Most Alzheimer’s research is focused on the medial temporal lobe of the brain, where memories are stored and the disease begins. It is also the region most vulnerable to the effects of aging. Dr. Jackson pointed out that memories aren't "stored" really but are rebuilt each time from many stored skills and pieces of knowledge. That's why elders affected by memory loss retain the oldest memories the longest; they are the ones that were reassembled the most.
There are many questions about how Alzheimer's forms and develops, but there are some established facts. First and foremost, Alzheimer's patients have a significant amount of amyloids, areas of plaque, that build up over time. Amyloids can be detected up to 25 years before symptoms appear, and 1 in 3 people with high levels of amyloid never develop Alzheimer's symptoms at all. More than 20 years ago, scientists identified tau as a key factor that results in the brain’s deterioration, and the newest research is focusing on tau and how it affects and interacts with amyloids.
Dr. Jackson gave a summary of the latest tests that are being developed to diagnose Alzheimer's, tests that don't depend on memory lapses as the only indicator.
- Smell test: because the sense of smell is located in the part of a brain closest to where memory function is located, a loss of smell can be symptomatic of amyloid buildup.
- PET and MRI: these scans are currently used in clinical trials as a screening measure, but in the next generation of trials, they will be used to measure treatment outcomes. Right now, success is measured by observing stability or improvement in memory and cognitive function, but soon treatment success will also be measured by a reduction in the amount of amyloid (or tau) evidenced in these scans.
- Blood test: Alzheimer’s can be detected through a blood test but only about five years before a diagnosis. At this time, other tests are able to detect it much earlier.
- Behavioral changes: there are other changes in behavior that could be caused by Alzheimer’s, such as irritability or depression. This is not a test per se, but it’s a symptom to be aware of.
Here are several interesting points from the talk:
- During the AAIC conference, some newspapers mistakenly published that a cure for Alzheimer’s had been found. It's unclear how this happened, but a press release announced new research on tau before that talk was actually given, and erroneous assumptions were made about the conclusions. The presentation ended up showing that this tau trial did not produce successful results, though the researchers had had high hopes. It still might inspire future trials.
- The current focus of research is on inflammation processes, to analyze how inflammation develops in the amyloids and progresses into Alzheimer’s.
- The rate of Alzheimer’s is actually declining for caucasians in industrialized nations, by as much as 25% relative to rates 20 years ago. This appears to be related to an affluent lifestyle that is able to take better care of the heart and the body.
- It’s commonly believed that women are twice as likely to develop the disease, but that might not be the case. Alzheimer’s is more difficult to diagnose in men, so it’s possible that the number of male patients is underestimated.
- 1 in 9 people develops Alzheimer’s over the age of 65. That is the zone of risk.
- Brain exercise is as important as diet (though one should pay attention to both).
Q: There is a PET scan that can test for amyloid, but is there a scan for tau?
A: Yes there is, but it’s not approved for clinical use by the FDA yet.
Q: What are the current treatments for Alzheimer’s?
A: There are four drugs that are approved right now. They don’t modify the disease, but they slow down symptoms and sometimes even improve them. Unfortunately, they don’t work for everyone, and when they do work, they only show effectiveness for 9-12 months in most cases. However, people vary wildly in their experience. These drugs are only used for those who are already diagnosed with Alzheimer’s, not for people who show a buildup of amyloid but no definitive symptoms.
Q: What is the difference between dementia and Alzheimer’s?
A: Dementia is a symptom, usually problems with memory. This can be caused by a number of different things, though Alzheimer’s is the most common cause in people over age 65. Alzheimer’s is a specific disease that can cause the symptoms of dementia.
Q: What is meant that a person “died of Alzheimer’s”?
A: It is a terminal disease because it will eventually spread to the areas of the brain that control swallowing and breathing. More often, though, cause of death is from complications that develop from Alzheimer’s. For instance, patients with advanced stages of Alzheimer’s end up lying in bed and not sitting up. They aren’t able to cough or expectorate, which can lead to respiratory problems and pneumonia--and death.
Q: Is the disease genetic?
A: Yes, but a history of Alzheimer’s in the family is not a guarantee that a person will have it. They are at higher risk, but only 1% of Alzheimer’s patients are predetermined to inherit it. This latter category is due to three specific mutations on genes that researchers have identified; they are now reaching out to later generations before symptoms appear.
Q: How does Alzheimer’s progress?
A: It is a very individual progression, based on two separate categories: the progression of the symptoms and the progression of the pathology in the brain. Each person’s experience with these two aspects of the disease is unique.
Q: What is a timeframe for early onset Alzheimer’s?
A: There is no specific timeframe because of the individual uniqueness, but progression is generally more aggressive.
Q: What are the most promising lines of research right now?
A: The research that is being done in clinical trials at the later stages is the most promising, to see how effective the current treatments are.
This last answer was reiterated in many ways throughout the presentation. Dr. Jackson emphasized that finding a cure was possible only through continuing research in clinical trials. And clinical trials are successful only when people volunteer to participate in them. Right now he is participating in a new Alzheimer Prevention study taking place in 70 sites in four countries: Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease, called “A4” for short. Below is a short description and a call for participants:
New Alzheimer Prevention Research Study. Healthy older adults (65-85) with normal memory are being sought for a 3 1/2 year Clinical Trial at Brigham & Women's Hospital to assess whether a new investigational treatment can prevent memory loss associated with Alzheimer's disease. To see if you might be eligible or to learn more go to www.A4study.org The study is funded by the National Institute on Aging/NIH and Eli Lilly. Must have a study partner, someone who lives with you or is in touch with you weekly. For more information, please call (617) 732-8085 or email [email protected]
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