Apathy, or loss of motivation, is a very common symptom in people with Alzheimer’s disease, and there is currently no approved drug to address this problem. Now, new research has shown that certain medications used to treat attention deficit hyperactivity disorder (ADHD) or depression may also be helpful in improving cognition and reducing apathy in patients with this type of disorder. dementia.
The aim of the new study, which has been published in the Journal of Neurology Neurosurgery & Psychiatry, was to test the efficacy of noradrenergic drugs – including antidepressants and others for ADHD or high blood pressure – in improving cognitive and neuropsychiatric symptoms associated with Alzheimer’s disease.
Noradrenergic drugs target a neurotransmitter called noradrenaline, which plays a key role in a large number of cognitive processes, including attention, learning, memory, preparing for action, and suppressing inappropriate behaviors, which are some of the Alzheimer’s symptoms.
In the early stages of Alzheimer’s disease, a noradrenergic alteration occurs that causes the appearance of the cognitive and neuropsychiatric symptoms that characterize this dementia, and for this reason the researchers assumed that a drug directed at the noradrenergic system would achieve good results in these patients.
A new therapeutic target to combat Alzheimer’s
Based on this hypothesis, the researchers searched for clinical trials that had been published between 1980 and 2021 and in which noradrenergic drugs – such as atomoxetine, methylphenidate and guanfacine – had been used to see if they could improve the symptoms of patients with neurodegenerative diseases . They conducted an analysis of 19 randomized controlled trials, including 1,811 patients, that had focused on Alzheimer’s disease and mild cognitive impairment.
“Reuse of established noradrenergic drugs is more likely to offer effective treatment in Alzheimer’s disease for general cognition and apathy”
Results from 10 of these trials, involving 1,300 patients, were combined for global cognition: visuospatial ability, verbal fluency, language, memory, and orientation/attention, and as measured by the Mini-Mental State Examination or the evaluation of Alzheimer’s disease, noradrenergic drugs were found to have a slight but significant positive effect on general cognition.
They then pooled the results of eight clinical trials — involving 425 patients — for behavior and neuropsychiatric symptoms, agitation, and apathy. And this revealed that noradrenergic drugs had a significant positive effect on apathy.
“Reuse of established noradrenergic drugs is more likely to offer an effective treatment in Alzheimer’s disease for general cognition and apathy,” say the researchers, adding: “There is a strong case for further targeted clinical trials of targeted treatments.” noradrenergic agents in Alzheimer’s disease.
These experts have warned, however, that before starting these studies, the individual characteristics of the patients must be taken into account and the effects of drug dosage and their possible interactions with other treatments must be well understood in order to maximize their benefits. and reduce the disadvantages as much as possible.
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