Imagine slowly losing your memories, beginning with those most recent. Common forgetfulness becomes a state of constant confusion. You can’t recall the names nor recognize the faces of friends and family. Communicating and performing everyday tasks becomes increasingly difficult.

For those living with Alzheimer’s disease, these frightening symptoms and many more develop as nerve cells die and tissue is lost in the brain.

A cure remains elusive for this disease, which is today’s sixth-leading cause of death in the United States, but treatment is improving.

A recent forum held at the University of Washington and soon premiering on UWTV, explored advances in pharmacological and non-pharmacological treatment of Alzheimer’s disease.

Dr. Murray A. Raskind, professor and vice-chair in the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine and director of the UW Alzheimer’s Disease Research Center.

Dr. Murray A. Raskind, professor and vice-chair in the Department of Psychiatry and Behavioral Sciences at the UW School of Medicine and director of the UW Alzheimer’s Disease Research Center, spoke at the forum about new pharmacological approaches to disruptive agitation in Alzheimer’s disease patients and those patients with other late-life neuro-degenerative disorders that cause dementia.
Controlling disruptive agitation is critical to ensuring care for Alzheimer’s disease patients remains manageable for their families, Raskind explained. It’s this type of behavior that is most often the precipitant for placing the individual in a nursing home.  

Raskind, who is also the director of mental health services at the VA Puget Sound Health Care System, has recently been involved in a University of Washington Alzheimer’s Disease Research Center study to show that prazosin, a drug initially introduced to treat high blood pressure, is helpful in reducing disruptive agitation in Alzheimer’s disease patients. Prazosin works by blocking excessive norepinephrine, or adrenaline, activity in the brain.

 “When you or I are exposed to something new, our brain releases norepinephrine to tell us to wake up, be alert to this,” Raskind explained. “And if it’s something dangerous, in a primitive way, it says we better get out of here, or we better fight with it. And too much stimulation by norepinephrine, if it’s excessive, will produce in anybody anxiety, agitation and often a fight-or-flight defensive response.

“The person with Alzheimer’s disease can be conceptualized as facing something new all the time because they can’t remember what just happened,” Raskind said. Since Alzheimer’s disease prevents the brain from retaining new memories – those which help a person orient themselves in time and space – the brain may be overrun with norepinephrine.

“In brain tissue from Alzheimer’s patients, we demonstrated that the receptors to norepinephrine are somewhat increased,” Raskind said. “And the amount of norepinephrine produced appears to be normal, despite the loss of some of the brain cells that produce norepinephrine. So, we have a situation where arousal’s happening all the time, asking the brain to adapt and the memory system is not working, and the receptors for norepinephrine, this brain adrenaline, are hyper-responsive, so if anything the response is excessive.

“The approach with prazosin is to block those receptors so that this excessive response will be calmed down.”

Raskind and others who’ve worked on this initial prazosin study presented their results at the International Conference on Alzheimer’s Disease held in Chicago in late July. Raskind calls the results of this pilot study “very exciting,” but a larger placebo trial is still needed.

In addition to these positive results, prazosin is also inexpensive and has a proven safety record.

“This medication’s very cheap,” Raskind said. “It costs a nickel or a dime a pill. It’s an old generic, off-label. It’s been used by millions of persons to treat high blood pressure, in millions of old men to treat urinary symptoms and prostate enlargement.”

Although prazosin appears promising, Raskind adheres to a more holistic treatment approach for those with Alzheimer’s disease.

“Usually the most effective treatment is a combination of a behavioral, psychotherapeutic intervention that works and a medication that works,” he explained. “Some people just need a medication, some people just need a psychotherapy, some people respond to one and not the other, but on average, combining the two is the best thing to do.”

Dr. Linda Teri, director of the Northwest Research Group on Aging, part of the School of Nursing, and professor and vice-chair in UW’s Department of Psychosocial and Community Health, is a leader in the field of non-pharmacological treatments for Alzheimer’s disease.

Dr. Linda Teri, director of the Northwest Research Group on Aging, part of the School of Nursing, and professor and vice-chair in UW’s Department of Psychosocial and Community Health, is a leader in the field of non-pharmacological treatments for Alzheimer’s disease. Teri and her team at the Northwest Research Group on Aging conduct research, teaching and community programs aimed at improving quality of life for older adults, with an emphasis on Alzheimer's disease.

“What we are interested in doing is helping families and improving care for older adults,” Teri explained.

“Most of our research and our clinical work is focused on families learning how to deal with the problems associated with Alzheimer’s disease.”

Teri, who is also the founding director of the University of Washington’s de Tornyay Center for Healthy Aging, is a believer in non-pharmacological treatment for a variety of reasons. This approach eliminates concern about side effects and interference with the patient’s other health problems, and not only helps the person with Alzheimer’s disease, but also empowers their caregiver as well.

“There’s actually consensus in the field that non-pharmacological approaches should be tried first,” Teri said. “There’s also consensus that staff in long-term care settings need to learn how to deal with these problems of disruptive agitation, because they’re not uncommon. It would be the equivalent of saying you’re going to work in a pediatric ward, but you’re not going to know how to deal with a crying baby.”
When working with the families of Alzheimer’s patients, Teri’s methods are focused on communication and problem solving. Caregivers learn how to talk to a person with dementia and how to ensure that person understands. They are taught how to analyze and solve current difficulties, and how to approach problems that may arise in the future.

“For families, most of our interventions are one-on-one,” she explained. “Some of the strategies are pretty universal: speaking slowly, planning what you’re going to do one step at a time, making sure you’re understood, speaking with compassion and understanding.”

Families are taught these and more skills through discussion, conversation, modeling activities and practice.

“The key to learning is they try it on their own and then we problem-solve with them, what worked, what didn’t work,” Teri said.

The Northwest Research Group on Aging has also developed a training program for assisted living staff who care for residents with dementia. The program, called Staff Training for Assisted Living Residents (STAR), focuses on the same kinds of skills families learn.

Despite the advantages of a non-pharmacological approach to treatment for Alzheimer’s patients in terms of negating the potential health risks and cost of prescription drugs, funding for this type of research and treatment remains difficult.

“Culturally, we fund drug studies, we fund pharmaceuticals,” Teri said. “We want quick fixes and these are not quick fixes. Everything from getting the research funded to getting insurance companies to cover it is difficult. That’s a societal issue.”

Teri believes education is the key to changing this outlook.

“We have to get people to realize that it’s not insanity, it’s not contagious, it’s not something to be avoided,” she said. “It’s something that affects a lot of people and we need to care for them as kindly as we can.”

“This is a disease that affects everybody: men, women, you name the ethnic group, you name the racial group, poor, rich,” Teri said. “We need more research in how to deal with it. It would be nice for a cure, of course, but we need to help people now.”

Could a cure for Alzheimer’s disease be in our near future?

“All chronic, late-life diseases are hard diseases to cure,” Raskind explained. “This is not unusual.”

“Everybody likes a cure,” he said. “But what we mostly do in medicine, in generally, broadly defined, is try to reduce symptoms, increase function, reduce distress and improve quality of life. So cures are very unusual.”

However, the University of Washington is currently taking part in ongoing research into a vaccine against Alzheimer’s disease, which Raskind calls promising.

“We’re making progress,” he said.

For more information about Insider features, contact Erin Lodi at erinlodi@u.washington.edu.