Alzheimer’s Drugs Frustrate Doctors

By Denise Grady

The drugs now available to treat the memory and thinking problems of Alzheimer's patients have failed to live up to the public's high expectations and offer such modest benefits that many doctors have doubts about prescribing them. Although the medication has its advocates, others express disappointment in the light of earlier hopes that the drugs approved in the past decade would stop the disease or markedly slow it.

At a recent meeting at Johns Hopkins University, doctors heard Alzheimer's researchers debate the usefulness of the present drugs and the prospects of better treatments being introduced soon. When a frustrated doctor accused a panel of experts of evading the question of whether the drugs should be prescribed, the rest of the auditorium burst into applause.

One expert replied that there was just one chance in 10 that the drugs would have an effect, and that patients should try them for six to eight weeks and then quit if there was no improvement. A second expert gave the drugs somewhat better odds of helping. A third recommended trying the drugs for six months. The moderator summed up, saying: "For us to tell you what to do, I think would be wrong. All you can do is look into your soul and do the best you can."

About 4.5 million Americans and more than 160,000 Australians suffer from dementia , of which Alzheimer's is the most common form, and many patients and their families see the five drugs now available to treat it as their only defence against its relentless destruction of the mind. The drugs are designed to aid thinking and memory, but they do not change the underlying course of the illness. The drugs do not help everyone, and when they do help, even their strongest fans agree, the effects are usually modest.

"We don't want to raise expectations that the effects of these drugs are large," said Peter Whitehouse, a professor of neurology and bioethics at Case Western Reserve University, Cleveland. "The public thinks a cure is around the corner," Constantine Lyketsos, a director of the Alzheimer's centre at Johns Hopkins, said. But he said he did not expect any "realistic reduction in the huge number of cases for decades".

Four drugs – Aricept, Exelon, Reminyl and Tacrine – are approved to treat the symptoms of mild to moderate Alzheimer's. All raise levels of acetylcholine, a chemical that transmits nerve signals in the brain. A fifth drug, Namenda, which works on a different neurotransmitter, was approved last year for moderate to severe cases.

Source: The New York Times

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