Combining Alzheimer’s drugs helps slow rate of decline in Alzheimer’s Patients

My mother is currently moving into the medium stage of Alzheimer’s so for us this is exciting news. I intend to send this information to our personal care physician and discuss it with him immediately. I just finished reading a study published in the journal Alzheimer Disease and Associated Disorders that indicates combining two different kinds of Alzheimer’s drugs works better one. This unique research took place over a long time frame, 1990-2005. Typical clinical trials last about 6-9 months. Those in earlier stages of Alzheimer’s disease are typically treated with cholinesterase inhibitors like Aricept, Razadyne, or Exelon. Those suffering from later stage Alzheimer’s disease are usually treated with Namenda (Memantine). The study found that people who took the combination of a cholinesterase inhibitor and Memantine showed a significantly slower rate of cognitve decline than those who took only a cholinesterase inhibitor or no drug. While still in an early stage and needing follow-up this study indicates that the combination of drugs significantly slows the deterioration of cognitive function in Alzheimer’s patients. “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,” Alireza Atri explains. “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.” John Growdon, MD, a senior author of the paper said, “The results of this study should change the way we treat patients with Alzheimer’s disease. Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia. But it looks like there is an advantage in prescribing both drugs as initial treatment.”

You can read more about the study by following the links:

Combining Alzheimer’s drugs helps, study says

Benefit Of Combination Therapy For Alzheimer’s Disease Confirmed

Combining Alzheimer’s drugs helps, study says

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

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Aricept Beneficial for Alzheimer’s Patients, But Expensive

I get asked this question frequently: “Does your mother take Aricept”? When I answer yes, I get the follow-up. “Does it work?”

I am confident that Aricept works well for my mother. There is little doubt that it has slowed the progression of Alzheimer’s disease and helped smooth out her behavior. I know from personal experience it works well with other persons suffering from Alzheimer’s but not all of them. I also learned it is critical if you suspect Alzheimer’s or dementia to get to the doctor and get on the appropriate medication as soon as possible. Delaying this decision can be more harmful then you could ever imagine.

Previously, I wrote about author Terry Pratchett, who suffers from posterior cortical atrophy — a rare form of Alzheimer’s. In the article Terry says the drug had a dramatic positive effect on him. Terry is raising the issue in the UK about the cost of Aricept and whether it should be free to those suffering from Alzheimer’s disease.

Aricept isn’t cheap. Our cost is $166.29 for a 30-day supply or approximately $2,000 a year. Medicare covers the first $2510 of prescribed medications before you get into the so-called doughnut hole (we pay the out of pocket co-pay of $25, so the actual coverage is less then $2510). Paying for Aricept plus my mother’s other medications gets us into the doughnut hole early in the year. When you get into the doughnut hole you pay for the next $1540 in prescribed medications. This means zero coverage between $2510 and $4050. This is how Medicare works.

Our personal physician helps by giving us samples of drugs when he has them. Amazingly, he has not had Aricept samples available to us this entire year (14 visits through August). It gets me to wondering about Pfizer. I guess they intend to make as much as they can before Aricept goes generic in 2010. When that happens Alzheimer’s patients all over the world will benefit greatly. We used to pay over $100 a month for Zocor (simvastatin) but last year it went generic and it has now dropped to $10 per month (thank goodness).

They pay a similar price for Aricept in the UK so it is easy to understand why Terry Pratchett is upset. He is fighting the good fight in the UK.

I want to make it clear, I have nothing against Pfizer. The drug is fantastic, I believe in Aricept, my mother has benefited, and I believe Pfizer should make a profit. But, I continue to wonder why Medicare doesn’t negotiate a better price. Most likely Medicare is the biggest purchaser of Aricept in the world.

Pfizer does offer an assistance program. If you have any type of prescription drug coverage, you won’t qualify. If you do not have coverage and your income is under $25,000 you might. You can visit the Pfizer website’s Patient Assistance Program or call 1-800-226-2072 to find out more. Learn more about Aricept.

The Alzheimer’s Action Plan: The Experts’ Guide to the Best Diagnosis and Treatment for Memory Problems

 

NovelistTerry Pratchett angry with NHS for failing to provide Aricept for Alzheimer’s patients

Bestselling author, Terry Pratchett, who suffers from posterior cortical atrophy –a rare form of Alzheimer’s– is questioning why he and other sufferers of Alzheimer’s are being denied free access to the drug Aricept in the UK.

Pratchett a millionaire who can afford the drug is speaking up on behalf of those that cannot (about 400,000 are being denied). He points to a flawed system that provides Viagra on the NHS while rejecting Aricept.

“My wife and PA both noticed real changes in me after two or three months on it. I used to fumble with buttons and needed help with seat belts. Now, I get dressed normally and seat belts slide in first time. Mentally, it’s the difference between a sunny day and an overcast day. Ye Gods, that’s worth it!”

The National Institute for Clinical Excellence in the UK, which advises the National Health Service (NHS), ruled that Aricept, along with Reminyl and Exelon, should be prescribed only to those with more severe forms of Alzheimer’s. Aricept cost about $5 a day in the UK.

Prachett says that he derived great benefit from Aricept within two or three months of taking the drug.

“My wife and PA both noticed real changes in me after two or three months on it. I used to fumble with buttons and needed help with seatbelts. Now, I get dressed normally and seatbelts slide in first time. Mentally, it’s the difference between a sunny day and an overcast day. Ye Gods, that’s worth it!”

Questioning how the National Institute for Health and Clinical Excellence rules on the cost effectiveness of drugs, he said: ‘I would very much like to know the basis on which these decisions are made because some of them don’t seem to make very much sense.

More on this story

Terry Pratchett’s anger over the life-changing Alzheimer’s drug not available on the NHS

Terry Pratchett launches attack on NHS

 

NovelistTerry Pratchett angry with NHS for failing to provide Aricept for Alzheimer’s patients

Bestselling author, Terry Pratchett, who suffers from posterior cortical atrophy –a rare form of Alzheimer’s– is questioning why he and other sufferers of Alzheimer’s are being denied free access to the drug Aricept in the UK.

Pratchett a millionaire who can afford the drug is speaking up on behalf of those that cannot (about 400,000 are being denied). He points to a flawed system that provides Viagra on the NHS while rejecting Aricept.

“My wife and PA both noticed real changes in me after two or three months on it. I used to fumble with buttons and needed help with seat belts. Now, I get dressed normally and seat belts slide in first time. Mentally, it’s the difference between a sunny day and an overcast day. Ye Gods, that’s worth it!”

The National Institute for Clinical Excellence in the UK, which advises the National Health Service (NHS), ruled that Aricept, along with Reminyl and Exelon, should be prescribed only to those with more severe forms of Alzheimer’s. Aricept cost about $5 a day in the UK.

Prachett says that he derived great benefit from Aricept within two or three months of taking the drug.

“My wife and PA both noticed real changes in me after two or three months on it. I used to fumble with buttons and needed help with seatbelts. Now, I get dressed normally and seatbelts slide in first time. Mentally, it’s the difference between a sunny day and an overcast day. Ye Gods, that’s worth it!”

Questioning how the National Institute for Health and Clinical Excellence rules on the cost effectiveness of drugs, he said: ‘I would very much like to know the basis on which these decisions are made because some of them don’t seem to make very much sense.

More on this story

Terry Pratchett’s anger over the life-changing Alzheimer’s drug not available on the NHS

Terry Pratchett launches attack on NHS

 

Banner Alzheimer’s Institute and Sun Health Research Institute Enrolling Patients in Alzheimer’s Study

If you or a loved one are taking Aricept you should find this announcement of interest. Follow the link to Banner Health for additional information.

clipped from www.bannerhealth.com Banner Alzheimer’s Institute and Sun Health Research Institute today announced that they are actively enrolling patients in a new study of the investigational drug Dimebon™ for the treatment of Alzheimer’s disease. The study will evaluate the safety and efficacy of Dimebon in patients with Alzheimer’s disease taken in combination with Aricept® (donepezil HCI tablets), an FDA-approved Alzheimer’s treatment. Results from a one-year study of Dimebon in mild-to-moderate Alzheimer’s disease – showing statistically significant improvements in memory, thinking, function and behavior – were highlighted at the recent 2008 Arizona Alzheimer’s Consortium (AAC) Annual Conference, a community service event. Banner Alzheimer’s Institute and Sun Health Research Institute are both members of the Consortium.

 

Banner Alzheimer’s Institute and Sun Health Research Institute Enrolling Patients in Alzheimer’s Study

If you or a loved one are taking Aricept you should find this announcement of interest. Follow the link to Banner Health for additional information.

clipped from www.bannerhealth.com Banner Alzheimer’s Institute and Sun Health Research Institute today announced that they are actively enrolling patients in a new study of the investigational drug Dimebon™ for the treatment of Alzheimer’s disease. The study will evaluate the safety and efficacy of Dimebon in patients with Alzheimer’s disease taken in combination with Aricept® (donepezil HCI tablets), an FDA-approved Alzheimer’s treatment. Results from a one-year study of Dimebon in mild-to-moderate Alzheimer’s disease – showing statistically significant improvements in memory, thinking, function and behavior – were highlighted at the recent 2008 Arizona Alzheimer’s Consortium (AAC) Annual Conference, a community service event. Banner Alzheimer’s Institute and Sun Health Research Institute are both members of the Consortium.

 

Fighting Alzheimer’s

By Dr. Kay and Dr. Max weigh in on ways to help those with Alzheimer’s and those pedisposed to Alzheimer’s turn back the clock.

Source Sacbee.com

By Dr. Kay and Dr. Max

Turning back the Alzheimer’s clock

Q: My father and my aunt both died of Alzheimer’s disease, and I am worried about my own risk. What can I do to prevent it?

A: Alzheimer’s disease is the most common form of dementia and currently affects almost 5 million Americans. Alzheimer’s disease is characterized by the deposition of protein plaques and tangled fibers in the brain. We don’t yet know what causes Alzheimer’s disease, though it is felt to have a genetic basis. However, environmental factors (translation: your lifestyle) play an important role.

Prescription medications like Namenda and Aricept may slow the progression of dementia once it is diagnosed, although the benefits are not dramatic by any means. Scientists are now trying to find medications that can prevent Alzheimer’s disease, and there is a lot of research being done on alternative therapies. A few look promising: Animal studies suggest that curcumin, the pigment that gives the spice turmeric its yellow color, may slow the formation of Alzheimer’s disease plaques in the brain; in mice brains, curcumin may even clear out pre-existing plaques. Curcumin works as an anti-oxidant and anti- inflammatory agent (it may also reduce the growth of cancer cells and reduce viral infections).

Some data also are starting to show that curcumin may play a role in the prevention of Alzheimer’s disease. In India, turmeric is consumed by most people on a regular basis; it is also prescribed medicinally by Indian doctors. Perhaps this might explain why India has one of the lowest rates of Alzheimer’s disease in the world.

Should you take up the consumption of curcumin, e.g., in supplement pills, especially if you might be at risk for Alzheimer’s disease? Several well-known health experts recommend it — 500 mg to 1,000 mg per day. Finding ways to cook with turmeric may also be a good way to consume curcumin — it can be added to many soups and vegetable dishes.

Another promising prevention therapy for Alzheimer’s disease is acetyl-L-carnitine (ALC), an amino acid that helps to increase the amount of acetylcholine in your brain (The brains of Alzheimer’s disease patients are deficient in this.) The dose used in studies has been 1,500 to 4,000 mg per day in divided doses. It seems to be a very safe supplement, but can cause some stomach upset. ALC also shows promise for patients with neuropathy, including diabetic neuropathy. If you take blood thinners, especially coumadin, talk to your doctor before taking ALC — it can increase the effect of coumadin in your blood.

Other natural therapies that are being studied for the prevention or treatment of Alzheimer’s disease include:

• B vitamins, vitamins C and E, zinc, selenium, alpha-lipoic acid, and coenzyme-Q.

• Fish oil — contains omega-3s which are good for your brain cells.

• Phosphatidylserine — a phospholipid, found in the brain.

• Ginkgo — an herb that may improve blood flow in the brain.

• Arginine (an amino acid that can improve blood flow — and can also drop your blood pressure — talk to your doctor).

One more way you can head off Alzheimer’s disease is to keep your brain and body active. A 2003 New England Journal of Medicine study of 469 seniors found that participation in activities such as reading, playing board games and playing musical instruments reduced the risk of dementia.

A 2006 study in the Archives of Internal Medicine showed that people who had a high level of physical function were three times less likely to get dementia compared to those who fit the couch potato model.

Bottom line? Exercise regularly, keep your brain active, and eat a healthy diet with lots of natural anti-oxidants and anti-inflammatories (translation: eat your fruits and vegetables).

For good measure, take a daily multivitamin that has B complex, vitamins C and E, zinc, and selenium. Consider taking fish oil (1 to 2 grams per day) if you don’t eat fish regularly and stay tuned for other supplement recommendations. If you are at risk for Alzheimer’s disease, consider adding turmeric and acetyl-L-carnitine to your health regimen, but as always, talk to your doctor.

About the writer:
Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter’s Downtown Integrative Medicine program. Have a question related to alternative medicine? E-mail adrenaline@sacbee.com.

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