DEMENTIA AND DRUG USE



Dementia and drug Use

Dementia and drug Use

Background

“About 145,000 people with dementia are wrongly being prescribed powerful anti-psychotic medication which causes around 1,800 deaths a year,” The Times reported. Many newspapers have reported this finding from a government-commissioned review. The government has responded to the report and agrees with its main findings.

The report makes several recommendations, mainly that people with dementia should receive antipsychotics only when they really need them, and that reducing their use in this group should be a priority for the NHS. It suggests this can be achieved by various means including training carers and medical staff to use alternatives to antipsychotics, providing psychological therapies for people with dementia and their carers, carrying out further research into alternative treatments, and audits.

Introduction

Alzheimer's disease is the most common form of dementia in the elderly and is the fourth-leading cause of death for patients aged 65 or older. The prevalence of AD is estimated to be about four million people in the U.S. alone, and approximately one million elderly Americans have severe dementia. Moderate to severe AD represents an identifiable stage of AD and can be reliably diagnosed. A hallmark of the transition to the moderate and severe stages of AD is the progressive loss of the ability to perform activities of daily living.

The current therapeutic options for AD approved by the FDA are the cholinesterase inhibitors (ChEIs), which are indicated for the treatment of mild to moderate AD. However, it is believed that seventy percent of diagnosed dementia patients already have advanced dementia symptoms. The time that the average AD patient spends in the mild stages, where episodic memory loss is the primary clinical finding, is relatively brief. Once the patient reaches the moderate stage, the remaining three to 12 years of life are spent experiencing further deterioration in cognition and activities of daily living (ADLs). There is no approved anti-dementia treatment in the U.S. for patients with advanced AD (MMSE <10).

During the mild-to-moderate stages, cognitive skills show deterioration and this decline leads to impaired ADLs. Instrumental ADLs begin to be affected in the mild-to-moderate stages of AD, followed by pronounced deterioration in physical or self-care functions during the moderate-to-severe stage. The progressive decline in the patient's ADLs ultimately lead to nursing home placement. Decline in ADLs and cognition further burden caregivers. In severe AD, all intellectual functions are severely compromised, and the clinical picture is dominated by the patient's limited function and disruptive behavior. The estimated annual cost of patient care rises from $18,408 in mild to $36,132 in severe stages. Thus, there is a need for therapeutic agents that will slow decline, potentially reduce care costs, and delay institutionalization.

Preclinical and postmortem studies of AD have associated changes in glutamatergic function with memory deficits, a hallmark of AD. Moreover, the excitotoxicity hypothesis holds that chronic glutamatergic overstimulation leads to neurodegeneration. Thus, the glutamatergic neurotransmitter pathway has been implicated in AD pathology and serves as a target for therapeutic ...