Americans love what I call the silver bullet approach to medicine," says 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 silver bullets with Alzheimer's."
Still, recent therapeutic treatments and future drug innovations promise to improve patients' quality of life. Early detection and aggressive treatment will help people who have Alzheimer's delay mental decline, Powers says. 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 says.
Who's At Risk?
An estimated 4.5 million Americans have 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 have had the disease typically exhibit sticky "plaques" made of amyloid protein deposits and tangles" that are comprised of a protein called tau. These remain key targets for drug interventions.
But, "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 says.
Today, there are two classes of medicines for treating Alzheimer's. One is cholinesterase inhibitors, which prevent the breakdown of acetylcholine, an important chemical messenger in the brain. This class includes the drugs Aricept (donepezil), Exelon (rivastigmine) and Reminyl (galantamine).
Namenda (memantine), approved in October 2003, is the first drug in a new medication class that appears to work by preventing the excess production of glutamate, an important chemical messenger in the brain that can become toxic in large quantities.
Drugs from each class often are prescribed in combination to lessen symptoms and slow the progression of the disease.
"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]," says Dr. Jacobo E. Mintzer, professor of psychiatry, neurology, physiology and neuroscience at the Medical University of South Carolina and co-director of Alzheimer's Research & Clinical Programs.
Medicines already approved for other conditions may also prove useful. For example, there's evidence linking the use of cholesterol-reducing statin drugs with a decrease in mental decline. Common blood pressure medicines also appear helpful in slowing the mental decline seen in these patients.
Second-generation vaccine research also holds promise, although human testing of early plaque-reducing vaccines was halted because some individuals experienced brain inflammation. "I think eventually we'll work out the vaccines," Powers predicts.
Scientists are learning more about what may be effective in preventing the disease. The new available information suggests that keeping 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 developing dementia," Mintzer says.
Because studies suggest lifestyle factors may influence the risk for Alzheimer's disease, the Alzheimer's Association recommends that people adopt heart healthy habits, such as exercising regularly, watching their fat and cholesterol intake and making sure their weight and blood pressure are in check.
For now, the best advice for preventing Alzheimer's, Powers says, is to stay physically and mentally vital, control depression and hypertension and limit alcohol use. "If we did these things," he says, "then I think we could probably make a real running start at trying to reduce the risk for dementia."
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