Friday, October 13, 2006

Alzheimer news

Drug Denial: Early diagnosis and treatment of Alzheimer's Disease (AD) has been shown to slow progression of the disease. You'd think that everyone would want early treatment, right? Well, apparently not in the UK.

An article from Times Online reports that their National Institute for Health and Clinical Excellence (Nice) is denying medications like Aricept and Exelon to early stage and late stage patients.
Neil Hunt, the chief executive of the Alzheimer’s Society, said: "This blatant cost-cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke.
I've talked about government interference with health care delivery before, so I won't belabor the point here. Suffice to say that from a disease treatment standpoint, I hope that Nice reconsiders its decision.

Ineffective Drugs: AD has limited drug treatment as it is. More advanced stages of AD are particularly difficult. Symptoms here include agitation, aggression, hallucinations, and delusions. Although no medications have FDA approval to treat the agitation symptoms of advanced stage AD, many docs have used psychiatric medications to try to control the symptoms.

An article from the LA Times reports a study conducted by the National Institute of Mental Health using two psychiatric meds commonly used to try to alleviate symptoms (Zyprexa, Seroquel).
Depending on the drug, 37% to 50% of patients discontinued their pills because they weren't working, and up to 24% stopped taking them because of side effects such as drowsiness, weight gain and confusion. All told, 82% of patients quit their drugs.
In my experience, I've found similar poor results in my assisted living and nursing home patients. I'm going to keep trying meds like Zyprexa and Seroquel, because there is very little else out on the market right now to treat advanced AD. Hopefully, there will be other treatment options in the future.

THC Treatment: The chemical name is delta-9-tetrahydrocannabinol. It is also called THC. If you don't already know, this is the active ingredent in marijuana. Some already use this to control side effects of cancer and AIDS treatments.

An article from The Age reports that the Scripps Research Institute in California performed a study which found that THC helps to decrease the formation of the protein plaques which cause AD.
THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, the researchers reported in the journal Molecular Pharmaceutics.
I'm just imagining how they actually performed the study. "Dude, my memory is so much better." "Dude, I'm hungry, pass the potato chips." "Dude, pass the controller. It's my turn for the XBox." "No, it's my turn." "No, it's my turn."

Finally, am I advocating citizens of the UK to smoke pot since they have no access to prescription AD drugs? No, of course not. But, from a cost standpoint, pot is less expensive than Aricept or Exelon (at least that's what I've been told -- HA!) Maybe something for them to consider...

I'm on call this weekend, and I'm feeling a little blog burnout. So, I'm taking a few days off. Back next week some time. See you soon.


Julie, RN said...

"Dude, where's my walker?"...
Here's another conundrum: Our local MHMR will not accept patients with a primary dx of 'dementia'. They are either placed in a facility (as appropriate) or need to follow up in a private office (as insurance allows).
Maybe a more creative diagnosis would be helpful? Damn bureaucrats.

fjl said...

My father has this sad condition, thanks for your interest here.

NeoNurseChic said...

Oh not the first time the UK has made these decisions. I wonder about that sometimes... I know cluster sufferers in the UK where their GP will only give them like 2 imigran (imitrex) a month because the drug is expensive. Prescribed meds come out of a fixed GP budget, so if the doc gives a patient his imigran, then supposedly someone else can't get what they need. I find this to be quite sad...

Maria, a psychiatrist over at Intueri just recently wrote an article on the recent study on the topic of Antipsychotics, Agitation and Alzheimers.

She has a very interesting blog that I tend to read near-daily, although she doesn't usually allow comments.

And then you have people like my grandmother and aunt. My grandma was diagnosed with early alzheimers (turned out in the long run to be an incorrect diagnosis - her duragesic patch was causing the symptoms). Her doctor prescribed aricept. After a couple of days, my aunt refused to let her take it because she didn't believe the diagnosis, so she refused to let my grandma take the med - believing that taking the med means she definitely has alzheimers. Aricept is also used for things like migraine prevention, etc - so it's not like the med "makes" her have alzheimers. I was really angry about that at first, but now that she's better after coming off the duragesic patch, I guess it didn't matter....!

Hope call goes well!
Carrie :)

Biomed Tim said...

Dr. A.,

Always enjoy your posts.

I have reasons to believe that these British officials recommended this policy for reasons that are not insidious, nor stupid.

Please review my post here if you have time.

Anonymous said...

Wow ... so pot helps keep the protein buildup down in people's brains ... kills nausea and increases appetites! Hmmm ... I wonder if any of my kids ...

... *blink* >;o)

Mimi Lenox said...

So what's the prescription for blog burnout? Inquiring minds want to know.

Anonymous said...

Haven't read the Alzheimer's report, but usually NICE does a decent job with their reviews. I'm guessing perhaps the cost seems high to them given that not all patients will see benefit from the drugs? Sure sounds like pot is the way to go. ;)