William Koopmans Summers (born April 14, 1944) is an independent neuroscientist and was the inventor of Tacrine (Cognex) as a treatment for Alzheimer's disease {US Patent No. 4,816,456}. [1] [2] [3] Tacrine was the first FDA approved anti-dementia drug. Today there are five FDA approved anti-dementia drugs. [4]
Summers was born in Jefferson City, Missouri. He graduated from Jefferson City Public High School in 1962. He began college at Westminster College in Fulton, Missouri in 1962 and transferred to the University of Missouri where he received a Bachelor of Science in 1966. Summers attended Washington University School of Medicine, graduating in 1971 after an elective year of basic research in nephrology. This effort led to his first academic publication [5] and a continued interest in medical research.
Summers’ post graduate education was at Washington University School of Medicine. He did a combined residency in internal medicine and psychiatry. Summers was in the last group of ‘ward internal medicine internships’ at Barnes Hospital under Carl V. Moore. [6] In psychiatry he was influenced by pioneers in biological psychiatry such as Eli Robins, George Winokur, George Murphy, John Feigner, John William Olney, Paula J. Clayton, Robert Woodruff, Ferris N. Pitts, and many other founders of the medical basis of psychiatry. [7]
Summers served as an Assistant Professor of Internal Medicine and Psychiatry at the University of Pittsburgh and later at the Los Angeles County+USC Medical Center. During this time Summers did a pilot intravenous, [8] trial of tacrine in Alzheimer's disease and found measurable acute improvement in the memory performance of the subjects. [9]
In 1981, Summers began private medical practice in Arcadia, California. He soon joined the clinical faculty of UCLA where he began working further on the development of tacrine as a practical treatment of Alzheimer's disease. He discovered that tacrine was readily absorbed by oral administration and did enter the central nervous system, [10] An intravenous treatment for a chronic disease is not a practical treatment. An oral preparation of tacrine was a potentially practical treatment for Alzheimer's. Safety experiments were done in animal models. [11] In 1984, it was inconceivable that a dementia patient could improve on a short or long term basis. Thus, psychometric scales had to be developed and validated. [12]
The oral tacrine study was published in the New England Journal of Medicine on November 13, 1986. [13] [14] The accompanying editorial was very positive, [15] but the scientific community of the time was not prepared to accept that Alzheimer's could be treated. Criticism by researchers associated with the Alzheimer's Association was sharp. [16] [17] [18] [19] [20]
The US Food and Drug Administration investigated Dr. Summers from November 18, 1986 through May 4, 1989. [21] Additionally, Dr. Summer's work was investigated by UCLA. [22] Considerable publicity occurred. Summers was defended by Robert L. Bartley and Daniel Henninger by a series of Wall Street Journal editorials. [23] [24] [25] [26]
On March 28, 1989 U.S. Patent 4,816,456 was issued to Dr. Summers. With no findings to support allegations and concerns, Frances Oldham Kelsey closed the FDA Office of Compliance investigation, in May, 1989. Nevertheless, the Office for Drug Evaluation I, placed Summers on a secret "black list" without informing him. [27] Once discovered by Summers, in 2007, the citation was removed. [28]
When Summers initiated his research, it was commonly accepted that Alzheimer's disease was a progressive unremitting neurodegenerative disease that could not be improved. Today, there are five FDA approved medications for the treatment of Alzheimer's or Dementia of other types. [4] In 2011, there are 842 Clinical trials on over 100 drugs under investigation for the treatment of Alzheimer's disease. [29] Since the 1980s, the majority of research effort was focused on the genetics and toxicity of beta amyloid protein [30] as the cause of Alzheimer's disease. Summers developed alternative hypothesis based on oxidative brain injury. [31] He hypothesized that brain insults (head trauma, viral infection, open heart surgery, hypertension, diabetes, and others) create a smoldering inflammation which produces free radicals and distant sites of inflammation. These areas of inflammation cause the production and deposition of beta amyloid and tau protein. Based on this theory, Summers created a complex, potent antioxidant which is classified as a health supplement. This antioxidant combination has been shown to improve memory in normal aging people. [32]
Alois Alzheimer was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of "presenile dementia", which Kraepelin would later identify as Alzheimer's disease.
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affects a person's ability to function and carry out everyday activities. Aside from memory impairment and a disruption in thought patterns, the most common symptoms include emotional problems, difficulties with language, and decreased motivation. The symptoms may be described as occurring in a continuum over several stages. Dementia ultimately has a significant effect on the individual, caregivers, and on social relationships in general. A diagnosis of dementia requires the observation of a change from a person's usual mental functioning and a greater cognitive decline than what is caused by normal aging.
Risperidone, sold under the brand name Risperdal among others, is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It is taken either by mouth or by injection. The injectable versions are long-acting and last for 2–4 weeks.
Vascular dementia (VaD) is dementia caused by problems in the supply of blood to the brain, typically a series of minor strokes, leading to worsening cognitive abilities, the decline occurring piecemeal. The term refers to a syndrome consisting of a complex interaction of cerebrovascular disease and risk factors that lead to changes in brain structures due to strokes and lesions, resulting in changes in cognition. The temporal relationship between a stroke and cognitive deficits is needed to make the diagnosis.
Hormone therapy or hormonal therapy is the use of hormones in medical treatment. Treatment with hormone antagonists may also be referred to as hormonal therapy or antihormone therapy. The most general classes of hormone therapy are oncologic hormone therapy, hormone replacement therapy, androgen replacement therapy (ART), oral contraceptive pills, and transgender hormone therapy.
Donepezil, sold under the brand name Aricept among others, is a medication used to treat dementia of the Alzheimer's type. It appears to result in a small benefit in mental function and ability to function. Use, however, has not been shown to change the progression of the disease. Treatment should be stopped if no benefit is seen. It is taken by mouth or via a transdermal patch.
Tacrine is a centrally acting acetylcholinesterase inhibitor and indirect cholinergic agonist (parasympathomimetic). It was the first centrally acting cholinesterase inhibitor approved for the treatment of Alzheimer's disease, and was marketed under the trade name Cognex. Tacrine was first synthesised by Adrien Albert at the University of Sydney in 1949. It also acts as a histamine N-methyltransferase inhibitor.
Stanozolol, sold under many brand names, is an androgen and anabolic steroid (AAS) medication derived from dihydrotestosterone (DHT). It is used to treat hereditary angioedema. It was developed by American pharmaceutical company Winthrop Laboratories in 1962, and has been approved by the U.S. Food and Drug Administration for human use, though it is no longer marketed in the USA. It is also used in veterinary medicine. Stanozolol has mostly been discontinued, and remains available in only a few countries. It is given by mouth in humans or by injection into muscle in animals.
Galantamine is used for the treatment of cognitive decline in mild to moderate Alzheimer's disease and various other memory impairments. It is an alkaloid that has been isolated from the bulbs and flowers of Galanthus nivalis, Galanthus caucasicus, Galanthus woronowii, and some other members of the family Amaryllidaceae, such as Narcissus (daffodil), Leucojum aestivum (snowflake), and Lycoris including Lycoris radiata. It can also be produced synthetically.
Memantine is a medication used to slow the progression of moderate-to-severe Alzheimer's disease. It is taken by mouth.
Amyloid plaques are extracellular deposits of the amyloid beta (Aβ) protein mainly in the grey matter of the brain. Degenerative neuronal elements and an abundance of microglia and astrocytes can be associated with amyloid plaques. Some plaques occur in the brain as a result of aging, but large numbers of plaques and neurofibrillary tangles are characteristic features of Alzheimer's disease. Abnormal neurites in amyloid plaques are tortuous, often swollen axons and dendrites. The neurites contain a variety of organelles and cellular debris, and many of them include characteristic paired helical filaments, the ultrastructural component of neurofibrillary tangles. The plaques are highly variable in shape and size; in tissue sections immunostained for Aβ, they comprise a log-normal size distribution curve with an average plaque area of 400-450 square micrometers (µm²). The smallest plaques, which often consist of diffuse deposits of Aβ, are particularly numerous. The apparent size of plaques is influenced by the type of stain used to detect them, and by the plane through which they are sectioned for analysis under the microscope. Plaques form when Aβ misfolds and aggregates into oligomers and longer polymers, the latter of which are characteristic of amyloid. Misfolded and aggregated Aβ is thought to be neurotoxic, especially in its oligomeric state.
Organic brain syndrome, also known as organic brain disease, organic brain disorder, organic mental syndrome, or organic mental disorder, refers to any syndrome or disorder of mental function whose cause is alleged to be known as organic (physiologic) rather than purely of the mind. These names are older and nearly obsolete general terms from psychiatry, referring to many physical disorders that cause impaired mental function. They are meant to exclude psychiatric disorders. Originally, the term was created to distinguish physical causes of mental impairment from psychiatric disorders, but during the era when this distinction was drawn, not enough was known about brain science for this cause-based classification to be more than educated guesswork labeled with misplaced certainty, which is why it has been deemphasized in current medicine. While mental or behavioural abnormalities related to the dysfunction can be permanent, treating the disease early may prevent permanent damage in addition to fully restoring mental functions. An organic cause to brain dysfunction is suspected when there is no indication of a clearly defined psychiatric or "inorganic" cause, such as a mood disorder.
Gaetano Perusini was an Italian physician. He was the pupil and colleague of Alois Alzheimer and contributed to the definition of Alzheimer's disease.
Kenneth L. Davis is chief executive officer of the Mount Sinai Health System in New York City, an American author and medical researcher who developed the Alzheimer's Disease Assessment Scale, the most widely used tool to test the efficacy of treatments for Alzheimer's disease designed specifically to evaluate the severity of cognitive and noncognitive behavioral dysfunctions characteristic to persons with Alzheimer's disease. His research led to four of the first five FDA-approved drugs for Alzheimer's.
Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems with language, disorientation, mood swings, loss of motivation, self-neglect, and behavioral issues. As a person's condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the typical life expectancy following diagnosis is three to nine years.
Pimavanserin, sold under the brand name Nuplazid, is an atypical antipsychotic which is approved for the treatment of Parkinson's disease psychosis and is also being studied for the treatment of Alzheimer’s disease psychosis, schizophrenia, agitation, and major depressive disorder. Unlike other antipsychotics, pimavanserin is not a dopamine receptor antagonist.
Acetylcholinesterase inhibitors (AChEIs) also often called cholinesterase inhibitors, inhibit the enzyme acetylcholinesterase from breaking down the neurotransmitter acetylcholine into choline and acetate, thereby increasing both the level and duration of action of acetylcholine in the central nervous system, autonomic ganglia and neuromuscular junctions, which are rich in acetylcholine receptors. Acetylcholinesterase inhibitors are one of two types of cholinesterase inhibitors; the other being butyryl-cholinesterase inhibitors. Acetylcholinesterase is the primary member of the cholinesterase enzyme family.
Cholinesterase inhibitors (ChEIs), also known as anti-cholinesterase, are chemicals that prevent the breakdown of the neurotransmitter acetylcholine or butyrylcholine. This increases the amount of the acetylcholine or butyrylcholine in the synaptic cleft that can bind to muscarinic receptors, nicotinic receptors and others. This group of inhibitors is divided into two subgroups, acetylcholinesterase inhibitors (AChEIs) and butyrylcholinesterase inhibitors (BChEIs).
Axona was previously marketed as a medical food for the clinical dietary management of the impairment of metabolic processes associated with mild to moderate Alzheimer's disease. It is a proprietary formulation of fractionated palm kernel oil, a medium-chain triglyceride. Cericin, the company that makes Axona, states that during digestion, caprylic triglyceride is broken down into ketones, which provide an alternative energy source for the brain. Its use is based on the idea that the brain's ability to use its normal energy source, glucose, is impaired in Alzheimer's disease. Axona was first sold in March 2009.
Rivastigmine is a cholinesterase inhibitor used for the treatment of mild to moderate Alzheimer's disease. The drug can be administered orally or via a transdermal patch; the latter form reduces the prevalence of side effects, which typically include nausea and vomiting.