ALZHEIMERS UPDATE
For the nearly 4 million Americans with Alzheimer's disease, prospects of a dramatic turnaround are, for the moment, dim. Certain drugs may stall the disease for several months, but all doctors really can do is ease some of the confusion and burden that accompany a patient's declining mental state, which is eventually fatal. But some doctors and families are attempting to fight the memory-robbing disorder with more and more drugs, and in some instances, they are intervening before the disease even strikes.
Dr Jeffrey Grossberg is one who contends that it's time to try something new. He recommends that his Alzheimer's patients take a combination of three or four drugs, not unlike the so-called drug cocktails used to combat AIDS. His particular regimen calls for patients to take one of two available Alzheimer's prescription drugs plus vitamin E and a low dose of aspirin each day. Women with Alzheimer's should also take estrogen therapies, he says.
"Hey, What Have We Got to Lose?'
Some doctors may prescribe an additional antiinflammatory drug, like ibuprofen or the new COX-2 inhibitors, but Dr. Grossberg, a professor of psychiatry at St. Louis University and veteran Alzheimer's researcher, claims there's not enough evidence in favor of these treatments. "Combination therapy is something that should be done until we know more," says Dr. Grossberg. "There's no hard-core prospective data on it, but hey, what do we have to lose?" Many doctors are not convinced that combining treatments is currently the way to go. "No one really knows if they work independently, let alone in combination," says Dr. Mary Sano, PhD, a professor at Columbia University who conducted the only rigorous study testing the effect of vitamin E on Alzheimer's patients. Many doctors are not convinced that combining treatments is currently the way to go.
Indeed, experts say only prescription drugs known as cholinesterase inhibitors have a proven a track record against Alzheimer's. But the limited effect of these drugs has prompted some to take a more aggressive approach. Along with calls to combine treatments with standard Alzheimer's medications, there is a growing interest in adding herbal remedies, including ginkgo biloba and two newly introduced memory aids, huperzine A and SAMe (S-adenosyl-methionine).
Preventive MedicationAccording to
a survey of nearly 100 people who took care of a loved one with
Alzheimer's, more than half said they tried at least one
alternative treatment to improve the patient's memory. And the
efforts do not stop there. Some doctors suggest that patients who
probably have Alzheimer's should start treatment before they are
actually diagnosed with the disease, out of fear of missing a
crucial time to intervene. Even those who may simply be at a
greater risk for Alzheimer's are increasingly prodded into taking
medications to prevent future memory problems. "These are
attractive possibilities, but people are just doing it on their
best guess," says Dr. Bill Thies, vice president of medical
and scientific affairs at the Alzheimer's Association. "There
are doctors who may say to their patients, 'I don't know if this
treatment will work, but I don't think it can hurt.'" To be
sure, most doctors steer their patients away from untested
therapies, which can be costly ventures with little known benefit.
Some of these treatments appear safe when used for a short time,
but there are still questions about possible long-term danger,
especially when taken in high doses with other drugs.
Treatment--Not Just a Laundry List"Treatment for these
patients should not be a laundry list of any therapy suggested in
an article or ad, on the grounds that it can't hurt," says
Dr. Claudia Kawas, a neurologist at Johns Hopkins. "As I
tell patients and their families, if you think these compounds
are potent enough to do some good, you need to appreciate that
they can be potent enough to do harm, particularly in combination."
Still, experts are quick to point out that combination approaches
are worthy of clinical study. Recent findings suggest that
inflammation and oxidative stress add to the brain destruction of
Alzheimer's, making antiinflammatory drugs and vitamin E, a
potent antioxidant, obvious choices for experiments. "Any
time you have drugs with a different mechanism of action there is
the possibility they may work in combination," says Dr.
Thies of the Alzheimer's Association.
Experts are quick to point out that combination approaches are worthy of clinical study.
Even more far-reaching are attempts to prevent the memory disorder altogether. The National Institutes of Health (NIH) is underwriting a large-scale study to determine if treatments can reduce the chances of developing Alzheimer's in those who suffer from mild cognitive impairment, a less disturbing memory condition that may lead to dementia. Researchers will test whether vitamin E or the Alzheimer's drug Aricept (generic name donepezil) can protect patients from further decline.Prevent No. Forestall Maybe
"It's an overstatement to say we can prevent the disease," says Dr. Ronald Peterson, of the Mayo Clinic and lead investigator for the NIH study. "But if we intervene early enough we may be able to forestall it, or slow its progress."For women, estrogen therapy is another prevention possibility. In a report published in the Journal of the American Medical Association, researchers found that studies generally show that women who undergo hormone replacement therapy have a 30% lower chance of developing Alzheimer's compared to those who don't. Given the potential for breast cancer and other well-known problems with estrogen therapy, most doctors remain cautious about prescribing hormones to prevent memory loss.
Two major studies, which will test estrogen on thousands of women at risk for Alzheimer's, are expected to resolve the controversy, although the results won't be available for 4-6 years.That is not to say that people should sit by and do nothing to keep their memories intact. Recent studies point to specific lifestyle measures that might help keep older people mentally fit, like exercising or eating a proper diet to bolster the heart. Researchers from Harvard, for example, found that socially active senior citizens showed a slower rate of mental decline than did seniors who had fewer contacts with others. A greater interaction with family and friends may mean lower stress and more intellectual stimulation, which can help boost brainpower. Moreover, a high level of education and mentally demanding jobs appear to promote greater brain reserve. These factors may not prevent memory disorders outright, but they may offset mental deterioration.
