EVALUATION AND MANAGEMENT OF ALZEIMERS AND DEMETIA

As with various medical conditions, early diagnosis is key to effective therapy in management of
neurodegenerative disorders.
In Alzheimers disease early diagnosis allows patients and their families to:
1.
2.
3.
4.

Have a better chance of benefiting from therapy

Be less anxious about unknown problems
Increase chances of participating in clinical drug trials helping in advanced research
creates more time to plan for the future

Diagnosing Alzheimers requires careful medical evaluation including the following:

1. Thorough medical history
2. Adequate mental status examination/testing e.g. Memory tests and mini mental state exam
(MMSE). This exam involves the health professional asking series of questions that have been
designed to test a range of everyday mental skills. Maximum score is 30; while a score of 2024 (Mild), 13-20 (Moderate) and < 12 (Severe)
3. Physical and neurological examination
4. Tests such as blood test and brain imaging help to rule out differential diagnosis. The diagnosis
can be confirmed with very high accuracy post-mortem when brain material is available and
can be examined histologically.
Association between Alzheimer and Dementia:
Dementia is a feature of many neurodegenerative disorders and Alzheimers is the most
associated

MANAGEMENT
There is no definitive care for Alzheimers disease and dementia but there are pharmacologic and nonpharmacologic interventions which are used for optimal therapy and management of cognitive,
behavioral and physiological symptoms of Alzheimers disease and dementia.
Management Goals include:
1.
2.
3.
4.

To maintain quality of life

To foster a safe environments
To maximize function in daily activities
To enhance cognition, mood and behavior

Pharmacologic Interventions
A. Medication Two classes of drugs are used in alleviating the cognitive problems of
Alzheimers disease: They include:
a. Acetyl-cholinesterase inhibitors: Tacrine, Rivastigmine, Donepezil, Galantamine
b. NMDA receptor antagonists: Mematine
c. Antipsychotics: Risperidon, Huperzine A, etc.
B. Mechanisms of Action of these medications
a. Acetylcholinesterase inhibitors increase cholinergic activity of cholinergic neurons by
inhibiting breakdown of acetylcholine by acetylcholinesterase
b. Glutamate is an excitatory neurotransmitter of the nervous system. Alzheimers and
other neurological diseases e.g. Parkinsons and multiple sclerosis exhibit excitoxicity
as a result of overstimulation of glutamate receptors. Blockade by NMDA receptor
antagonist blocks overactivity of glutamate at these sites.

c. Antipsychotics moderately reduce aggression and psychosis of Alzheimers disease.

However, NO antipsychotics have been Licensed for use in Alzheimers disease
Non-pharmacologic intervention
A. Psychosocial intervention: This is used as adjuncts in therapy of Alzheimers. It include:
a. Counselling caregivers on how to show supportive care
b. Changes of environment
c. Management of symptoms such as behavioural problems, confusion and sleep
problems

PROSPECTS FOR NEW TREATMENTS: Cells and Gene Therapy

Current pharmacological treatment produces symptomatic benefit particularly in early stages
(buttressing the point of early diagnosis) but none can delay or stop the progression of these diseases.
There is therefore a need for new therapies which can modify disease progression.

FRONTIERS IN TREATEMENT OF NEURODEGENERATIVE DISORDERS

This is based on:
1. Gene therapy
2. Cell therapy
Gene therapy
Most of the available gene therapies are still undergoing development, an example is the CERE110 gene therapy which stabilizes brain cells in Alzheimers. This therapy is still under phase I
clinical trials.
NGF is a naturally occurring protein that may prevent nerve cells in the brain from dying and may
help these cells to function better. During the study CERE-110 will be injected by a neurosurgeon
in to the nucleus basalis of Meynert, an area of the brain where nerve cells die in patients with
Alzheimers disease.
It has been shown via a small study in humans that CERE-110 is generally safe and well tolerated
The Phase II study will evaluate whether the therapy is safe for a larger group of patients, and
whether it helps the symptoms of Alzheimers disease
If clinical development of this therapy is successful, CERE-110 could offer the possibility of
delaying the course of Alzheimers disease which is a real improvement over existing therapies.
Unfortunately this would not be a cure for Alzheimers disease but a way of slowing it down.
Stem cell Therapy
Stem cells are the origin of all cells in the body. Cell replacement therapy for an injured brain has
provided the basis for potentially powerful new therapeutic strategies for a broad spectrum of
human neurological disease. However, the shortage of suitable cell types for cell replacement
therapy in patients suffering from neurological disorders has hindered the development of this
promising therapeutic approach.