As we have discussed before, the best way to fix Alzheimer’s Disease (AD) is to not get it in the first place. There is no cure for Alzheimer’s Disease, but two classes of drugs have been approved by the FDA to treat the cognitive decline seen in AD. However, as I am about to show you, their effectiveness is questionable.

There are two types of drugs that are FDA approved to treat AD, cholinesterase inhibitors and namenda (1). Lets examine them both.

Cholinesterase inhibitors act by slowing down the re-uptake of a neurotransmitter (acetylcholine) by nerve cells, allowing it act on the neuron for a longer period of time. in 2005 a meta-analysis was done on 22 clinical trials of cholinesterase inhibitors to investigate the effectiveness of this class of drugs in AD patients. The conclusion of the study was:
CONCLUSION: Because of flawed methods and small clinical benefits, the scientific basis for recommendations of cholinesterase inhibitors for the treatment of Alzheimer’s disease is questionable.” (2)
The authors go on to state that doctors often argue that CI’s are beneficial in approximately 10-20% of patients with AD, and that since this sub-group can not be identified before treatment that every patient with AD should be treated. The authors make a good point and argue that perhaps further research should be conducted to help identify that sub-group, rather than medicate every AD patient with drugs that (like all drugs) can cause dangerous side-effects. I think they make an excellent point- why do those 10-20% of people respond to this class of drugs, and how can we identify them in advance? This would cut the cost of AD medications by- oh wait, that’s why there’s no pharmaceutical sponsored research on this. We wouldn’t want to cut down on drug costs, now would we?

Namenda is a class of drugs that are NMDA-receptor antagonists. In 2011 a meta-analysis was conducted that evaluated three clinical trials on Memantine (Namenda) in over 1,000 patients with mild to moderate AD. Their conclusion was similarly unimpressive:

“CONCLUSIONS: Despite its frequent off-label use, evidence is lacking for a benefit of memantine in mild AD, and there is meager evidence for its efficacy in moderate AD. Prospective trials are needed to further assess the potential for efficacy of memantine either alone or added to cholinesterase inhibitors in mild and moderate AD.” (3)

Would you want to take your chances with this kind of results? Let’s prevent cognitive decline before it sets in, rather than rely on questionably effective pharmaceuticals. Once again I make the arguement you can’t unscramble a scrambled egg.
Until next time, gang.
Nikki

References
(1) http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
(2) Kaduszkiewicz H “Cholinesterase inhibitors for patients with Alzheimer’s disease: systematic review of randomised clinical trials.” BMJ. 2005 Aug 6;331(7512):321-7.
(3)  Schneider LS “Lack of evidence for the efficacy of memantine in mild Alzheimer disease”

Arch Neurol. 2011 Aug;68(8):991-8. Epub 2011 Apr 11.

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