ALZHEIMER'S DISEASE

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Have you ever said, “I can’t find my keys. I must be getting Alzheirmer’s?” Forgetting where you put your car keys, is not a sign of Alzheimer's disease. Forgetting how to drive you car may be a sign. In fact, if you have Alzheimer's disease, you may not notice you have it at all. However, close family and friends may notice that you sometimes forget things to do with time and place like where you live, and that your personality has changed.

It is estimated 500,000 Canadians have Alzheimer's disease or related dementia. Over 50,000 of them are under the age of 60. Women make up almost 75% of the group. As the baby boomers age, we expect the number of people in Canada with Alzheimer’s disease to double.

Alzheimer’s disease is the most common form of dementia. Dementia is a condition with symptoms like loss of memory, poor judgement and reasoning, changing moods and change in ability to talk and communicate. Alzheirmer’s disease was discovered by Dr. Alois Alzheimer in the early 1900’s. He found plaques and tangles in the brains of some dementia patients after they died. These are still the hallmarks of the disease doctors look for when confirming Alzheimer’s disease after the death of the patient.

In Alzheimer's disease, brain cells die. The result is of loss of memory and cognitive functioning. One key brain chemical, acetylcholine, appears to be in short supply in Alzheimer’s disease. Many drugs used to treat Alzheimer's disease are aimed at increasing the amount of acetylcholine in the brain.

Cholinesterase is an enzyme that breaks down acetylcholine. Drugs that inhibit this enzyme will leave more acetylcholine in the brain. The first cholinesterase inhibitor to gain wide scale use in Canada was donepezil or Aricept. We now also have rivastigmine or Exelon and galantamine or Reminyl. All three of these are cholinesterase inhibitors and they are indicated for mild to moderate Alzheimer’s disease.

Memantine or Ebixa is a little different. It is called an NMDA receptor antagonist. It works on a different brain chemical called glutamate. It is approved for use in moderate to severe Alzheimer’s and can be used with Aricept.

Here is the bad news. None of these medications is a cure. None of these medications will stop the disease from progressing. The best any of these medications can do is help manage symptoms and help maintain a person’s functioning for as long as possible. I see a lot of false hope in the pharmacy that these medications will “fix” a loved one with Alzheimer’s. They won’t. And these medications are expensive and not always covered by Manitoba Health.

The future for Alzheirmer’s may be brighter, though. The researchers are learning more about how to prevent the dementia. One thing from the research I found interesting is that preventing concussions and head injuries in the young may help those people to avoid dementia when they are older. And there is research happening today that we hope will produce treatments in 5 to 10 years that may be able to slow and stop the progression of Alzheimer’s disease.

For more information see: Alzheimer’s Society of Canada www.alzheimers.ca

As always if you have any questions or concerns about these or other products, ask your pharmacist.