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Alzheimer’s Disease: The Future Just Got Brighter

By Chris Iliades, MD

Did you know that after reaching the age of 85 your chance of having Alzheimer's disease is almost 50 percent? As the baby boomer generation becomes the senior generation, the number of people with Alzheimer's disease is expected to rise. According to the American Alzheimer's Association, by the year 2050, 13.5 million Americans may be affected.

But there is good news. A new use for an existing treatment for symptoms of moderate to severe Alzheimer's has just gotten approved by the US Food and Drug Administration (FDA) and a new Alzheimer’s treatment that may actually stop the disease or even prevent it could be available within the next few years.

Alzheimer's starts with slight memory loss and confusion, but eventually progresses to irreversible brain damage. Up until now, doctors have had little to offer people who had progressed into the moderate-to-severe stages of the disease.

A Once-Daily Pill For Moderate To Severe Alzheimer's Disease

In July, the FDA approved a higher dose of the medication donepezil, known as Aricept, for moderate to severe Alzheimer's disease. This approval is based on a large study of 1,400 patients that compared Aricept at the previously approved dose of 10 milligrams to a higher dose of 23 milligrams. "Although Aricept is not a new treatment for Alzheimer's disease, the approval of a higher dose for moderate to severe disease gives us the ability to advance treatment as the disease progresses," says Dr. Martin R. Farlow, lead author of the study and professor and vice-chairman of research in the neurology department at Indiana University School of Medicine.

"Although Aricept is not a cure for Alzheimer's disease, it is the first and only prescription medication approved by the FDA for the treatment of all the stages of the disease from mild, to moderate, to severe dementia." - Dr. Martin R. Farlow

Dr. Farlow's study found that the patients with moderate to severe Alzheimer's who took the higher dose of Aricept showed a significant improvement in their symptoms. Aricept does not work well for everyone and side effects such as nausea, vomiting and diarrhea may limit Aricept's use for some people. "Most of the side effects are seen when people first start treatment. Since people who will be taking the higher dose will have already been taking Aricept at the lower dose, we would not expect to see a great increase in side effects at the higher dose," explains Dr. Farlow.

How Aricept Works

Although we don't know exactly why Alzheimer's disease occurs, we do know that a protein called beta-amyloid starts to accumulate in the brains of people with the disease. This protein may have normal functions in the brain, but when it is overproduced or not properly cleared out of the fluid surrounding the brain, it starts to clump up and cause damage to brain cells. Brain cells depend on a chemical messenger called acetylcholine to communicate with each other. As the brain cells become more damaged, less and less acetylcholine is available.

"Aricept works by blocking the enzymes that normally break down acetylcholine. That makes more acetylcholine available. It does not stop the damage to the brain cells, but it does buy more time. Symptoms of Alzheimer's disease can be improved or stabilized, and the progression of the disease can be slowed down," says Dr. Farlow.

The second part of this article highlighting a new treatment currently in clinical trials, will post on Friday August 27.