Alzheimer Disease
Health Page| Diseases and Remedies

Battlefield Alzheimer’s

Alzheimer’s Disease is the most common type of dementia caused by gradual death of neurons (nerve cells) in the brain. It was first described by Alois Alzheimer in 1907. The frequency increases with age, being 0.3 per cent between 60 and 69 yea rs, three per cent between 70 and 79 years and 11 per cent over 80 years of age. Alzheimer’s is becoming more common in India as the life expectancy increases.

The death of neurons seems to be mainly due to deposits of proteins called beta amyloid between the neurons and may also be due to tangles in the neuron. A lot of research into preventing deposition of beta amyloid and formation of tangles is underway. However, the approved drugs for treatment of Alzheimer’s act by modulating the levels of chemicals called neurotransmitters in the brain which help neurons to communicate with each other.

It is important that the diagnosis of Alzheimer’s be confirmed by consulting a physician, neurologist, psychiatrist or geriatrician. Alzheimer’s progresses gradually to a severe stage in around seven years and hence rapidly progressive dementia is likely to be due to another cause. About 10 per cent of cases of dementia have a reversible cause which is completely treatable. It is vital that these should not be missed.

The symptoms of Alzheimer’s are broadly divided into two types — cognitive and behavioural or psychiatric.

Treatment of cognitive symptoms

There are two types of drugs available for treatment of Alzheimer’s. The first group are cholinesterase inhibitors (AChI) and there are three drugs in this class — donepezil, rivastigmine and galantamine. They increase the brain levels of a neurotransmitter called acetyl choline. Unfortunately the effect is mild and these drugs are not useful in the earliest stage of the disease. They are approved for mild, moderate and severe disease. These drugs stabilise the progression of the disease for around twelve months in about half the patients using them. After that the disease starts to worsen again. The drugs are generally well tolerated, the only side effect being nausea, vomiting or diarrhoea in a few. Donepezil is the most widely used and is relatively cheap costing around Rs. 300 per month.

The other approved drug is called Memantine. It blocks a neurotransmitter called NMDA. It is approved for moderately severe Alzheimer’s and again has a modest effect. It can be used along with AchI, is well tolerated and costs around Rs. 600 per month.

Treatment of behavioural and psychiatric symptoms in dementia (BPSD)

All attempts should be made to treat these symptoms without drugs (see “Tips to caregivers”). No drugs are specifically approved by the US FDA for BPSD. However, if the patient is at risk to himself or to others because of violent or dangerous behaviour, he needs to be put on psychiatric medications. The most common medications used are risperidone, haloperidol and quetiapine.

Patients who are apathetic may be depressed and may require antidepressants. Drugs like haloperidol or quetiapine can also be used for intractable sleep disturbance or night time wandering.

Tips to caregivers