A review of currently available
treatments suggests a number of areas for further study. Some of these recommendations
are within the realm of improved evaluation and assessment.[i]
§
Improved detection and
evaluation of dementia, especially in the prodromal and early stages, when
treatment that slows progression would be more likely to be beneficial. This
implies the development of a reliable diagnostic tool.
§
There is a clear need for
increase biomarkers for measuring disease progression – the lack of these means
that trials of disease modifying therapies will not move ahead as rapidly as
possible. The use of surrogate endpoints
e.g. imaging also needs more investigation. (see below).
§
Development of consensus on
clinically meaningful outcome measures and ‘hard’ endpoints, such as
institutionalization and mortality.39
§
Within the field of
pharmacologic therapy, there is a critical need for medicines with greater
ability to improve cognition or at least halt the progression of dementia.
Areas that are already being actively studied in patients with AD include
cholinergic agonists, vitamin E, NSAIDs and antioxidants.39
§
Despite the progression in the
areas mentioned above, research and development needs to further identify and
test new cognition-enhancing medicines based on the pathophysiology and
information learned about the disease from neuroscience and molecular genetics.
For example, pharmacologic agents that prevent or slow amyloid deposition or
remove precipitated amyloid which might serve to prevent or reverse AD.39
§
Other research directions that
can greatly affect management of AD, is the optimal pharmacologic treatment of
noncognitive symptoms, including psychosis, agitation, depressions and sleep
disturbances. Many current recommendations are based on small-uncontrolled
studies or agents no longer in common use and/or at doses well above those used
in current practice. There is, therefore, a critical need for randomized
controlled studies and guidelines on up-to-date treatments for non-cognitive
symptoms present in AD.39
§
Clinical questions that need to
be further evaluated and studied include what to treat? There is a problem
surrounding the terminology, and diagnosis associated with dementia and AD.
Confusion remains about when to initiate treatment; how to treat -i.e. what
agents to start, how to switch drugs in the case of decreased efficacy,
intolerance, adverse effects or drug interactions and how long to treat AD.39
§
In addition to symptomatic or
palliative options, increased knowledge of the anatomical, cellular and
molecular basis of AD, together with the identification of new drug targets,
which may prevent, slow or delay its onset are needed. These possibilities may
be expedited by the further progress in research and development of improved
animal; introduction of more efficient and effective clinical trials, and the
use of non-invasive imaging to monitor the progression of the disease. It has
been estimated that delaying the onset of AD by approximately 5 years would
reduce the numbers dramatically by about 50% by 2050.[ii]
Combination therapies are likely to offer
maximum benefit in longer term disease modification
[i] http://wismed.medicallibrary.medem.com.
Wisconsin
Medical Library. American Psychiatric Association. Excerpted from “The American
Psychiatric Association’s Practice Guideline for the Treatment of Patients with
Alzheimer’s Disease and other Dementias of Late Life”. Last accessed April 1,
2004.
[ii] Palmer A. Pharmacotherapy for Alzheimer’s
Disease: Progress and Prospects. Trends in Pharmacological Sciences. 2002;
23(9): 426-433.
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