We had one doctor here giving rapamycin to the bed bound elderly (which is a similar patient population), see here: Using rapamycin in bed bound elderly
I would be concerned with the grapefruit juice as it impacts all the other medications (and most people are on multiple medications at that age), so you have to be really careful.
I personally have found good results starting low and increasingly slowly; starting at 1mg / week and slowly increasing by 1mg over time (every few weeks). People sometimes have bad reactions when you jump in with a high dose (like even 3 or 4 mg in one dose). Related thread: What is the Rapamycin Dose / Dosage for Anti-Aging or Longevity?
My 88 year old mother used rapamycin for a few months. She noticed an increase in rashes and red areas on the skin and I couldn’t keep her on it just because I was not living close and medical support (results tracking/blood testing/monitoring) was difficult.
Unfortunately, intervention with rapamycin in these mouse studies commenced before or early in the appearance of these pathological hallmarks. Later in Alzheimer disease, when dementia actually manifests, the brain’s lysosomal system is severely damaged and treatment with rapamycin is likely to exacerbate this damage. We reassess literature described by a recent perspective article calling for the use of MTOR inhibition in dementia and conclude that rapamycin could be useful, but only in people who are in the earliest stages of Alzheimer disease. We contend that our interpretation of preclinical data concerning use of rapamycin in Alzheimer disease models is necessary if we are to avoid another failed Alzheimer disease drug trial.
One of the most interesting studies to come out used plasminogen to treat six Alzheimer’s patients. They experienced very rapid and highly significant improvements in cognition within two weeks. The study used lys-plasminogen, but it seems likely that glu-plasminogen would also work. Only the latter is available as a prescription medication. It is generally a well-tolerated drug. However, it’s IV-infusion. Sold under the brand name of Ryplazim. It promoted clearance of both Aβ42 peptide and Tau protein from the brain.
The sample size was small. More trials are needed for confirmation.
It seems your patient is in the ‘not much left to lose’ category. I would try Rapamycin as a Hail Mary attempt to rejuvenate her health span.
As @RapAdmin has stated, I think a slow easing into it over a few weeks may be best. Maybe try 1 mg + GFJ and gradually increase the dose. However you need to check drug interactions with the GFJ.
I wish your patient all the best.
However, in the end it’s your call and this is not medical advice.
The same question was presented (Rapamycin and Alzheimers?) at the webinar “Maintaining Brain Health Through Life | Prof David Dodick”. At 38 minutes in the webinar.
I suspect the combination of the mechanical therapy along with the Rapamycin will be a useful and interesting intervention here.
Does anyone on this forum have insights into practical ways to implement the ultrasound therapy? The focused ultrasound devices and operators are not available in many countries, this patient is in South Africa, wondering if there are any other devices that can be refactored safely?
Should consult with Alan Green. IMHO once someone is at late stage disease, best course it to cease all treatment and keep the patient comfortable. They’re not really consenting to any treatment.
Sorry, not an MD.
But please, can you tell us how the patient would be doing if you end up prescribing rapamycin?
Also, are you considering reporting it as a case study in a journal? Maybe it’ll require more rigorous (cognitive) testing but I think it might be of interest to the broader community and data accumulation is important.
The parents or guardian consent for children and elderly with severe dementia will have POA either prearranged or assigned by court.
Using experimental treatments especially if they are unlikely to help and potentially make them worse in patients that are unable to consent due dementia is highly unethical IMO. We should let them die with dignity.
This why people like that are usually DNR status, so we don’t shove endotracheal tubes down their throats and needlessly fry them with electricity trying to resuscitate them.
Exactly. I don’t think that’s at issue — it was presumably a comment on the ethics of making decisions for dependents who cannot consent. I just don’t see the problem. If I’m in a coma I won’t be able to consent to any treatment either. How is that to tie the hands of whomever is responsible for me from making the decisions they think are in my best interests?
I would expect my loved ones to make decisions in my best interest if I am capacitated. I trust the ones who would be making the decision. Remember that not doing anything is also a decision.
Spend some time around the ICU at a large hospital. You will see plenty of seniors with DNR and no extraordinary care directives that were made later in life immediately overriden by their next of kin, child grandchild etc. As soon as they are incapacitated they have authority and pull the DNR. People do uncharacteristic things when faced with fear and pain of loss. Watched my mothers husband (remarried) go thru this exact thing with his kids even though it was discussed and they all knew his wishes. He had advanced MS. Unconcious for a week no higher brain function (I forget the techincal term for the test and result diagnosis). But the daughter shows up and refused to let the directive proceed to withdrawl support. 3wk in ICU hooked up till he finally gave out. People act differently in those emotional personal situations. It becomes about them not the person in the bed.
