Treating and Managing Alzheimer’s disease

Management of AD could involve treatment approaches or preventative interventions addressed at risk factors.

Treatment Approaches

Once AD has developed, no treatment can stop or slow down the degeneration of affected brain cells (Alzheimer’s Association, 2011). However, the US Food and Drug Administration (FDA) has approved five drugs that prevent the aggravation of symptoms, but, even these drugs do not show expected efficacy in as much as half of the affected individuals who take them (Alzheimer’s Association, 2011). Another study showing that serotonin inhibitors, antipsychotics and galantamine have a beneficial effect on semantic or frontotemporal dementia, advises the use of such in managing symptoms of AD, due to the similarities observed in the two dementias (Carderelli, Kertesz & Knebl, 2010). Similarly, Acetylcholinesterase (Ach) inhibitors and N-methyl-D-asparate (NMDA), have been suggested to better treatment for AD (Savica & Petersen, 2011). In this respect Ach inhibitors by reducing production of Ach, are suggested to avert the progression to dementia stage (Savica & Pertersen, 2011). NMDA, on its part, is suggested to regulate levels of glutamate and thus maintaining toxicity levels of the neural system (Savica & Pertersen, 2011).Major challenge in the use of such drugs (e.g. Ach inhibitors) has however been highlighted with regard to their high costs, despite their inability to reverse or eliminate the impact of degenerative disorders (Mielke & Lyketsos, 2010).

Increasing research targeted to identify therapies for AD (to slow or stop its progression) however have led to an estimated 75- 100 candidate-drugs, whose testing is at the clinical level (Alzheimer’s Association, 2011, p. 212). Such studies have suggested that any successful candidate would better effects when administered at the early stages of the disease, hence additional studies have been towards identifying biomarkers that would help identify the condition at these early stages (Alzheimer’s Association, 2011). Such studies have buttressed the importance of early detection in enhancing treatment outcomes, a factor that is critical in other terminal illnesses such as cancer.

Preventative Approaches

Without a known cure, effective management of AD currently lies with preventative approaches. Medical approaches as those identified by Savica and Peterson (2011) – Ach inhibitors and NMDA – may offer potential approaches to avert progression to dementia in at-risk individuals. Other preventative measures have been advanced on nutritional and social perspectives that would avert the cognitive decline, as individuals grow old.

One such study identifies the important of constituents of dairy products (e.g. milk, cheese and yoghurt) in maintaining neurocognitive health in old age. According to Camfield, Owen, Scholey, Pipingas and Stough (2011), such dairy products could reduce the pathological changes in people with AD. However, the authors also note of importance of low-fat diet in maintaining neurocognitive health in old age, thus dairy products rich in fats may not confer the envisaged preventative benefit. Savica and Peterson (2011) reinforce nutritional aspects as a preventative approach. According to their study, aspects such as low levels of folate, could heighten the risk of AD. Accordingly, they propose the inclusion of Vitamin E supplements in the diet for the elderly, in addition to consumption of such foods as fruits, fish and poultry.

Other studies note the importance of physical activity (a social intervention) in averting the development of AD. Savica and Peterson (2011), for instance, suggest that activities such as swimming, and hiking could better the cognitive condition of the elderly since they are activities requiring substantial cognitive involvement. Other aspects argued to favor these methods include their effect of reducing depression and isolation, factors that could enhance the risk of AD (Savica & Petersen, 2011). Such social aspects have also been supported by other studies (Buchanan, Christenson, Hoolihan & Ostrom, 2011). However, noting the limitations (e.g. that old population may not be capable of intensive physical activity due to co-occuring debilitating disorders), Buchanan et al. (2011) advise the use of these approaches as supplementary rather than alternatives to medical approaches.

Conclusion

Dementia is a commonly occurring condition in the elderly population, posing a challenge to public health. Among the various types of dementias, AD is the most common and its public health effects are reinforced in its high prevalence, associated high costs and mortality of the elderly population. The subject of this paper was thus to provide a description of the condition and review the approaches that could better treatment and management of the condition.

AD is characterized by a cognitive degeneration to the extent of interfering with daily life activities. Its symptoms include difficulties in recalling new information and challenges in planning and solving problems, with later stages being associated with impaired movement. diagnosis is usually via a family history assay reinforced by magnetic resonance imaging scans. Although causes remain ambiguous, an hypothesis suggesting deposition of amyloid and tau proteins resulting in death of neurons has been proposed. Other identified causes are of a genetic etiology in cases of familial AD. Risk factors include aging, genetic history, traumatic brain injury and cardiovascular diseases such as hypercholesterolemia. Although there exist no treatments that can slow or halt progression of AD once developed, symptomatic treatment and use of Ach and NMDA to avert development have been suggested. In case of preventative approaches, dietary approaches and exercise could supplement medications aimed to avert cognitive decline.

 References

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Armstrong, R. (2009). Alzheimer’s Disease and the Eye. Journal of Optometry, 2(3), 103-111. doi:10.3921/joptom.2009.103.

Buchanan, J., Christenson, A. Hoolihan, D., & Ostrom, C. (2011). The role of behavior analysis in the rehabilitation of persons with dementia. Behavior Therapy, 42 (1), 9-21.

Camfield, D., Owen, L., Scholey, A., Pipingas, A., & Stough, C. (2011). Dairy constituents and neurocognitive health in ageing. British Journal of Nutrition. Retrieved from http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8130367

Carderelli, R. Kertesz, A., & Knebl, J. (2010). Frontotemporal dementia: a review for primary care physicians. American Family Physician, 82 (11), 1372-1377.

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Mielke, M. & Lyketsos, C. (2010). Alterations of the sphinglolipid pathway in Alzheimer’s disease: new biomarkers and treatment targets. Neuromolecular Med, 12 (4), 331-340. doi: 10.1007/s12017-010-8121-y

Savica, R.., & Petersen, R. (2011). Prevention of dementia. Psychiatric Clinics of North America, 31 (4), 127-145.

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