RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

In personal health, a look at progress in Alzheimer's disease. A decade ago, the best doctors could offer Alzheimer's patients and their family was an early diagnosis. There weren't any treatments available. Now, doctors have four medications to choose from, but there's confusion over which drug or combination of drugs works best.

NPR's Patricia Neighmond reports.

PATRICIA NEIGHMOND reporting:

None of the medications cure Alzheimer's, but slowing the speed of the disease's deterioration of the brain is exciting enough to psychiatrist Gary Small. Small directs UCLA's Center on Aging, and has done significant research in Alzheimer's medications.

Dr. GARY SMALL (Director, UCLA Center on Aging): Families will come back and they'll report that the patient seems brighter, he seems more independent. They really observe differences in target symptoms.

NEIGHMOND: Small says after patients take medication for about a month, families report change. One woman noticed her husband stopped asking the question again and again throughout the day. He seemed less agitated and irritable.

Dr. SMALL: Another family, they notice that dad would spend more time with the grandkids, that he would play pool more with the family, which was a lot of fun. And when he got back to familiar activities, that seemed to help him even more.

NEIGHMOND: So there's this sort of synergy, says Small, between getting back to normal routine and the medication. There are basically two classes of drugs now available. One includes three medications. The brand names are Aricept, Exelon, and Razadyne. They work by bolstering a neurotransmitter in the brain that helps brain cells communicate. Dr. Small.

Dr. SMALL: These drugs will increase the amount of that brain messenger, that neurotransmitter, so that there's better cellular communication. They actually benefit memory, other forms of cognition. There have been studies showing that they will even reduce the caregiver burden.

NEIGHMOND: That is, caregivers report having to spend to less time helping Alzheimer's patients once the patient start the medication. The fourth drug, called Namenda, also strengthens the brain's cellular communication system, but it works differently.

Dr. SMALL: This medication, in essence, cuts down on the noise in the communication system so that the signal that is important is able to get through more effectively.

NEIGHMOND: Both types of medication can be taken simultaneously, which can increase their benefit. But Dr. 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 while patients do improve on memory and cognition tests, the improvement is tiny, and that most studies show no meaningful practical change.

Dr. TOM FINUCANE (Geriatric Specialist, Johns Hopkins University ): If you go to the patients and the caregivers themselves, and you say is your life better since you started taking the pill that the doctors are giving you, there's really little or no difference between these drugs and placebo on the ground. That is to say, as far as the quality of life of the patient with the disease or the psychological symptoms of the caregivers, there really is no difference between these drugs and placebo.

NEIGHMOND: And Finucane's concern that the cost, which can be $150 a month, just isn't worth it. For his part, UCLA's Gary Small couldn't disagree more. Doctors have a responsibility to offer patients the best that's available, he says, and right now for Alzheimer's patients, that's one or two of these four medications.

Patricia Neighmond, NPR News.

MONTAGNE: Without a proven effective treatment, the best care for Alzheimer's continues to come from family members. Caregivers can find resources on how to ease an Alzheimer patient's stress, as well as their own at npr.org.

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