Alzheimer’s disease has gained a reputation as a disorder we can’t do anything about. As someone who has made this disease my life’s work, I want to tell you that’s wrong.
I’m not alone. At this week’s Alzheimer’s Association International Conference in Toronto, I and several fellow physicians and experts in the field are calling for an end to the underdiagnosis and undertreatment of Alzheimer’s disease. This initiative was funded by Axovant Sciences Ltd., a biopharmaceutical company focused on treatments for dementia.
Lack of attention to early Alzheimer’s is a tragedy because there are things we can do to help people whose memories are beginning to fade and the people who care for them.
Many people aren’t diagnosed with Alzheimer’s disease early enough. One hurdle is that primary care physicians often feel that their medical training did not properly prepare them to diagnose Alzheimer’s early in its course. That leads to missed diagnoses and, in turn, delays in treatment. By the time Alzheimer’s has been diagnosed, patients have often progressed into more severe stages of the illness. The lost ground is impossible to regain.
It should really be a group effort. As Dr. Rachelle Doody, who directs the Alzheimer’s Disease and Memory Disorders Center at Baylor College of Medicine, has said, “It is imperative that we train primary care doctors to diagnose dementia, and especially to diagnose it early. We must also train the general public to be cognizant of the early signs of Alzheimer’s. Early and effective treatment regimens are a patient’s only hope at a high quality of life despite Alzheimer’s.”
Underprescription of medication is another problem. There is a misconception among physicians and patients that the medicines available to treat early symptoms of Alzheimer’s disease — several cholinesterase inhibitors and an NMDA receptor blocker — aren’t effective. Cholinesterase inhibitors work by increasing the concentration of acetylcholine, a neurotransmitter that carries information from one cell to another. NMDA receptor blockers alter the activity of glutamate, another neurotransmitter involved in learning and memory. Multiple investigations have demonstrated that cholinesterase inhibitors and the NMDA receptor blocker offer cognitive, behavioral, and functional benefits for people with Alzheimer’s disease.
Yet these medications aren’t prescribed often enough. In fact, the market for them dropped by 3 percent last year, according to data from the IMS National Prescription Audit.
Another concern is that even when they are prescribed, less than 12 percent of patients take them for more than a year. And patients who do continue taking these drugs are often prescribed suboptimal doses.
These medicines do not cure Alzheimer’s disease. But they do help people living with it maintain their cognitive abilities and remain longer at higher levels of functioning.
Early diagnosis and treatment could help some of the 5.4 million Americans, and the 50 million people worldwide, who are currently living with Alzheimer’s disease. These steps would also be a boon to their caregivers, usually family members, who step in to take over their loved one’s daily needs, whether it’s tracking medications, balancing checkbooks, or assisting with bathing and other basic functions.
The emotional and economic burden of caregiving is huge: 1 out of every 2 primary caregivers develops major depression and, in the United States alone, the annual cost of care is more than $200 billion.
Many of my patients and their caregivers are waiting with bated breath for a cure to become available. While many novel drugs are in various phases of development, the problem with waiting for these miracle drugs is that with each passing day, patients’ mental states continue to deteriorate. The road to development and approval of a drug is a long and arduous one, and only a small percentage of drugs under development is ever approved. This is time that Alzheimer’s patients simply cannot afford to waste.
Properly diagnosing individuals as early as possible and making sure they take adequate doses of medication — and stick with them — can help preserve and maintain cognitive function. Sadly, these relatively simple measures often aren’t put in place because of the misconceptions surrounding the treatment of Alzheimer’s. It’s time to put these aside and take action to alleviate the burden imposed by this terrible disease, before it’s too late for patients and their caregivers.
Gary W. Small, MD, is professor of psychiatry and biobehavioral sciences and the Parlow-Solomon Professor on Aging at the David Geffen School of Medicine at UCLA, director of the UCLA Longevity Center, and director of the geriatric psychiatry division at the Semel Institute for Neuroscience & Human Behavior. He consults with several companies involved in marketing, manufacturing, and/or developing drugs to treat Alzheimer’s disease: Activis, Allergan (AGN), Axovant, Forum, Janssen, Lilly, Novartis (NVS), Ostuka, and Pfizer (PFE).