Alois Alzheimer

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Outras Possibilidades Terapêuticas

Outras possibilidades terapêuticas
Alguns estudos tentam esclarecer que outras drogas poderiam retardar a evolução da doença de Alzheimer. Esses estudos são preliminares e seus resultados devem ser comprovados em ensaios controlados e bem conduzidos. Drogas que reduzem o colesterol sérico, anti-inflamatórios, antioxidantes e estrogênios são algumas substâncias estudadas com essa finalidade. Os resultados preliminares são conflitantes.

Drogas anti-inflamatórias
Pessoas que tomam grandes doses de anti-inflamatórios não hormonais (AINH), geralmente para tratar dores articulares, apresentam, de acordo com alguns estudos, menor probabilidade de desenvolver a doença. Os AINH que são vendidos mesmo sem receita médica, como a aspirina, e outras drogas, como Celebra® (celecobix) e Vioxx® (rofecoxib), podem ter a propriedade de reduzir a inflamação cerebral associada com a doença de Alzheimer, retardando efetivamente sua evolução. Nenhum dos resultados até o momento é definitivo.
Essas drogas devem ser estudadas, dentro desse objetivo, em ensaios rigorosamente desenhados e bem controlados, antes que esses potenciais benefícios sejam colocados em prática.
Um desses ensaios, Alzheimer´s Disease Anti-Inflammatory Prevention Trial (Adapt) (Green et al.), foi iniciado em 2001 com o objetivo de testar a eficácia de alguns AINH na prevenção da doença de Alzheimer. O estudo com mais de 2.500 participantes, sem demência, com 70 anos ou mais, é uma iniciativa do National Institute on Aging (NIA).

Antioxidantes
Pesquisadores também estão examinando se o uso de agentes antioxidantes como as vitaminas E e C, o selênio, a seleginina e o caroteno poderiam diminuir ou anular as ações maléficas em nível celular dos radicais livres (compostos com papel fisiológico quando em concentrações adequadas). As defesas orgânicas naturais desempenham bem esse papel, mas declinam com o envelhecimento. Alguns estudos sugerem que os antioxidantes podem proteger as células e adiar o início da doença. No entanto, um estudo com duração de 4 anos com cerca de 1.000 idosos, realizado na Columbia University, demonstrou que, apesar de esses indivíduos consumirem essas substâncias em dietas ou usarem suplementos, não houve diminuição do risco para o desenvolvimento da doença de Alzheimer. Os resultados desse estudo foram publicados em fevereiro de 2003 na respeitada revista Archives of Neurology.
Existem fitoterápicos com propriedades antioxidantes. Um deles, o Ginkgo biloba, usado na China há milhares de anos, em um estudo limitado, mostrou promover discreta melhora cognitiva, comportamento social e nas atividades da vida diária como vestir-se e comer.
Um estudo, com cerca de 3.000 participantes, conduzido pelo National Institutes of Health (NIH), investigou a ação do Ginkgo biloba em prevenir ou retardar o declínio cognitivo em idosos e demonstrou sua ineficácia.
 A FDA alerta que alguns suplementos podem interagir com as medicações prescritas pelo médico e provocar sérios danos. Aconselha ainda que qualquer tipo de medicação, inclusive ervas e compostos ditos “naturais”, só deve ser indicado pelo médico.

Estrogênio
Vários estudos relacionam o hormônio feminino estrogênio com a melhora cognitiva e a possível prevenção ou retardamento do desenvolvimento da doença de Alzheimer em mulheres. No entanto, um estudo patrocinado pelo NIH, abrangente, representativo e de longo prazo, mostrou o contrário. Nesse estudo – “Women´s Health Initiative Memory Study (WHIMS)”, uma parte das mulheres com 65 anos e mais que receberam estrogênio e progesterona tiveram o dobro da taxa de demência, inclusive doença de Alzheimer, quando comparadas com as que não usaram as drogas. Esse estudo publicado em 28 de maio de 2003, no JAMA, também concluiu que o uso dessa combinação também não as protegeu do chamado “prejuízo cognitivo leve”, uma forma de declínio cognitivo menos grave do que a demência.
Fica claro que ainda são necessários mais estudos, rigorosamente controlados e bem desenhados, para incluir essas possibilidades terapêuticas no receituário dos especialistas.
Recentemente, descobriu-se que a isoflavona, composto obtido da soja, possui propriedades que mimetizam a ação benéfica do estrogênio, inclusive aumentando sua produção. Trata-se de uma alternativa promissora, já que é isoflavona é natural, o que a torna uma opção racional a ser cogitada se os resultados forem confirmados por estudos sérios e bem conduzidos.

Outras estratégias terapêuticas questionáveis
A doença de Alzheimer é uma doença idade-dependente, e, des-
sa maneira, a maioria dos pacientes são idosos que apresentam outras doenças concomitantemente. Esse é um grande problema para os geriatras que muitas vezes têm que prescrever mais drogas do que desejariam.
Diante de um quadro, por exemplo, de hipertensão arterial, a nimodipina poderia substituir o anti-hipertensivo usado, já que esta controla os níveis pressóricos (seu efeito colateral mais importante) e proporciona benefícios “neuroprotetores”. A nimodipina pode ser indicada nas demências vasculares e mistas: doença de Alzheimer somada a múltiplos infartos cerebrais.
Recentemente, os níveis elevados de homocisteína foram relacionados com a gênese da doença de Alzheimer, o que está baseado na teoria do estresse oxidativo. Essa substância é passível de ser quantificada em laboratório, e o tratamento consiste na administração de 0,4 mg de folato ao dia, em dieta ou suplementos.

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