The Problem With Drugs For Treating Alzheimer’s Disease

Regularly reported drug trials tell us that pharmaceutical companies have found a new treatment for Alzheimer’s disease. Over time, none so far have been successful in either stopping or slowing the disease. In fact, the drug manufacturers are required to put that in writing in their packaging. Everyone wants a simple pill to “cure” or slow Alzheimer’s or other forms of dementia. We do not have that yet. Maybe we won’t in the future either, as Alzheimer’s is a complex disease perhaps not amenable to being cured with just a pill. My discussion here uses “dementia” and “Alzheimer’s disease” interchangeably. Alzheimer’s disease is the most common form of dementia, a progressive, deteriorating neurological disorder. I am speaking only in generalities.

Protein deposits: cause or effect?

When the brains of those who had these dementias are studied on autopsy, researchers find protein deposits (”plaques and tangles”) there. They then focus on trying to get rid of the deposits with these various experimental drugs. But some researchers also find those same deposits in the brains of people who did not have Alzheimer’s or any other dementia. Is there cause and effect: do the protein deposits cause the disease, or are they a result of the disease caused by something else? The answer is not clear. Some researchers believe that the protein deposits are a result, not a cause of the disease process. If that theory proves to be true, every drug now offered would end up being essentially a failure. So far, these medications are indeed failing, in that they do not stop the disease progression. They don’t cure Alzheimer’s. At best, some appear to temporarily result in better short-term memory. There is no proof that this effect lasts. The question is whether that limited positive outcome, if it exists for some, is worth the risks, side effects and actual value to the patient and family. Further, the cost of these medications to the individual can be exorbitant, particularly when Medicare does not approve them.

What makes sense to this retired RN is to focus on prevention of the disease, rather than spending billions of dollars on experimental medications that eventually prove to have limited value or no value in the long run to “cure” it. As we do not know precisely what causes Alzheimer’s disease, we can’t pinpoint exactly what to go after in prevention. However, we do know that a strong possibility exists from credible studies, that the disease may be caused by inflammation. It is a similar theory as to the underlying causes of heart disease: inflammation. Some things can stop or prevent inflammation.

Can we do more to prevent Alzheimer’s disease?

The National Library of Medicine lists numerous scholarly articles on research into prevention. According to one of them, Advances in the Prevention of Alzheimer’s Disease, there are numerous modifiable risk factors for the disease. This reflects findings in other studies, as well. Researchers find that midlife hypertension, diabetes mellitus, smoking, midlife obesity, stroke and cardiovascular disease all can substantially increase risk of dementia. One can take from this that preventing or managing these factors in one’s own life can help prevent dementias.

Researchers also identify nutritional factors as protective against Alzheimer’s disease. They include consuming omega-3 fatty acids and unsaturated fats, antioxidants, vitamins and moderate alcohol consumption. These are contained in what is called the “Mediterranean diet” consumed by people in countries that have far lower rates of these chronic diseases than Americans who consume the typical American diet.

These factors identified above are connected to the third category of reducing the risk of Alzheimer’s disease. This category includes lifestyle and psychosocial factors. They cite examples of living alone, having feelings of loneliness, depression, social isolation and psychosocial stress which can increase dementia risk. By contrast, higher levels of education, engaging in regular exercise, and cognitively and socially stimulating activities reduce the risk.

The Takeaways:

I see up close the long term effects and burden on families of a loved one with Alzheimer’s disease or any other form of dementia. In my work at AgingParents.com, where I consult with these families, living with or caring for a person with dementia. I hear sadness, frustration, fears about the costs of care, legal complications as a person’s cognition declines, the emotional cost, and many other woes. Prevention makes complete sense to me. But it takes a lot of effort, long term, to follow the recommendations about prevention that researchers have identified for us. I’m working on these very things myself! As I get older, my risk increases and I don’t want to have what I see in my own clients and their loved ones. Consider:

1. If you don’t want to develop dementia, focus on your lifestyle in mid-life. Give up the “typical American diet” and move to a Mediterranean diet. Preventing heart disease apparently helps prevent dementia too.
2. Get on an exercise program, even just walking briskly most days. The American Heart Association
   AHA
   recommends at least 150 minutes a week for adults.
3. Don’t isolate. Find things to join, activities to do with others, ways to keep yourself engaged in something you find meaningful. This takes a lot of effort, especially if you are shy, have some physical impairments or lack transportation. Find a way to fend off loneliness. Isolation can lead to poor health.
4. Don’t wait around for a pill to do the work of curing dementia for you. It may not happen with this complex disease. Prevention seems to be a lot better strategy than hoping you won’t have to do any work on your lifestyle because a medication is going to fix you. Realistically, you need to focus on your own responsibility for living a healthy life. Any effort i