Dec 29, 2009

A Cure for Alzheimer's?

The two biggest misconceptions are “It’s just aging” and “It’s untreatable, so we should just leave the person alone.” Both of these misconceptions are remnants of an outdated view that hinders families from getting the best diagnosis and best care.
By Bob DeMarco
Alzheimer's Reading Room

A Cure for Alzheimer's? | Alzheimer's Reading Room
P. Murali Doraiswamy is
co-author of the
Alzheimer's Action Plan.
If I was going to buy one book on Alzheimer's it would be the Alzheimer's Action Plan.

I refer to this book often. The book sits right on the top of my desk. The Alzheimer's Action Plan is an excellent resource for Alzheimer's caregivers. Among the many issues discussed, the book also covers medications, and possible alternative diagnoses to Alzheimer's disease.

It is not unusual for me to refer to the book when I get questions from readers via email.

The interview below is concise and answers several of the most frequently asked questions about Alzheimer's disease.

Bob DeMarco  is the Founder of the Alzheimer's Reading Room

Can Alzheimer's Be Cured?

P. Murali Doraiswamy is the head of biological psychiatry at Duke University and is a Senior Fellow at Duke’s Center for the Study of Aging.

He’s also the co-author of The Alzheimer’s Action Plan, a guide for patients and family members struggling with the disease. Mind Matters editor Jonah Lehrer chats with Doraiswamy about recent advances in Alzheimer’s research and what people can do to prevent memory loss.

LEHRER: What do you think are the biggest public misconceptions of Alzheimer's Disease?

DORAISWAMY: The two biggest misconceptions are “It’s just aging” and “It’s untreatable, so we should just leave the person alone.”

Both of these misconceptions are remnants of an outdated view that hinders families from getting the best diagnosis and best care. They are also one of the main reasons I wanted to write this book.

Although old age is the single biggest risk for dementia, Alzheimer’s is not a normal part of aging. Just ask any family member who has cared for a loved one with Alzheimer’s and they will tell you how different the disease is from normal aging.

Alzheimer’s can strike people as young as their forties; there are some half a million individuals in the United States with early-onset dementia.

Recent research has pinpointed disruptions in specific memory networks in Alzheimer’s patients, such as those involving the posteromedial cortex and medial temporal lobe, that appear distinct from normal aging.

The larger point is that while Alzheimer’s is still incurable it’s not untreatable. There are four FDA-approved medications available for treating Alzheimer symptoms and many others in clinical trials. Strategies to enhance general brain and mental well being can also help people with Alzheimer’s. That’s why early detection is so important.

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LEHRER: Given the rapid aging of the American population - by 2050, the Alzheimer's Association estimates there will be a million new cases annually - what are the some preventative steps that people can take to prevent or delay the onset of the disease?

DORAISWAMY: Unfortunately, there isn’t yet a magic bullet for prevention. You can pop the most expensive anti-aging pills, drink the best red wine, and play all the brain games that money can buy, and you still might get Alzheimer’s.

While higher education is clearly protective, even Nobel Laureates have been diagnosed with the disease, although it’s likely their education helped them stave off the symptoms for a little bit.

My approach is more pragmatic - it’s about recognizing risks and designing your own brain health action plan.

The core of our program is to teach people about the growing links between cardiovascular markers (blood pressure, blood sugar, body weight and BMI, blood cholesterol, C-reactive protein) and brain health. A population study from Finland has developed a fascinating scale that can predict 20-year risk for dementia – sort of a brain aging speedometer. Obesity, smoking, lack of physical activity, high blood pressure, and high cholesterol are some of the culprits this study identified. So keeping these under control is crucial.

Depression is another risk factor for memory loss, so managing stress and staying socially connected is also important. B vitamins may prevent dementia in those who are deficient and there are some simple blood tests that can detect this.

For the vast majority of people, however, there are no prescription medications that have been proven to prevent dementia. This means that a brain-healthy lifestyle is really our best bet for delaying the onset of memory loss.

In the near future we will likely have prevention plans that are personalized based on genetic, metabolic and neurological information. In familial Alzheimer’s disease, pre-implantation genetic diagnosis has already been used to successfully deliver babies free of a deadly Alzheimer causing mutation – though only time will tell if deleting such dementia risk genes in humans has other consequences.

LEHRER: Your book talks about a new technique that allows doctors to image amyloid plaques in the brain. How will these change the diagnosis of the disease?

DORAISWAMY: Amyloid PET scans are in the late stages of validation testing to see if they can improve the accuracy of clinical diagnosis.

The Alzheimer’s brain is defined by beta-amyloid plaques and tangles but, at present, these can only be definitively diagnosed with an autopsy. If an amyloid PET scan is “plaque negative” that will tell a doctor that Alzheimer’s is unlikely to be the diagnosis and help reassure the family.

Early findings suggest that people who carry risk genes are more likely to have plaque positive scans even before they develop symptoms - suggesting that the scans could possibly be useful for predicting future risk.

If true, this might eventually lead to a change in diagnostic terminology where “preclinical” Alzheimer’s is diagnosed purely based on biomarker and scan findings long before memory symptoms start.

Therapies to treat Alzheimer’s by blocking amyloid plaques are already in trials but are currently given blindly to patients without knowing their brain plaque status – raising their risk for side effects and treatment failure.

So this scan may also help drug development by helping select the most appropriate subjects for treatment and then monitoring treatment effects. Amyloid accumulation with aging is seen in many animal species and the scan offers us a tool to study what role plaque plays in normal brain aging.

So this could do for the brain what colonoscopy did for the gut!

Source: Scientific American

Original content Bob DeMarco, the Alzheimer's Reading Room