Cerebrolysin – A unique therapy that specifically works to delay the progression of Alzheimer’s Disease.

The words Alzheimer’s disease (commonly referred to as AD) fill many of us with dread, particularly as we grow older. It’s all too easy to conjure up an image of a frail, confused elderly person living in residential care who no longer recognises even the closest members of their family. It’s not a future any of us would want.

For many years researchers and pharmaceutical companies have worked to try and find a cure for this destructive disease but so far success has been limited to essentially treating the symptoms rather than tackling the disease itself. But now Cerebrolysin offers a new and unique approach to Alzheimer’s disease that is aimed specifically at delaying the progression of this devastating disease.

But before we look at Cerebrolysin is more detail, it’s useful to understand a little more about Alzheimer’s disease itself.

What is Alzheimer’s disease?

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys higher brain functions such as memory, thinking and personality. Symptoms vary from person to person, but all people with Alzheimer's Disease have problems with memory loss, disorientation and thinking ability. Sufferers may have trouble finding the right words to use, recognizing objects, family and friends, and may become frustrated, irritable, and agitated. As the disease progresses, physical problems emerge. These may include loss of strength and balance, and diminishing bladder and bowel control. Eventually the disease robs the sufferer of the ability to carry out even the simplest tasks. They are no longer able to look after themselves and require full time care.

There are two forms of Alzheimer’s disease - sporadic Alzheimer’s disease and familial Alzheimer’s disease.

Sporadic Alzheimer’s disease, which can affect either gender, accounts for over 90 per cent of all Alzheimer’s disease cases. The symptoms of sporadic Alzheimer ’s disease tend to appear in people over the age of 65 years whereas the age at onset of familial Alzheimer’s disease is often much younger with symptoms usually developing when the sufferer is in their 30’s, 40’s or 50’s.

Alzheimer’s disease is named after Dr Alois Alzheimer who, in 1906, noticed changes in the brain tissue of a woman who had died from an unusual mental illness, the symptoms of which included memory loss and language problems. When examining her brain he found many tangled bundles of fibres (which we now refer to as neurofibrillary tangles) and abnormal clumps (now known as amyloid plaques). These two features, along with a loss of connections between neurons (nerve cells) form the main features of a brain that has been attacked by Alzheimer’s disease.

Although we know that familial Alzheimer’s disease is caused by a rare genetic gene mutation, we still do not know what causes the sporadic Alzheimer’s disease process to start up in some people’s brains, even though it’s more than a century since Dr Alzheimer made his discovery. However, what we do know is that Alzheimer’s disease begins to damage the brain some 10 to 20 years before any problems become evident. Neurofibrillary tangles start to develop in the entorhinal cortex, an area that is hidden deep within the brain. Plaques begin to form in other areas. Gradually as more and more plaques and tangles form in particular areas of the brain, healthy neurons start to work less efficiently. Eventually they cease to function and can no longer communicate with one another. Ultimately cell death occurs.

Inexorably, this insidious process spreads to the hippocampus - the part of the brain that is essential in forming memories. As more and more neurons die, damage spreads throughout the brain and affected regions begin to shrink. By the final stage of Alzheimer’s disease, damage is widespread, and brain tissue has shrunk significantly.

Although Alzheimer’s disease is a slow disease that starts with mild memory problems, it ends with severe brain damage and, unfortunately, it is always fatal. As more and more of the brain is affected, areas that control basic life functions, like swallowing and breathing, become irreversibly damaged, resulting eventually in death.

The time from diagnosis to death varies. If a person is over 80 at the time of diagnosis, life expectancy is as little as 3 to 4 years. However, if a person is younger when they are diagnosed they may live for well in excess of 10 years. Their gender, severity of cognitive problems at the time of diagnosis and their general health all contribute to their life expectancy. In some cases the eventual cause of death is not Alzheimer’s disease itself but a different illness or infection. This is because AD ultimately leaves a person less resistant to other diseases. And as yet there is no cure and no way yet proven to prevent the disease from developing.

Today, Alzheimer’s disease is the most common form of dementia amongst older people, accounting for 50-70% of all dementias. Dementia is a general term that refers to a loss in cognitive function i.e. thinking, reasoning and remembering that is extensive enough to interfere with a person’s everyday life. This decline in cognitive function is not a disease itself, but a group of symptoms that often accompanies a disease or condition. Alzheimer’s disease is one such cause of dementia.
It is estimated that somewhere between 2.4 million to 4.5 million Americans have Alzheimer’s disease (1). And if current population trends continue with populations aging, the number of people with Alzheimer’s disease will continue to rise. For example, the number of Americans aged 65 and older is expected to grow from 39 million in 2008 to 72 million in 2030, and, as things currently stand, the number of people with Alzheimer’s disease doubles for every 5-year interval beyond age 65(1).

Unfortunately age, which is the greatest risk factor for developing sporadic Alzheimer’s disease, is not something that we can avoid. Up to 10% of people aged 65-74 have the disease, and nearly half of those aged 85 and older may have the disease. The average age at diagnosis is 80. Although Alzheimer’s disease is not gender specific, it appears to be a disease that particularly affects women, with more women than men dying from the disease. This skew in the figures could though be due more to the fact that women generally live longer than men and so are more likely to be diagnosed with Alzheimer’s disease (2).

And diagnosis itself is problematic - indeed the only conclusive diagnosis can be made by examining brain tissue during an autopsy. No single clinical test can be used to identify Alzheimer’s disease. Instead a person is given a comprehensive patient evaluation which would include such things as a complete health history, physical examination, neurological and mental status assessments, and blood and urine analysis. This type of evaluation may provide a diagnosis of possible or probable Alzheimer’s disease with up to 90 percent accuracy.

Finally, it’s important to remember that Alzheimer’s disease affects more than just the sufferer. It places a huge burden financially, physically and emotionally not only on the sufferer but on their carers and family and upon society in general. And this burden is only set to worsen as the incidence of Alzheimer’s disease increases.

It’s clear than that something needs to be done. Cerebrolysin offers Alzheimer’s disease sufferers and their families new hope - whilst not a cure, it is a unique therapy that specifically works to delay the progression if the disease.

What is Cerebrolysin?

Cerebrolysin is an injectable protein-based solution that contains small-molecule biologically active neuropeptides. Neuropeptides are small protein-like molecules used by neurons to communicate with each other. They work as neuronal signalling molecules and influence the brain’s activity in a number of specific ways. They are, therefore, involved in particular brain functions like learning and memory. Neuropeptides penetrate through the blood-brain barrier and act directly on neurons.

Rather than being a synthetic product, Cerebrolysin is based on natural products. It contains biologically active peptides that have been produced from purified porcine brain proteins via standardised enzymatic processes.

How does Cerebrolysin work?

What makes Cerebrolysin different from other Alzheimer’s disease treatments is that, rather than being targeted at improving the symptoms of Alzheimer’s disease, it is specifically designed to delay progression of the disease.

To do this, Cerebrolysin possess a unique multimodal action. It works on the brain in a number of specific ways to support the survival, stability and function of neurons. It acts as both a neuroprotective and neurotrophic agent (a neurotrophic agent is one that induces the survival, development and function of neurons). As a neurotrophin, Cerebrolysin is capable of signalling particular nerve cells to survive, differentiate, or grow. In particular, Cerebrolysin exerts this growth like factor on the neurons of the dorsal root ganglia. The dorsal root ganglia are groups of cells located close to the spinal cord. These cells transmit information about the different sensations you feel in your arms and legs to the brain.

Cerebrolysin also promotes neurogenesis i.e. the production of new neurons. For a long time, it was thought that neurogenesis did not occur in adult brains - once you were grown, it was thought that all you could do was watch your brain cells die! But in the mid 1960’s it was discovered that adult neurogenesis does occur although it was only accepted as a general phenomenon in human brains in the late 1990s. It is now well established that one of the areas of the brain in which neurogenesis does occur is the hippocampus - which, as discussed above, is the area of the brain that is crucial to the formation of memories.

Cerebrolysin also appears to affect synaptic transmission and promotes synaptic repair in the hippocampus. Synaptic transmission is also known as neurotransmission. It refers to the electrical movement within synapses caused by nerve impulses. Synapses are the contact points between neurons. Neurons do not actually touch each other - minute gaps called synaptic gaps exist between them. Neurons use nerve impulses to transport information. When a nerve impulse reaches the neuron’s synapse, special chemicals known as neurotransmitters are released that cross the synaptic gap and influence the next neuron in either in an inhibitory way or in an excitatory way.

Cerebrolysin also acts to decrease amyloid production. As discussed earlier, the formation of amyloid plaques in the brain is one of the key characteristics of Alzheimer’s disease. The production of these plaques is strongly correlated with the brain damage that Alzheimer’s disease causes. Therefore, reducing amyloid production is a crucial element in the control of the progress of Alzheimer’s disease.

Evidence also suggests that Cerebrolysin may decrease the rate of apoptosis (the process of programmed cell death) which again may be a factor in Cerebrolysin’s ability to slow the progress of Alzheimer’s disease.

The effects of Cerebrolysin

By helping to support, protect and maintain the brain in so many vital ways, Cerebrolysin brings about both clinically and statistically significant improvements in the cognitive and behavioural performance abilities of suffering from Alzheimer’s disease. This in turn makes daily life that much easier.

Its efficacy has been tested in 80 randomized controlled clinical trials involving over 5000 patients. These studies have produced consistently excellent results. The studies have highlighted significant symptomatic improvements in patients with mild to moderate Alzheimer’s disease who have received Cerebrolysin either via intra-muscular injections or via intra venous infusions for 5 days a week.

Cerebrolysin has a relatively fast onset of action - it takes around a month of treatment before symptomatic improvements appear. It also induces long term benefits and appears to have a stabilizing effect on the pathological processes of Alzheimer’s disease. Improvements appear to remain stable for at least 6 months and beneficial effects have been sustained for at least 3 months after withdrawal from Cerebrolysin therapy.

Can Cerebrolysin be used for treating other conditions?

Cerebrolysin is not just limited to treating patients with Alzheimer’s disease. In particular Cerebrolysin may be used to treat: