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Pharmacological treatments to reduce the progression of Alzheimer's disease
Most Alzheimer's clinicians, researchers, and advocacy groups have bet on a pharmaceutical cure to solve this problem for years, but failure after failure has occurred. The FDA approved the first medicine thought to be able to reduce the development of Alzheimer's disease pathology in the brain last year, despite much expert dispute. The assumption, which has yet to be verified, is that if such medicine is given early enough — before any symptoms appear — the disease will advance in such a way that people will be able to live out their lives without suffering dementia.
A looming crisis
Although this desired path is rational and admirable, the immediate consequences may be costly. The vast majority of novel Alzheimer's disease drugs, including the one authorized by the FDA, are being tested in people who already show symptoms like memory loss. As a result, millions of people with mild Alzheimer's symptoms will be the first to receive these new disease-modifying medications. Individuals with symptomatic Alzheimer's disease will continue to progress, and if the therapies are successful, they will progress more slowly, because these drugs slow down (but not stop) the accumulation of pathology. It's possible that the mild stage of dementia will last four, five, or six years instead of three. Instead of the last four years, the moderate stage could last five, six, or seven years. This means that, for the time being, disease-modifying medications will not reduce the number of people living with dementia; rather, they will vastly increase it.
As a result, it is vital for the United States and other countries to invest in both pharmaceutical and nonpharmacological treatments for Alzheimer's disease and other dementias. Although many treatments have been devised to improve memory in patients with mild memory problems, few, if any, have undergone extensive clinical trials to confirm (or disprove) their effectiveness.
In the early stages of Alzheimer's disease, nonpharmacologic memory-boosting techniques may be beneficial.
A group of Boston researchers looked at 32 people with modest memory issues, half of whom had mild cognitive impairment and the other half had mild Alzheimer's disease dementia. When learning new knowledge, they discovered that both groups increased their memory by merely thinking about the following question: "What is one distinctive attribute of this item or personal experience that distinguishes it from others?" Another study conducted by Boston researchers discovered that 19 people with mild cognitive impairment could improve their ability to remember items in a virtual supermarket by simply thinking systematically about whether or not the items were already in their cupboard before placing them in their shopping cart. However, larger investigations are needed to see if these memory methods are generalizable.
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Music, pets, robotics, and the environment are all in the moderate to severe stages.
Similarly, several nonpharmacological treatments appear to bring comfort and reduce agitation in people with moderate to severe dementia, but larger and more rigorous studies are needed to verify or disprove their efficacy and, as a result, promote their widespread use.
A group of Portuguese physicians and academics examined more than 100 trials testing music-based therapies for patients with dementia who exhibited agitation or other behavioural and psychological signs of dementia, finding that the great majority were beneficial with little or no adverse effects.
A group of Florida neurologists looked into the effects of dog therapy and ownership and discovered that both were safe and effective treatments for chronic and progressive neurological illnesses.
When robot pets were provided to dementia patients, other researchers discovered that anxiety and the usage of psychoactive medications decreased.
A review of the built environment (the architecture of the home or facility) concluded that "specific design interventions are beneficial to the outcomes of people with dementia."
Families' education
It's also crucial to educate families and other caregivers on how to deal with the many stages and characteristics of dementia. Brazilian physicians conducted pilot research in which carers were invited to participate in educational sessions and reported a high degree of program satisfaction. Unfortunately, substantial clinical studies of caregiver education interventions are rarely conducted.
Enormous savings are possible.
If mild dementia solutions were effective enough to save just one hour per week of a caregiver's time for the nearly two million people with mild dementia in the United States, it may save 104 million hours worth $1.7 billion per year. For example, that extra hour would allow a "sandwich caregiver" to assist their child with homework while their parent with moderate dementia takes pills or pays bills on their own.
Nonpharmacologic therapies in the moderate to severe stages could save more than $31 billion dollars (based on a semi-private nursing home room costing $93,075 per year) for the nearly four million people with moderate to severe dementia in the United States. Individuals with Alzheimer's disease and their families will save money in addition to benefiting socially and emotionally.
New reimbursement models are being developed.
Finally, after nonpharmacological treatments have been shown effective, new reimbursement models will be required to fund their implementation, as standard insurance payments are targeted toward medications. Nonpharmacological techniques must be utilized in conjunction with pharmacological therapies if the United States — and the rest of the globe — is to cope with the expanding number of persons with dementia.
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