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Drug Treatments for Alzheimer's Disease Can Improve Patients' Lives Improvements temporary; drugs cannot stop progression of disease
Using drugs to treat Alzheimer's disease (AD) can temporarily improve the cognitive ability of patients, but do not slow the progression of the disease, according to Peter J. Whitehouse, M.D., Ph.D., Director, Alzheimer's Center, University Hospitals of Cleveland, Ohio.
"Through the development of drugs and innovations in care programs, we are learning how to improve the quality of life for patients and caregivers," says Dr. Whitehouse.
For example, Dr. Whitehouse says an AD drug can allow a patient to use the telephone, help around the house or do their hobbies, instead of being inactive.
Dr. Whitehouse made his comments today at an American Medical Association media briefing in New York on AD. About four million Americans have AD, which is the fourth-leading cause of adult death in the U.S. It occurs in nearly half of people who are over 85-years old.
There are currently two drugs in the U.S. approved for use by AD patients: tacrine and donepezil. Both are used to improve daily functioning and cognitive thinking abilities. They work by inhibiting the breakdown of acetylcholine, a brain chemical vital for nerve cells to communicate with each other. The longer acetylcholine stays in the brain, the better memory function is.
The two drugs work essentially the same way, although donepezil and tacrine differ somewhat on the enzymes they affect in the brain and body. Tacrine can affect related chemicals throughout the body, which can cause side effects, including liver toxicity, which requires blood tests every couple weeks. The main side effects with donepezil include nausea and diarrhea.
But Dr. Whitehouse adds that the effectiveness of the drugs varies in patients. "Some people will argue that the benefits are pretty modest. On an objective assessment scale, the average patient improves by about the same amount that performance would deteriorate in four to six months of disease progression. So arguably, it's not a small amount, but it's not really getting people back to where we want them to be."
Dr. Whitehouse says that researchers are uncertain how long the drugs can benefit patients, but some long-term studies have indicated that the drugs can be effective and provide improvements for patients for several years.
The FDA has developed standards that the drugs must meet, including improving thinking abilities (memory, attention and language). The improvement must also be clinically measurable and meaningful.
Dr. Whitehouse says there will be more drugs available to treat secondary AD symptoms such as paranoia and depression, and also to treat the primary symptoms. "Medications are being developed that might actually preserve the health of nerve cells--that is prevent the cells from dying. More drugs are needed to improve symptoms, but a more fundamental level of therapy is needed to slow the death of cells."
Dr. Whitehouse expects more AD drugs to be approved in the next several years.
Editor's Note: Dr. Whitehouse is a consultant and receives grants and speaking fees from several pharmaceutical companies, including Eisai Inc. and Pfizer Inc.
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For more information: contact the AMA's Jim Michalski at 312/464-5785. email: [email protected]
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