The World Health Organization (WHO) estimates that 47 million people have dementia globally. In the United States alone, about five million Americans live with the debilitating consequences of Alzheimer’s disease (AD), according to the Centers for Disease Control and Prevention (CDC). WHO projects an additional 9.9 million cases each year, worldwide.
With such sobering figures, you may wonder about the course that treatments methods have taken. AD and certain forms of dementia remain incurable. However, recent research has revealed some declines in the number of cases both in the United States and Europe. Hope exists that one day both conditions will be treatable.
Identification of Alzheimer’s
German psychiatrist Dr. Alois Alzheimer first described the disease in 1906. He had treated a woman who experienced a wide range of symptoms such as behavioral changes and confusion. It suggested mental illness. However, the autopsy revealed several abnormalities including clumps now called amyloid plaques and tangles of fibers.
The initial treatment for the patient consisted of known psychiatric practices of the day. It soon became clear that Dr. Alzheimer was witnessing the progression of an unknown disease. The publication of his findings led to reports of similar cases. Then as now, definitive diagnosis of AD is made post-mortem.
The Evolution of Alzheimer Treatment Methods
Identification was just the first step in what is still today an arduous journey toward a cure. The path toward treatment took a major leap forward with the invention of the electron microscope in 1931. It made it possible to study the minute changes going on in brain tissue. That paved the way for better diagnosis with validated cognitive measurement scales.
That made it possible for doctors to better assess the degree of brain damage based on the severity of symptoms. Several milestones helped propel research forward including the 1971 founding of the National Institute on Aging and the 1980 formation of the Alzheimer’s Association. Now scientists had a funding source and a means to coordinate research.
New information came to light quickly. The first drug trial for a medication for treating the symptoms of AD launched in 1987. In the same year, researchers also identified a gene associated with its development. Tacrine was the first federally approved drug for treating memory and cognitive symptoms. Today, there are five FDA-approved medications.
Several advancements and breakthroughs have occurred in subsequent years including:
- 1999: First Alzheimer’s disease vaccine in mice
- 2004: Identification of Pittsburgh Compound B (PIB) for better early detection
- 2009: Standardization of identification of biomarkers associated with AD
- 2011: Guidelines for care established
- 2013: International Genomics of Alzheimer’s Project (IGAP) identifies 20 new genetic risk factors
- 2014: Donepezil and memantine approved for moderate to severe stages
There are three type of approaches for current treatments. Medications address a variety of cognitive symptoms but do not cure the disease. Psychosocial interventions use an array of different therapies to manage behavioral issues. And finally, caregiving seeks to maintain a good quality of life for the patient as they reach its final stages.
Dementia Treatment Options
Dementia is a catch-all term that describes the symptoms associated with brain damage and dysfunction. Treatment depends on the cause of the condition with some overlap with Alzheimer’s disease. Other disorders such as frontotemporal dementia often occur concurrently with AD.
Some drugs can treat a variety of diseases. For example, acetylcholinesterase inhibitors used to treat AD is also effective for Lewy body dementia. Other medications target specific symptoms. Antipsychotics are an option for managing inappropriate behavior in patients with frontotemporal dementia.
Treatment methods have evolved with a better understanding of the underlying cause. For example, reversible memory loss caused by a vitamin B12 deficiency can now be managed with administration of the nutrient. Likewise, hormone therapy can restore cognitive function in cases of hypothyroidism.
When memory loss is irreversible, treatment involves palliative care to keep the patient as comfortable as possible. Health care providers will use similar psychosocial as AD for behavioral manifestations of the disease or damage. A recent development includes the discovery of neuroplasticity in the human brain.
This concept of brain malleability represented a major turning point. Before, the general consensus was that the brain stopped growing once it reached adult size. The reality is that it continues to develop new connections between nerve cells all through life. It is even able to react to traumatic events.
Scientists have learned that the brain is capable of adapting to changes such as brain injury caused by trauma or other causes of dementia. Research is ongoing to find ways to harness the brain’s natural abilities to respond to conditions such as Huntington’s disease. It has been used successfully with stroke patients. The brain reorganizes itself to compensate for reduced functionality.
Targeting Risk Factors
Treatments for dementia have further evolved with the discovery of risk factors that can worsen existing conditions. They target lifestyle changes such as obesity and smoking. They also consider better management of chronic issues such as high blood pressure and diabetes. These approaches can help prevent or reduce the risk of further damage.
Some care options focus more on the emotional aspects of dementia and AD rather than the physical elements. Healthcare practitioners use these therapies to address the psychological impacts of these conditions. Cognitive behavioral therapy tackles issues of this sort by reprogramming the trigger-response path with an action that is more appropriate.
Sometimes, it’s a matter of just being heard and understood. That is the goal of validation therapy. It strives to reduce stress and anxiety in patients by accepting their perceptions of their world even if they’re not accurate.
The evolution of Alzheimer’s and dementia treatment methods is a work in progress. The more science learns about the causes and effects of these conditions, the better it can fine tune the best approach. More research is needed to continue to hone in on the right options. In the meantime, the patient’s quality of life is the primary concern no matter what the illness or its cause.