Learning More About Alzheimer's

Early diagnosis and combination therapy hold keys to treatment

A dignified elderly woman enjoys a quiet moment in an indoor afternoon setting

by Dee Silver, Neurologist

It’s been 100 years since Alzheimer’s disease was first described by Alois Alzheimer, a German psychiatrist. A century later, as the average age of our population increases and the “Baby Boom” generation approaches the age when the disease becomes more common, we are learning more and more about its diagnosis, symptoms and treatment.

Alzheimer’s disease is characterized by the degeneration or breakdown of the cognitive system. Its symptoms include loss of short-term memory that steadily progresses into impairment of other cognitive functions such as recognition, language and everyday living skills.

The sooner we can diagnose and treat someone with Alzheimer’s disease, the better that person’s quality of life. Treatment can improve symptoms but does not slow down the progression of the disease.

Risk factors and diagnosis

Our goal is to identify people who are at high risk of developing Alzheimer’s disease as early as possible. Age is the greatest risk factor. At age 65, two to three percent of people will develop it. At age 70, that number grows to five to six percent. The risk doubles every five years or so; by age 85, it is a common disease that affects 30 to 40 percent or more of this age group.

Genetics also contribute to one’s risk of Alzheimer’s disease, mainly in patients who develop it at a younger age. Environmental factors likely play a role as well, although we don’t know what that role is. Other diseases (co-morbidities) that add to cognitive impairment and behavior disorders are diabetes, hypertension and stroke. Smoking and excess alcohol also may play a role.

Currently, there is no blood test or laboratory test that we can use to determine whether or not a patient has Alzheimer’s disease. We diagnose it through clinical examination in the office; we’ve found that careful evaluation of the patient’s mental state and a medical history will result in a highly accurate diagnosis.

Often, caregivers, spouses or family member can provide better history than the patients themselves.

Combined therapies for better results

There is no cure for Alzheimer’s disease. However, we have found that using a combination of two types of drugs — acetylcholine esterase inhibitors and glutamate antagonists — can significantly affect the symptoms of the disease.

Taken together, these medications have shown a definite ability to improve a patient’s cognition, behavior, activities of daily living and quality of life.

In addition, these medications may enable patients to delay moving into a long-term care facility, thus allowing them to stay in their own homes longer and save thousands of dollars.

Long-term care facilities for Alzheimer’s patients can cost $4,000 to $6,000 a month; studies have shown that treatment with these mediations can reduce caregiver time by 1 to one and 1.5 hours a day — and delay long-term care placement by 400 to 500 days.

Acetylcholine esterase inhibitors

The first group of medications, acetylcholine esterase inhibitors, was introduced in the early 1990s. Acetylcholine is the active neurotransmitter in the brain that helps send messages from one nerve to another and also helps to encode memories.

In Alzheimer’s disease, the cells that produce acetylcholine slowly deteriorate. Acetylcholine esterase is a naturally occurring substance that breaks down acetylcholine and may interfere with the transfer of messages and memory from one cell to another.

Acetylcholine esterase is inhibited by these drugs, hence allowing more available acetylcholine. These drugs include Aricept (donepezil), Exelon (rivastigmine), and Razadyne (galantamine). Side effects are minimal but include nausea and upset stomach.

Glutamate antagonists

Glutamate antagonists are the second group of medication used in combination therapy and have only been around for a few years. Glutamate is one of the important message transmitters in the brain. When the glutamate receptor is overly stimulated, transmission of messages becomes disrupted.

Glutamate antagonists such as the drug Namenda (mementine) help the glutamate neurotransmitter to function more normally. While Namenda may cause slight confusion and agitation, it also helps to reduce the side effects of the acetylcholine esterase inhibitors.

Along with improving cognition, behavior, activities of daily living, and quality of life, these drugs may also improve symptoms such as hallucinations and paranoia. They help reduce the need for anti-psychotic drugs, thus saving patients money and avoiding serious side effects including seizures, trembling, abnormal movements and rigidity.

Combination therapy is most effective when it is started in the earliest stages of the disease, so early screening and diagnosis is key. If you or a loved one is approaching the age where your risk for Alzheimer’s disease begins to increase, talk to your physician about screening.

This Scripps Health and Wellness information was provided by Dee Silver, M.D., a neurologist at Scripps Memorial Hospital La Jolla.