Medications make gains against Alzheimer's

October 06, 2002|By Jane Glenn Haas | By Jane Glenn Haas,Knight Ridder / Tribune

Scientists don't know why Alzheimer's disease occurs. But they do know what chemicals in the brain are depleted by the disease and that this is important in the area of memory, says Malcolm Dick, senior neuropsychologist at the Institute of Brain Aging and Dementia at the University of California, Irvine.

Before 1989, no drugs helped delay the progress of Alzheimer's.

The first drug, Cognex, was an inhibitor drug but not as successful as people hoped because of liver and stomach problems.

"Only about one-third could take the drug, and maybe one-half to one-third of those patients showed some benefit," Dick says. "So it was not helping a large population."

Aricept (1997) and Excelon (1999) were the first to slow progress of the disease, Dick says. Last year, another drug, Reminyl, came on the market and shows promise.

The drugs inhibit -- or erase -- the effects of the disease, which destroys acetylcholines-terase, the chemical affecting the way brain cells connect, or "talk" to each other.

"The drugs try to prevent the eraser from working," Dick says.

By slowing the progress of Alzheimer's, scientists hope an individual will maintain independence longer, delaying expensive nursing-home care.

As many as 25 percent of patients show improvement on these medications, Dick says. Upward of 60 percent show a slowing of the disease.

"This is why it's important to get an early diagnosis so we can get a patient on these drugs," he says.

A person suspected of having Alzheimer's or some other form of dementia first should have a complete medical work-up to rule out treatable problems, Dick says. If the diagnosis is Alz-heimer's, an inhibitor drug is usually prescribed.

"We also know other ways to slow the disease," he says. "There are studies that show vitamin E might help."

Treatment for some problem behaviors, such as agitation, include anti-psychotic medications. Education and socialization -- with involvement in day care or other programs -- also seems to help, he says.

"If the caregiver learns about the disease and has support or respite help, the patient may stay at home," Dick says. "The treatment plan is multifaceted."

Forgetting names and where items were placed is common in older adults, he says.

"But when memory problems start to interfere with everyday living, that's a red flag something should be done. It could be as simple as depression. It all needs to be looked at before jumping to a conclusion."

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