Current Opinion on Treatments for Alzheimers Disease
Current Opinion on Treatments for Alzheimers Disease
There are a number of treatment strategies available for elderly patients suffering from Alzheimer’s disease today. Not all of them are usually considered essential when thinking about dementia and very often patients or their families have to struggle for their right to obtain adequate healthcare and avoid harm. Even though their detrimental effects are well known, benzodiazepines are still over-prescribed in the elderly, while anti-cholinergic substances are inadvertently overused, because a large number of substances with anti-cholinergic side effects seem unsuspicious at first glance.1
The following interventions need to be considered in a patient with neurodegenerative dementia of the ‘Alzheimer type’.
Symptomatic Anti-dementia Substances
The evidence for the modest but measurable efficacy of memantine and the cholinesterase-inhibitors has grown in recent months. There have been four European memantine trials on vascular (or mixed) dementia and three US trials on Alzheimer’s dementia, all of them yielding positive results. The body of evidence regarding the cholinesterase inhibitors donepezil, galantamine and rivastigmine has been the subject of a recent Cochrane analysis with rather positive results.2 Treatment goals and their estimation are still a matter of debate,3 as are the probably useful and beneficial effects of these substances in a severe stage of dementia,4 over a prolonged period of time5 or in the questionable preclinical stage of illness – mild cognitive impairment.
Other Psychopharmacological Support
“There should be support and not suppression over a longer period of time.” This may be one message taken from the deadly conclusion of a recent study on the effects of atypical neuroleptics for the treatment of behavioural disturbances in dementia.6 “Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis, aggression, or agitation in patients with Alzheimer’s disease.” Unfortunately, there is no second sentence explaining that there truly are patients who need to be treated for safety’s sake and that offering traditional medicine (haloperidol, neuroleptics with low potency, other tranquilisers) may put the patients at an increased risk of suffering a stroke and dying. Pharmaceutical companies may lose their interest in elderly patients, who should only receive very low dosages for a very few days. The use of non-anticholinergic antidepressants in apathetic and depressed patients with Alzheimer’s remains under-researched.7
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- Birks J, Cholinesterase inhibitors for Alzheimer’s disease (review), The Cochrane Library, 2006.
- Rockwood K, Fay S, Song X, et al., Attainment of treatment goals by people with Alzheimer’s disease receiving galantamine: a randomized controlled trial, CMAJ, 2006.
- Winblad B, Kilander L, Eriksson S, et al., Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study, Lancet, 2006.
- Winblad B, Wimo A, Engedal K, et al., 3-year study of donepezil therapy in Alzheimer’s disease: effects of early and continuous therapy, Dement Geriatr Cogn Disord, 2006.
- Schneider LS, Tariot P, Dagerman KS, et al., Effectiveness of atypical drugs in patients with Alzheimer’s disease, NEJM, 2006.
- Lyketsos CG, DelCampo L, Steinberg M, et al., Treating depression in Alzheimer’s disease: efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS, Arch Gen Psychiat, 2003.
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- Burn D, Emre M, McKeith I, et al., Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson’s disease, Mov Disord, 2006.
- Hachinski V, Iadecola C, Petersen R, et al., National institute of neurological disorders and stroke—Canadian stroke network vascular cognitive impairment harmonization standards, Stroke, 2006.
- ESPRIT-study group, Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial, Lancet, 2006.
- Mielke MM, Zandi PP, Haematologic risk factors of vascular disease and their relation to dementia, Dement Geriatr Cogn Dis, 2006.
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- Mittelman MS, Haley WE, Clay OJ, et al., Improving caregiver well-being delays nursing home placement of patients with Alzheimer’s disease, Neurology, 2006.
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- Sparks L, Sabbagh MN, Connor DJ, et al., Atorvastatin for the treatment of mild to moderate Alzheimer disease: preliminary results, Arch Neurol, 2005.
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- Landreth G, PPARgamma agonists as new therapeutic agents for the treatment of Alzheimer’s disease, Exp Neurol, 2006.
- Sastre M, Dewachter I, Rossner S, et al., Nonsteroidal antiinflammatroy drugs repress beta-secretase gene promoter activity by the activation of PPARgamma, PNAS, 2006.
- Pedersen WA, McMillan PJ, Kulstad JJ, et al., Rosiglitazone attenuates learning and memory deficits in Tg2576 Alzheimer mice, Exp Neurol, 2006.
- Risner ME, Saunders AM, Altman JFB, et al., Efficacy of rosiglitazone in a genetically defined population with mild-tomoderate Alzheimer’s disease, Pharmacogenomics J, 2006.
- Mudher A, Shepherd D, Newman TA, et al., GSK-3beta inhibition reverses axonal transport defects and behavioural phenotypes in drosophila, Mol Psychiat, 2004.
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- Terao T, Nakano H, Inoue Y, et al., Lithium and dementia: a preliminary study, Prog Neuro-Psychopharmacol Biol Psychiat, 2006.
- Anekonda TS, Resveratrol – a boon for treating Alzheimer’s disease, Brain Res Revs, 2006.
- Anekonda TS, Reddy PH, Neuronal protection by sirtuins in Alzheimer’s disease, J Neurochem, 2006.
- Lacomblez L, Bensimon G, Douillet P, et al., Xaliproden in amyotrophic lateral sclerosis: early clinical trials, Amyotroph Lateral Scler Other Motor Neuron Disord, 2004.
- Mazza M, Capuano A, Bria P, et al., Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer’s dementia in a randomised placebo-controlled double-blind study, Eur J Neurol, 2006.
- Vellas B, Andrieu S, Ousset PJ, et al.,The GuidAge study: methodological issues, Neurology, 2006.
- Dinamarca MC, Cerpa W, Garrido J, et al., Hyperforin prevents beta-amyloid neurotoxicity and spatial memory impairments be disaggregation of Alzheimer’s amyloid-beta-deposits, Mol Psychiat, 2006.
