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A drug that combines a cough suppressant with a medication to fight heart arrhythmias might offer some peace for one of the most troubling symptoms of advanced Alzheimer’s disease – agitation – researchers reported Wednesday.
The drug is already approved to treat uncontrollable laughing, crying or other outbursts caused by head injuries and degenerative disease such as amyotrophic lateral sclerosis, better known as ALS or Lou Gehrig’s disease. The symptom is called pseudobulbar agitation.
It’s a combination of dextromethorphan – a cough suppressant – and the anti-arrhythmic drug quinidine.
A trial in Alzheimer’s patients showed it improved nearly half of them, researchers told the Alzheimer’s Association International Conference.
“This is one of the most tough symptoms for families to manage,” said Dr. Jeffrey Cummings of the Cleveland Clinic center for brain health in Las Vegas, who led the study.
“These are people who will shout or slam doors or strike out or in some way make very difficult for the caregiver to take care of them.”
It’s hard to measure improvements in behavior, but on a scale that measures agitation, patients who got the drug improved from a 7 on the scale to about 3.5, Cummings said.
Cummings said he was giving the drug to a patient outside of the clinical trial. “The caregiver said to me, ‘He came back to us’. I thought that was such a powerful, powerful statement,” Cummings told a news conference.
It’s a rare glimpse of light for caregivers of Alzheimer’s patients, who can become inexplicably agitated, kicking, screaming, cursing and struggling. Agitation is the main reason that Alzheimer’s patients must be moved to specialized care facilities, taking them away from family and familiar surroundings. And residential care can be extremely expensive.
“Hard-to-manage care situations, wandering off and challenges with the bathroom are the primary reasons families are forced to move their loved ones into institutional care centers,” said Maria Carrillo, chief science officer for the Alzheimer’s Association.
The dextromethorphan works in the brain. The quinidine simply stops the body from breaking it down, raising the effectiveness, Cummings said. Researchers testing the drug for pseudobulbar agitation noticed it also seemed to relieve agitation, and decided to try it for Alzheimer’s.
Earlier, researchers released details of trials showing that drugs called monoclonal antibodies might work in the very early stages of Alzheimer’s to remove the brain-clogging amyloid deposits that underlie the diseases. But if they work at all, it’s only going to be in patients who don’t have severe symptoms yet, said Dr. David Knopman, an Alzheimer’s specialist at the Mayo Clinic who was not involved in the research.
There’s nothing comparable to offer patients with advanced dementia, or their caregivers. Antipsychotics can be used to treat agitation but experts and regulators discourage the practice, saying it's dangerous.
More than 5 million Americans have Alzheimer’s now and that will balloon as the current Baby Boom generation gets older. The Alzheimer’s Association predicts 28 million cases of Alzheimer’s by 2050.