Advances in treatment may slow dementia’s progression

Watching a loved one slowly succumb to the memory-robbing illness known as Alzheimer’s disease can be devastating.

Although there’s no known cure for this type of dementia, recent therapeutic treatments and future drug innovations promise to improve sufferers’ quality of life.

“Americans love what I call the silver bullet approach to medicine,” said Dr. Richard Powers, an associate professor at the University of Alabama at Birmingham and director of geriatric psychiatry at the Alabama Department of Mental Health. “There ain’t going to be no silvers bullets with Alzheimer’s.”

Yet, early detection and aggressive treatment will help people with Alzheimer’s delay mental decline, Powers added. Even small improvements - a father who can recognize his son for another year or a mother who maintains urinary continence for a while longer - can provide comfort. “Keeping someone out of the nursing home is a major event for families,” he said.

Meanwhile, new research may further scientists’ understanding of why Alzheimer’s occurs and who is most at risk of developing it. That’s reason to be encouraged this November, which marks National Alzheimer’s Disease Awareness Month.

An estimated 4.5 million Americans are afflicted with Alzheimer’s disease, according to the National Institute on Aging. By 2050, total cases will reach 13.2 million unless new ways to prevent or treat the disease are discovered.

While the exact causes of Alzheimer’s are not fully understood, the brains of people who’ve had the disease typically exhibit sticky “plaques” made of amyloid protein deposits and “tangles” made of another protein called tau. These plaques and tangles, the hallmark of Alzheimer’s, remain key targets for drug interventions.

There’s also a theory that interruptions in brain blood flow may contribute to Alzheimer’s.

“The idea that there’s just a single cause for dementia in the vast majority of individuals is not being substantiated by the pathologists, now that we have better tools for identifying the damage,” Powers said.

Today, there are two classes of medicines for treating Alzheimer’s. One is the cholinesterase inhibitors, which prevent the breakdown of an important chemical messenger in the brain called acetylcholine. This class includes the drugs Aricept (donepezil), Exelon (rivastigmine), and Reminyl (galantamine).

Namenda (memantine), approved last October, is the first drug in a new medication class that appears to work by protecting against the excess production of glutamate, an important chemical messenger in the brain that can become toxic in large quantities.

Today, drugs from each class often are prescribed in combination to lessen symptoms and slow progression of the disease.

Second-generation vaccine research also holds promise, although human testing of early plaque-reducing vaccines had to be halted because some individuals experienced brain inflammation. “I think eventually we’ll work out the vaccines,” Powers predicted.

Medicines already approved for other conditions may also prove useful. For example, there’s evidence linking the use of cholesterol-busting statin drugs with a decrease in mental decline. Common blood pressure medicines also appear helpful in slowing the mental decline seen in these patients, according to a report in the October issue of Neurology.

“The most promising news is the possibility of using multiple compounds that target different elements of the chain of events that results in the development of [Alzheimer’s],” said Dr. Jacobo E. Mintzer. He is a professor of psychiatry, neurology, physiology and neuroscience at the Medical University of South Carolina and co-director of Alzheimer’s Research & Clinical Programs.

Scientists are also learning more about what may be effective in preventing the disease.

“The new available information suggests that to keep an active mental activity schedule, such as doing word games or being involved in creative activities and a healthy lifestyle, can reduce the odds of individuals to developing dementia,” Mintzer said.

“I’m telling all of my old people to take up computers,” Powers added.

And because studies suggest lifestyle factors may influence the risk for Alzheimer’s, the Alzheimer’s Association recommends that people adopt heart-healthy habits, like exercising regularly, watching their fat and cholesterol intake and making sure their weight and blood pressure are in check.

As for ginkgo biloba, a natural substance touted as a potential Alzheimer’s treatment, the National Institute on Aging says there’s no evidence that it will cure or prevent the disease. But some recent case studies suggest is could cause nasty side effects, such as excessive bleeding, particularly in people on daily aspirin therapy.

For now, the best advice for preventing Alzheimer’s, Powers said, is to stay physically and mentally vital, control depression and hypertension, and limit alcohol use.

“If we did these things,” he said, “then I think we could probably make a real running start at trying to reduce the risk for dementia.”