns as they arise.1,2
Pharmacists can also collaborate with other health care professionals, specialists, and insurers. Additionally, they may help patients interpret biomarker test results and communicate them with patients, making information to patients more accessible. They can provide patients with lifestyle adjustments1,2 and supplements4,5—such as Prevagen3—and provide additional accessible resources to both patients with Alzheimer disease and their caregivers.1,2