Alzheimer’s Disease

What potential new treatments are being researched?

A number of new drugs are being tested to see if they prevent AD, slow the disease, or help reduce symptoms. Some ideas that seem promising turn out to have little or no benefit when they are carefully studied in a clinical trial.

Mild Cognitive Impairment.

During the past several years, scientists have focused on a type of memory change called mild cognitive impairment (MCI), which is different from both AD and normal age-related memory change. People with MCI have ongoing memory problems, but they do not have other losses such as confusion, attention problems, and difficulty with language. The NIA-funded Memory Impairment Study compared donepezil (Aricept), vitamin E, or placebo in participants with MCI to see whether the drugs might delay or prevent progression to AD. The study found that the group with MCI taking the drug donepezil were at reduced risk of progressing to AD for the first 18 months of a 3-year study when compared with their counterparts on placebo. The reduced risk of progressing from MCI to a diagnosis of AD among participants on donepezil disappeared after 18 months, and by the end of the study, the probability of progressing to AD was the same in the two groups. Vitamin E had no effect at any time point in the study when compared with placebo.

Communication Difficulties: Assessment and Interventions

Della Frazier-Rios, RN, MS; Cora Zembrzuski, APRN, MSN, CS, PhD (cand.)

Why
Dementia impairs a person's ability to communicate effectively. It reduces the ability to decode and understand information (receptive language) and the ability to encode and therefore express information (expressive language). Ability to mediate actions through internal speech is also reduced, thus decreasing the person's capacity to plan and problem-solve. These language deficits are compounded by other dementia-related impairments, including memory loss, decreased attention span, and impairments in judgment, insight, abstraction, and visuospatial abilities. The combination of language deficits and other dementia-related impairments result in serious communication difficulties for older adults with dementia. The hospital setting, with its unfamiliar faces and routines, and the effects of acute illness, often exacerbate these difficulties. As a result, hospitalized older adults with dementia may be unable to understand explanations, follow directions, report symptoms and needs, ask for help, or develop and maintain relationships with staff that would support their acceptance and cooperation with treatment and care. These problems have profound implications for patient care and outcomes when the patient is hospitalized.

The newer antipsychotics have shown significant results with people diagnosed with schizophrenia or have other signs of psychoses.
Many people with dementia, especially late stage Alzheimer's disease show signs of dementia, such as agitation, aggression, hallucinations, and delusions. Therefore, one might anticipate that these antipsychotic drugs might also be a God-Sent to not only these people, but their caretakers.

Drug treatments specific for Alzheimer's Disease (AD) have been on the market since 1993 (NOTE: The first drug had too many liver side effects, and is no longer used). These drugs are mainly cholinesterase inhibitors (CI). That is a big name, with a simple definition: a chemical, acetylcholine, is needed for cognitive abilities to take place; i.e. memory, language, orientation. In AD the amount of acetylcholine over time is eliminated, as the cells that manufacture this chemical are destroyed. With a CI, additional acetylcholine can be manufactured.

A research study which ran from 1998 to 2004 studied approximately 2000 people of Medicare Age. Results of their study indicated that three cognitive domains improved with training: Memory, Speed of Processing, and Reasoning.

For the full report, go to the Consumers Reports.pdf

The medicines used to slow mental decline in people with Alzheimer's disease are not particularly effective. When compared with a placebo, only 10 to 20 percent more people taking an Alzheimer's drug seem to benefit at all. And it is the rare person who has a significant delay in the worsening of their symptoms over time.

A new study from the University of California, Los Angeles offers a four-step plan to improve your memory with noticeable changes in just two weeks.

How might vitamin E supplements benefit a person with Alzheimer’s disease?

The normal cell function termed “oxidative metabolism” results in byproducts known as free radicals. Free radicals are highly reactive compounds that quickly “attack” other cell substances, causing damage to the cell wall, metabolic machinery, and genetic material (DNA). The cells have natural defenses against this damage, which include the antioxidants vitamins C and E, but with age some of these protective mechanisms decline. Brain cell damage caused by free radicals may play a role in Alzheimer’s disease.

Information about memantine from the Alzheimer's Association Fact Sheet:

What is memantine?

Memantine is a drug approved in October 2003 by the U.S. Food and Drug Administration (FDA) for treatment of moderate to severe Alzheimer’s disease. Forest Laboratories Inc., memantine’s U.S. developer, markets the drug under the trade name Namenda. Memantine was first approved in Germany for treatment of various neurological disorders in 1982, where it is marketed by Merz + Co. as Axura. Since 2002, it has been approved in the rest of the European Union, where it is marketed by Lundbeck as Ebixa.

Fact Sheet: About FDA-approved cholinesterase inhibitors

What are cholinesterase inhibitors?

Cholinesterase (KOH luh NES ter ace) inhibitors area a class of drugs approved by the U.S. Food and Drug Administration (FDA) to treat cognitive symptoms of mild to moderate Alzheimer’s disease (symptoms affecting memory and other thought processes). Three cholinesterase inhibitors are commonly prescribed: donepezil (Aricept), approved in 1996; rivastigmine (Exelon), approved in 2000; and galantamine (approved in 2001 under the trade name Reminyl and renamed Razadyne in 2005). Tacrine (Cognex), the first cholinesterase inhibitor, was approved in 1993, but is rarely prescribed today because of associated side effects, including a risk of liver damage.