Alzheimer's disease: Prevention, symptoms and treatment, plus one family's story

Learn about the basics of Alzheimer's disease: how it happens, the symptoms and treatment, and how it can be prevented. Plus, read about the author's experience caring for parents who suffer from Alzheimer's.

By Peter D. A. Warwick

Alzheimer treatments
Avoiding burnout
Spending time and energy on myself is also important. It does my father no good if I'm not in prime shape physically, psychologically and emotionally. I go for long walks or bicycle up to 143 kilometres at a time just to clear my head. I also spend time with friends, go to church and do some freelance writing. Sometimes I put dad in overnight respite care so I can take a longer break.

Another godsend are the caregiver support group meetings I attend at the local Alzheimer Society of Canada. We're a group of women and men who are caring for a parent or spouse with Alzheimer's, a feat that can be unbelievably exhausting. We talk about our experiences, pass along tips and information, and share our emotions, which run the gamut from fear and resentment to a strange kind of peace and satisfaction. Those meetings are a true lifeline for me.

Typical of many caregivers, my dad kept my mom home far too long. I'm determined not to make the same mistake, so I have my dad on a waiting list for long-term care. I'll move him when caring for him gets too much for me. Fortunately, I have power of attorney for property and personal care, which makes handling his affairs much easier.

The future
Having witnessed the mental decline of both my parents due to Alzheimer's, I am concerned about getting the disease myself. I try to optimize my chances of retaining my mental faculties by eating a healthy diet and staying physically and mentally active. And while my family history makes me vulnerable to Alzheimer's, I can't help but share the enthusiasm of Canadian scientists about an eventual cure. "I'm very optimistic about Alzheimer's," says Diamond. "I, and many others, look forward to seeing the disease brought under control in the next seven to 10 years or, perhaps, even conquered altogether."

Treatment
Back in the early 1990s, when my mother first battled Alzheimer's disease, her treatment options were limited. Today, there are several choices with more on the way.

Drugs currently used to treat Alzheimer's include:
• Aricept (donepezil);
• Reminyl (galantamine);
• Exelon (rivastigmine); and
• Ebixa (memantine hydrochloride).

The first three drugs inhibit an enzyme that causes the neurotransmitter acetylcholine to break down; by allowing the acetylcholine to build up, the drugs slow, but don't stop, the progression of Alzheimer's. The fourth works to block the reuptake of another neurotransmitter, glutamate, and may help preserve cognition and memory. Possible side-effects of some of these drugs include nausea, vomiting, diarrhea and loss of appetite. Exelon is available in a patch that helps avoid some of these symptoms.

Scientists are also working on exciting new therapies that attack or inhibit beta-amyloid, the culprit behind Alzheimer's disease. These include:
• Vaccines that trigger the body to build antibodies against beta-amyloid, which is responsible for plaque formation (or tau, which causes the tangles).

• Intravenous immunoglobulin (IVIg), a purified mixture of human antibodies that helps get rid of beta-amyloid. In one study, at the New York-Presbyterian Hospital/Weill Cornell Medical Center in New York City, eight patients with mild to moderate Alzheimer's were given IVIg for six months. Most saw their cognitive functions stabilize or even improve.

• A class of drugs called beta-secretase inhibitors. These drugs block the process that splits beta-amyloid molecules from their larger parent molecules, preventing amyloid accumulation.

• Drugs that mop up beta-amyloid once it has formed.

• Gene therapy that silences or compensates for a defective gene that sets the stage for Alzheimer's.

• Estrogen replacement therapies that don't have a negative impact on the heart. "We're looking at chemicals – or molecules – that very closely resemble estrogen and do what that hormone does but without the adverse effects on the heart that [currently available] hormone replacement therapy has," says Dr. Jack Diamond, scientific director of the Alzheimer Society of Canada. (Scientists are also investigating the role of testosterone.)

• Stem cells that turn into new nerve cells to replace those that have died due to Alzheimer's disease.

• Cholesterol-lowering drugs called statins. They may have positive effects on the processing of amyloid. In research published in the journal Neurology, investigators studied donated brains and found that there were significantly fewer tangles in the brains of people who had taken statins prior to death than in those who had not.

• Diabetes drugs.
With Alzheimer's disease, the brain doesn't make as much insulin – or use it as effectively – as it should. Researchers have noted that people with type 2 diabetes who take a class of drugs called glitazones, which help the body's cells better use insulin, are less likely to develop Alzheimer's disease.


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