|Village in canton Bern being developed to accommodate|
persons with dementia, foreseen to be completed in 4 -6 years.
In 2010, there were 110,000 persons with AD in Switzerland, with 25,000 additional cases diagnosed each year. In 2050, it is projected there will be 300,000 cases. In 2009, the cost for care of AD patients was 7 billion Swiss francs (7.68 billion dollars).
In the United States the cost of dementia was $200 billion in 2012 and could go to as high as one trillion dollars in 2050. Only 8 out of 194 Member States of the World Health Organization have a “plan Alzheimer’s” for early diagnosis, better care of the sick, assistance for family members, and support for scientific research. Switzerland will become the ninth country to implement the plan.
In 2012, four medications to treat Alzheimer’s generated $4.2 billion in sales, but these drugs only treat symptoms without preventing the disease or stopping its evolution. There is no single cause for AD, but rather, an accumulation of risk factors.
Some 455 pharmaceutical and biotech companies in the world are trying to elucidate the mechanisms of this affliction and elaborate preventive and therapeutic treatments. In Switzerland, 18 companies, not including universities and hospitals, are developing drugs or preparations eliciting hope for treatment. The companies include Novartis and Roche.
Medications are being developed for limiting the action of enzymes linked to beta amyloid deposits. Poor regulation of these enzymes may cause overproduction of these deposits. Ways to inhibit these enzymes and thus, slow down or block the process of buildup of these deposits is being explored, however these enzymes participate in other vital biological mechanisms and cannot be inhibited without perturbing other functions of the organism.
Another treatment being researched is immunotherapy through antibody injection, the concept being to destroy amyloid plaques by suppressing accumulation of toxic residues resulting from amyloid cascade. The antibody injections would enhance the immune defenses of the patient. Another way to stimulate the immune system would be through vaccination.
The drug developed by the Swiss company AC Immune, anti-Abéta (crenezumab) has been selected by the National Institutes of Health (NIH) to be the first medication ever studied in a world trial for prevention of Alzheimer’s. It is being tested on a Colombian family having a rare genetic mutation which sets off AD symptoms towards age 45. The drug is being evaluated to determine whether injections can slow appearance of the disease. The NIH has contributed $100 million towards this trial. An agreement was concluded by the Banner Alzheimer’s Institute and Genentech (a subsidiary of Roche) with AC Immune in 2006 to conduct a 5-year trial of the drug, to be launched in 2013.
AC Immune is also exploring vaccines. Results in testing on rats have been promising, but it is unlikely that a vaccine alone could treat Alzheimer’s due to the disease’s complexity. The idea is to combine a vaccine with anti-body therapy.
Current medications include donepezil (Aricept made by Pfizer-Eisai), rivastigmine (Exelon made by Novartis) and galantamine (Reminyl made by Janssen-Cilag). These prevent an enzyme known as acetylcholinesterase from breaking down acetylcholine in the brain. Increased concentrations of acetylcholine lead to increased communication between the nerve cells that use acetylcholine as a chemical messenger, which may in turn temporarily improve or stabilize the symptoms of Alzheimer's disease.
These drugs carry strong and persistent side effects including nausea, diarrhea, insomnia, vomiting, muscle cramps, fainting, fatigue, loss of appetite and weight.
Another drug, memantine (Ebixa made by Lundbeck), blocks a messenger chemical known as glutamate. Glutamate is released in excessive amounts when brain cells are damaged by Alzheimer's disease, causing the brain cells to be damaged further. Memantine can protect brain cells by blocking the effects of excess glutamate. There are a wide range of side effects similar to those of the three other drugs used to treat Alzheimer’s symptoms.
Non-medication therapies exist such as cognitive therapy but these are more difficult for persons living at home who must be moved to a hospital several times a week to receive the therapy. Other therapies include sensory stimulation, zootherapy (pet therapy), musicotherapy, art, cooking, walking, games.
For preventing Alzheimer’s, a Mediterranean diet is suggested: fruit, vegetables and fish, also green tea, red wine, vitamins C,D and E, beta-carotene, and omega 3.
In the Netherlands, there are special villages for persons with Alzheimer’s. At De Hogeweyk, south of Amsterdam, persons with AD or dementia may go out freely in the village to eat in a restaurant or go to the hair dresser’s, movies, grocery store. The persons running these establishments are also care-givers trained in how to manage those afflicted with dementia. This concept is being imported into Switzerland. Such environments encourage persons to be as autonomous and independent as possible.
Ref: Hebdo article on Alzheimer’s (not available on-line to non-subscribers) , c-health.canoe.ca, and "Berne: Un Village pour les malades d’Alzheimer", 24heures, 3 January 2012.