Alzheimer’s Disease, Essay Example

Abstract

Alzheimer’s disease causes changes in the brain including one that results in “a decrease in the levels of acetylcholine, a chemical messenger that’s believed to be important for alertness, memory, thought, and judgment.” (Mayo Clinic, 2010) Alzheimer’s disease affects many older individuals both in terms of their health and quality of living. Research in this area of study is critically important with the growing number of elderly in the United States to ensure the best treatment possible and to enable these seniors to have the best possible quality of life in their retirement years. The research question addressed in this study is one that seeks to examine treatment options for Alzheimer’s disease and specifically one that asks: What treatments are available for Alzheimer’s disease?

Finding Evidence to Answer a Clinical Question Assignment

Introduction

Alzheimer’s disease causes changes in the brain including one that results in “a decrease in the levels of acetylcholine, a chemical messenger that’s believed to be important for alertness, memory, thought, and judgment.” (Mayo Clinic, 2010) Alzheimer’s disease affects many older individuals both in terms of their health and quality of living. Research in this area of study is critically important with the growing number of elderly in the United States to ensure the best treatment possible and to enable these seniors to have the best possible quality of life in their retirement years.

Research Question

The research question addressed in this study is one that seeks to examine treatment options for Alzheimer’s disease and specifically one that asks:

• What treatments are available for Alzheimer’s disease?

Literature Review on Alzheimer’s Treatment and Medications

According to an article published by the Mayo Clinic staff entitled “Alzheimer’s Drugs Slow Progression of Disease” there is still no known cure for Alzheimer’s disease however, “medication can improve the quality of life for people with Alzheimer’s and their caregivers. It may even delay placement in a nursing home.” (Mayo Clinic, 2010) It is unfortunate that Alzheimer’s medications are not effective for all individuals. In fact, the drugs most commonly used to treat Alzheimer’s works for less than fifty percent of individuals tested. Even those individuals who the medications help experience only “modest and temporary” relief from the progression of the Alzheimer’s disease. (Mayo Clinic, 2010) There are two primary mediations that the Food and Drug Administration has approved for use in treating Alzheimer’s with one of the medications being more effective in the earlier stages of Alzheimer’s disease and the other medication being more effective for the later stages of the disease. The first type of medication is that of the Cholinesterase inhibitor. Cholinesterase inhibitors are a type of drug that makes improvement in the “effectiveness of acetylcholine either by increasing the amount of it in the brain or by enhancing nerve cells response to it.” (Mayo Clinic, 2010)

According to the Mayo Clinic report, these types of medications “lose their effectiveness over time. They work best in the early to middle stages of Alzheimer’s, although they may improve cognition and behavior in people who have moderate to severe Alzheimer’s as well.” (2010) The most common cholinesterase inhibitors are those of: (1) donepezil (Aricept); (2) galantamine (Razadyne); and (3) reviastigmine (Exelon). (Mayo Clinic, 2010)

Donepezil or Aricept is the most commonly prescribed cholinesterase inhibitor as it was the first of these types of medications taken by the patient in a single dose each day and was less likely to produce side effects of a serious nature. This medication is of the nature that temporarily postpones Alzheimer development in individuals with “mild cognitive impairment, (MCI), a memory-related condition that may precede Alzheimer’s.” (Mayo Clinic, 2010)

Galantamine or Razadyne is taken twice each day with food to reduce gastrointestinal side effects or it can be taken in a once a day extended release form. There is a significantly higher rate of death in those who taking galantamine half of which have been linked to heart attacks and strokes. Finally, Rivastigmine or Exelon has more gastrointestinal side effects that other drugs of this type therefore, this medication is prescribed in low dosages. Later stages of Alzheimer’s disease is treated with Memantine or Namenda which works through regulation of the activity of glutamate “a messenger chemical involved in all brain function – including learning and memory.” (Mayo Clinic,2010)

It was reported in a 2008 study that extended treatment with Alzheimer’s disease medication can “significantly slow the rate at which the disorder advanced, and combination therapy with two different classes of drugs is even better at helping patients maintain their ability to perform daily activities. In a large population, study researchers analyzed data on patients treated at the MGH Memory Disorders Unit since 1990. Included were 144 who received no pharmaceutical treatment, 122 who received a Cholinesterase inhibitor alone and 116 who received both a Cholinesterase inhibitor and memantine. Patients were assessed every six months on both their cognition abilities and their carrying out of daily activities. Results are stated to show that there were “significant differences in the rate of symptom progression among all three groups – with the smallest level of decline in those receiving combination therapy.” (Science Daily, 2008) According to a report published by UC Davis Alzheimer’s Disease Research Center five prescription medications are currently approved by the FDA for treating Alzheimer’s disease including two not reported by the Mayo Clinic and specifically that of: (1) Cognex or tacrine; and (2) Namenda (memantine). (2010)

As of the present, researchers have not discovered the precise cause of Alzheimer’s and the medications available for treating the disease are limited in their effectiveness. Switching cholinesterase inhibitors in older adults with dimension is reported to be “a reasonable option in cases of intolerance of lack of clinical benefit.” (Massoud, Desmarais, and Gauthier, 2010) Mamantine is reported to have been discontinued for use in nursing home residents with Alzheimer’s however, when compared to continuous treatment discontinuation of the drug resulted in worsening of the individual with Alzheimer’s “cognition and mood”. (Hofbauer, et al, 2010)

Prevention of dementia, and specifically prevention of Alzheimer’s disease, presents a major challenge for researchers and clinicians alike and it is reported by Barak and Aizenberg (2010) that the “mixture of evidence, observations and hypotheses in the current literature is categorized into four avenues for possible preventive interventions which include those of: (1) antihypertensive medications; (2) nutrition; (3) cognition engagement; and (4) physical activity.”

Selection of Articles for Review

A search of the literature conducted in the PubMed database using the search term ‘Alzheimer’s Disease medications’ yielded 1924 articles listed by date of publication. The top six articles were evaluated for determining the most up-to-date information available concerning medications used in treating Alzheimer’s disease. Google was also searched using the same term to access any very recent reports and information relating to medications used in treating Alzheimer’s disease.

Summary and Conclusion

There is presently much left unknown about the causes of Alzheimer’s disease. Medications used to treat Alzheimer’s are used variously and in combination with one another to establish and maintain the best cognitive effect and for assisting the individual in performing their routine daily activities successfully. More research is needed in precisely what causes Alzheimer’s disease and for determining what medication or medications are most successful in treating Alzheimer’s disease.

References

Alzheimer’s Disease Medication Fact Sheet (2010) UC David Alzheimer’s Disease Research Center. Martine and Sacramento. Retrieved from: http://alzheimer.ucdavis.edu/faq/drugs.php

Barak, Y. and Aizenberg D. (2010) Is Dementia Preventable? Focus on Alzheimer’s Disease. Expert Rev Neurother 2010. Nov 10(11): 1689-98. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed

Benefit of Combination Therapy for Alzheimer’s Disease Confirmed (2008) Science Daily. 23 Sept. 2008. Retrieved from: http://www.sciencedaily.com/releases/2008/09/080922122510.htmAlzheimer’s Drugs

Hofbauer, F.H., et al (2010) Memantine Discontinuation and the Health Status of Nursing Home Residents with Alzheimer’s Disease. J Am Med Dir Assoc. 2010 Nov, 11(9): 636-644. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed

Massound, F., Desmarias, JE, and Gauthier, S. (2010) Switching Cholinesterase Inhibitors in Older Adults with Dementia. Int. Psychogeriatr 2010 Nov 3:1-7. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed

Slow Progression of Disease (2010 )Mayo Clinic. Retrieved from: http://www.mayoclinic.com/health/alzheimers/AZ00015