By RICK COUSINS Correspondent
Ronald Reagan, Charlton Heston, Charles Bronson, Norman Rockwell, Rita Hayworth. All were famous; all were victims of Alzheimer’s disease. The statistics are alarming, and the future of the disease unclear.
Our guide, again, to the current science is Giulio Taglialatela, Ph.D., who serves as professor and vice chair for research at the University of Texas Medical Branch.
Q: Alzheimer’s disease is surely one of the most feared pathologies on the planet. Is there any hope offered by current research into its genesis and treatment?
A: While some rare forms of Alzheimer’s have genetic origins, its most common form accounts for about 95 percent of the cases and the cause of these remains unknown. It is likely that the results of multiple insults and risk factors together concur to the clinical manifestation of the disease. This makes the devising of an effective treatment difficult because targeting any one of these factors may, per se, not be sufficient to modify the disease progression since other (often unknown) factors may still drive the disease.
Down Syndrome and Type 2 diabetes can also be co-morbid, that is, occur together with Alzheimer’s.
Q: Since it seems impossible to tease apart risk factors, what can be done to study prevention? Is there a ray of hope here?
A: In my lab, we have taken an innovative approach to this problem. We discovered certain individuals that remain cognitively intact despite having all the neuropathological traits of Alzheimer’s. We are trying to discover the mechanisms underlying such an extraordinary resistance. If these mechanisms are identified, then the hope is to induce them in others, making patients resistant to cognitive decline regardless of what known or unknown factors might be driving the clinical manifestation of this disease.
Also, we have encouraging initial results in humans treated with an FDA-approved drug that inhibits a protein that is increased in Alzheimer’s patients, but normal in the non-demented subjects who appear to share the same basic pathologies. We found that the incidence of Alzheimer’s in these treated subjects is practically none, which is a remarkable observation.
Other labs are working on vaccines, stem cells or to prevent inflammation of the nervous system.
Q: As things currently stand, when should someone seek a diagnosis for themselves or someone they care for? What warning signs can a layperson look to? Is a loss of the ability to smell really significant?
A: Memory problems are the most important signs suggesting to seek medical attention. The most affected at the beginning is the ability to form short memory, while recall of established memory is usually intact. For example, being able to remember one’s third grade teacher’s name but forgetting what one had for breakfast — that might be a warning sign.
But it is also important to notice that temporary, short-term memory problems are normal, especially with advancing age, however memory is always eventually recollected. Loss of smell can be a serious sign in some people since the area of the brain governing the sense of smell is affected early by this disease.
However, there might be other reasons for loss of smell, so this symptom alone, especially if intermittent, may be benign.
Short memory problems remain the most prominent telltale of possible Alzheimer’s.
Q: Once diagnosed, what treatments are accepted and what is the general prognosis for this disease?
A: There are only two classes of drugs approved by the FDA for treatment. One type increases the levels of a neurotransmitter; the other reduces the impact of toxic material on the system. Both drugs may enhance memory symptoms, but their effectiveness is rather low and limited in time.
Besides these, several drugs can be prescribed to control side symptoms accompanying the disease such as depression and psychosis. Exercise and social interactions (such as in a support group) can also be beneficial. Prognosis is usually poor, with a median life expectancy after diagnosis of seven years. The most common cause of death is pneumonia.
Q: Does early intervention help?
A: Yes. It is generally believed that any current or future treatment strategy would be more effective if applied early in the disease. The reason is that when neuronal death sets in (middle to late stages) there is little that can be done for lost neurons.
Ideally, treatments should be preventive, started during the preclinical phase of the disease. Accordingly, current research focuses in identifying markers (ranging from blood test to brain imaging techniques) that could predict the future development of the disease. The results are encouraging; however, no certain marker has been identified unequivocally so far.
Q: Is psychological counseling recommended for new patients?
A: Yes, psychological support is part of a coordinated, multifactorial therapeutic approach to the early stages of the disease.
Q: Is there an underlying reason for the dramatic, sometimes, violent personality shifts that occur in some patients?
A: Dysfunction of neural networks due to death of a variety of neurons affected by the disease’s pathology leads to
personality changes normally observed at different phases. These may or may not initially be controlled by psychoactive drugs, but eventually the personality of affected individuals is profoundly and irreversibly affected, leading to loss of connection with the surrounding environment and people.
Rick Cousins can be reached at rick.cousins@galvnews.com.