Treatment of Alzheimer's disease

So far there is no treatment, with Alzheimer's disease can be cured. However, do all sorts of promising research studies that focus on combating the disease or its prevention is available. People suffering from Alzheimer's today, are drugs available that help control the symptoms of the disease. Additionally, there are drug treatments, the excitement, depression, or psychotic symptoms (hallucinations or confusion) that can occur in the course of the disease to help alleviate. Non-drug therapies are also often designed to alleviate symptoms associated with Alzheimer's disease or to improve thinking and memory. Other non-drug approaches attempt to enhance the daily living of patients and support relatives. You can navigate through the two categories and reach of the slogans on the various topics.

Categories

Drugs for the treatment of Alzheimer's disease
Non-drug therapies

Drugs for the treatment of Alzheimer's disease

In general, it is noted that there are no medicines to cure Alzheimer's disease. The pharmacotherapy of Alzheimer's disease offers specific drugs that delay the progression of the disease, other substances that are used for the following areas:

• Treatment of concomitant diseases and behavioral stabilization
• Prophylactic and neuroprotective (nerve protective) measures

All treatments should be thoroughly discussed with the treating physician.

1st Specific drugs for the treatment of Alzheimer's disease

Specific drugs for the treatment of mild to moderate dementia in Alzheimer's disease, which belong to the group of acetylcholinesterase inhibitors, are available in Germany since 1995. The acetylcholinesterase inhibitors can not cure the disease, but delay its progress, or stabilize a certain time. A institutionalization can be delayed up to two years. It is therefore important that patients go to the doctor early on so that the disease can be halted at an early stage. All medications are prescription.

Donepezil HCl (Aricept ® trade name of Eisai / Pfizer) and rivastigmine hydrogen tartrate (approved as Exelon ®, Novartis Pharma). For donepezil There are also studies that show that benefit patients with moderate to severe Alzheimer's disease from treatment. End of 2007 was admitted a rivastigmine patch. The patch is stuck once daily and deliver the drug over 24 hours.

Since March 2001, galantamine (Reminyl ® trade name in Jansen-Cilag) is available. It is based on a substance isolated from snowdrops and is now produced synthetically.

The NMDA receptor antagonist memantine (under the trade name Axura ® by Merz and Ebixa ®, Lundbeck) is for the treatment of moderate and severe forms of Alzheimer's disease admitted. 2006 approval was the moderate form of Alzheimer's disease increased to. Memantine is in the market since 1982 and was formerly the treatment of mild and moderate brain disorders used to.

Treatment with Alzheimer's drugs should be strictly carried out under close supervision of the physician as it may have a number of side effects.

2nd Treatment of concomitant diseases and behavioral stabilization

Antidepressants are drugs for the treatment of depressive moods. They are suitable in patients with dementia not only for the treatment of depression, but also for the treatment of insomnia, mild psychomotor agitation and anxiety. The selection of eligible drugs in Alzheimer's disease is limited. The reason is that some antidepressants would strengthen the basis of their mode of action of the already existing shortage of acetylcholine in the brain of patients. These antidepressants differ therefore in favor of treatment. Possible, however, is the use of active substances from the group of so-called selective serotonin reuptake inhibitors.

Antipsychotics are drugs used to treat Wahnerleben, hallucinations, psychomotor agitation and aggressiveness and anxiety and sleep disorders. Treatment must always be under medical supervision, since side effects may occur. Is usually a several-month treatment was not necessary.
 
Newer antipsychotics have proven themselves in delusion, hallucinations, agitation and aggressive behavior. Regular medication and frequent blood count checks are necessary to protect against side effects.

In psychomotor agitation and aggression, improve night sleep and day-night rhythm, there are risperidone (trade name Risperdal ®). This medication is used to treat psychotic symptoms in dementia admitted, are significantly affected by the patient. A recent analysis of clinical studies showed that treatment could be associated with risperidone in elderly patients with dementia with an increased risk for vascular events such as a brain region or a stroke, even in death.
Therefore, the physician should always risks and benefits of treatment with risperidone on the basis of individual risk balance. Physicians should ask their patients, symptoms of a possible cerebrovascular event, immediately notify the attending physician, so that immediate action can be done for diagnosis and treatment, including removal of the drug.

For the relief of insomnia, mild and light Unruche psychotic states, there are now niederpotente neuroleptics and anxiolytics.

AEDs can be displayed in psychomotor agitation, aggression and anxiety in the treatment.

3rd Brain performance

Medicines from the group of Nootropica have long been known and are used to improve blood flow to the brain. This group includes Piracetam, nicergoline and Pyritinol. A positive effect in Alzheimer's disease could not be detected.

Ginkgo biloba, a plant extract from the leaves of the ginkgo tree, is rated ineffective by the Medicines Commission of the German medical profession (DCGMA) than for dementia prevention. A recent survey, which includes data from 4247 patients from 35 trials, comes to the conclusion that there is no convincing evidence for the Ginkgo biloba a clinically significant benefit for people with dementia or cognitive difficulties, (Birks et al. Cochrane Database Syst Rev, 2009).

4th Prophylactic and neuroprotective actions

The preventive effect of hormone replacement therapy (HRT) by women to treat menopausal symptoms and osteoporosis prophylaxis will be discussed controversially. Some large epidemiological studies showed that these women are rarely affected with Alzheimer's disease as a comparison group without hormone therapy, while new studies have found no preventive effect.

Antioxidants work against free oxygen radicals. These include radical scavengers such as vitamin E (alpha tocopherol), vitamin C, selenium, and green tea. Also from Ginkgo biloba, this property is known.

The gift of a-lipoic acid in combination with acetylcholinesterase inhibitors has improved in a test series, the life skills of patients.

5th Other substances, where a positive effect is attributed to their effectiveness is not sufficient evidence

People who had taken non-Steroidal anti-inflammatory-drugs (NSAIDs) for more than five years sick, less likely to have dementia, according to a study in 2008 (Neurology, 70, 2008). Especially strong was the protective effect of ibuprofen. An intake of more than five years was associated with a 44 percent reduction in Alzheimer risk. For other NSAIDs, however, no preventive effect was found. A recent study in 2009 (Neurology, E-pub ahead of print, April 2009) showed the opposite. There was detected at a higher age group that ibuprofen does not reduce the risk of Alzheimer's, but even increased.

There is currently no evidence base to ensure that this type of painkillers on Alzheimer's prevention should be used.

Also showed that people who have been treated for their high cholesterol levels with statins, less often diagnosed with Alzheimer's disease. Here too, further studies are awaited before it can be decided whether statins in preventing or treating can be used.

6th New drugs

A variety of research projects investigating new approaches for the treatment of Alzheimer's disease. Furthermore, to test various drugs for their efficacy in Alzheimer's disease.

The war on Plaques

In animal experiments were halted characteristic of Alzheimer's protein deposits on the brain cells by vaccination and some are even regressed. An initial study was begun in 2001, which should take about two years. The study was terminated in February 2002, as 25 patients with encephalitis are seriously ill. The investigations are continuing to develop a better tolerated form of vaccination.

Antibodies that bind to the beta-amyloid plaques, can be administered intravenously. If the antibodies bind to beta-amyloid protein and can then be mined, such infusions may slow the progression of Alzheimer's disease. The data suggest that the plaques in the brain at 12 weeks of treatment resolve ". A Phase III study is planned which will begin in 2009.

Towards the clumping of beta-amyloid in the brain seeks a Swedish study. Patients with mild Alzheimer's disease are treated with a derivative of clioquinol, an antibiotic, which was taken in 1970 because of less severe side effects from the market. The drug reduced the soluble amyloid in the cerebrospinal fluid. The memory performance could not be improved but it was the "word fluency" improved, ie more words in the test could be returned to and even other test tasks were done better. These results must be confirmed in larger studies.

Dye against fibrils

20 years ago, researchers had found a chance that a drop of methylene blue tau proteins in the test tube led to the disappearance. The dye for laboratory experiments was formerly used in medicine. It has been demonstrated that it may be possible to stop the progression of the disease by the tau proteins are attacked, which are directly related to the disease. The effect was compared with the effect of existing drugs, and a two and a half times achieved better results. The methylene blue is more larger studies under the name "Rember" in 2012 to be available.

Surprising success with Dimebon

Another old drug also raises hope. The American biochemistry company could show that was to stay with the Russian antihistamine "Dimebon" the illness of one year. It seems to work at least as good as the currently used Actylcholinesterase inhibitors, cognitive abilities and ADL improved. It is also interesting that Dimebon appears to through a different mechanism of action has, as the existing funds. A combination would be possible. Now in larger studies must show whether the drug is actually so good.

Non-drug therapies

Cognitive therapy

The cognitive approach focuses on the activation and reactivation of cognitive functions. This approach is particularly suitable for treatment in the early stages of dementia, because the learning of avoidance strategies is possible in spite of impaired memory.

The cognitive activation includes many options: one part includes exercises to maintain cognitive functions, like the ability to concentrate, or for specific service areas (for example, special exercises, memory or computational capability). Good work on the reference in the personal environment relevant knowledge. The cognitive functions can be trained with a playful exercise in groups and in combination, preferably with professional guidance.
A framework implemented in the home activation of the patients can perform work pressure and impatience sometimes negative reactions of the patient. It is particularly important, patients with neither overwhelming nor to confront their mistakes. "Brain jogging" as it is very popular with seniors and helpful, is not suitable for dementia patients.

Behavior

The behavioral approach is based on the gain desired behavior by reward. This, in addition to behavioral therapy, individual and combined treatments are modified as the skills training. In particular, the focus on skills obtained seems to have positive effects while reducing depressive symptoms. Through the application of behavior therapy can be expanded as the autonomy of the patient, and lost skills are recovered.

Both the cognitive and the behavioral approach aimed at building skills that will enable the patient to cope with everyday tasks or a realistic approach it.

Emotion-focused approach

For this approach include, among others the famous Validation therapy. These are the absolute value of feeling and the experiential world of the patient and the mobilization of resources still available in the center. In challenging behavior is to be tried for example to understand this as a response to the disease in the context of individual biography and involve them in a biographical context of meaning.

The self-preservation therapy, and the biographical work (memory therapy) are more emotion-focused treatment approaches. Here too is the subjective memory, vision and perception of the patient at the center, which will enable him or her a sense of personal identity, continuity and consistency mediate.

Approaches to calm and activation

Among the treatments that are aimed at activating or tranquilizers, are mentally and bewegungsbezogene approaches such as the Snoezelen. With this form of multi-sensory stimulation to be achieved both changes in behavior, in interaction and communication with others and in the experience of those affected.

Other treatment approaches include aromatherapy, light therapy, treatment of animals, as well as art, dance and music therapy for the treatment of generalized symptoms including acupuncture, speech therapy and physical therapy used. The occupational therapy appears in the performance of everyday activities and the quality of life of individuals and families to achieve good results, especially if the treatment takes place at home.

Caregiver training

On the social level can not fit the training of nurses and caregivers. Objectives of training are especially understanding of the deficits of dementia patients who still support existing resources and improving communication skills. By caregiver training seems the placement of dementia patients in a nursing home herauszögern clearly leave. In this framework, individual and group interviews are used where available information and experience in the foreground. Very helpful for members to prove self-nationals that are offered, among others, the regional groups of the German Alzheimer Society.