This past Mother’s Day, my father’s wife told my brother and me that our dad was forgetting her name as well as having some other short-term memory difficulties.  He is in his early 80s and for years has tried to put up a good front, telling anyone who asked that the weather was great and life was copasetic.  However, the truth was that he has been slowing down his activity over the past few years, decreasing his interactions with other people and never telling his doctors what was really going on.  The concern, of course, is whether this is an early Alzheimer’s presentation or just an older man being stubborn and perhaps in denial.  As we assessed all the clinical information from a thousand miles away, it made sense to review the current research and treatment options for Alzheimer’s disease.

The Alzheimer’s Association, working with the National Institute on Aging (part of the National Institute of Health), issued new criteria and guidelines back in 2011.  These criteria differentiate preclinical/pre-symptomatic Alzheimer’s, mild cognitive impairment due to Alzheimer’s, dementia due to the disease, and Alzheimer’s related changes seen at autopsy.  Diagnostic assessment and biomarkers for Alzheimer’s disease include cerebral spinal fluid proteins, brain MRI studies and positron emission topography (PET) scans.

Also in 2011, the National Alzheimer’s Project Act (S. 3036) was signed into law, which led to the development of the National Alzheimer’s Plan in May 2012.  This plan was updated in 2014, and the current fiscal year 2014 budget has an additional $100 million in research, education, awareness and caregiver support.  Population predictions are that by 2050, there will be 16 million Americans with Alzheimer’s disease.

Four medications are approved by the U.S. Food and Drug Administration to treat Alzheimer's.  Donepezil (Aricept®), rivastigmine (Exelon®) or galantamine (Razadyne®) are used to treat mild to moderate Alzheimer's (donepezil can be used for severe Alzheimer's as well).  Memantine (Namenda®) is used to treat moderate to severe Alzheimer's.  These drugs work by regulating neurotransmitters, the chemicals that transmit messages between neurons. They may help maintain thinking, memory and speaking skills, and may help with certain behavioral problems.  However, these drugs don’t change the underlying disease process, are effective for some but not all people, and may help only for a limited time.   See more on Alzheimer’s treatment here

What does the future hold?  Clinical trials are numerous, some holding intriguing promise.  Nasal insulin, antioxidants, tau proteins, nerve growth factors, CSF and blood plasma biomarkers are all being looked at for unlocking the key to this difficult disease.  My family will be following these studies with keen interest.


Stuart J. Glassman, MD

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