The Rise Of Treatable Neurology
In October 2019, another patient was admitted to the John Radcliffe hospital.Pippa Carter, aged 19, had just begun an English literature degree at the University of Leeds when she noticed that her vision seemed to be strangely distorted.
I would be in lectures and I was really struggling to focus with my eyesight and with concentration in general, she says. I was trying to audition for a university play, and I had to stop because I couldnt really read at all. Initially, I thought it was just nerves because I was starting a new chapter in life.
Within weeks, she found herself unable to get her words out properly, before she was taken to hospital after suffering a large seizure. Just like Abraham, it was the speed of her decline which alerted doctors to a potential autoimmune cause. Within a week she was hallucinating, shouting things, remembers Irani. In her hospital room, which she was in for several weeks, she drew these bizarre childlike pictures on the wall, like the sorts of things a four-year-old would draw. It was like something was causing her to regress in her behaviour.
Carter was suffering from a neuropsychiatric syndrome caused by an autoantibody binding to the brains NMDA receptors, proteins which play a key role in learning and memory formation. Soon after she began treatment, first with steroids, and then an immunotherapy called rituximab, she began to improve. Now more than a year on, she is hoping to resume her university studies soon.
Stem Cells And Dementia
Stem cells are “building block” cells. They can develop into many different cell types, including brain or nerve cells.
Scientists have taken skin cells from people with certain types of dementia, such as Alzheimer’s disease, and “reprogrammed” them into stem cells in the lab. They’ve then triggered these stem cells to become brain cells.
These brain cells can also be used to test potential treatments at a very early stage.
Fdas Accelerated Approval Program
Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
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How Is Dementia Diagnosed
Confirming the diagnosis of dementia can be difficult due to the many diseases and conditions that cause it as well as because its symptoms are common to many other illnesses. However, doctors are able to make the diagnosis based on the results of personal medical history, review of current symptoms, neurological and cognitive tests, laboratory tests, imaging tests and by interacting with the patient.
Current general symptoms that would indicate dementia are, by definition, a decline in such mental functions as memory, thinking, reasoning, personality, mood or behavior that are severe enough to interfere with the ability to accomplish everyday tasks. Patients undergo mental function testing to identify problems in these areas. Interviews with family members and/or close friends who may have noticed changes in these areas are helpful as well.
Laboratory tests rule out other diseases and conditions as the cause of dementia, such as thyroid problems and vitamin B12 deficiency. Similarly, brain scans can look for signs of a stroke or tumor that may be the source of the dementia. A PET scan can determine if amyloid proteins are present in the brain, a marker for Alzheimers disease.
Oftentimes, neurologists and geriatricians assist in making the diagnosis.
What Are Cholinesterase Inhibitors
If your loved one has Alzheimerâs disease that isnât too severe yet, their doctor might prescribe them a cholinesterase inhibitor. If they have another type of dementia, their doctor may consider it, too.
What they do: Scientists think these help prevent a âmessenger chemicalâ in our brains called acetylcholine from breaking down. Acetylcholine is important in learning, memory, and mood. Cholinesterase inhibitors also appear to delay the worsening of Alzheimerâs symptoms.
These medicines include:
What to expect: Most people with Alzheimerâs who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.
But the improvements donât seem to last long — about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.
All three medicines work similarly, but one might work better for your loved one than it does for someone else.
Side effects: Most people donât have side effects when they take cholinesterase inhibitors, but some do have:
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The New Treatments For Ad
Alzheimers cure breakthrough studies and potential treatments have shown some promising results.
Dissolving the plaques: Most of the current focus on the management of AD has been targeting the protein plaques known as amyloid. These plaques are a classic feature of the disorder and often deposit early in the brain. Individuals who develop these plaques in the brain are more likely to develop symptoms of AD than those without plaques. Hence, several drugs have been developed that prevent the formation or clumping of these amyloid plaques. The monoclonal antibodies are very similar to the naturally occurring antibodies in the blood circulation, but they have only one target: amyloid beta. Unfortunately, amyloid is not found in all patients with AD and why this happens is not known. It is believed that close to 30%-35% of AD patients with mild to moderate disease may not have brain amyloid and, hence, cannot benefit from this treatment.
Currently, Aducanumab is only approved for use in select patients with mild cognitive impairment or early Alzheimers disease. Before the treatment can be administered, all individuals with AD must undergo a PET scan to determine if they have amyloid plaques.
Several other monoclonal antibodies have also been developed by different drug manufacturers and they also target amyloid in the brain. All these agents are currently being evaluated in clinical trials.
To be eligible for Aducanumab treatment, one has to meet the following criteria:
Are There Treatments For Vascular Dementia
There are treatments to help with many of the symptoms of dementia. At the moment we do not have a treatment that cures vascular dementia.
How quickly it progresses is different for everyone. Your symptoms may stay the same for months, or even years, but then they will suddenly get worse. Although your dementia will not get any better, it may be possible to slow down how quickly it progresses.
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How To Protect Yourself
Here are some other ways to protect yourself and others from fake Alzheimers treatments:
- Question any product that also claims to be a scientific breakthrough. Companies marketing these products take advantage of people when they are most vulnerable and often looking for a miracle cure.
- Always check with your doctor or health care professional before buying or using any over-the-counter product, including those labeled as dietary supplements.
A great deal of scientific research is being conducted on Alzheimers disease, but at this point, no cure or treatment have been shown to stop or reverse the progression of the disease. Several prescription drugs have been approved by the FDA to treat people who have been diagnosed with Alzheimers disease. Most medicines work best for people in the early or middle stages of Alzheimers, and can slow down some symptoms, such as memory loss, for a time. But none of these medications stops the disease itself.
Treatment development and FDA-approval requires clinical research and testing to ensure that any new drugs are both effective and safe. For patients interested in accessing investigational drugs, there are legal ways to do so, such as by taking part in clinical trials.
First Drug That Can Slow Alzheimer’s Dementia
Health editor, BBC News online
A US drug company says it has created the first therapy that could slow Alzheimer’s disease, and it is now ready to bring it to market.
Currently, there are no drugs that can do this – existing ones only help with symptoms.
Biogen says it will soon seek regulatory approval in the US for the “groundbreaking” drug, called aducanumab.
It plans to file the paperwork in early 2020 and has its sights on Europe too.
Approval processes could take a year or two. If successful, the company aims to initially offer the drug to patients previously enrolled in clinical studies of the drug.
The announcement is somewhat surprising because the company had discontinued work on the drug in March 2019, after disappointing trial results.
But the company says a new analysis of a larger dataset of the same studies shows that higher doses of aducanumab can provide a significant benefit to patients with early Alzheimer’s, slowing their clinical decline so they preserve more of their memory and every day living skills – things that the disease usually robs.
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Dementia Cure Less Than 10 Years Away Claim Experts
A cure for dementia could be less than a decade away, according to experts in the brain-wasting disease. World-renowned neuroscientist, Professor Bart De Strooper, who works at University College London , has spoken out saying that an effective treatment could become available by 2028.
Despite there being no definitive route to finding a way to combat the disease at present, he said that researchers were heading in the right direction. Recent studies have made it clear that the key to overcoming dementia is to target it in the early stages, before irreparable damage has occurred.
Among the strategies that are currently being developed are looking at the genetic causes of the disease and preventing the build-up of plaques in the brain. Recently, scientists revealed that a blood test can now predict dementia ten years before symptoms develop.
Approximately 850,000 people in the UK have been diagnosed with dementia, but the condition has been steadily rising in recent years. And its not just this country in which it is a problem, with America being home to 5.7 million dementia patients and cases prevalent across the world.
Professor De Strooper heads up a team of 270 scientists at the Dementia Research Centre at UCL. Expertise has been gathered from six universities in order to bring together those at the top of their field to try and find a cure.
Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 60-70% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . Dementia may also develop after a stroke or in the context of certain infections such as HIV, harmful use of alcohol, repetitive physical injuries to the brain or nutritional deficiencies. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
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The Dementia That Can Be Cured
There are more than 200 subtypes of dementia. And researchers have found that in one, confusion and memory loss can be treated. But the trick is to spot it
When John Abraham began to lose his mind in late 2019, his family immediately feared the worst. Abraham had enjoyed robust health throughout retirement, but now at 80 he suddenly found himself struggling to finish sentences.
I would be talking to people, and all of a sudden the final word wouldnt come to mind, he remembers. I assumed this was simply a feature of ageing, and I was finding ways of getting around it.
But within weeks, further erratic behaviours started to develop. Abrahams family recall him often falling asleep mid-conversation, he would sometimes shout out bizarre comments in public, and during the night he would wake up every 15 minutes, sometimes hallucinating.
Patients can go from being in a nursing home, unable to communicate, to returning to work
To his son Steve, the diagnosis seemed inevitable, one which all families dread. I was convinced my dad had dementia, he says. What I couldnt believe was the speed at which it was all happening. It was like dementia on steroids.
A lot of patients over 60 are misdiagnosed, says Flanagan. Thats a concern because if you miss these cases, youre committing them to a presumed neurodegenerative course when they could respond to immunotherapy, and their symptoms resolve.
Can Dementia Be Cured
Frustratingly, medical science has so far been unable to find a cure for dementia. The truth is that there is unlikely to be a single silver bullet to treat the condition because the brain damage of dementia is caused by many different diseases. However, research is continuing aimed at reducing risk factors, slowing down the decline and improving function and quality of life.
When someone you love is diagnosed with dementia, it can be frightening and overwhelming. Although there is no definitive remedy, doctors and researchers have a much better understanding of the condition, how it is caused and how it progresses.
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Treatment For Moderate To Severe Alzheimers
A medication known as memantine, an N-methyl D-aspartate antagonist, is prescribed to treat moderate to severe Alzheimers disease. This drugs main effect is to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both the person with Alzheimer’s and caregivers.
Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.
The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for the treatment of moderate to severe Alzheimers.
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Disproportionate Impact On Women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years due to dementia are roughly 60% higher in women than in men. Additionally, women provide the majority of informal care for people living with dementia, accounting for 70% of carer hours.
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Who Are These Medications For And What Are The Benefits
These medications are prescribed for people with mild to moderate Alzheimers disease. Studies show that between 40 70% of people taking the drugs benefit from them with symptoms improving temporarily for between 6-12 months.
The impact of taking cholinesterase inhibitor medications can include: reduced anxiety, improvements in memory and concentration daily activities such as personal care, dressing and shopping.
Trials to determine if these drugs also bring benefits for behavioural changes such as agitation or aggression are inconclusive, with mixed results. Unfortunately the impact of these medications gradually reduces with symptoms then gradually worsening.
Medication For Other Forms Of Dementia
Unfortunately the medications for other forms of Dementia are minimal. Cholinesterase inhibitors may be offered to patients with dementia with Lewy bodies or Parkinsons disease dementia if they have particular symptoms such as hallucinations or challenging agitation or aggression. There are no firm scientific conclusions as to the efficacy of Memantine for either of these forms of dementia.
Other Treatments available:
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Alzheimers Vaccine And Immunotherapy
Researchers have been attempting to develop a vaccine for Alzheimers disease for almost a decade. The strategy behind the immunotherapy approach is to use the bodys own immune system to destroy beta-amyloid plaques.
The first Alzheimers vaccine was tested in clinical trials in 2001. However, the trial was prematurely halted because six percent of participants developed serious brain inflammation. However, the vaccination did appear to benefit thinking and memory in some unaffected participants who were monitored after the end of the trial. Researchers have now developed a safer vaccine by using antibodies against a smaller fragment of the beta-amyloid protein, which they hope will avoid the complications of the previous trial.
Another approach to developing a vaccine involves using immunoglobulin, a filtered human blood product containing antibodies. Immunoglobulin was shown to be successful in a very small trial of 8 people with mild Alzheimers disease, with most showing improvement on tests of cognitive function after treatment. Although this trial is very small, it suggests the potential for larger trials of immunoglobulin therapy, which may have safety advantages over other vaccination techniques. Although this initial research is promising, much more research needs to be done before we know whether this approach will work.
Types Of Dementia Medications
Several prescription medications are approved by the Food and Drug Administration to treat symptoms of dementia caused by AD. These drugs can provide short-term relief from cognitive dementia symptoms. Some can also help slow the progression of AD-related dementia.
While these drugs are approved to treat symptoms of AD, theyre not approved to treat symptoms of other types of dementia. However, researchers are exploring off-label uses of these medications for people with non-AD dementias.
OFF-LABEL DRUG USE
Off-label drug use means that a drug thats been approved by the FDA for one purpose is used for a different purpose that hasnt been approved. However, a doctor can still use the drug for that purpose. The FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.
According to the Alzheimers Association, some AD medications may benefit people with Parkinsons disease dementia and vascular dementia.
Some of the most commonly prescribed medications used to treat symptoms of AD are cholinesterase inhibitors and memantine.
Cholinesterase inhibitors work by increasing acetylcholine, a chemical in your brain that aids in memory and judgment. Increasing the amount of acetylcholine in your brain may delay dementia-related symptoms. It may also prevent them from worsening.
The more common side effects of cholinesterase inhibitors include:
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