Jan. 7, 2003 -- A class of drugs used to slow the loss in memory and thinking ability caused by Alzheimer's disease may also help reduce problems in everyday activities such as dressing and bathing, as well as the depression, hallucinations, and delusions suffered by most patients.
In the brains of Alzheimer's patients, levels of a brain "messenger" called acetycholine are low due to loss of cells that specialize in memory and thinking. Drugs called cholinesterase inhibitors help prevent the breakdown of this messenger -- thus increasing levels of the chemical. Four such drugs have been approved by the FDA for use in the U.S. -- Reminyl, approved in 2001; Exelon, approved in 2000; Aricept, approved in 1996; and Cognex, approved in 1993, but rarely used now because it can cause liver problems. These drugs have been shown to modestly slow memory loss in about half of patients.
But now, researchers suggest these drugs may do even more for Alzheimer's patients. In reviewing 29 studies, they report that treatment with one of these drugs for at least one month slowed the worsening of functional skills such as the ability to dress, bathe and shop. And it improved psychiatric symptoms including depression, hallucinations, delusions, anxiety, and apathy. Their findings are reported in the Jan. 8 issue of TheJournal of the American Medical Association.
These functional problems eventually occur in all Alzheimer's patients, who include about 4 million Americans. Nearly 80% also suffer these psychiatric symptoms at some point.
"The message of this finding is that the current medications used to treat Alzheimer's disease are effective in improving the quality of life for people with Alzheimer's," says Bill Thies, PhD, spokesman for the Alzheimer's Foundation. "They do not stop the progression of the disease, but can be extremely valuable in affecting some of the symptoms. Basically, this finding suggests that other researchers have said, that people with Alzheimer's disease probably should get a trial on one of these medications."
The study is among the first to compile previous clinical trials to measure how these drugs impact the "secondary" symptoms that greatly impact those with Alzheimer's and their families. The researchers reviewed more than 3,000 articles and studies dating back to 1966 that examined various drug treatments for Alzheimer's, and then honed in on the 29 studies that looked at these four drugs.
These drugs are likely used mostly to treat the memory problems of Alzheimer's, but there is a lot of talk on whether they might be useful for the behavioral and functional impairment that occurs with the disease, lead researcher Nhi-Ha Trinh, MD, MPH, tells WebMD. "And based on our study, it definitely gives the impression that these drugs could be helpful."
In her study, researchers noted small but significant improvements from the use of cholinesterase inhibitors, compared with patients taking a placebo. By no means do the drugs stop progression of the disease, but if patients are beginning to have problems -- for instance, in dressing themselves -- their use might slow the downhill spiral by weeks or months, says Trinh.
Alzheimer's symptoms typically worsen over time, as more brain cells die and the connections between cells are lost. Cholinesterase inhibitors, which work on minimizing or stabilizing thought function, typically produce only minor side effects such as stomach pain, but may also lower blood pressure.