Treating Alzheimer's symptoms is still worthwhile

by Donovan Vincent for The Star:

Doctors need to focus more on using existing prescription drugs now to treat symptoms of Alzheimer’s disease, rather than waiting for the next generation of medicines, say leading researchers.

Dr. Gary Small, a professor of psychiatry and biobehavioural sciences at UCLA’s school of medicine, and Dr. Rachelle Doody, chair of Alzheimer’s research at the Baylor College of Medicine in Texas, released a report Sunday showing that doctors aren’t taking advantage as much as they should of medicines already proven to have “important positive clinical impact” on all stages of Alzheimer’s disease.

Their report, issued during the kickoff of the Alzheimer’s Association International Conference this week in Toronto, notes that less than half of people being affected by Alzheimer’s have actually been diagnosed.

The conference has drawn about 5,000 experts, including Small, Doody and other physicians, nurses, scientists and researchers.

The pair noted that less than 25 per cent of diagnosed Alzheimer’s patients are being treated, and less of than half of those who are prescribed medications for it remain on therapy after four years.

“It is unfortunate that only a minority of primary care doctors believe they have received sufficient training to diagnose the disease,” Small said in a statement.

“We see patients regularly for whom the diagnosis of Alzheimer’s was missed,” he added. “Unfortunately, the result is people with the disease are not getting treated.”

Approved drugs that affect the cholinergic system — which involves a chemical made by brain cells that is essential for memory, behaviour and thinking — have been available since the 1990s and are the only drugs “shown to have a positive impact on all stages of Alzheimer’s disease,” the researchers note.

But there’s a “general misconception” among doctors and patients that these drugs don’t provide much benefit, Doody said.

It’s important to treat patients immediately after diagnosis to slow down progression of the illness, she adds.

Dr. Sharon Cohen, medical director of an Alzheimer’s program called Toronto Memory Program, a medical facility specializing in the diagnosis and treatment of Alzheimer’s, echoes the findings by Doody and Small.

“The disease is a progressive disease, and both physicians prescribing and treating patients (as well as) patients and their families haven’t understood clearly enough that we’re treating symptoms in a progressive disease — and treating symptoms is still worthwhile,” Cohen said in a Sunday interview at the conference.

Cohen says the next generation of Alzheimer’s treatments being tested, medicines that actually modify the disease, will slow progression and get at the underlying brain changes, not just symptoms of Alzheimer’s. The hope is that new medicines will be able to stabilize or perhaps even reverse or cure the disease.

“So that goal is very valid, but we’re not there yet,” she says.

The approved drugs that treat the symptoms have been “trivialized” for many reasons, unfortunately — and not just in Canada, Cohen argues.

“You see experts from the U.S. expressing concern that drugs we have already are not being used. And I think the general public gets the feeling there’s nothing for Alzheimer’s disease,” Cohen said.

But some of these newer treatments currently in the discovery or development phase actually count on the existing prescribed medicines being in use. They will augment the effect of these already available meds, Cohen said.

Axovant, one of the sponsors of this week’s conference in Toronto, is among the companies working on late-stage development of these “add-on” treatments.

“We will need combination medicine. So we don’t want to throw out the gains we have made over the years for the hope there will be one thing that will make the original gains obsolete,” Cohen said. “We’re not that far in the field that we don’t need these current medicines that we have.”

Source: http://on.thestar.com/2ayuNQM