Download Alzheimer`s Disease

Alzheimer's Disease
WHY WE NEED MORE RESEARCH
Prepared by: Adaku Otuonye & Heather Blair
MPH 543: Leadership and Organizational Management in Heathcare
Concordia University Nebraska
October 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
Unavoidable
Avoidable

Gender (female) – Being a female unavoidably
increases the chances of developing Alzheimer’
disease.
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
Age – the older (85 yrs. and above) the more likely to
get the disease. A greater proportion of over-85-yearolds 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.

Head Trauma – history of past head trauma is
correlated with increased risk


(Mayo Clinic, 2014)
Stages
Stages of
Alzheimer’s
Disease
Alz.org, 2014
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
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
Indirect 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.
Training treatment providers and auxiliary
staff

Home care provided by the family, financial
and mental stress that the family incurs

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

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.

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.
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 Medications
Pharmacologic Category – Acetylcholinesterase Inhibitors
Donepezil (Aricept)
Donepezil reversibly and
noncompetitively inhibits centrallyactive 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)
Galantamine (Razadyne)
Benefit of this drug Rivastigmine
increases acetylcholine in the
central nervous system through
reversible inhibition of its hydrolysis
by cholinesterase
Centrally-acting cholinesterase
inhibitor (competitive and reversible).
Reversibly inhibits
acetycholinesterase and
butyrylcholinesterase enzymes.
Modulates nicotinic acetylcholine
receptor to increase acetylcholine
from surviving presynaptic nerve
terminals.
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 enhances cholinergic
function in two ways: It is a weak
acetyl cholinesterase inhibitor and an
allosteric potentiator of both nicotinic
and muscarinic acetylcholine
receptors.”
It elevates acetylcholine in cerebral
cortex by slowing the degradation of
acetylcholine.
(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
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.hrtproxy.libraries.vsc.edu/lco/action/home

Mayo Clinic Staff. (2014). Alzheimer's disease. Retrieved from http://www.mayoclinic.org/diseasesconditions/alzheimers-disease/basics/definition/con-20023871

Turok, A. (2014).Understanding the Emotional, Societal and Financial Strain of Alzheimer’s. Retrieved
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.
Neuroscience,
from