Ep 5: Treatment for Alzheimer’s Disease (Part 2): Medicine and Rehabilitation Therapies

Transcript

[00:00:00] Micaela: In the last episode, we talked about how diet, exercise, sleep, and other healthy lifestyle habits can help manage and even slow the progression of Alzheimer’s disease. For some people, medication and physical therapy can help too. And that’s what we’ll talk about in this episode of the Alzheimer’s disease podcast.

I’m your host Micaela Arneson.

This show was created for educational purposes only. It is not a substitute for formal medical advice, diagnosis, or treatment. So if you have questions about a medical condition, talk to your qualified healthcare provider.

In the last few decades, scientists have developed drugs aimed to slow the progression of Alzheimer’s disease and address some of the confusion and brain fog associated with it.

Dr. Jason Karlawish explains.

[00:00:49] Dr. Jason Karlawish: Beginning in the late 1980s, early 1990s, drugs were tested in humans who had Alzheimer’s disease that showed that they could improve performance on cognitive test scores and have some effect as well on daily function. And those medications are fit into a category called cholinesterase inhibitors.

[00:01:05] Micaela: Cholinesterase inhibitors help boost the level of neurotransmitters in the brain. If you’ll remember from episode one, neurotransmitters are little chemicals that carry messages around the brain and to the rest of the body.

[00:01:18] Dr. Jason Karlawish: And that translates into, for some patients, improvements in their cognitive performance. Many patients don’t notice a difference and their families as well.

[00:01:26] Lori La Bey: We didn’t know if the drug was helping slowing down the process or not.

[00:01:31] Micaela: Lori La Bey’s mom had Alzheimer’s for 30 years and took a cholinesterase inhibitor called Aricept.

[00:01:37] Lori La Bey: As she progressed, then the question was, should we take her off or should we keep her on? The doctor said we can take her off, but if you realize that it was helping, we can put her back on, but she’ll never be where she was. And so then we said, just keep her taking the medication until the very end. And so that’s frustrating too, because you don’t really know what’s helping or what’s not with these medications.

[00:02:07] Dr. Jason Karlawish: The balance of the data does not support that they have an effect on slowing the progression of the disease. That was a hotly contested area for a number of years in the field. You can almost divide a room up on that question. But I think the consensus is that they have a role in care treatment, but they don’t have that kind of disease slowing effect that we would desire.

[00:02:25] Micaela: In June 2021, a new drug to treat Alzheimer’s was approved by the FDA. here’s neurologist Dr Andrew Budson

[00:02:33] Dr. Andrew Budson: Aducanumab, or Aduhelm, has actually been FDA-approved in the United States for use in individuals with mild stages or early stages of Alzheimer’s disease.

[00:02:48] Micaela: But the approval of Aducanumab was controversial.

[00:02:52] Dr. Andrew Budson: The FDA’s own advisory panel voted against its approval. And after it was approved, three of the advisory panel members resigned. And what I can tell you is that, like the advisory panel, I am not convinced that this medication works.

[00:03:14] Micaela: Aducanumab is not a cholinesterase inhibitor. It’s part of a different class of medication that actually goes after the production or accumulation of amyloid plaques.

[00:03:23] Dr. Andrew Budson: There was one large trial, with approximately a thousand participants, which looked positive, it looked like it did work to perhaps slow down the disease the equivalent of three months in an 18-month trial. But the other large trial, with about the same number of patients, did not work. So we’re left with one trial that worked, one trial that didn’t work.

[00:03:49] Micaela: Dr. Karlawish says his mind is open to the potential of Aducanumab and other similar drugs to clear amyloid. But he believes it’s still not clear whether that approach will successfully treat Alzheimer’s disease.

[00:04:00] Dr. Jason Karlawish: The challenge with those drugs has been showing that clearing amyloid actually changes the natural history of the disease. There are a variety of reasons why that remains a sort of contested area, and a lot of them have to do with dosing of the drug, eligibility criteria of the subjects, duration of therapy. So the issue is in still figuring out who’s the right patient to be in these studies and how best to study them.

[00:04:23] Micaela: The bottom line is that more research is needed.

[00:04:26] Dr. Jason Karlawish: And the good news is those studies are in the works. There are at least three or four studies of drugs like Aducanumab, which will read out in the coming six to 24 months. And if we get together again in a year or two, we could have a conversation about those drugs, either sadly that they didn’t pan out, or they’re a beginning, they’re a start.

[00:04:46] Micaela: If you’re interested in learning more about Aducanumab, you can find links to information about it, the clinical trials, and FDA approval on our website, hupstaging.wpengine.com. And as always, you should talk to your qualified healthcare provider, if you have any questions or wanna know if Aducanumab could be right for you. In the meantime, people like Paul Hornback still have access to cholinesterase inhibitors and other medicines that aim to treat the memory loss and brain fog associated with Alzheimer’s disease.

[00:05:15] Paul Hornback: My neurologist put me on both medications, Namenda and Exelon.

[00:05:21] Micaela: Exelon is a cholinesterase inhibitor and Namenda is another class of drug.

[00:05:25] Paul Hornback: I still take them, and I think that they help because when I forget to take them, usually the next day is not quite as good as the day before. I really hope that they find the miracle drug, which probably doesn’t exist. It may be more of a cocktail that is designed to each person’s specific needs, but I hope they find that. And I hope that when they find it that the cost will be affordable. And I also hope that more people become aware of this disease and how it impacts families and that municipalities can learn how to help people with Alzheimer’s improve their lives.

[00:06:09] Micaela: Another aspect of Alzheimer’s disease management is physical, occupational, or speech and language therapy, because Alzheimer’s disease can mess with coordination and communication.

[00:06:19] Teepa Snow: One of the phenomena that can happen is I try to think about something that I’ve been doing automatically and suddenly it’s much more challenging.

[00:06:28] Micaela: This is Teepa Snow, an occupational therapist.

[00:06:31] Teepa Snow: That could be as complex as driving a car, or as simple as going up a set of steps with a laundry basket. Also, when I get distracted by things, I could lose abilities. Suddenly my feet and my body are not paying attention the way they normally would have.

[00:06:48] Sandra Robinson: They could be more easily distracted, forget that there’s even food in the mouth and require reminders to swallow.

[00:06:57] Micaela: It may surprise you to learn that swallowing disorders are really common in Alzheimer’s disease. Speech and language therapists, like Sandra Robinson, can help.

[00:07:07] Sandra Robinson: Sometimes we might be one of the first clinicians to spot the kind of symptoms that would make us think, oh, I wonder if this person has started with alzheimer’s.

[00:07:17] Micaela: Therapy can help people with Alzheimer’s disease improve their functioning.

[00:07:21] Sandra Robinson: For example, if they want to move from particular texture of food to a greater one that requires more chewing and swallowing.

[00:07:30] Micaela: Continue doing the things that are important to them.

[00:07:32] Teepa Snow: Whether it’s running or biking or whether it’s just climbing steps or getting out of a tub.

[00:07:38] Micaela: And in later stages.

[00:07:40] Sandra Robinson: As the person is nearing the end of life, we can support with comfort measures at that point.

[00:07:47] Micaela: Any therapy program will take the person’s specific needs and abilities into account and will likely involve family and caregivers who can support them in meeting their goals.

[00:07:56] Sandra Robinson: There is no one size fits all.

[00:07:58] Micaela: But, both Teepa and Sandra said the earlier someone comes to therapy, the better their chances are of preserving function and independence.

[00:08:05] Teepa Snow: I think historically there was very little consideration for rehab. That whole idea of once you’ve got dementia, you’re on the road to death, and that’s not true. I think we’ve gotten a little better, but we still wait until there’s falls, until there’s disengagement, language challenges.

[00:08:22] Sandra Robinson: The one thing we do try to do is promote independence or assist people only as so far as they actually really need it, because the more somebody can do for themselves, the more messages are being sent back to the brain.

[00:08:36] Micaela: If you think therapy could help you or someone you love, you can find more information and practitioners at the American Physical Therapy Association and American Speech Language and Hearing Association. Teepa also works with Total Health Works, a service that offers online brain and body training. Also clinical trials are a great way to learn about and contribute to the development of medication and other therapies. If you’re interested, you can find trials at Alzheimers.gov and on the Alzheimer’s Association website. The association also has a list of cognitively stimulating activities to try with your loved one. Links to these resources and more are on our website, hupstaging.wpengine.com.

If you love someone with Alzheimer’s disease, in the next episode, we’ll share some stories and advice about caring.

[00:09:23] Anthony Copeland Parker: She doesn’t dress herself, she doesn’t shower by herself. And so all those things I have to do for her.

[00:09:30] Sandra Robinson: It can require a fair bit of experimentation in some cases.

[00:09:34] Micaela: We’ll talk about what not to do.

[00:09:36] Dr. Jane Mullins: Often people like to try and test someone’s memory.

[00:09:39] Micaela: And the importance of caring for yourself too.

[00:09:41] Anthony Copeland Parker: If the caregiver isn’t having a manageable life, it’s gonna be really hard for the person with dementia to have one.

[00:09:48] Micaela: This is the Alzheimer’s disease podcast. This show is part of the Health Unmuted audio library by Mission Based Media. To listen and learn more, visit hupstaging.wpengine.com and follow our show on your favorite podcast player. The Alzheimer’s disease podcast is written, hosted and produced by me, Micaela Arenson. Many thanks to Dr. Daniel Gibbs, Anthony Copeland-Parker, Paul Hornback, and Lori La Bey for sharing their personal experiences, and to Dr. Gibbs, Dr. Philip Sloane, Dr. Andrew Budson, Dr. Jason Karlawish, Teepa Snow, and Sandra Robinson for sharing their medical expertise.