Alzheimer’s Treatment
Come Relax and ReThink
Alzheimer’s Disease
Alzheimer’s Disease (AD) is the most common form of dementia. An estimated 26.6 million people worldwide had Alzheimer’s in 2006; this number may quadruple by 2050.
In the early stages, the most commonly recognized symptom is memory loss, such as difficulty in remembering recently learned facts. As the disease advances, symptoms include confusion, irritability and aggression, mood swings, language breakdown, long-term memory loss, and the general withdrawal of the sufferer as their senses decline. Gradually, bodily functions are lost, ultimately leading to death. The mean life expectancy following diagnosis is approximately seven years.
The cause and progression of AD are not well understood. Research indicates that the disease is associated with plaques and tangles in the nerve cell bodies of the brain. Currently-used pharmaceutical treatments offer a small symptomatic benefit; no treatments to delay or halt the progression of the disease are as yet available.
Alzheimer’s Disease Prevention
At present, there appears to be no definitive evidence to support the belief that any particular measure is effective in preventing AD. However, epidemiological studies have proposed relationships between certain modifiable factors, such as diet, cardiovascular risk, pharmaceutical products, or intellectual activities among others, and a population’s likelihood of developing AD.
Diet
The components of a Mediterranean diet, which include fruit and vegetables, bread, wheat and other cereals, olive oil, fish, and red wine, may all individually or together reduce the risk and course of Alzheimer’s disease. Several vitamins such as B12, B3, C, and folic acid have been found in some studies to be related to a reduced risk of AD but other studies indicate that they do not have any significant effect on the onset or course of the disease and may have important secondary effects. Curcumin from the curry spice turmeric has shown some effectiveness in preventing brain damage in mouse models.
Cardiovascular Risk
Although cardiovascular risk factors, such as hypercholesterolemia, hypertension, diabetes, and smoking, are associated with a higher risk of onset and course of AD, statins, which are cholesterol lowering drugs, have not been effective in preventing or improving the course of the disease. However long-term usage of non-steroidal anti-inflammatory drug (NSAIDs), is associated with a reduced likelihood of developing AD in some individuals.
Intellectual Activities
Intellectual activities such as reading, playing board games, completing crossword puzzles, playing musical instruments, or regular social interaction may also delay the onset or reduce the severity of Alzheimer’s disease. Bilingualism is also related to a later onset of Alzheimer’s. Some studies have shown an increased risk of developing AD with occupational exposure to magnetic fields, intake of metals, particularly aluminum, or exposure to solvents.
Limited Success of Standard Alzheimer’s Disease Treatments
We have made very little progress in the treatment of Alzheimer’s Disease. Standard treatments, such as donepezil (Aricept) and memantine (Namenda), accomplish very little with regards to improving quality of life in these unfortunate individuals. Similarly, research and development by the pharmaceutical industry has not yielded any “home runs.” We have spent many years and many dollars developing drugs to target amyloid beta plaques with little success.
Recently, the FDA approved lecanemab (Leqembi) for the treatment of Alzheimer’s disease. The results showed that lecanemab successfully removed amyloid and tau proteins from the brains of people living with early Alzheimer’s disease. For the people taking lecanemab, this meant that the decline in their thinking and memory skills was slowed down by 27%. It also slowed down the decline in quality of life by up to 56%.
Donanemab is the most recent of the immunotherapy drugs targeting amyloid beta, as it successfully leads to the removal of amyloid from the brain. In May 2023, the company reported its Phase III study showed the drug could slow the pace of Alzheimer’s disease by 35%. In July 2023, results from 1,736 people treated with donanemab showed slowing of Alzheimer’s progression at 76 weeks, with 24% of the people, however, displaying cerebral edema.
Yet, the best we have been able to do is to slow down the rate of cognitive decline; not stop the decline nor reverse it. There are a growing number of scientists that are challenging the buildup of insoluble plaques of beta-amyloid as the cause of Alzheimer’s disease. Many people with amyloid plaques have no symptoms of dementia, and treatments aimed at slowing the buildup of plaques have shown no effect on reversal of the disease process.
Is There a Solution?
So, what is the solution to this problem called Alzheimer’s Disease? What if I substituted Alzheimer’s Disease for the word “Cancer;” or substituted any other chronic disease? With chronic diseases, there is typically not a single drug or a single modality that will successfully treat or manage the disorder. The disorder must be treated with multiple modalities.
Therapeutic Plasma Exchange (TPE)
Alzheimer’s Management by Albumin Replacement (AMBAR) study: At 14 months, participants in the TPE-treated group vs the placebo group experienced significantly less decline.
Importantly, there was a statistically significant improvement in quality of life (QoL) measured by a self-reported questionnaire among patients with mild-AD from baseline to 14 months among the TPE-treated groups compared with the control group. A self-reported improvement was not seen among patients with moderate-AD, although an improvement in QoL was reported by caregivers among this population, perhaps suggesting diminished awareness of cognitive and functional impairments in the moderate-AD group.