Alzheimers Disease: Therapies - Medical Essentials
DRUG TREATMENTS
The symptoms of Alzheimer’s worsen as brain cells die and the connections between cells are lost. Although current drugs cannot alter the progressive loss of cells, they may help minimize or stabilize symptoms. These medications may also delay the need for residential care.
The Senior Alliance notes its gratitude to The Alzheimer’s Society for fighting a high court battle against NICE (National Institute of Clinical Excellence) for refusing advanced Alzheimer’s drugs to early and late stage NHS patients on the basis that they are too expensive at a cost of £2.50 a day and not cost effective. As you’ll see from their website: “The Alzheimer’s Society continues to campaign for drugs to be made freely available to anyone who may benefit from them”.
If and as allowed by NICE, doctor’s have access to a number of drug treatments which can temporarily slow down the progression of Alzheimer’s
symptoms in some people. Aricept, Exelon and Reminyl all work in a similar way and are known as acetylcholinesterase inhibitors. There is also a newer drug, Ebixa, which works in a different way to the other three.
ARICEPT, EXELON AND REMINYL
Research has shown that there is not enough of the chemical ‘acetylcholine’ in the brains of people with Alzheimer’s disease. Acetylcholine is one of the chemicals that nerve cells use to communicate.
Aricept, Exelon and Reminyl prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased acetylcholine lead to increased communication between nerve cells, which may in turn temporarily improve or stabilise the symptoms of Alzheimer’s disease.
Aricept, Exelon and Reminyl work in similar ways. However, Reminyl also appears to act on the nicotinic neuronal receptors in the body, making them release more acetylcholine. As well as stopping acetylcholine breaking down, Reminyl can help more of it to be produced.
It is possible that one of these drugs might suit an individual better than another.
EBIXA (MEMANTINE)
The action of Ebixa is quite different to, and more complex than, that of Aricept, Exelon and Reminyl. Ebixa blocks a messenger chemical, known as a neurotransmitter glutamate. Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer’s disease, which causes the brain cells to be damaged further. Ebixa can protect brain cells by blocking this release of excess glutamate.
Medline Plus says “US research has suggested that a combination of Aricept and Ebixa is more effective than Aricept alone. Although this research is not conclusive, there is little evidence to support a contrary view. Ebixa works in a completely different way from the acetylcholinesterase inhibitors.” Whether doctors will be allowed to prescribe both drugs together on the NHS, is unclear.
At present Aricept, Exelon and Reminyl are only used in people with mild to moderate Alzheimer’s disease. They are not effective for everyone and may
only temporarily improve memory or delay memory loss. Research is ongoing
to find out whether any of these drugs may be effective in the later stages of Alzheimer’s disease. Ebixa, however, can temporarily slow down the progression of symptoms in people in the middle and later stages of the disease. This is the first time a drug has been available for this group of people. There is also a suggestion that Ebixa may slow down the disease process itself.
There are side-effects to be considered with all the drugs used for Alzheimer’s. Side-effects of Ebixa include hallucinations, confusion, dizziness, headaches and tiredness. Caution is also recommended for people with epilepsy and heart problems.
Researchers continue to study drugs that may prevent or slow the progression of Alzheimer’s disease. Nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to treat arthritis, are an example. Very exciting progress has been shown in a study published in the journal Molecular and Cellular Neuroscience and reported in the Guardian on 24 July 2007. This deals with a two-protein mechanism for plaque formation. Most encouragingly, it shows how a third protein may be used to disrupt this mechanism at an early stage. This indicates a way in which Alzheimer’s may be stopped at an early stage and even reversed. So far it looks good in mice, and the years of development seeking to create a viable drug are underway.
OBTAINING EXISTING ALZHEIMER’S DRUGS
NICE has recommended that Aricept, Exelon and Reminyl should be available on NHS prescription for anyone with a diagnosis of Alzheimer’s disease who could benefit from the drug treatment.
In the first instance, these drugs can only be prescribed by a consultant. A GP will need to refer the person to a hospital for a specialist assessment. A consultant will carry out a series of tests to assess whether the person is suitable for treatment and will write the first prescription if appropriate. Subsequent prescriptions may be written by the GP or the consultant.
Private prescriptions can be obtained either through a consultant, a GP or a private hospital. Private prescriptions are subject to consultation fees, prescription charges and dispensing fees, which vary. The current cost of these drugs to the NHS ranges from £800 to £1,000 per patient per annum.
COMMUNITY CARE is available for Alzheimer’s. GETTING AN ASSESSMENT for this and getting all the many forms of help it provides is extremely important. You can speak to your doctor about getting this ongoing support, and be sure to see our section on GENERAL HELP WITH ALZHEIMER’S RELATED PROBLEMS to learn more.
