The Moon Jae-in administration has vowed to boost support for state dementia examinations and long-term nursing services, but such efforts could end up being wasted due to lack of dementia treatments, an expert said.
Among available dementia treatments, acetylcholinesterase inhibitors (ACEI) are said to be more effective to preserve cognitive functions than conventional remedies.
Marketed ACEIs include Eisai Korea’s Aricept (ingredient: donepezil), Novartis Korea’s Exelon (rivastigmine), and Janssen Korea’s Reminyl (galatamine). Other various generic drugs are also accessible.
However, the expert noted that there are too few dementia treatments to make the government’s effort to support dementia diagnosis programs effective.
Suh Guk-hee, a professor of psychiatry at Hallym University Medical Center Dongtan Sacred Heart Hospital, wrote a column titled “Brain as a complex system and dementia” in the “Evidence and Values in Healthcare 2018,” published by the National Evidence-based Healthcare Collaborating Agency (NECA).
In the column, Suh pointed out that the government’s programs to diagnose dementia early through blood tests and long-term research support may not be fruitful.
“Diagnosing dementia early is a difficult challenge for even experts. Unprofessional public health centers and dementia centers should not diagnose dementia without expertise,” Suh said. “Those who are reported to be suspected of dementia may suffer anxiety, physical pain, and fear. They may visit hospitals prematurely and indiscriminately.”
Mini-Mental State Examination (MMSE) scores vary significantly, depending on educational levels and age. Thus, getting the full mark of 30 out of 30 does not always mean the examinee is free of dementia, or receiving less than 10 may not indicate dementia at all, according to Suh.
Amid such vague standards for dementia diagnosis, there is no drug to slow the progression of dementia, he said.
“ACEIs improve cognitive functions by attaching to acetylcholine receptors, instead of nicotine. These ACEIs are attached to the receptors longer than nicotine, but they do not show meaningful effectiveness to conclude that they restored patients’ daily activities,” Suh said.
He went on to say that even if dementia patients take dementia drugs continuously, their dementia worsens anyway in the end. “Dementia patients who were regular smokers naturally stopped smoking after taking ACEIs. This suggests that the ACEIS’ pharmacological effectiveness is equal to or slightly better than nicotine,” Suh said.
Suh said it was too premature to conclude that ACEIs were dementia treatments.
“To say it accurately, there is no cure for dementia yet. Currently available medicines known as dementia drugs only extend cognitive functions for up to one year,” Suh said. “Some of the world’s leading pharmaceutical firms have tried to develop dementia treatments but failed to see any visible results.”
Early dementia diagnosis programs could cause an astronomical cost, he warned. Instead, the government should consider supporting patients after the diagnosis of dementia, he said.
“What the government needs to do now is not to declare war against dementia. It should help dementia patients do not get abandoned and end life with dignity, even if their cognitive functions regress to the level of three- or four-year-old children by dementia,” Suh added.
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