Do Alzheimer’s drugs like donepezil and memantine slow the disease itself, or mainly help with symptoms?

Donepezil and memantine primarily treat symptoms. Donepezil inhibits acetylcholinesterase, reducing the breakdown of acetylcholine so available signaling lasts longer. Memantine acts on NMDA-type glutamate receptors through a different mechanism. Neither is an amyloid-removing antibody or a cure that replaces lost neurons. Depending on disease stage and individual response, treatment may help maintain cognition or daily function for a time, even though the underlying illness continues to progress.[1]

In the DOMINO trial, people with moderate-to-severe Alzheimer’s disease who continued donepezil had better average cognition and function than those who discontinued it over a year. Memantine also provided benefits on the trial’s scales, but adding it to continued donepezil did not produce a significant advantage over donepezil alone on the primary outcomes. Those findings show why symptomatic treatment can still matter to patients and caregivers. They do not prove disease reversal or justify using these prescriptions as general memory enhancers in healthy people.[2]