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Can it be treated?

A premise is necessary: ​​there is no pharmacological remedy that can restore the integrity of its mental functions to the elderly with dementia. In other words, the drugs available to treat Alzheimer's once it is manifested are few and of limited effectiveness.
Nevertheless, the fact that we can currently count on "cholinergic" therapy - that is, on substances that increase the presence of acetylcholine in the synapses by inhibiting the activity of the enzyme that degrades it (acetylcholinesterase) - shows that even in the dementias it is possible today some pharmacological intervention: which gives hope.
However, this possibility only affects patients with mild to moderate forms of Alzheimer's disease (Alzheimer Disease).
There are two drugs registered at the European level, donepezil and rivastigmine that despite having purely symptomatic and limited effects over time, are used in some EU countries. They currently represent the only specific therapeutic possibility against Alzheimer's disease.
The delivery of the two medicines is linked to the need to follow a precise diagnostic and therapeutic path. Therefore, if the decline of cognitive functions in Alzheimer's is inevitable, the rapidity of the evolution of the disease, on which it is attempted to intervene also with other therapies (some non-pharmacological), is not predictable.
Apart from the aforementioned donepezil and rivastigmine, which increase cholinergic transmission and may improve memory disorders, some other possible therapeutic options are being studied.
Such as the non-steroidal anti-inflammatory drugs (Fans), which are among the most used painkillers: rheumatologists have long reported that their patients, who for treatment of diseases of the joints - rheumatoid arthritis, for example - usually take these drugs , appear to present a lower incidence of Alzheimer's disease. Recent studies have shown a similar protective effect in women in menopause who take estrogen: Alzheimer's is less common in those who have taken these hormones for ten years or more, compared to the rest of the female population.
It is not yet known how to explain the protective effect of estrogen on the development of Alzheimer's disease, but is believed to stimulate the formation of new connections - ie synapses - between brain cells.

The beneficial effects of "antioxidants", such as vitamin E., are being evaluated. Their mechanism of action consists in neutralizing the toxic effects of free oxygen radicals, substances which due to their strong reactivity alter ("oxidize") ) cellular structures - such as membranes - of the brain and other organs. Vitamin E, together with other anti-oxidant substances, is a kind of defensive shield against free radicals. But the researchers have not yet established the optimal dosage of these substances to be taken daily by mouth: and that would be added to those already normally introduced with a diet rich in fruit, vegetables, fish and extra virgin olive oil.
In patients with Alzheimer's disease, an extract of Ginkgo biloba, a plant that promotes blood circulation in the brain, can slow or make memory loss decrease. Also in this case further confirmatory studies are necessary, and in any case the product should be taken with caution in subjects who take anticoagulant drugs, of which they can enhance the effect. The objective of the research is obviously to identify substances that can prevent the death of brain nerve cells.
Many hopes have focused on the nerve growth factor (NGF) that has shown in animals to prevent the degeneration of cholinergic cells involved in Alzheimer's disease. In humans, however, administration of NGF is hampered by the inability to cross the blood-brain barrier, which is the filter that prevents the entry of potentially damaging molecules into the brain.
Increasingly encouraging results come from the cognitive rehabilitation programs of patients, who are based inter alia on exercises aimed at stimulating spatio-temporal orientation, memory, and verbal functions. It has been seen, among other things, that cognitive rehabilitation is able to alleviate the behavioral disturbances of the demented patient, which provoke great apprehension in his family members. The treatment of the patient suffering from Alzheimer's disease should therefore satisfy a series of needs:

1. Provide an appropriate level of specific care:

  •     specific pharmacological treatment (acetylcholinesterase inhibitors)
  •     non-pharmacological therapies
  •     treatment of other competing diseases
  •     prevention of complications (eg infections)
  •     neuropsychological and neuromotor rehabilitation;
  •     optimize the functional status;
  •     avoid drugs with harmful effects on the central nervous system;
  •     stimulate physical and mental activity;
  •     provide adequate nutrition (a diet rich in antioxidants);


 2. Identify and treat non-cognitive symptoms and complications:



  •     risk of falling and loss
  •     incontinence
  •     malnutrition;

3. Provide adequate information support to the patient and the family:



  •     on the nature of the disease
  •     on evolution and prognosis
  •     on the possibilities of prevention and treatment

 4. Provide social-assistance supports:



  •     territorial services, (Assisted Health Residences)
  •     legal advice
  •     psychological support.

(source: Pharmacy thirty-three).








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