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Early Detection of Alzheimer's Disease
By Kristine Dwyer, Staff Writer

(Page 4 of 6)

AD changes the brain in many ways, which results in a decrease of acetylcholine levels. It is believed that acetylcholine is a chemical messenger that is important for memory, thought and judgment. The US Food and Administration currently approves five prescription drugs, yet only three are actively marketed for the treatment of mild to moderate AD.

According to the Mayo Clinic, these medications are referred to as cholinesterase (ko-lin-ES-tur-ase) inhibitors and seem to improve the effectiveness of acetylcholine, either by increasing the amount in the brain or strengthening the way nerve cells respond to it. The top three cholinesterase inhibitors are Aricept, Razadyne and Exelon. They have all been effective treatment options in clinical trials. The other two medications are: Cognex, which has been on the market since 1993 but is rarely prescribed, and Namenda, which is the first drug approved by the FDA to treat moderate to severe dementia and may be co-prescribed with cholinesterase inhibitors. Treatment with medications has revealed delays in nursing home placements and improvements in cognition and functional abilities in many patients with AD.

Doctors usually start patients on a low dosage of medication and then gradually increase the dosage based on the tolerance level of the patient. According to a journal of the American Academy of Family Physicians, the above named medications have a low incidence of serious reactions, but they do have common side effects that can occur such as nausea, vomiting, diarrhea or weight loss. Tolerance to these medications often develops over time. Cholinesterase inhibitors must be taken regularly and in a sufficient dosage to benefit the patient. Interruptions of the drug treatment over time will result in sustained or irreversible cognitive decline. If a patient is unlikely to follow a drug regimen or has an illness that could interrupt the drug regimen, benefits will decrease and patients may face greater side effects. The healthcare provider should consult with the patient and the family to decide together on the best plan of treatment. Pharmacists are also a valuable resource for medication information.

It is important to understand that medication alone cannot stop the disease and medications do not work for everyone. For those who are helped, the effects may be only modest or temporary. Treatment with medication may help prevent symptoms such as depression, sleeplessness or wandering from becoming worse for a period of time and can help keep behavioral symptoms under control. Periodic monitoring and testing of a patientís functional and cognitive abilities is also recommended. These results may offer encouragement to the patientís family and can serve as a guide for doctors, patients and families in planning for the future.

Clinical Trials:
The best evidence of progress in AD research lies in the growth of clinical testing of treatments, prevention of the disease and diagnosis. This alone gives patients and families a reason to hope. Advances in our knowledge and understanding of AD have also led to the development of many new drugs, diagnostic tests and treatment plans. Scientists now recognize the need for earlier detection of AD and are devising new brain imaging techniques and lab tests that could improve diagnosis. One landmark trial that began in 2005 is the Alzheimerís Disease Neuroimaging Initiative. The goal of this trial is to determine whether standardized brain images combined with laboratory and psychological tests may offer a better way to identify those at risk for Alzheimerís, track disease progression and monitor treatment effects.


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