Alzheimer's DiseaseWHY WE NEED MORE RESEARCH

Prepared by: Adaku Otuonye & Heather BlairMPH 543: Leadership and Organizational Management in Heathcare

Concordia University NebraskaOctober 2014

What is Alzheimer's Disease?

Alzheimer’ Disease is defined as:

- a neurological disorder caused by the death of brain nerve cells

- a neurodegenerative disease – which means there is progressive brain death over time

- cell death progresses to tissue loss throughout the brain

- brain impairment, due to tissue loss the brain shrinks and affects nearly all bodily functions

- leading cause of dementia

Alzheimer’s Brain Images

Without Disease

With advanced Alzheimer’s disease

Size comparison of the two brains

Symptoms of Alzheimer’s Disease

There are several symptoms of Alzheimer’s Disease. The symptom that most people are familiar with is memory loss.

It may be subtle at first with mild confusion and forgetfulness.

As symptoms worsen –

- Repeating statements and questions over and over

- Forgetting conversations, appointments, and events. Not remembering later.

- Routinely misplacing items, not in logical places

- Not recognizing family members by face or name

- In ability to take care of daily bodily needs (Dressing, bathing, eating, etc…)

(Mayo Clinic, 2014)

Risk Factors Associated with Alzheimer's Disease

Avoidable

Head Trauma – history of past head trauma is correlated with increased risk

Heart Disease – there is a correlation that notes heart disease may increase risk for Alzheimer’s disease

Life Style Choice – smoking, diet lacking in fruits and vegetables, poorly controlled autoimmune diseases, obesity, and lack of exercise

(Mayo Clinic, 2014)

Unavoidable

Gender (female) – Being a female unavoidably increases the chances of developing Alzheimer’ disease.

Age – the older (85 yrs. and above) the more likely to get the disease. A greater proportion of over-85-year-olds have it than of over-65s.

Genes (family history) - having Alzheimer's in the family is associated with higher risk. usually the second biggest risk factor after age.

Certain gene (the apolipoprotein E or APOE gene) predisposes someone, depending on their specific genetics, at three to eight times more risk than a person without the gene.

Stages of Alzheimer’s Disease

Stages

Level of Impairment

Signs

Stage 1

No Impairment No evidence of any memory problems

Stage 2

Very mild decline Small lapses in memory – names, where keys are. Not detected through medical exam or by friends or family

Stage 3

Mild decline Noticeable to friends and families.During medical exam doctor may recognize beginning symptoms.

Stage 4

Moderate decline Forgetfulness of recent events, personal history, withdrawn in social situations and difficulty with organizational tasks.Definite diagnosis can be made

Stage 5

Moderately severe decline

Gaps in memory, need help with daily tasks.

Stage 6

Severe decline Memory continues to worsen, need extensive help with daily activities, changes in sleep patterns, incontinence, wander/lost

Stage 7

Very severe decline Cannot respond to environment or carry on a conversation. Physical impairment – difficulty swallowing, unable to smile, unable to sit without support, reflexes become abnormal, muscles may become rigid

Alz.org, 2014

Any direct/indirect

costs associated

with Alzheimer's

disease

THE COST ASSOCIATED WITH ALZHEIMER’S DISEASE IS THE VALUE OF ALL GOODS AND SERVICES GIVEN UP IN ORDER TO PREVENT, DIAGNOSE, TREAT, AND DEAL WITH THE DISEASE.

ALSO INCLUDED IN THE COST ARE EXPENSES ASSOCIATED WITH ALZHEIMER’S DISEASE RESEARCH AND EDUCATION PROGRAMS.

ON THE AVERAGE ALZHEIMER’S DISEASE IS EXPECTED TO COST $215,000 THROUGHOUT THE ENTIRE COURSE OF THE DISEASE ($40,000 FOR DIRECT COSTS; $175,000 FOR INDIRECT COSTS).

What is the cost of Alzheimer’s Disease?

Direct Costs Direct Provider Services – Consultations,

hospitalizations, homecare providers Diagnosis – variety of tests including: laboratory

blood tests, psychological evaluations, imaging exams and in some cases genetic testing.

Care expense - nursing home, long-term care facility, or at home, short-term acute hospital care, provider services, adult day-care, assisted living, prescription medication, home care provided by outside agencies, drugs, and travel

Durable medical equipment – Examples beds, walkers, bathing products, GPS device for those that may wander, and adult diapers

Majority of Alzheimer’s patients use public programs — Medicare and/or Medicaid — to pay for care. This is very expensive for all of us.

Indirect Costs Training treatment providers and auxiliary

staff

Home care provided by the family, financial and mental stress that the family incurs

Patients’ own mental and physical stress from the disease

Other comorbidities – heart disease, diabetes, kidney disease and cancer, which may contribute to treatment complications and increase financial cost of the disease.

Medication Treatment Options

At this time there are three medications that have been approved for the treatment of Alzheimer’s Disease –

- Donepezil (Aricept)

- Rivastigmine (Exelon)

- Galantamine (Razadyne)

Alzheimer’s disease is characterized by a cholinergic deficiency in the cortex of the basal forebrain, this contributes to the deficits noted in this disease.

All three drugs are all Acetylcholinesterase Inhibitor’s.

There have not been sufficient studies to compare the efficacy of one drug to another.

(Lexicomp, 2014)

Approved MedicationsPharmacologic Category – Acetylcholinesterase

Inhibitors

Donepezil (Aricept)Donepezil reversibly and noncompetitively inhibits centrally-active acetylcholinesterase, the enzyme responsible for hydrolysis of the neurotransmitter acetylcholine after its release from the presynape.

This appears to result in increased concentrations of acetylcholine available for synaptic transmission in the central nervous system.

Ultimately the benefit is that it delays the progression of cognitive symptoms of Alzheimer’s disease.

Rivastigmine (Exelon) Benefit of this drug Rivastigmine increases acetylcholine in the central nervous system through reversible inhibition of its hydrolysis by cholinesterase

Reversibly inhibits acetycholinesterase and butyrylcholinesterase enzymes.

The delivery system is through transdermal absorption. The use of a patch allows the patient to experience less gastrointestinal side effects and deliver higher doses of the medication.

Galantamine (Razadyne)Centrally-acting cholinesterase inhibitor (competitive and reversible).

It elevates acetylcholine in cerebral cortex by slowing the degradation of acetylcholine.

Modulates nicotinic acetylcholine receptor to increase acetylcholine from surviving presynaptic nerve terminals.

“Galantamine enhances cholinergic function in two ways: It is a weak acetyl cholinesterase inhibitor and an allosteric potentiator of both nicotinic and muscarinic acetylcholine receptors.”

(ALZFORUM, 2014), (Lexicomp, 2014)

Medication Side Effects

There are many similar side effects among these medications:

- Gastrointestinal: diarrhea, nausea, vomiting, reflux, abdominal pain, weight loss, loss of appetite

- vertigo

- sleeplessness/fatigue

- urinary incontinence

- bradycardia

- seizures

- bradypnea

(ALZFOURM, 2014)(Lexicomp, 2014)

How do we get from here…….

First, there is a worldwide quest to find new treatments to stop, slow or even prevent Alzheimer's. Usually new drugs take years to produce and be in the market, and because drugs that seem promising in early-stage studies may not work as hoped in large-scale trials. It remains critical that research for Alzheimer's treatment continues to receive funding to ensure that the effort to find better treatments receives the focus it deserves.

Second, despite the increasing momentum in Alzheimer's research, a cure for Alzheimer's disease remains in great need with 4.5 million Americans currently suffering from Alzheimer's, and that number expected to triple in the coming decades, an effective treatment is needed more than ever. While existing Alzheimer's drugs offer limited benefits, there are exciting new drugs in the testing pipeline offering tantalizing hope for major progress for millions of Alzheimer's sufferers worldwide.

…..To here?

Third, there are a number of other health conditions that compound the symptoms of Alzheimer’s disease because they affect one’s cognition. People with Alzheimer's may not be able to communicate such health problems to others. Their reactions may be interpreted as part of the Alzheimer's disease process. There is a critical need for further research on proper drug treatment of these comorbidities to help get these health conditions to improve or resolve. Adequate correction of these disorders will greatly improve mental function.

Finally, investing in drug treatment research for Alzheimer’s now will cost our nation far less then the cost of care for the rising number of Americans who will be affected by Alzheimer's in coming decades.

References

Alz.org. (2014). Seven Stages of Alzheimer’s. Retrieved from http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp

ALZFORUM. (2014). Therapeutics. Retrieved from http://www.alzforum.org/therapeutics/donepezil

Davidson, M & Schnaider Beeri, M. (2000). Cost of Alzheimer’s disease. Dialogues in Clinical Neuroscience, 2(2): 157-161. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181598/#!po=21.4286

Hay, J. W. & Ernst, R. L. (1987). The economic costs of Alzheimer’s disease. American Journal of Public Health, 77(9) Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1647016/

Lexicomp. (2014). Lexicomp online for dentistry. Retrieved from http://online.lexi.com.hrt-proxy.libraries.vsc.edu/lco/action/home

Mayo Clinic Staff. (2014). Alzheimer's disease. Retrieved from http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/basics/definition/con-20023871

Turok, A. (2014).Understanding the Emotional, Societal and Financial Strain of Alzheimer’s. Retrieved from http://www.alznyc.org/nyc/newsletter/summer2014/06.asp#.VDKxwRbWyGA

Wilcock G, Howe I, Coles H, Lilienfeld S, Truyen L, Zhu Y, . Kershaw P. (2003). A long-term comparison of galantamine and donepezil in the treatment of Alzheimer's disease. Drugs Aging. 20(10):777-89. PubMed.