US Pharm. 2015;40(1):1.
I can’t remember exactly when I first heard about a disease where older people “lose their minds,” but I guess it was at a pretty young age because what stuck with me was the name of this odd disease—what my friends and I called old timers’ disease. Little did I realize we were making fun of a very grave illness that we have since come to know and respect as Alzheimer’s disease (AD). And now that I have reached the age of an old timer, it really doesn’t seem quite so funny.
As it turns out, we weren’t so far from the truth about old timers getting a disease in which they lose their minds. Although early-onset AD is possible, it affects less than 5% of all AD patients, according to the National Institute on Aging (NIA). A progressive brain disease that slowly destroys memory and thinking skills, AD affects as many as 5 million Americans aged 65 years and older. And while the malady, first described by the physician Alois Alzheimer in 1906, has been studied intensively over the years, it remains an incurable neurodegenerative disease. Although some progress has been made in studying its etiology, AD remains mostly a mystery since the time Dr. Alzheimer studied the brain tissue of a woman who had died of an unusual mental illness that included memory loss, language problems, and unpredictable behavior. What he found were many abnormal clumps and tangled bundles of fibers and a loss of connection between nerve cells in the brain.
Unlike other catastrophic illnesses such as cancer and heart disease, which can be diagnosed through a battery of tests, AD is a complex condition that can be difficult to diagnose because dementia, a decline in function and cognition, is a common by-product of the normal aging process. Another roadblock in diagnosis is that degeneration of a patient’s neurologic functions can take a number of years to reach a stage where the diagnosis of AD becomes definitive.
As with all chronic and potentially fatal diseases, the pathway to a cure is successful research. But research by trial and error is expensive and funds are short. Regardless of how much funding comes from the government, it never seems to be enough. In addition to the cost of research and development of new products and procedures, the price of care for patients with AD can be staggering. The NIA estimates that caring for AD patients, including routine healthcare, long-term care, and hospice, amounts to $214 billion annually, with Medicare expected to cover approximately 70% of it.
While there are currently no drugs that can stop or even slow down the progression of AD, there are several FDA-approved medications that deal with the disease’s symptoms by helping to improve memory loss and cognition. Pharmacists dispense these medications daily. They are oftentimes asked questions about the disease and its prognosis and how the drugs work. U.S. Pharmacist continues to be the pharmacist’s journal of clinical excellence by presenting important clinical information that pharmacists need to better counsel patients on a variety of disorders and diseases, including AD. On page 49 of this issue is an excellent continuing education lesson titled “Alzheimer’s Disease: Overview and Pharmacologic Treatment.” Lead author Jennifer Confer, PharmD, a critical care clinical specialist at Cabell Huntington Hospital in Huntington, West Virginia, discusses the pathophysiology of AD and its current and future treatment options while identifying factors that may positively or negatively impact its insidious progression.
It is estimated that approximately 500,000 people aged 65 years and older will develop AD this year alone, with that number expected to double or triple by the year 2050. It is imperative that pharmacists learn more about this devastating illness and offer counseling to patients and their caregivers.
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