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Dementia with Lewy bodies — also known as Lewy body dementia — is the second most common neurodegenerative dementia affecting older adults, accounting for between 15–20% of all dementia cases. Dementia with Lewy bodies is most likely caused by deposits of a protein called alpha-synuclein in the brain. They can help reduce the severity of the symptoms but can’t stop the disease from progressing. This is similar to how taking a Tylenol can help with the pain associated with an injury but doesn’t cause the injury to heal any faster. About 126,000 participants were taking the prostate medications terazosin, doxazosin, or alfuzosin. 

Researchers became interested in these medications’ terazosin, doxazosin, and alfuzosin a bit over 5 years ago. It was realized then that the medications have a secondary effect where they activate an enzyme called PGK1. PGK1 is important because it is the first enzyme that produces ATP — the chemical cells used for energy. Researchers compared the findings from the participants taking terazosin, doxazosin, or alfuzosin to participants taking other prostate medications — about 437,000 taking tamsulosin and about 80,000 on 5ARIs.

Terazosin, doxazosin, alfuzosin — our three medications that we think increased energy in the cell — and tamsulosin are all of the same class of medications. All are commonly used to treat this prostate disorder — benign prostatic hyperplasia (BPH) and work with similar levels of effectiveness. These medications reduce the symptoms of BPH almost immediately once started. However, the 5ARIs are of a different medication class and work differently. While terazosin, doxazosin, alfuzosin, and tamsulosin help relax muscles around the bladder allowing easier urination, 5ARIs act to reduce the size of the enlarged prostate. 5ARIs work through a hormonal process and take much longer to kick in — a couple of months. All study participants were followed for an average of 3 years to see who developed dementia with Lewy bodies. 

Upon analysis, the scientists reported that 195 participants taking terazosin, doxazosin, or alfuzosin developed dementia with Lewy bodies for a rate of 5.21 cases per 10,000 people per year. 

After factoring in age and other health conditions, Simmering and his team discovered that male participants taking terazosin, doxazosin, or alfuzosin were 40% less likely to develop dementia with Lewy bodies than participants taking tamsulosin, and 37% less likely than those taking the 5ARIs. 

The theorized mechanism activation of PGK1 creates more energy for the cell to slow or stop the neurodegeneration associated with these diseases — suggests a broad potential benefit. This association between these prostate medications and risk of dementia with Lewy bodies doesn’t provide proof of an effect but it is an exciting development and, hopefully, will someday lead to a treatment demonstrated in a randomized controlled trial. Researchers say that The findings are promising, suggesting that certain commonly used prostate drugs could potentially offer a protective effect against dementia with Lewy bodies. Given the significant impact dementia with Lewy bodies has on patients’ quality of life and the current lack of effective preventive treatments, this study opens a potential new avenue for reducing the risk of this debilitating disease. Currently, there are no drugs specifically approved to prevent or treat dementia with Lewy bodies effectively. Finding new methods or repurposing existing drugs could help to address this significant therapeutic gap.