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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