VLADIMIRHACHINSKIMD, FRCPC, DScMed
ANYTHING IS better than nothing in treating a relentlessly progressive disease. Gauthier argues convincingly that several drugs have shown definite, albeit modest amelioration of the symptoms of Alzheimer disease. Pryse-Phillips points out that many of these trials have been brief, typically 3 to 6 months, in a condition that usually spans 7 years after diagnosis, and that no drug halts the disease itself. Both contributions favor further and better trials.
While there always will be a place for symptomatic treatment, the most hopeful approach is to strike before the disease does. Converging evidence suggests that molecular dysfunction occurs decades before the clinical manifestations. The ability to identify high-risk groups by molecular markers may make it possible to begin prevention trials with drugs that interfere with brain amyloid interactions, agents with anti-inflammatory properties, and drugs aimed at other plausible mechanisms in brain degeneration. In the meantime, our gratitude for having something to offer our patients should not cloud the need to continue to learn by doing, each successful or failed clinical trial contributing to answers that likely will be as slow and complex in the development as Alzheimer disease itself.
Hachinski V. Treatment of Alzheimer Disease. Arch Neurol. 1999;56(6):735. doi:10.1001/archneur.56.6.735