Alzheimer's disease weighs disproportionately on women

Alzheimer's disease affects both men and women. But with the graying of America, Alzheimer's disease will increasingly become a women's issue. Ann Marie Hake, M.D., assistant professor of clinical neurology, Indiana University School of Medicine, explained, "Alzheimer's disease affects women more than men-partly because women live longer than men. But, even when you take that into account, it occurs more commonly in women. The double whammy is that the caregiver is most often a woman. It's a woman's problem from either perspective."

Currently more than four million Americans suffer from Alzheimer's disease; by 2050, some predict that number will swell to 14 million. Unfortunately, though, the cause of Alzheimer's is not well understood. Hake believes a combination of factors is necessary for the disease to evolve. Supporting this hypothesis is autopsy evidence showing patients with brain abnormalities consistent with Alzheimer's who had normal cognitive function during their lifetimes. She views a multifactorial pathogenesis as promising, "It gives us multiple areas to attack," she said. "If we could shift the balance in one or two areas, that might be the difference between developing dementia or not."

The past decade of research has offered Alzheimer's patients symptomatic treatment and drugs that can slow the decline in cognition by six to 12 months, but then the disease continues, largely unabated. "If you look at the way the curve goes [for functioning with drug treatment], the first couple of months there may be a stabilization, but then the decline basically runs parallel to the placebo group," noted Judith Beizer, Pharm.D., CGP, clinical professor at the College of Pharmacy and Allied Health Professions, St. John's University.

The one trial showing benefit of vitamin E 2000 IU per day in patients with moderate severity Alzheimer's (Sano M, et al. New England Journal of Medicine 1997; 336 (17):1216-22) is being reassessed in light of more recent evidence reported at the 2004 annual American Heart Association meeting. Researchers presenting there suggested that doses of vitamin E > 400 IU slightly increase an individual's risk of death.

The premise that postmenopausal estrogen treatment can prevent Alzheimer's disease suffered a knockout blow with the results of the Women's Health Initiative (WHI). However, as Hake pointed out, women studied in WHI were all over 65 years old. "We don't know yet whether taking estrogen earlier would be helpful," she said.

There does seem to be growing consensus that the same sorts of interventions that benefit heart health also improve brain health. The basis of the Alzheimer's Association public health education campaign Maintain Your Brain is to raise awareness of diet, exercise, and other lifestyle changes that support brain health. Drug research is also moving in that same direction. Preliminary information from one small trial suggests an ACE inhibitor that crosses the blood-brain barrier may be bene-ficial in mild to moderate Alzheimer's disease. "Some epidemiological studies just coming out suggest statins may offer some benefit in preventing cognitive decline," commented Jennifer Faulkner, Pharm.D., BCPP, clinical pharmacy specialist in psychiatry, Central Texas Veteran's Health Care System, Temple, Texas. "But that information is still in its infancy," she noted.

R.Ph.s' role

Pharmacists in all practice settings are likely to encounter Alzheimer's patients, and they can fulfill several important roles. One is to have information about Alzheimer's available in the pharmacy. Many Alzheimer's support groups as well as pharmaceutical companies offer useful educational information. Some handouts can prompt early diagnosis, allowing earlier treatment, and a slower decline in the patient's functioning.