Antibiotics for Alzheimer's
Alzheimer's Disease Antibiotic Therapy
A pilot study of treating Alzheimer's disease with antibiotics showed some promise that this treatment could delay the deterioration of the mind with this disease. This study is being replicated on a larger scale, providing a more definitive answer to this question. In addition to looking at changes of the mind (through cognitive tests), we would like to use MRI scans in these patients before and after treatment to study the structural changes and the chemical changes in the brain. This would provide a non-invasive look at the bran processes that protect the brain from the effect of Alzheimer's as well as confirming that the disease has been modified with treatment.
The novel treatment of Alzheimer's with antibiotics has provided a potential breakthrough in the field. In addition to verifying changes in the brain, MRI scans can observe HOW this process could occur, thus opening doors to other new treatments for Alzheimer's and perhaps even cures.
Antibiotics treatments for Alzheimer's disease?!
Using antibiotics to treat Alzheimer's disease is new and radical approach in the treatment of Alzheimer's disease. It is based on the finding at autopsy that some people with Alzheimer's disease show traces of the common bacterium Chlamydia pneumoniae.
Dr Mark Loeb conducted a clinical trial on 101 people with Alzheimer's disease using a combination of two antibiotics, doxycylin and rifampin. The researchers found a statistically significant improvement in mental function between the group of people on placebo and those taking the antibiotic medication. The improvement was still present at 12 months but was too small a difference to be considered significant.
Side effects from antibiotic medication were minimal and included nausea, diarrhea and sleep disturbances.
Infection rates with the Clamydia bacterium showed no change.
The Alzheimer’s Association has expressed caution about new research on antibiotics and Alzheimer's disease. It is not recommended that antibiotics are used to treat Alzheimer's disease. Clearly more research is required. But the role of infection in Alzheimer's disease is an interesting one.
"Researchers have been looking into possible infectious causes of Alzheimer's for decades, but none have yet been found," comments Samuel E. Gandy, M.D., Ph.D., Chairman of the Scientific Advisory Board of the Fisher Center for Alzheimer's Research Foundation. "While the current results are provocative, independent confirmation is needed. Antibiotics and anti-viral drugs have not been proven effective against the disease, and patients should not be taking these medications to treat Alzheimer's."
These antibiotics may have benefits against Alzheimer's that are distinct from their infection-fighting properties, although further study is needed. Both of these antibiotics, and rifampin especially, for example, may prevent the buildup of beta amyloid, the toxic protein that builds up in the brain of those with Alzheimer's disease. They may also have inflammation-fighting properties that help protect the brain.
In the current study, investigators at McMaster University in Ontario enlisted 101 people with mild to moderate Alzheimer's at five medical centers across Canada. Half received daily doses of both doxycylince (200 mg) and rifampin (300 mg) for three months, while the others received look-alike dummy pills.
After six months, memory tests were administered. Results indicated that those who had been receiving the antibiotics had less mental decline than those who received a placebo. The antibiotic group showed slight improvement after 12 months as well, although those benefits were not considered statistically significant.
The researchers, however, did not find noticeable differences between the two groups in terms of levels of infection with the Clamydia pneumoniae bug, the common cause of pneumonia in seniors that some research has linked to Alzheimer's.
Another recent study pointed to common herpes viruses as a possible link to Alzheimer's (see the Fisher Center article "Cold Sore Virus Might Play A Role in Alzheimer’s" ), and other infectious organisms have been explored as possible causes of the disease. Still, any connection between Alzheimer's and infections remains highly speculative.
This interesting new avenue of Alzheimer's research requires further study in larger groups of patients.
Antibiotics May Ease Alzheimer's Symptoms"It's not ready for prime time," says Dr. Mark B. Loeb, an associate professor in the department of pathology and molecular medicine at McMaster University in Hamilton, Ontario. He is to present his findings on Oct. 11 at the Infectious Diseases Society of America's annual meeting in San Diego.
An estimated 4.5 million Americans have Alzheimer's disease, according to estimates from the Alzheimer's Association. Up to 16 million are projected to have it by 2050, the group says, unless an effective cure or treatment is found.
Loeb and his colleagues evaluated 101 patients with "probable" Alzheimer's and mild-to-moderate dementia. The team assigned them randomly to a group that received 200 milligrams of the antibiotic doxycycline and 300 milligrams of rifampin daily for three months. They evaluated them before the study using a standard Alzheimer's test to determine mental functioning, and then repeated the test to the 43 remaining in the antibiotic group and the 39 remaining in the placebo group after six months.
The scores of those in the dummy pill group declined on average by 2.75 more points than those in the treated group on a 70-point scale. At 12 months there was still a difference in function, although it was not a significant one.
"The magnitude of the difference was similar to the effects seen with therapy with cholinesterase inhibitors," Loeb says. This class of drugs, approved by the U.S. Food and Drug Administration to treat cognitive Alzheimer's symptoms, are meant to boost memory and other cognitive functions by influencing certain chemical activities in the brain.
"Other people should replicate this," Loeb says of his study.
Loeb's group decided to study the antibiotic treatment because one theory suggests the bacterium Chlamydia pneumoniae may play a role in causing Alzheimer's.
But in the study, the antibiotics did not cause a drop in the levels of the bacteria as greatly as would be expected.
Loeb speculates the antibiotics may work by interfering with the accumulation of protein plaques around the brain's neurons, which are associated with the disease. "Or it could be a local anti-inflammatory effect," he says.
Meanwhile, caution was urged by William Thies, vice president of medical and scientific affairs for the Alzheimer's Association.
"It's interesting data," he says. "But there is really no data about mechanism." He adds, "It's a relatively small study, with a relatively short follow-up."
While the idea definitely deserves more research attention, Thies says, "It's not a clarion call to put large parts of the population on antibiotic therapy."
And, he notes, the number of Alzheimer's experts who think the Chlamydia pneumoniae bacteria play a role in the onset of the disease is small. "It's clearly a very small number," he says, "although that doesn't mean it [the concept] isn't right."
Antibiotics and Alzheimer’s and End-of-Life Care
People in the most advanced stages of Alzheimer's disease most often live in nursing homes and are prone to respiratory infections, fevers and other ills. Antibiotics are typically prescribed for these patients in their final weeks of life, even though that may not be the best course of treatment, a new study reports.
The study, published in the Archives of Internal Medicine, looked at 214 nursing-home residents with advanced dementia living in the Boston area. The researchers, from Beth Israel Deaconess Medical Center, found that antibiotic use increased the frailer and further advanced the dementia. Two thirds of patients received at least one course of antibiotics during their stay, with many receiving four or more courses of the drugs. Antibiotic use was particularly common during the final weeks of life.
"The proportion of residents taking antimicrobials was seven times greater in the last two weeks of life compared with six to eight weeks before death," the authors write. More than 40 percent of the antibiotics given in the last two weeks of life were administered intravenously rather than by mouth, a method that may be especially uncomfortable for patients with advanced dementia.
The findings are important, because experts estimate that some 70 percent of the more than five million Americans with Alzheimer's will live in a nursing home at some point during their illness. Fevers and recurrent infections are common in this group.
Overuse of antibiotics breeds drug-resistant bacteria that can present a serious danger to other residents. Infections from these potent germs do not respond to standard medications and can often prove fatal.
"This extensive use of antimicrobials and pattern of antimicrobial management in advanced dementia raises concerns not only with respect to individual treatment burden near the end of life, but also with respect to the development and spread of antimicrobial resistance in the nursing home setting," the authors continue. The results support "the development of programs and guidelines designed to reduce the use of antimicrobial agents in advanced dementia."
The authors point out that deciding whether to give antibiotics to a loved one with advanced dementia can be a difficult decision. In general, antibiotics are given to cure infectious diseases and prolong life. However, this and earlier observational studies suggest that for many frail patients with terminal Alzheimer's, antibiotics given at the very end of life may be of less value.
Providing comfort and care, without drugs, may achieve more benefits in many of these patients, the authors note.
"We must ask whether the interests of the patient are being served by using antibiotics," write doctors from Tel Aviv Medical Center in an editorial accompanying the study. "We must further ask whether the use of antibiotics in each specific patients justifies the risk placed on others by their use." Once again, the doctors are referring to very advanced cases of dementia and not to people in earlier stages of Alzheimer's.
They note that each decision must be made individually, based on the likely benefits and risks to the individual patient. The individual wishes of patients and their families should also be considered, as well as the treating doctor's judgment, the doctors say.
Facts of Life - Antibiotics for Alzheimer's
"My dad suffers from either Alzheimer's disease or age-related dementia. He is wheelchair-bound and in the advanced stages of mental deterioration. He seldom shows recognition of family members, and when he speaks it is almost always a meaningless jumble of sounds. But when he is hospitalized for recurring Urinary Tract Infections, caused by his pulling on his suprapubic catheter, he becomes almost lucid. He recognizes me and my sister. He still babbles, but he speaks a few complete sentences.
My sister and I think the strong antibiotics counteract the Alzheimer's or dementia. When his UTI is cured and he is removed from the antibiotics, he quickly returns to his pitiful mental state. If you know an Alzheimer's or dementia researcher, inform that person of this fact."
Antibiotics treatments for Alzheimer's disease - is not fully proved!