Advancements in Alzheimer’s and Parkinson’s: Newer avenues for older diseases
Advancements in Alzheimer’s and Parkinson’s: Newer avenues for older diseases
Neurodegenerative disorders threaten the increasing geriatric population of a country like India, and under the given scenario is India ready to tackle these diseases? Are the right treatment options with the latest advancements in the field available in the country?
The human body starts degenerating with increasing age and two of the most common neurodegenerative disorders that affect the elderly population worldwide are Alzheimer’s and Parkinson’s. Alzheimer’s is the most common form of dementia in human population. Although affecting primarily older age groups (60+), symptoms can start appearing a bit earlier and are often ignored as age-related changes or stress disorders.“This disease has been estimated to affect anywhere between 25 to 50 million people worldwide, though its prevalence is believed to be increasing due to changing lifestyle habits and exposure to environmental hazards,” points Murali Rao, Associate Vice President – Healthcare, Technopak. Parkinson’s is a degenerative form of disorder of central nervous system in humans, most commonly developing as movement disorders. These disorders have been affecting humans for a long time but with newer technologies and research studies today there has been significant advancements in the diagnosis and treatment options for Alzheimer’s and Parkinson’s.
Global impact and Indian scenario
The prevalence of disease varies with cultures and ethnic groups and increases directly with age. Globally, Parkinson’s is thought to afflict close to 6 million cases, though many cases remain undiagnosed or misdiagnosed. The world’s highest prevalence of Parkinson’s disease of any country is Albania, ie, 800 per 100,000 population. The disease is thought to afflict around 0.3 per cent of population in industrialised countries. “Economic impact of these diseases can be gauged from the fact that the total estimated worldwide costs of dementia were $ 604 billion in 2010. Western Europe and North America bear almost 70 per cent of these costs, due to high prevalence in these parts of the world. Costs are attributed to informal care (unpaid care provided by family and others), direct costs of social care (provided by community care professionals, and in residential home settings) and the direct costs of medical care (the cost of treating dementia and other conditions in primary and secondary care,” states Rao. Both these diseases are prevalent worldwide but when we talk about India the incidence is less than the western countries. However, with an increased geriatric population soon India will see a rise in the number of patients. “We are finding increased numbers of Alzheimer’s cases in India like out of per 1,000 population almost 33 people are affected. Whereas for Parkinson’s, the occurrence of the disease varies from 150 to 300 per one lakh population,” informs Dr Puneet Agarwal, Senior Consultant – Neurology, Max Hospital.
The true prevalence of these diseases in our country has been difficult to estimate, though some studies suggest that there are about 37 lakh Indians affected by Alzheimer’s at present. “It is estimated that the number of people suffering from Alzheimer’s will double by 2030.Therefore, it is indeed a source of concern, and a concerted effort by government and private healthcare providers is required to create awareness and generate facilities for early and timely diagnosis, treatment and rehabilitation of these cases,” suggests Rao.
Available treatment options
Both the diseases require a multi-display approach, which involves family support, technological counselling as well as pharmacological treatment along with physiotherapy. “In Alzheimer’s there is an entity known as Mild Cognitive Impairment (MCI), which is precursor of Alzheimer’s and if it is diagnosed at an early stage and treated then we can delay the progression of the disease converting into Alzheimer’s, so diagnosis at an early stage for these diseases is very crucial and helpful,” says Dr Agarwal. The treatment modalities available for Alzheimer’s can be classified as pharmacological as well as non-pharmacological. “No proven medical therapy exists as of now for the cure or reversal of degenerative changes as seen in Alzheimer’s. Though clinical trials are going on globally, results have not been very encouraging. Treatment modalities are mostly guided towards slowing down the progression of the disease,” says Rao. India as a country has low prevalence of Parkinson’s disease, though the Parsi community has reported higher number of cases. Over the years extensive research has been conducted and today we have newer medications and technologies helping patients and clinicians understand the complexities of these disorders.
One of the latest technological breakthroughs in the diagnosis of Alzheimer’s is the use of molecular imaging facilities like PET, which have so far been primarily used for cancer diagnosis in our country. As of now, Alzheimer’s can be diagnosed only when the symptoms of dementia can be observed in the patient and there is an impact on daily living. “However, with the use of PET with an injected biomarker called 18F-FDG, physicians may soon be able to predict dementia or the onset of Alzheimer’s disease years before clinical symptoms start to show. This would mark a shift in the diagnosis of Alzheimer’s, which has so far been done by the exclusion criteria to exclude possible trauma, haemorrhage, tumour or metabolic disorder,” states Rao. At a global level, it has been estimated that such advances in preclinical detection would result in a nearly 45 per cent reduction in the number of people with Alzheimer’s by 2050, and reduce the projected medicare costs of Alzheimer’s from $ 627 billion to $ 344 billion. While when it comes to medications newer drugs are being developed, “Like in Parkinson there are newer medications that are hitting the market, which can modify the disease formation as well as deep brain symptoms with less side effects,” states Dr Agarwal. Tramiprosate, brand name Alzhemed (made by Neurochem), is an orally administered amyloid beta antagonist; inhibitors of and-secretase are currently undergoing clinical trials to assess its safety, efficacy and disease-modifying effects in patients with mild to moderate Alzheimer’s. Studies show that there is possibility that oestrogen-only replacement might afford protection against Alzheimer’s, especially if administered at or around the onset of menopause rather than many years later.
Apart from the diagnostic technologies discussed above, numerous researches are being conducted, with the aim of finding a cure for Alzheimer’s disease and Parkinson’s. “There are a number of studies that have been conducted to find ways to slow the progression of the disease and also cure those who are suffering. In a study conducted in the US, stem cells have been found to secrete a protein that causes the brain to form new synapses and repair neurons, therefore improving cognitive functioning thereby providing hope for slowing the progression of Alzheimer’s,” informs Rao. It is speculated that stem cells can be used to not only improve the cognitive functioning, but also slow the progression of AD and ultimately the death of the individual. “Stem cell therapy is a promising treatment option for Alzheimer’s and dementia, which is under trial,” says Dr Agarwal. A number of different approaches to vaccine development are also in the works. Several scientific teams are working to develop a vaccine that can induce the body’s own immune system to attack the amyloid plaques that build up in the brains of those with Alzheimer’s disease. However, most of these advancements are still at the clinical trial/research stage, and their efficacy in long-term use is yet
to be determined.
Is India on track with the advancements?
Patients in India have been a bit unlucky in reaping the fruits of the latest advancements in the treatment and diagnosis for Alzheimer’s and Parkinson’s disease, partly due to the nature of disease and partly due to poor healthcare facilities in India. “Other reasons include the difference in age onset of these diseases and demographic profile of the country, relative lack of research in this part of the world, epidemiological impact of other communicable and non-communicable diseases and due to ignorance and illiteracy,” says Rao. While Dr Agarwal says that due to lack of awareness there is reduced cases of early diagnosis and hesitation among patients to utilise the latest advancements. Though the trends are changing and patients are seen inquiring more and demanding better, but till there is a considerable lag present. From the clinical aspect, though all the latest medications and technologies are available in India, more awareness on the same will improve the current treatment scenario.