A Solution To Treat Alzheimers Health And Social Care Essay
Can Galantamine be the most effective treatment for Alzheimer’s disease?
Alzheimer’s disease is the most common form of dementia. It is a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioural changes. Cross section of healthy and Azlheimer's brain
Alzheimer's disease is not a normal part of aging. Symptoms include having difficulty remembering things, making decisions and performing everyday activities. These changes can affect the way a person feels and acts. There is currently no way to stop the disease, but research is improving the way we provide care and will continue to search for a cure. (1)
It is estimated that 460,000 people in the UK are suffering from Alzheimer’s disease and this substantial figure only emphasises the great importance of finding effective treatment. It is stated by the Alzheimer’s society that around 7% of people that are 65 years or more are affected my Alzheimer’s disease. It is also stated that it is more likely to occur in women rather than men because women generally live longer than men. (2)
Which parts of the brain does Alzheimer’s affect? (3)
This section of the brain is in charge of making decisions, solving problems and other mental functions. The frontal lobe allows the processing of information, making the decision to signal for the right response. When the frontal lobe is affected by Alzheimer’s disease, a number of symptoms occur such as personality fluctuations, inappropriate behaviour and erratic actions.
Another part of the brain which is affected by Alzheimer’s disease is the temporal lobes of the brain. This part of the brain is responsible for both short and long term memory. Generally, when this part of the brain becomes affected by Alzheimer’s disease it leads to memory loss.
This part of the brain is behind the temporal lobe. The primary role of the parietal lobe is speech. Moreover, the parietal lobe helps integrate the visual system with the rest of the brain, to allow analysis of visual stimuli. As Alzheimer’s disease progresses, a problem develops in the speech and visual functions leading to visual disorder and abnormal speech.
Who is at risk of getting Alzheimer’s? (4)
The primary risk factors of Alzheimer’s are age, family history, and genetics. However, there are different risk factors that you can influence. Maintaining a healthy heart and avoiding high blood pressure, heart disease, stroke, diabetes, and high cholesterol can decrease the risk of Alzheimer’s. Watch your weight, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and mind.
Here are the risk factors of Alzheimer’s? (5)
Age- The greatest known risk factor for Alzheimer’s is advancing age. The chances of developing Alzheimer’s disease doubles every five years after the age of 65. For ages greater than 85, the risk reaches about 50%, in other words, as age increases; the more likely it is to develop Alzheimer’s disease.
Family- You are more likely to develop Alzheimer’s disease if you have a family history of Alzheimer’s disease.
Gender- More women develop Alzheimer’s disease than men but this is most likely because women tend to live longer than men, and the older you are, the more likely you are to develop the disease. (6)
Routinely placing important objects in odd places- keys in the fridge, wallet in the dishwasher.
Search for casual names and words- Forget names of family members and common objects.
Feel occasionally sad- Experience rapid mood swings, from tears to rage, for no discernible reason
Get lost in familiar places, don’t remember how you got there or how to get home
How the solution works:
At the moment, there is no certain cure for Alzheimer’s, but there are however some drugs which can be used to slow down the progression of Alzheimer’s or slow down the symptoms.(8)
The mechanism of the drug Galantamine is that it slows down the enzyme which breaks down Acetylcholine. Acetylcholine is an important chemical released by the brain cells so that messages are delivered to other cells. During the release of this substance, the enzyme Acetylcholiestrease is also released to break down Acetylcholine so that it can be used over and over again. Alzheimer’s disease destroys the brain cells which prohibit acetylcholine from getting released and so these drugs by inhibiting the enzyme help to maintain acetylcholine levels. (9)
Open trial (10) Methodology
In this randomized controlled trial, patients with mild to moderate Alzheimer's disease were treated with either galantamine or placebo for 4 months, followed by a 4-month open-label extension during which all patients received galantamine. The primary outcome measures were Goal Attainment Scaling (GAS) scores from assessments by clinicians and by patients or caregivers of treatment goals set before treatment and evaluated every 2 months. Secondary outcome measures included the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Clinician's Interview-based Impression of Change plus Caregiver Input (CIBIC-plus), the Disability Assessment for Dementia (DAD) and the Caregiving Burden Scale (CBS). To evaluate treatment effect, we calculated effect sizesAn external file that holds a picture, illustration, etc. Object name is 21FF2.jpg Object name is 21FF2.jpg
Results The graph demonstrates the results from the trial, and show that the GAS scores expressed a significantly greater improvement among patients in the galantamine group than among those in the placebo group.
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The patient– caregiver-rated GAS scores showed a similar improvement in the Galantamine group. However, because of the improvement also seen in the placebo group difference between groups was not statistically significant.
Clinicians observed a significant improvement in goal attainment among patients with mild to moderate Alzheimer's disease who were taking galantamine than among those who were taking placebo.
Placebo controlled trial: (11)
A 5 month controlled study to evaluate the safety and efficacy of Galantamine 16 and 24 mg/day in a subgroup of patients was carried out. This trial was a double-blind placebo controlled trial where the efficacy was measured by calculating the ADAS-cog.
Mean ADAS-cog scores of patients with mild AD demonstrated significant improvement from baseline with Galantamine 16 and 24 mg/day, whereas cognitive function did not change significantly for placebo patients. Patients with moderate AD showed clear improvement with Galantamine 24 mg but not 16mg.
However, patients with moderate AD appear to gain additional benefit from galantamine 24 mg/day.
Social Implications of Galantamine (12)
According to a report published by the BBC, there are social implications of taking Galantamine. Mr Richardson, 71, husband of a woman diagnosed with Alzheimer’s disease in 1999 talked about the drug Galantamine and said "it made a phenomenal difference. Three months after she was prescribed it we were going on trips to London and she could watch semi-violent films such a James bond or medium to heavy opera and she was very very happy. "This demonstrates that the drug has a huge impact on the sufferer’s social life and makes it easier for the carer to look after the patient as well as reducing some responsibilities. The drug overall helps to maintain the meaning of life and eases some symptoms of the sufferer. This means they are able to stay home for longer and patients in nursing homes decrease, benefiting society in both economic and social way.
Economical implications of Galantamine (13)
Patients are expected to pay £28,134 over 10 years of treatment without pharmalogical treatment. 70% of these costs are from providing full time care for these patients. The use of Galantamine amazingly reduces the period of the full time care state by 1.2% and avoids an average of £192 per patient. For patients who continue treatment for more than 6months savings are predicted to be £1380 per patient. Therefore, society’s money is saved by using Galantamine as a treatment in addition to the clinical benefits associated with this drug.
Benefits and risks of Galantamine: (14)
Benefits- A known benefit of Galantamine is that it inhibits a specific enzyme from prematurely breaking down the memory molecule acetylcholine. This plant is derived drug effectively increases the brain levels for this neurotransmitter. But that’s not all. There is more to Galantamine’s extraordinary benefits are:
Unlike other drugs such as Donepzil, Galantamine does not induce drug tolerance. Therefore the drug is more effective as the body doesn’t become more tolerant of it.
Modulation of nicotinic receptors:
On the other hand, Galantamine modulates certain key receptors on our brain cells called nicotinic receptors thus preserves their number and functional integrity. Nicotinic receptors are important as they are primary receptors for acetylcholine.
Risks- However this drug is known to have several side effects, which are: (15)
Loss of appetite
Changes in your blood pressure
Efficiency of Galantamine: (16)
Between 40 and 70 per cent of people with Alzheimer's disease benefit from cholinesterase inhibitor treatment, but it is not effective for everyone and may improve symptoms only temporarily, between six and 12 months in most cases. According to an Alzheimer's Society survey of 4,000 people, those using these treatments often experience improvements in motivation, anxiety levels and confidence, in addition to daily living, memory and thinking.
Memantine- The action of Memantine, also known as Ebixa, is a type of NMDA receptor antagonists. It works in a more complex way compared to cholinesterase inhibitors. The role of memantine is to block the messenger chemical known as glutamate which is released in large quantities. Gluatamate is released when the brain cells are damaged by Alzheimer’s disease. (17)
"Memantine targets glutamate, a neurotransmitter present in dangerous levels on AD. This excess glutamate attaches to nerve cell neuro-receptors which enable the calcium to move into the cell causing damage to brain cells. Memantine attaches to the receptors in order to block the glutamate which in turn prevents damage." (18)
Gingko Biloba- plant extract which is known to have positive effects on brain and body cells. Recently it was discovered that ginkgo biloba could be effective at slowing down the progression of dementia and the remedy still has its proponents.
Kami-Umtan-To (KUT) - This is a Kampo mixture containing 13 different plants. A clinical trial found a slower drop in the group of people with Alzheimer's disease given this preparation. (19)
Suitability of methods
In the controlled study, the population of the patients taking part in the study was not mention so cannot be generalised. Also because their ages were not mentioned, therefore, I think the trial is not valid.
Moreover, most information was not included, which made it extremely difficult to obtain results. This reduces reliability alongside validity.
In the open trial, patients were given suitable dose which was then increased to a higher level as suggested by the clinician. Then GAS score was measured, which has been regarded a suitable test in which the severity of patients with Alzheimer’s can be calculated.
A major advantage of this trial was that a placebo was used, which means the results can easily be compared with the Galantamine. Although the drug is effective, the placebo allows us to conclude how effective the drug is.
The placebo controlled trial also used a placebo control group could be compared with the treatment group and so the effectiveness of the drug would be more visible.
The placebo controlled trial was also double blinded for 5months which means that the clinicians and doctors involved in the trial could not have distorted the results considering the fact they were not aware who had been given treatment or placebo.
Validity and reliability of results
None of the patients withdrew from the trial suggesting that Galantamine is a well tolerated drug and helps reduce symptoms caused by Alzheimer’s.
The results in the open trial show that the GAS scores established a massive improvement among patients taking the Galantamine drug compared to those in the placebo group.
In both trials, Galantamine has only been compared with the placebo, therefore only showing how effective Galantamine is alone. However it was not compared with other drugs which can be used to treat Alzheimer’s, hence we cannot say how affective it is in treating Alzheimer’s compared to the other Cholinesterase inhibitor drugs such as Donepezil, Rivastigmine.
The placebo controlled showed that patients with mild AD made a significant improvement by taking Galantamine, and also patients with moderate AD benefited from Galantamine. It was also well tolerated by most patients and did not create any clinical abnormalities. Considering that it was a double blind controlled placebo indicates that it is somehow reliable.
The open trial expresses an improvement in cognition and global function for patients taking Galantamine. The double blind controlled placebo also establishes a significant improvement in cognitive functions. Therefore, I can conclude that both results are valid as they do not contradict each other.
Validity and reliability of sources
Both trials come from Pubmed, a government website published by researchers in that field of work. It is reliable as it is a government document and the government would have no motive to misinform the public about the treatment.
‘Dancing with dementia- my story of living positively with dementia’ is a book which makes this source reliable and as the authors of books generally have a variety of sources to write the books and all the sources must be checked by the publisher of the book. This is more reliable than other sources such as internet etc. However, it is unlikely to get up to date information on a topic from books unless they only have been recently published. Facts should always be checked, especially for scientific subjects where new things are constantly developed.
Never the less, it is safe to say Galantamine is an effective drug used to treat Alzheimer’s. Galantamine is proven to lower symptoms of the disease. It has also saved money for our society for the past several years. Despite the fact that Galantamine causes a number of unnecessary side effects, this problem should be and hopefully will be taken care of by the progression in our technology.