Whenever the subject of Alzheimer’s disease comes up, the discussion always includes a line that there is no cure. Those affected are told to get their finances, wills, living arrangements and do-not-resuscitate (DNR) instructions in order for when others will be making decisions for them after they literally have lost their minds. But if you’ve been following the news, maybe you’ve noticed a flurry of reports on potential crossover drugs—drugs already on pharmacy shelves—that may be repurposed or pave the way to halt Alzheimer’s disease. Among these are a currently available drug for psoriasis and another for Lou Gehrig’s disease.
Although it is unlikely that doctors will begin prescribing these drugs to treat dementia in the very near future, we want to keep you in the loop, because the possibility of being able to participate in clinical trials of these drugs for Alzheimer’s—either for you or for a loved one—is now very real.
FINDING NEW TRICKS FOR OLD DRUGS
The truth is that we are in a high-stakes race for a cure. More than five million Americans have Alzheimer’s disease, and that number is going to substantially increase because the population, as a whole, is aging and living longer. The Alzheimer’s drugs we now have treat the symptoms poorly, and none slow down the disease. We need treatment that prevents and stops it.
Enter the oral psoriasis drug acitretin (Soriatane). It may help the body counter the buildup of a protein called amyloid plaque that, in Alzheimer’s disease, crowds brain cells and contributes to their death. Because acitretin contains an enzyme that protects nerve cells and also increases the body’s production of a protein that inhibits amyloid plaque, a team of German researchers decided to study its impact on the brains of people with mild-to-moderate Alzheimer’s disease.
This small study included 21 patients who were given either 30 milligrams per day of acitretin or a placebo. After a short four weeks, levels of the neuroprotective amyloid-protein–fighting enzyme increased by an average 25% in the patients receiving acitretin. The researchers did not go on to compare cognitive function between people receiving acitretin or placebo, but they are planning larger and longer studies, including clinical trials, to evaluate this. Acitretin is not without side effects, including dryness and irritation of the skin, eyes and mouth, but it has been used safely in elderly patients with psoriasis, so the researchers expect it to be relatively safe in people with Alzheimer’s disease.
The other promising drug is riluzole (Rilutek), used to slow Lou Gehrig’s disease (also known as amyotrophic lateral sclerosis, or ALS), a condition whereby excess of a neurotransmitter called glutamate destroys brain cells responsible for muscle function. A neurotransmitter is a chemical that carries messages across synapses through dendrites, branches protruding from brain cells that connect to communicate with other brain cells. Glutamate excess also has been implicated in damaging and destroying brain cells related to cognition.
Because riluzole inhibits glutamate overload, researchers affiliated with the Icahn School of Medicine at Mount Sinai Medical Center and at The Rockefeller University in New York City examined what it could do in rats that had natural age-related memory loss.
Along with their normal diets, either plain water or water treated with riluzole was fed to elderly, cognitively impaired rats for 17 weeks. During this time, memory and other cognitive functioning of these rats and a group of young rats were periodically tested by putting the rats through various maze exercises. They were then euthanized and their spines examined so that correlations between cognitive performance and structural brain changes could be made.
The results: The untreated elderly rats had terrible memory performance during the maze exercises—in fact, their performance swiftly and dramatically declined during the 10-minute tests. In contrast, the performance of the treated elderly rats nearly matched that of young rats. They noticed and retained memory of changes to the maze set-up from one exercise to next and also had a much greater ability to recognize objects and remember where they could be expected to be found in the maze. And their performance significantly increased instead of decreased across a 10-minute maze exercise. Further, the dendrites in the spines of rats drinking riluzole-laced water were more clustered than those of untreated rats, significantly increasing synaptic strength…the communication between neurons.
HOW YOU CAN GET ON BOARD
The riluzole researchers are now conducting a clinical trial in patients with mild Alzheimer’s disease. If you or a loved one want to get on board, you may be able to. First, be aware that, like other powerful drugs, riluzole can cause side effects, which include but are not limited to stomach upset, dizziness, drowsiness, fatigue and numbness/tingling around the mouth. Then, if being part of an experiment to improve treatment for Alzheimer’s disease is still calling to you, talk to your doctor about getting in on the clinical trial being conducted through The Rockefeller University in New York City. Its coordinators are actively recruiting people with mild Alzheimer’s who are 60 to 85 years old. More information on the trial can be obtained by contacting the Rockefeller recruitment office at 800-RUCARES (800-782-2737) or RUCARES@rockefeller.edu.