Diagram showing acetylcholine at the synapse [8]
removed from the brain. Acetylcholine is a neurotransmitter. The diagram shows the acetylcholine (neurotransmitters in the synaptic vesicles) at the synapse ready to be transferred across and thus reach the brain. Studies have shown that in people with Alzheimer’s, there is a lack of this acetylcholine in the brain. Cholinesterase inhibitors work by helping the acetylcholine to cross the synapse by carrying them across the synaptic cleft [2]. In 10 trials enrolling a total of 7300 patients, treatment with cholinesterase inhibitors for periods of 6 months and 1 year produced improvements compared with placebo in cognitive activities of daily living, and behaviour. Clinicians rated global clinical state more positively in cholinesterase inhibitor-treated patients than in those who received placebo [9].
Alternative treatment to drugs 1: Aromatherapy [1]
Aromatherapy is used in everyday society merely as a means of relaxing a person through the use of scented oils and plant extracts. In Alzheimer’s sufferers, the relaxation was hoped to help with some of the agitation that the diseases causes and perhaps aid other symptoms. Three studies in the last two years show significant benefits of aromatherapy on agitation in advanced Alzheimer's with little or no side effects. In each of the studies different oil was used. One used lavender oil once a day; another used lavender oil twice a week and the third used lemon oil twice a day. Over the course of 6 months, the patients showed a significant improvement in how agitated they became when certain things happened to them or went on around them.
It is thought that the oils contain substances called terpines. Terpines are reported to have effects similar to those of cholinesterase inhibitors and so have the same kind of effect if they are absorbed into the lungs where they can make their way into the brain of the patient [11].
Alternative treatment to drugs 2: Reminiscence therapy [1]
Reminiscence therapy is a technique that is employed with Alzheimer’s patients mainly to help them remember some part of their identity before the dementia took hold. The patient is encouraged to re-live memories with friends, family or carers through several different mediums. Visually through photographs or films, through sound with music from their youth or through talking to a group of other patients or carers in a similar way to a conflict resolution group but instead for reminiscence. Even remembering stressful or upsetting times can help a person to re-establish their identity, even if it means that they may endure some minor distress. It is hoped that all of these things will increase the neuro-pathways to some of the patient’s memories and slow down the process of memory loss and perhaps help the patient to retrieve some of the memories that they may have forgotten [12].
Social and Ethical Implications of Cholinesterase Inhibitors
Cholinesterase Inhibitors are a major treatment for Alzheimer’s disease. However, they are not exactly cheap. One year worth of treatment will cost each person £1200. This is something that will not be covered in the NHS and therefore it will be the burden of the person who is caring for the Alzheimer’s sufferer. Many people will be unable to afford this treatment and therefore demand for these drugs will fall, causing them to rise in price even further. Does this mean that treatment for dementia could end up only being available for the super-rich? Ronald Reagan suffers from Alzheimer’s disease and is also a rich man. He would be able to afford the treatment that he needed but others would not. If there is indeed a genetic factor in the disease, could it potentially lead to a divide in society where the rich are free from dementia but those who could not afford the treatment are more likely than ever to develop the disease? If the drugs were to be made more commercially available, or were supported by the government, then we could potentially be stopping a massive increase in the amount of people with Alzheimer’s disease.
Ronald Reagan, Former US President, suffers from Alzheimer’s disease [3]
Ethical implications that need to be considered are mainly to do with the side effects of cholinesterase inhibitors. The side effects of these drugs can be very unpleasant for some people. If a person who suffers from Alzheimer’s has particularly severe confusion, then they may be unaware that they are being given a drug. It would be up to the carer to decide if the person with dementia should receive this drug or not. Is it right to give a person a drug that they are unaware they are taking, especially if it is a drug that can have particularly bad side effects? This is the next thing to potentially torturing a person for what could have no or little positive effect on them whatsoever. In a country where euthanasia is illegal because the person who is being euthanized might be unaware of what is going on and what will happen to them, how can we permit Alzheimer’s patients to go through a similar experience that although it would not end in death, it would be very traumatic?
Future Treatments
A lot of research is going into a possible cure for Alzheimer’s disease. One of these is the drug memantine. It can be taken by people in the late stages of the disease and in a small number of people, appears to temporarily help people to think more clearly and behave more normally. It is believed to protect some brain cells from being killed by a protein that leaks out of cells damaged by Alzheimer’s disease [1].
More recently, a drug called etanercept has been found to produce almost miracle results. Etanercept is a drug normally used in arthritis sufferers as it reduces inflammation. However, recent research in the University of California has discovered that injecting this drug directly into the spinal cord produces miraculous effects after only 5 minutes. The only perceived problem is that the drug has only been tested on a very small group of people, with no formal clinical trials taking place. [6]
Another possibility is gene therapy. Research into gene therapy over the last few years has shown promising results. Out of 8 patients who had genetically modified tissue surgically inserted into their brain, 6 of them have shown improvements in the condition. Tests have shown that the treatment slowed cognitive decline by as much 50%. [7]
Conclusion
Despite being discovered almost 100 years ago, there has been little definitive progress in actually curing Alzheimer’s. It effects many people across the world and can be very distressing not only for the afflicted but for their families as well. But hope is not lost. Research projects are going on all over the world and awareness is being raised greatly. All of these possibilities provide a lot of hope for the future and a cure for the disease is not completely out of sight.
Bibliography
Books
- Need to Know: Alzheimer’s disease by Jim McGuigan. First published 2005. Page 6, 36-41.
5. Essential Genetics by Anna Hodson. First published 1992. Page 174-5.
Websites
-
British Columbia ,Cholinesterase Inhibitors, accessed 25th February 2011
6. The Belfast Telegraph,Discovery of the Decade? Injection ‘could cure Alzheimer’s in minutes’ accessed 14th February 2011
7. BBC , Alzheimer’s Gene Therapy hailed, accessed 18th February 2011
9. Medscape , Cholinesterase Inhibitors similarly effective for Alzheimer's disease. Accessed 3rd March 2011
10. Advances is psychological treatment , Use of cholinesterase inhibitors in dementia. Accessed 3rd March 2011
11. Health and Age, Alzheimer’s, Aromatherapy and Bright Lights. Accessed 3rd March 2011
12. About.com, Reminiscence Therapy and Activities for People with Dementia. Accessed 3rd March 2011.
Pictures
-
Health-Care-Information. Accessed 25th February 2011
-
Boingboing.net .Accessed 18th February 2011
8. University of Bristol. Accessed 3rd March 2011
Reliability of sources
Source 1 is a book by Jim McGuigan, it is a fairly slim volume but is filled with helpful information about the disease. I would say that it is fairly reliable because although it was published in 2005, a lot of the information that it used was proved to be correct upon further investigation and it provided a very starting point for a lot of my research.
Source 2 is likely to be quite reliable. This is because it is a government website. This means that not only would be the website be under regular maintenance, but everything that was published would have to be of a certain standard and have will have undergone thorough research into the topic. It will also be for a national or state-wide audience and will therefore have a large spectrum of information so as to satisfy as many people as possible.
Source 3 is a picture taken from a website dedicated to healthcare. It is an image of brain scans from Alzheimer’s patients and I consider it be fairly useful as a lot of the article it was used in, contained information that later proved to be correct, which would imply that the image was also a genuine one and can be relied upon.
Source 4 is a picture of former US president, Ronald Reagan. Because of the nature of the source, the reliability is difficult to comment upon.
Source 5 is a book by Anna Hodson. It is a thick book with information relating not only to Alzheimer’s but many other genetic diseases and genetics in general. I consider it to be fairly reliable because the sheer volume of information that was all very in depth shows that author clearly spent a lot of time researching into the topics she was writing about. Also, the information contained about Alzheimer’s was not information that would go out of date depending on when it was written and is therefore reliable.
Source 6 is from The Belfast Telegraph. This means that any of the information it contains is likely to be exaggerated greatly in order to gain a great ‘scoop’. However, the article was clearly well researched and this is the reason I decided to include it.
Source 7 is from the BBC News website. Despite being a media company, the BBC is a nationally respected company and is unlikely to report on anything that is not true at least in some respect and this makes the article more reliable. However the article is from 2005. This means that a lot of the information within it could be out of date. I decided to include it in the end because a lot if the research that the article talks could take a long time to research and investigate further.
Source 8 is from the University of Bristol. This makes it a reliable source. Bristol’s university is a highly respected one and the information on the website would be used by students studying degree at the university itself. This means that the information is likely to be accurate and more importantly, up to date.
Source 9 is from a website called Medscape. Medscape is a site that contains a lot of information across a very broad range of topics. Despite this, its articles are very detailed and include reports of studies from several well known sources and this makes it a reliable source.
Source 10 is from a website called Advances in Psychological Treatment. This means that the website is dedicated to treatments of diseases like Alzheimer’s. This in turn means that the data it contains is going to be accurate and reliable.
Source 11 is from Health and Age, a website all about how health decreases as a person grows older. As such, it contains a lot of information about diseases and disorders in general along with treatments. It also displays scientific knowledge alongside easier to understand language. This means that is a fairly reliable source because it can be used by a wide range of people but to great effect by all.
Source 12 is from About.com. This is a website which answers questions about any topic. This means that it is quite unreliable, however I decided to include it because the information that it had was relevant to the section I wanted it for and was also quite detailed in places.
