Alzheimer' s Disease: A Summary of Research Findings -Part XVII
(9/28/17)- Yet another once-promising treatment for Alzheimer’s disease has come up short in the final stage of development, this time adding Wall Street drama to the familiar disappointment that has plagued the drug industry for decades.
A pill called intepirdine, developed by the biotech startup Axovant Sciences Inc., failed to blunt the symptoms of Alzheimer’s in a large clinical trial. The drug was never seen as a cure, but the company had hoped it would delay the worst symptoms of the disease, giving patients a few more months of health before needing around-the-clock care.
The company announced that the drug had failed to meet the goals of the trial, since the subjects in the study did not show signs of improved cognition or daily living.
Axovant will stop pursuing the drug’s use for the treatment of Alzheimer’s disease.
(6/26/17)- According to new data from the Centers for Disease Control and Prevention, Alzheimer’s deaths increased by 55 percent among all Americans between 1999 and 2014.
But they increased 99
percent for African-Americans and 107 percent for Latinos. While striking,
that’s likely to be an underestimate because some independent studies have
found that Alzheimer’s deaths are underreported on death certificates by
approximately six times because death is often attributed to more immediate
causes, like pneumonia."
(6/13/17)- As per a Centers for Disease Control and Prevention (CDC) “it is estimated that total health and long-term care costs for persons with Alzheimer’s and other dementias in the United States will total $259 billion in 2017, more than two thirds of which is expected to be covered by public sources such as Medicare and Medicaid.”
Most of the care for those who do not live in long-term facilities is done by family members or other unpaid caregivers— “in 2015, caregivers of persons with dementia, including Alzheimer’s provided 18.2 billion hours of unpaid assistance.”
(5/28/17)- A total of 93,541 Alzheimer’s deaths occurred in the United States in 2014 at an age-adjusted (to the 2000 standard population) rate of 25.4 deaths per 100,000 population, a 54.5% increase compared with the 1999 rate of 16.5 deaths per 100,000. Most deaths occurred in a nursing home or long-term care facility.
The percentage of Alzheimer’s decedents who died in a medical facility (e.g., hospital) declined from 14.7% in 1999 to 6.6% in 2014, whereas the percentage who died at home increased from 13.9% in 1999 to 24.9% in 2014.
(11/26/16)- The results of a study, published recently online by the journal JAMA International Medicine, that was funded by the National Institute on Aging concluded that dementia rates are declining, even though the population is aging.
The study found that the dementia rate in Americans 65 and older fell by 24% over 12 years, to 8.8 percent in 2012 from 11.6 percent in 2000. In 2000, people received a diagnosis of dementia at an average age of 80.71; in 2012, the average was 82.4.
The study included 21,000 Americans 65 and older across all races, education and incomes in the study known as the Health and Retirement Study. The study required participants to recall 10 nouns immediately and after a delay; to serially subtract 7 from 100, and to count backwards from 20.
(10/8/16)- 56% of persons aged 90 years or more with Alzheimer’s disease use psychotropic drugs whereas the same figure was 48% among younger persons with Alzheimer’s disease and 38% among those aged 90 years or more but without Alzheimer’s disease.
Psychotropic drugs include antipsychotics, antidepressants and benzodiazepines and related drugs which are used for anxiety and insomnia in short-term treatment. On the contrary, persons aged 90 years or more with Alzheimer’s disease used less frequently anti-dementia drugs (63%) when compared with younger persons with the same disease (72%).
(11/5/10)- The following is taken from an email sent by Physicians First Watch
"Contrary to epidemiological studies suggesting that docosahexaenoic acid (DHA) might lower risk for Alzheimer disease, a randomized trial in has found that DHA does not slow cognitive decline in patients with AD.
Researchers randomized some 400 adults with mild-to-moderate AD to receive DHA (2 g daily) or placebo for 18 months. At the end of treatment, there was no difference between the groups in the rate of cognitive decline, as measured by the Alzheimer's Disease Assessment Scale and the Clinical Dementia Rating sum of boxes.
Given their findings, the authors conclude that "there is no basis for recommending DHA supplementation" for patients with AD.
(1/28/09)- Researchers at Vanderbilt University concluded that long term usage of antipsychotic drugs pose a substantial risk to the elderly and the young. The results of the study were published in a recent edition of the New England Journal of Medicine.
The study also found that the risk of death increased for patients receiving larger doses of these drugs. Wayne Ray, a professor of preventive medicine at Vanderbilt was the lead investigator for the study.
The drugs involved in the study were Zyprexa made by Eli Lilly & Co., Risperdal made by J&J, Seroquel made by AstraZeneca PLC and .Clozaril, made by Novartis AG..
Researchers for the study reviewed the medical records of about 277,000 Tennessee Medicaid enrollees for the years 1990 to 2004. About 46,000 of them were taking atypical antipsychotic drugs and 44,000 were taking typical antipsychotic drugs. About 187,000 were not taking any of the drugs. Patients ranged in age from 30 to 74 years, with the average age being 46.
The researchers concluded that among patients taking the antipsychotic drugs, there were about three sudden cardiac deaths for every 1,000 patient-years. The death rate was about half that level for the control group of patients who were not taking any antipsychotic medications.
The study also found that the risk of death increased for patients receiving larger doses of both kinds of drugs.
(1/13/09)-The dementia antipsychotic withdrawal trial )DART-AD) long-term follow-up of a randomized placebo controlled trial study appeared in The Lancet Neurology, Early Online Publication, 9 January 2009. It was conducted by Clive Ballard et al "for the DART-AD investigators". These researchers looked at mortality in patients with Alzheimer's disease (AD) who are prescribed antipsychotics. They were interested in mortality data from a long-term placebo-controlled trial.
Between October 2001, and December 2004, patients with AD who resided in care facilities in the UK were enrolled into a randomized, placebo-controlled, parallel, two-group treatment discontinuation trial. Participants were randomly assigned to continue with their antipsychotic treatment (thioridazine, chlorpromazine, haloperidol, trifluoperazine, or risperidone) for 12 months or to switch their medication to an oral placebo. The primary outcome was mortality at 12 months. An additional follow-up telephone assessment was done to establish whether each participant was still alive 24 months after the enrolment of the last participant (range 24?54 months). Causes of death were obtained from death certificates.
The results indicated a reduction in survival in the patients who continued to receive antipsychotics compared with those who received placebo. The researchers concluded that there is an increased long-term risk of mortality in patients with AD who are prescribed antipsychotic medication. These results further highlight the need to seek less harmful alternatives for the long-term treatment of neuropsychiatric symptoms in nursing homes.
Usually, antipsychotics are prescribed when a demented patient is agitated. It should be noted that The Physicians' Desk Reference (PDR) labels these medications with a blackbox warning indicating an increased risk of death and/or strokes in these patients. We recently reviewed a book, The Nursing Home Guide by Dr. Joshua D. Schor (look in our index under books) who expressed an approach well worth quoting. "Do I personally prescribe antipsychotics? Of course I do, but I do so cautiously and only after talking to staff and family. I do follow the rules of trying to wean the medications at least twice a year, unless there is a very compelling reason not to...If you get in a tussle with the physician, ask him or her to provide documentation that the proposed drug works and see what they say." (p. 139-140) The need for long-term care patient advocacy is an essential factor in enhancing quality of life in care facilities.
(5/24/06)- The February 2006 issue of the Archives of General Psychiatry published a study that indicated that Alzheimer's patients with a lifetime history of depression have increased plaques and tangles in the hippocampus section of the brain and more rapid cognitive decline into dementia than those who did not have depression. Present treatment outcomes for this type of patient is less favorable.
(7/3/02)-After writing 16 articles on various aspects of Alzheimer's disease, it would seem helpful to our readers to summarize what is known about the disease as reflected in the many peer reviewed studies published in the research literature. More detailed information on many of the items listed below can be found in the various articles in this series.
These conclusions are subject to future research findings, but represent the most recent state of knowledge in the field.
See: Alzheimer’s Disease-PartI-Medications
See: Alzheimer’s Disease Part II- Selegiline and AD.
See: Alzheimer's Disease Part III- Use of Gingko Biloba in memory problems of Alzheimer patients.
See: Alzheimer's Disease PartIV-Alternative Treatment.
See: Alzheimer's Disease Part V-Possible New Drugs for Alzheimer's Disease Treatment.
See: Alzheimer's Part VI -Early Diagnosis.
See: Alzheimer's Part VII -New Medication-Metrifonate