New drug helps common form of dementia
United Press International - December 14, 2000 20:30
LONDON, Dec. 15 (UPI) -- A drug that targets one of the chemicals responsible for transmitting messages in the brain may lesson some of the most severe symptoms of a type of progressive dementia that affects more than half a million Americans.
Dr. Ian C. McKeith says the drug, rivastigmine, relieved symptoms such as visual hallucinations, anxiety, confusion and apathy in 63 percent of the patients who took the drug in his study. McKeith of the Institute for the Health of the Elderly, Newcastle-upon-Tyne, England, randomized 59 patients were given the drug randomly and another 61 patients were given sugar pills. He reports his findings in the December 16 issue of The Lancet.
The type of dementia studied is called dementia with Lewy bodies because of the abnormal structures called Lewy bodies found in the brain at autopsy. It is not Alzheimer's disease but it is the second most common cause of dementia in elderly patients.
The symptoms include severe psychiatric symptoms like hallucinations or delusions as well as tremors seen in Parkinson's. McKeith said, "With dementia, troublesome psychiatric symptoms and Parkinson's, these patients have a double or even a triple whammy so their chances of being institutionalized are very great."
David S. Geldmacher, MD, assistant professor of neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio said that the psychiatric symptoms associated with this type of dementia "are far more troubling to many caregivers than symptoms such as memory loss." Geldmacher is familiar with the drug but was not involved in the study. He said these patients tend "to have more rapidly progressing disease and traditionally have been sent to nursing homes earlier." Thus, a drug that "has this magnitude of improvement is very encouraging."
In an interview with United Press International, McKeith said that patients with this type of dementia have low levels of acetycholine, a chemical that carries messages in the brain. Rivastigmine appears to increase acetycholine levels, says McKeith and thus can eliminate or lesson some symptoms. "But this drug doesn't work on everyone," McKeith warns. "I had a patient yesterday who was very troubled by visual hallucinations, he was seeing people in his house. Since he has been taking the drug, the hallucinations are gone. But other patients have no change in symptoms." He said that at this point "we have not identified any predictors of response."
In the study, he enrolled 120 patients from the United Kingdom, Italy, and Spain. The treatment period last 20 weeks, followed by a 3-week washout period. The patients were assessed for symptoms at 12, 20 and 23 weeks, McKeith says. "Sixty-three percent of the patients taking rivastigimine showed at least a 30 percent improvement, that's roughly twice the improvement reported in the placebo group," he says. Among patients who responded there was a decrease in hallucinations, delusions, and anxiety as well as improved attention and thinking skills, he said.
The Alzheimer's Association estimates that 4 million Americans have been diagnosed with dementia. About 15 percent of them have Lewy-body dementia said Geldmacher.
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