IS THERE TREATMENT FOR ALZHEIMER'S DISEASE?

There are now 5 approved drugs for the primary symptoms of Alzheimer’s disease (AD), 4 of which inhibit acetylcholinesterase and 1 that acts as a noncompetitive antagonist to the N-methylD-aspartate (NMDA) glutamate receptor. The acetylcholinesterase inhibitors are approved for use in mild to moderate AD, whereas the drug that acts as a noncompetitive antagonist to the NMDA glutamate receptor is approved for moderate to severe AD. Therefore, patients have different treatments available for different stages of the disease. These medications have demonstrated efficacy in delaying cognitive decline in numerous randomized, controlled trials. Recent studies are focusing on longer-term follow-up (1 year and beyond), in addition to more “clinically relevant” outcomes, such as measures of function and nursing home placement. The AD drugs also appear to offer benefit with these outcomes. In addition, treatments such as vitamins E and C, nonsteroidal anti-inflammatory drugs, and statins (cholesterollowering drugs) show some promise in preventing or delaying AD progression, although more data are needed. This article reviews the pivotal clinical studies of each drug, the more recent studies of other outcomes, and the therapies currently undergoing investigation. The guidelines from leading medical authorities are also briefly reviewed (ie, the American Academy of Neurology, the American Geriatrics Society, the American Psychiatric Association, and the American Association of Family Physicians). Although some may argue that the measured effect of these drugs is minimal, in reality any preservation of function and delay of nursing home placement has important and permanent consequences for the patient and caregiver, and all parties should be aware of the expected outcomes with these medications. (Adv Stud Pharm. 2005;2(5):160-174)