Alzheimer's - the future

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Ginkgo biloba for Alzheimer's disease - 'promising evidence'

Alzheimer's Society

The Alzheimer's Society, together with the Cochrane Collaboration, has published the biggest ever comprehensive review on the use of Ginkgo biloba for the treatment of dementia. The systematic review has identified 33 previous clinical trials of Ginkgo, dating back to 1976.

This new research provides promising evidence that taking Ginkgo biloba can improve memory and overall function for people with dementia.

The review to be published, 21 October 2002, by the Cochrane Collaboration has concluded that:

'Ginkgo biloba appears to be safe in use with no excessive side effects compared with a placebo. Many of the early trials used unsatisfactory methods, were small, and we cannot exclude publication bias. But overall there is promising evidence of improvement in cognition and function associated with Ginkgo. Our view is that there is need for a large trial using modern methodology to provide robust estimates of the size and mechanism of the treatment effects.'

Dr Mike Clarke, speaking on behalf of the Cochrane Collaboration, said:

'Cochrane Reviews, such as this one, aim to bring together all the relevant evidence, so that it is easier to make well-informed decisions about health care. This review helps to identify the types of research that are now needed to find the best
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treatments for people with dementia.'

Michael McIntyre, a Trustee of the Prince of Wales Foundation for Integrated Health, Chair of the European Herbal Practitioners Association and one of the UK's best known medical herbalists said:

'On behalf of the Prince of Wales Foundation for Integrated Health and the European Herbal Practitioners Association, I can only express my delight at this comprehensive review by the Alzheimer's Society and Cochrane Collaboration on the use of Ginkgo for the treatment of dementia. This work is bound to have a major impact, drawing the attention of the medical community to the benefits of this ancient oriental remedy.'

These findings have provided the green light for a major new clinical trial of Ginkgo in people with early dementia who are looked after by their GP. The new study, supported by more than £¼ million from the Alzheimer's Society, will recruit 400 people with dementia, following them over a period of six months while they receive treatment either with Ginkgo or a placebo.

The trial is being jointly run by Imperial College and the Royal London Homeopathic Hospital.

Dr Richard Harvey, director of research for the Alzheimer's Society, said:

'The work of the Cochrane Collaboration has been instrumental in gathering together evidence accumulated over the past 26 years that taking Ginkgo supplements probably has real benefits for people with dementia. Our new clinical trial will apply modern methods and robust quality controls to finally answer a question that has been hanging in the air for 5000 years.'

Ginkgo biloba is an extract from the leaves of the Ginkgo tree, which in the UK is more commonly called the maidenhair tree. This tree has survived unchanged in China for more than 200 million years and there is a history of its medicinal use for almost 5000 years.
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Dr Peter Fisher, Director of Research at the Royal London Homeopathic Hospital, said:

'Ginkgo contains a number of organic biologically active components. It is the ginkgolides that are unique to the Ginkgo tree although it is not fully known which component or components are the ones that give the leaves their medicinal properties.'

Dr James Warner, senior lecturer and consultant in Old Age Psychiatry at Imperial College London, said:

'The medicinal effects of Ginkgo are believed to be gained by causing blood vessels to dilate, improving blood flow to the brain, and through thinning the blood and making it less likely to clot. Ginkgo probably also has some anti-oxidant effects, protecting nerve cells against biological 'rusting'. All of these effects would suggest that Ginkgo might slow down a degenerative process.'

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Alzheimer’s Disease: number of sufferers increasing but drug companies must raise awareness of both the disease and available therapies

By Datamonitor

London, 29th April 2002 - Independent market analyst Datamonitor’s new report, ‘Treatment Algorithms 2002: Alzheimer’s Disease’, finds that the number of sufferers of Alzheimer’s disease is increasing, however less than half of those affected seek diagnosis, mistakenly believing that there is nothing that can be done to help. With the number of Alzheimer’s disease sufferers set to triple in the next 30-40 years as the effect of the global ageing population takes hold, many drug companies are battling to grab a share of this lucrative market. Many physicians surveyed by Datamonitor questioned the effectiveness of current drugs as they cannot prevent the progression of the disease, and are not available for severe cases. The key area of research over the next five years will be in developing potential Alzheimer’s disease ‘vaccines’. However, these treatments are unlikely to be available before the end of the decade and the main challenge until then is to increase awareness of both the disorder and available therapies.

1 in 10 over 60’s suffer from Alzheimer’s, but only 1 in 3 are receiving any treatment
Alzheimer’s disease is by far the most common form of dementia and is characterised by loss of mental function in elderly people. However, whilst 1 in 10 people over 60 suffer from this disease globally, only 1 in 3 sufferers are currently undergoing any form of treatment according to Datamonitor’s recent global survey of 220 physicians. Part of the problem is that lack of awareness means a huge number of patients do not seek diagnosis for their symptoms, believing that Alzheimer’s disease is just an unpleasant side effect of old age and that nothing can be done to help. Results from Datamonitor’s physicians survey showed that less than half of Alzheimer’s disease sufferers visit their doctor at any point.

Doctors doubt effectiveness of current drugs – 44% of patients fail initial treatment
Ben Greener, Neurology Analyst at Datamonitor comments: “Alzheimer’s disease develops in stages, gradually destroying memory, reason, judgement, language and eventually the ability to carry out even the simplest of tasks. Whilst there is no cure for Alzheimer’s disease, there are drugs available that can help to modify its symptoms and effectively reduce the burden of the disease for the sufferer and their families. Currently, there are three drugs approved for the treatment of mild to moderate Alzheimer’s disease; Aricept, Exelon and Reminyl. These drugs all work in much the same way by prolonging the action of a vital neurotransmitter (a chemical substance that transmits impulses between nerve cells in the brain) that is depleted in Alzheimer’s brains. However, many of the physicians Datamonitor interviewed voiced concern over the effectiveness of these drugs. Almost 45% of patients fail initial treatment and if the treatment is ‘successful’, physicians observe only modest improvement in symptoms. The feeling amongst the physicians surveyed is that these drugs simply delay the onset of severe symptoms and are not effective in the long term.”

New drug for severe Alzheimer’s disease patients to be launched in UK by 2003
There is some hope on the horizon. By the end of 2002, a new drug called Ebixa marketed by Danish company Lundbeck, which has a different mechanism of action than current treatments, will be available for the treatment of moderate to severe Alzheimer’s disease patients. Whilst this launch will come as a welcome relief to the families of these patients, some experts believe that Ebixa, which has been available in Germany for over a decade, is no more effective than other drugs at treating the disease. It does, however, have few side effects and may be used in conjunction with other therapies meaning that Ebixa will be a welcome addition to the drug management of Alzheimer’s disease.

Early intervention is vital as drugs are more effective at the onset of the disease
As scientists are still unclear as to the exact cause of Alzheimer’s disease, it is unlikely that a cure will be found for at least another 10 years. Recent studies have shown that neuronal cell loss occurs several months before the symptoms of the disease arise. As such, existing drugs, which merely manage the symptoms of the disease, are being used once a significant level of neuronal depletion has already occurred and it is too late at this stage to stop further cells depleting. This problem is compounded by the fact that many sufferers do not seek diagnosis until the later stages of the disease when neuronal death is irreversible. The neurologists interviewed by Datamonitor agree that early intervention would be extremely beneficial. Studies show that drugs are far more effective in the initial stages of the disease, and that if they were more widely used from the outset, the quality of life for both the patient and the caregiver could be greatly improved. Nevertheless, a rise in early diagnosis rates would depend on both increased public awareness of the disease and the treatments available, as well as the introduction of more accurate and efficient diagnostic tests.

Prevention is better than cure – Alzheimer’s disease vaccines in the pipeline
Perhaps the most promising approach to Alzheimer’s disease treatment is in the prevention of beta amyloid plaques in the brain, one of the main hallmarks of Alzheimer’s disease. Many scientists agree that these plaques lead to neuronal loss and the onset of dementia and as such believe that by reducing the levels and/or deposition of beta-amyloid in the brain they could halt the progression of the disease. Irish company, Elan, recently developed a ‘vaccine’ for Alzheimer’s disease, which worked by stimulating a patient’s immune system to attack beta amyloid thus rendering it harmless. However, it was pulled from trials due to several cases of severe side effects. Nevertheless, Elan, along with other pharmaceutical companies recognise that immunisation in Alzheimer’s disease is an extremely promising direction to follow and Datamonitor believes that we will see a flurry of activity in this area of research over the next 5 years.

Cases of Alzheimer’s to triple in next 30-40 years as the elderly population grows
The healthcare costs associated with this disease are already vast, but with the global ageing population growing dramatically researchers agree that the number of Alzheimer’s disease patients will triple over the next 30-40 years. Whilst this represents a huge burden on the global Cont…
economy and a headache for governments striving to cut healthcare costs, it presents pharmaceutical companies with a very lucrative opportunity. Datamonitor expects that more and more companies will seek to take a slice of this market, and will invest aggressively in drug development programs.

This can only be good news for the patient population, as increased investment in Alzheimer’s disease research will hopefully result in the introduction of more effective treatments, safe vaccines and ultimately a cure for the disease

Ben Greener comments; “For pharmaceutical companies and other potential investors, Alzheimer’s disease represents a huge opportunity for generating revenues. The market is currently worth over $1.2bn, and is likely to grow rapidly over the coming years as awareness of available treatments increases. Nevertheless, because the drug pipeline lacks promising candidates in late stage development, patients will have to have to make do with existing symptomatic therapies for some years to come. Nevertheless, in the face of a rise in patient numbers, the biggest challenge will be for governments to improve support and quality of life with non-pharmacological methods for both the patient and caregiver groups, whilst controlling healthcare spend.”