Mike FITZPATRICK
An old friend and veteran of the psychiatry of the elderly tells me he experienced a feeling of déjà vu over celebrations of the latest “extraordinary breakthrough” in the treatment of Alzheimer’s disease. These reports greeted the preliminary approval by the US regulatory authorities of aducanumab, a monoclonal antibody that targets the amyloidbeta proteins that are deposited in the destructive plaques in the brain that cause the inexorable cognitive decline of Alzheimer’s.
He recalled the rapturous reception received more than 20 years ago by the first-generation drug treatments for dementia – the so-called “anticholinesterase inhibitors”. These drugs were prescribed on a large scale – before rigorous studies showed that they were of very limited effectiveness.
“This is an area where emotions and pressure groups and vested interests have muddied the waters, creating a demand for therapies before proven products actually become available,” he says.
Several authorities have noted that US approval of aducanumab is based on its potential for slowing the pathological process of amyloid deposition, even though clinical studies suggest only marginal benefits when the drug is used in high doses in selected cases. Another experimental drug, solanezumab, was withdrawn by its manufacturer in 2016 after similarly disappointing results.
Speaking to the Science Media Centre, Robert Howard, professor of old age psychiatry at University College London, said the decision to approve aducanamab was “a grave error” that would have a negative impact on patients and families affected by Alzheimer’s and potentially delay other areas of research.
The appalling death rate from Covid-19 of people with dementia in care homes over the past year underlines the importance of high standards of social care for these patients. Issues of staff recruitment and training, continuity, infection control, testing and personal protective equipment have long been neglected in the allocation of resources as well as in the focus of media attention. Yet, in terms of quality of life for the foreseeable future, social care will be more important to people with Alzheimer’s than any medication currently in development.
Second jab doubts
In the Covid-19 vaccination clinic, I have encountered several patients returning in a spirit of deep resentment for their second jab. On further inquiry it often emerges that they came only reluctantly for their first jab and their hesitancy has only intensified as a result of subsequent publicity about adverse side effects.
Some admit they have only come under some duress, either from work colleagues in social care or the health service, or, more commonly, from family members – with children and grandchildren urging them to get the protection of the vaccine so that some semblance of “normal” family life can resume. Some have even accompanied their hesitant and grumpy relatives to the clinic.
It is striking that this reluctance is often associated with a more severe and prolonged range of the familiar minor adverse effects of the vaccine – sore arm, fatigue and malaise, headaches and chills, aches and pains. Although some experienced this full range of flu-like symptoms, few needed to take palliative medication or seek medical advice. Once given the opportunity to report these symptoms and reassured that they are unlikely to be so marked after the second jab, they are generally happy to join the ranks of the doubly vaccinated and Covid-protected.
Hay fever hope
Further to earlier letters to this newspaper, another reader reports the dramatic improvement in his hay fever symptoms since having the Covid-19 vaccination – and the similar experience of a neighbour. He has customarily taken an antihistamine tablet every day from February to November to relieve his runny nose and itchy eyes. Yet, since having his Oxford Astrazeneca Covid-19 jab, he has not needed to take a single tablet.
The late arrival of spring weather provides the perfect opportunity to see whether the Covid vaccine “cure” for hay fever has a wider effect. Let’s hope it does!
Better social care is more important for those with dementia than any medication in development