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Drugs to treat Alzheimer’s disease have shown only modest success in easing symptoms of the incurable illness that robs people of their memory and makes them unable to lead normal lives. But a new study from Boston researchers offers a glimmer of hope that combining two kinds of drugs may help delay progression of the symptoms.
Researchers at the Massachusetts General Hospital Memory Disorders Unit report in the journal Alzheimer Disease and Associated Disorders that combining two types of Alzheimer’s drugs works better than giving none or one of the drugs alone to slow cognitive and functional decline. Previous clinical trials have compared the drugs with placebos in short studies of safety and effectiveness, but the MGH group says theirs is the first to look longer-term at patients in a real-world clinical setting. Their study was funded by the National Institute on Aging and the Massachusetts Alzehimer’s Disease Research Center.
Led by Dr. Alireza Atri, the researchers analyzed the records of 382 patients who were treated at the Boston clinic from 1990 to 2005. The earliest group of 144 patients did not receive any medication, the second group got a cholinesterase inhibitor approved by the Food and Drug Administration in the mid-1990s, and the third group took that drug plus memantine, a drug approved in 2003 that helps patients think more clearly. The patients were followed for an average of two and a half years and given tests to measure both their cognitive abilities and their capacity to carry out the activities of daily living.
People who took the combination of drugs showed a significantly smaller rate of decline than those who were taking only a cholinesterase inhibitor or no drug. Memantine was not studied alone because by the time it was available, cholinesterase inhibitors were widely used. The researchers accounted for differences among the groups, such as how early in the disease they were diagnosed and whether they had other illnesses, but the differences in how they scored on tests of cognition and function still held true.
The results raise the intriguing possibility that the drugs may be protecting the patients’ brains from further deterioration, the authors said.
“Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer’s treatment, but we really don’t know if that is happening or what the mechanism behind these effects might be,” Atri said in a statement. “What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient’s symptoms get worse, that doesn’t mean the drug isn’t working, since the decline probably would have been much greater without therapy.”
Original content the Alzheimer’s Reading Room