Vanishing Minds
New research is helping Alzheimer's patients cope--and hope
Getting it later, not sooner, would be an improvement, of course. For many people, a condition called mild cognitive impairment, or MCI--you forget things regularly, but your judgment and reasoning are intact--is a precursor to Alzheimer's. So Ronald Petersen of the Mayo Clinic took about 750 people with MCI and put some of them on Aricept, a common Alzheimer's drug, and some on a placebo. At first, he reported in Philadelphia, fewer people in the Aricept group developed Alzheimer's. Unfortunately, the rates evened out at the end of an 18-month period, so Petersen described the study as encouraging but no more than "a foot in the door."
Disappointment. It was also a small boost for Aricept, which works by limiting the destruction of a neurotransmitter, acetylcholine, in the brain. It's the most frequently prescribed Alzheimer drug, but a recent study in the medical journal Lancet questioned its value. After following over 500 Alzheimer's patients for three years, the study reported those on Aricept ended up disabled or in nursing homes just as often as did those on a placebo. The research has generated a strong reaction. Sam Gandy, an Alzheimer's researcher at Thomas Jefferson University in Philadelphia, points out that the study showed Aricept did have some early benefits, delaying cognitive decline. Others are even more optimistic. Says Rachelle Doody, director of the Alzheimer's Disease Center at Baylor College of Medicine in Houston: "Other studies show the disease can be stabilized, often for years, with treatment. I can't emphasize that enough."
For more severe cases, the newest kid on the block is memantine, sold as Namenda and approved last fall by the Food and Drug Administration. In tests in people in later stages of Alzheimer's--when patients lose the ability to dress or clean themselves--the drug slowed their decline by 50 percent. Again, this benefit generally lasted for no more than a year. Memantine works on a different principle than Aricept, inhibiting a chemical that overexcites brain cells, leading to cell damage and death. Because of that, says Barry Reisberg, a psychiatrist and Alzheimer's specialist at New York University, it lends itself to combination therapy: "It's likely that doctors will be giving cocktails of Aricept and memantine to their patients." Indeed, a study that paired the drugs showed that not only did patients' cognition stabilize for six months, but their temperament--their levels of crankiness--improved as well.
Patient agitation and irritation are a huge and neglected aspect of Alzheimer's. "The public thinks Alzheimer's is a memory disease. But, in fact, there are lots of neuropsychiatric symptoms," says Constantine Lyketsos, a psychiatrist at the Johns Hopkins University School of Medicine. "Apathy, depression, agitation are the most common problems." Adds Reisberg: "Alzheimer's patients often develop delusions. They think their family is stealing things from them, for example. And they get very aggressive and irritable towards their spouse." That kind of behavior, studies have shown, hastens patients down the road toward institutionalization, since families can't cope with it.
The agitation often starts as patients get frustrated with themselves, as simple memories start slipping away, says Janelle Lafser. Her husband, Frank, was diagnosed with Alzheimer's in 2002, at the unfortunate early age of 53, but began having problems several years before that. "We'd have a date to meet someone, and he'd come up and ask me what time we were leaving the house. I'd tell him. And then 20 minutes later he'd come up and ask me again," says Janelle, of La Quinta, Calif. "I'd tell him, and then 10 minutes later it would happen again. And again. I'd get irritated, and he'd get agitated." Frank started having trouble doing the household bills, got seriously depressed, and told Janelle, "I just can't do it anymore." A former executive at Sherwin-Williams, he declined to the point where he couldn't hold a job mixing paint at a local hardware store.
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