Drug Slows Alzheimer’s Disease

By Jill Ross

Forgetting where you put keys happens to everyone now and then. Mary Menna realized this. But when her husband, Danny, a retired Michigan steelworker, asked her the same question four times one afternoon, she began to wonder if he had a real memory problem.

“I thought, ‘Wow. What’s going on here?'” recalls Mary, a retired special education teacher. She suspected Danny had Alzheimer’s disease, a progressive loss of memory so severe that it interferes with a person’s ability to function. Their family doctor told her if it was Alzheimer’s, there wasn’t much that could be done.

Fortunately, for Danny Menna, 83, that wasn’t so. Time was on his side. A specialist diagnosed him as having the early onset of Alzheimer’s and helped him enroll in a clinical trial of a new drug derived from the bulbs of daffodils.

That drug, Reminyl® (galantamine hydrobromide), was approved by the U.S. Food and Drug Administration (FDA) and joins several other drugs already on the market to treat Alzheimer’s Disease, which affects an estimated 4 million Americans. Galantamine was developed by the Janssen Research foundation under a co-development and licensing agreement with the UK-based Shire Pharmaceuticals.

Like the other medications – Cognex® (Tacrine), Aricept® (Donepezil) and Exelon® (Rivastigmine Tartrate) – Reminyl is indicated for mild-to-moderate cases of Alzheimer’s (such as Danny Menna’s), explains Gary Small, M.D., director of the Center on Aging and professor of psychiatry and biobehavioral sciences at the University of California in Los Angeles.

Helping patients function better

All Alzheimer’s drugs work to slow the progression of the disease by inhibiting the production of the enzyme, cholinesterase, which breaks down acetylcholine – a neurotransmitter responsible for transmitting signals involved in memory and cognition. Researchers have found that Alzheimer’s patients have an extremely low level of acetylcholine.

Unlike the other Alzheimer’s drugs, galantamine also affects nicotinic receptors in the brain. Nicotine, researchers have found, enhances the brain cell release of acetylcholine. (That revelation shouldn’t encourage anyone to smoke, Small says. In fact, delivering nicotine straightforward, as smoking does, may have a paradoxical effect and actually shut down nicotinic receptors, he notes.)

Data from four clinical trials involving more than 2,650 patients and lasting up to six months show that galantamine not only has a beneficial effect on patients’ ability to think but also their daily functioning. The latter, experts say, is often the paramount concern for many patients and their families.

“Families and patients don’t care about improvement of a couple points on pencil and paper tests,” Small says. “What they care about is that the patient isn’t asking the same question over and over and able to dress themselves. Those are the meaningful gains you see with this medication.”

Mary Menna says she has seen some slight improvement in her husband’s condition during the past four-and-a-half years. He’s capable of doing a word jumble and sorting out mixed letters. He writes checks, and he can drive – with Mary providing the directions.

“When you’re 83, you don’t expect to be 40,” she says. “He’s like a dancer who doesn’t dance as fast.”

Mary urges other families in similar situations to get help quickly if they notice that an older family member or relative is showing signs of memory problems. Small agrees the sooner people seek medical help, the better.

“As far as the prevention and treatment of Alzheimer’s is concerned, drug discovery and pharmacology are very important,” Small says. “We can keep people out of the nursing home, give families a year – maybe more – something we never did before.” The drugs, he adds, are not a cure, but they can stabilize an Alzheimer’s patient and slow the mental decline.

How to stay mentally sharp

In addition to medications, there also are some lifestyle choices people can make that “might benefit our brains,” Small says.

The Alzheimer’s Disease Education and Referral (ADEAR) Center, which is a service of the National Institute on Aging (NIA), has a Web site (www.nia.nih.gov/alzheimers) that includes a list of tips on how to take care of your gray matter. They include:

  • Eat more fruits and vegetables. These foods are rich in nutrients called antioxidants that are involved in the prevention of cell damage. Antioxidant nutrients include vitamin A, vitamin C, vitamin E, the mineral selenium, and vitamin A’s chemical relatives, the carotenoids, among them beta-carotene (found in carrots and broccoli, for example).
  • Drink tea. Black and green tea have been found to also be high in antioxidants and other compounds, such as flavonoids, that help prevent stroke and the memory damage it can cause.
  • Take a multivitamin. Several studies have shown that vitamin supplements improve memory and mental functioning.
  • Exercise. It’s known that exercise can help prevent heart disease, diabetes, high blood pressure and other conditions. It’s also true that exercise, or aerobic conditioning, may be mentally stimulating. Physical activity increases blood flow through the brain and helps fine-tune the neurons that control mental acuity.
  • Try ginkgo. Ginkgo bilboa, which is currently being tested in Alzheimer’s patients, has been shown to improve recall and mental acuity in people without Alzheimer’s. However, Small says research about ginkgo is inconclusive. He also notes that there are all different kinds of combinations of ginkgo and that none are regulated, so people need to be cautious of that.
  • Get enough sleep. Sleep experts recommend at least seven hours a night to function well. Any less and they say you can develop a “sleep debt” that interferes with memory, judgment and reaction time.