Progress notes on Alzheimer’s disease
by Dr. Rey Pagtakhan
Writing progress notes on a patient’s medical chart is a constant practice among physicians. These notes document the course of their patients’ illness and help as a guide to patient management. I thought I would again exercise this habit of work – not on patients, since I am retired, but on health issues about which I write in this column – to keep our readers continually informed.
Alzheimer’s disease (AD) is characterized by cognitive impairment (dementia), that is, by a decline or loss in a person’s ability to think, reason, remember and use one’s knowledge or intellect in daily life.
One promising opening to a treatment breakthrough in Alzheimer’s disease comes from the Department of Pharmacology and Center for Translational Medicine, Temple University School of Medicine in Philadelphia, USA. Alerted to a recently reported scientific study from this centre by Dana Dovey writing for IB Times, I read the full research paper as published online on 31 January 2017 by Drs. D. Praticò, E. Lauretti, J. Li and A. Di Meco. These researchers have provided the first in vivo – in life – experimental evidence showing that reduced levels of glucose (a simple form of sugar) in the brain “directly triggers” cognitive impairments associated with the disease in humans, and that a certain type of protein, called p38, is produced in response to glucose deprivation. These findings augur well for the development of a “novel and viable therapy for preventing and/or halting the disease progression.”
Also exciting are the works in progress at the Flinders University in Australia and the Baylor College of Medicine, the Texas Children’s Hospital, and Johns Hopkins University School of Medicine in the USA, where research scientists are also actively working on drugs that could prevent the build-up of brain protein plaques – “the main hallmark of the disease.”
Need for a national strategy
Four-and-a -half years ago, this columnist called on the federal government to develop a national strategy on AD (Pilipino Express, Oct 1, 2012). I was echoing the first call for such a national strategy jointly made eight years earlier in 2004 by the Alzheimer Society of Canada and the National Advisory Council on Aging. In support I wrote:
“Imagine seeing our parents, spouse, friends, loved ones or oneself robbed of memory and of the ability to remember events, to think and to reason, and to do the usual requirements of daily living and social relationship and eventually… of bodily functions, including total loss of speech, over a period of seven years – the average life span following diagnosis before death.
Four months ago, the Canadian Senate its Committee’s report, Dementia in Canada: A National Strategy for Dementia-Friendly Communities, which highlighted the need for: “(1) programs that will help dementia patients live independently, (2) including $Three billion over four years to provide homecare services, (3) expanding Employment Insurance’s compassionate leave benefits for people who take time off work to care for a family member with dementia, and (4) a tax credit for low-income Canadians when they are thrust into caregiving roles.”
Committee chair Senator Kelvin Ogilvie sais, “By helping Canadian communities become more dementia-friendly and enhancing access to home health care, federal and provincial governments can make a major social advance permitting patients a higher quality of life and extending the time they have in their own homes and community.” Committee vice-chair Senator Art Eggleton added, “Dementia is going to become a major public health issue and a serious financial issue to governments as Canada’s aging population grows. We need to start putting measures in place now before the problem escalates further.” Nearly 750,000 Canadians – some 72 per cent of whom are women – had the disease in 2011 and that number is expected to double in 15 years. It is projected that the costs to the Canadian economy would increase from $33 billion a year to $293 billion by 2040.
Desirable government response
It is, indeed, regrettable that Canada has not yet put in place a national plan. In contrast, the United States has had a national Alzheimer’s strategy since January 2011, when then President Barack Obama signed the National Alzheimer’s Project Act (NAPA) into law. Its twin goals are to prevent and to treat the disease by 2025.
A pan-Canadian strategy is envisioned to also heighten public awareness of the disease and thereby draw additional research funding. Federal funding for Alzheimer’s research has more than doubled in the U.S. since its NAPA became law. The Canadian Senate report has recommended increased funding for Alzheimer’s research. Research is key to making any scientific breakthrough, which, in medicine, is finding a cure and a vaccine for a given disease. With the Senate report as a blueprint, a positive Canadian response is highly desirable.
Dr. Rey D. Pagtakhan, a former lung specialist and Professor of Pediatrics at the University of Manitoba (UM), graduated from the University of the Philippines and the UM Faculty of Graduate Studies and Research. He is also a former Member of Parliament and cabinet minister. Widely published and lectured and the recipient of many awards and honours, he remains a community volunteer and advocate.