DEAR DR. GOTT: My wife was diagnosed with Alzheimer’s dementia about five years ago. The current drugs being prescribed are galantamine, Namenda and citalopram. Other than Alzheimer’s, her overall health is good.
Shortly after being diagnosed, she placed in her age class at the Bloomsday road race. We were both runners. Anyway, her height is 5 feet 5 inches, her weight is 115 pounds, and her blood pressure is normal.
Is there any other possible course of treatment? We have been to specialists and more. We did participate in the failed dimebon trial.
DEAR READER: The dimebon trial you refer to did fail. An old Russian antihistamine remedy developed for hay fever and known as dimebon was one of the world’s most promising hopes for the treatment of Alzheimer’s. While originally providing good results in a small trial, a newer one involving a greater number of patients with mild to moderate symptoms failed to show progress after six months for the treatment of cognitive decline, nor did it help the behavioral problems associated with the disease when compared with a placebo. As you can well imagine, the outcome was unexpected and tragic for individuals such as yourself and your wife, as well as for Pfizer, who had been paying for 60 percent of the development costs.
Alzheimer’s is an irreversible and progressive brain disease that destroys memory and thinking. It is estimated that more than 5 million Americans may have the disease, so you can understand why so much hope was placed in the dimebon.
Brain damage for this disorder can begin 10 to 20 years before any symptoms are present. Tangles develop and plaque forms in certain areas of the brain. As this occurs, healthy neurons work less efficiently before they lose their ability to function properly. By the time Alzheimer’s reaches its final stage, damage is widespread and brain tissue has significantly atrophied.
There are four FDA medications approved for the treatment of Alzheimer’s. In no particular order and for a mild to moderate disorder are rivastigmine (Exelon), galantamine (Razadyne) and donepezil (Aricept). The heavy hitter for advanced cases is memantine (Namenda). All four regulate the chemicals that transmit messages between neurons within the brain. Their purpose is to help memory and speech and assist with behavioral problems. The big issue is that they don’t modify the underlying disease process, nor do results last more than a few years.
While it’s not what you really want to hear and I wish I could be more helpful, research has been phenomenal over the past few years and important advances have been made. Scientists and physicians are working together for a better understanding of the disease. Every effort brings us a step closer to the time when we will be able to better manage this horrible condition. While the last trial was a failure, perhaps another one is on the horizon that might make all the difference in the world for you. I suggest you contact the Alzheimer’s Disease Education Center at (800) 438-4380 or online at www.nia.nih.gov/Alzheimers.
