Alzheimer's: An Investigation into Treatment Options Dana McGuire and Jessica Scharfenberg MPH...

Alzheimer's: An Investigation into

Treatment Options

Dana McGuire and Jessica Scharfenberg

MPH 543: Leadership and Organizational Management

Concordia University

June 2015

What is Alzheimer’s Disease?

It is the most common cause of dementia and a primary progressive degenerative disease of nerve cells in the brain.

Risk Factors

• Age

• Family History

• Genetics

• Sex

• Past history of head trauma

• Heart Health

Disease Progression

• Mild (Early Stage)

• Moderate (Middle Stage)

• Severe (Late Stage)

Mild (Early Stage) Alzheimer’s

• Function Independently but feel they have memory lapses

• Word searching-Unable to come up with the right word or name

• Difficulty performing tasks in social settings

• Losing or misplacing objects

• Trouble with planning and organizing

Moderate (Middle Stage) Alzheimer’s

• Forgetfulness of one’s personal history

• Withdrawal from social situations

• Troubles with bladder and bowel control

• Wandering

• Changes in sleep pattern

• Delusions and compulsiveness

Severe (Late Stage) Alzheimer’s

• 24 hour care is needed

• Loss of awareness to surroundings

• Assistance of all daily activities including eating, grooming, and bathing

• Difficulties communicating

• Increasing vulnerability to infections

Direct Costs

• $172 billion each year (indirect and direct)

• Hospitalizations

• Nursing Homes/Groups Homes for 24 hour care

• Accidents

• Medical Bills

• Research

Indirect Costs

• Mental anguish of family members

• Depression

• Setting up a safe environment

• Absenteeism

• Lost productivity

Current Treatment Options

Cholinesterase Inhibitors- inhibit the breakdown of Acetylcholine and prevents the destruction of nerve cells.

• Donepezil (Aricept)

• Rivastigmine (Exelon)

• Galantamine (Razadyne)

Donepezil (Aricept)Benefits• Highly Specific Reversible Inhibitor• Use for all stages of disease• Taken once daily

Side Effects• Nausea• Vomiting• Diarrhea

Rivastigmine (Exelon)Benefits

• Mild to Moderate Stages• Pill, syrup, or skin patch• As good as Aricept• Can block activity of other enzymes

Side Effects• Nausea• Vomiting• Diarrhea• Weightloss

Galantamine (Razadyne)Benefits

• Used for mild/moderate Alzheimer’s• Proven to slow cognitive decline in patients for up to 36

months• Stimulates release of Acetylcholine

Side Effects• Nausea• Vomiting• Rare cardiac events in some patients

Why Fund these Treatments?

• They are temporary, but have shown improvement for past patients.

• Proven to lessen severity of symptoms.

• Treat symptoms of memory loss, reasoning, language, and thinking.

• Use for patients in mild to moderate stages.

• Keeps hospitalizations down.

• More aware and productive.

• Better family dynamic.

ReferencesAlzheimer's Association. (2012, January). FDA-Approved Treatments for Alzheimer's. Retrieved from

https://www.alz.org/national/documents/topicsheet_treatments.pdf

Alzheimer’s Association. (2015a). Risk factors. Retrieved from

http://www.alz.org/alzheimers_disease_causes_risk_factors.asp

Alzheimer’s Association. (2015b). Stages of Alzheimer’s. Retrieved from

http://www.alz.org/alzheimers_disease_stages_of_alzheimers.asp#overview

Auriacombe, S., Pere, J., Loria-Kanza, Y., & Vellas, B. (2002). Efficacy and Safety of Rivastigmine in Patients with Alzheimer's Disease

who Failed to Benefit from Treatment with Donepezil. Current Medical Research and Opinion, 18(3), 129-138. Retrieved from

http://informahealthcare.com/doi/abs/10.1185/030079902125000471

Birks, J. (2006). Cholinesterase inhibitors for Alzheimer's Disease. Cochrane Database System Review, 1. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/16437532

Birks, J., & Melzer, D. (2003). Donepezil for mild and moderate Alzheimer's disease. The Cochrane Database of Systematic Reviews.

doi:10.1002/14651858.CD001190

Mayeux, R., & Sano, M. (1988). Treatment of Alzheimer's disease. The New England Journal of Medicine, 662(1), 17-18.

doi:10.1007/bf03309184

Mayo Clinic. (2014). Alzheimer’s disease. Retrieved from http://www.mayoclinic.org/diseases-

conditions/alzheimers-disease/basics/risk-factors/CON-20023871

Mayo Clinic. (2014a, July 11). Alzheimer's: Drugs helps manage symptoms. Retrieved from

http%3A%2F%2Fwww.mayoclinic.org%2Fdiseases-conditions%2Falzheimers-disease%2Fin-depth%2Falzheimers%2Fart-20048103

National Center for Policy Analysis. (2007). Cost of Alzheimer’s care to rise. Retrieved from

http://www.ncpa.org/sub/dpd/index.php?Article_ID=14331