ResearchThere have been dramatic improvements in understanding the basic biology of Alzheimer's disease in the past 25 years and I am encouraged that public awareness, medical knowledge, support and care for Alzheimer's patients has never been better.
But I remain frustrated with the limits of current treatments to improve the outcome for patients and families dealing with a cruel condition that progressively robs them of the ability to remember, reason, speak, understand and function independently.
With the publicity about Alzheimer's at a peak with the death of President Reagan after more than a decade of his family's struggle with the illness, we as a nation should take a hard look at where we stand in the fight against the disease. Much is understood about how the Alzheimer's-diseased brain produces the toxic amyloid protein and how it interferes with brain cell function.
The brain cells that are particularly affected during Alzheimer's and their signalling chemicals are known and have been the basis for development of the first Alzheimer's drugs approved by the FDA; all five of them were permitted for sale within the past decade. These medications provide modest but significant improvement in symptoms, with a better preservation of patients' abilities to function. Public and medical awareness is leading to earlier and more accurate diagnosis.
Patients and families can receive counselling at an early stage to avert emotional and financial crises. Medications and counselling also help relieve anxiety, depression, paranoia and apathy that can occur throughout the course of the disease.
Strategies to reduce the risk of Alzheimer's are gaining evidence in their support. Practical lifestyle changes such as increased intellectual and physical activity or diets rich in antioxidants, along with medications such as cholesterol-lowering statins or anti-inflammatory drugs, may lower the eventual risk of Alzheimer's. These risk-reducing factors may help blunt a rise in the number of new Alzheimer's patients as the life span of people in the western world increases.
All of these advances in understanding and treatment are little consolation to patients and families faced with the reality of this progressively worsening brain disease and inadequate resources for their care. We hope for treatments that will not only relieve symptoms but also prevent further worsening and restore patients to normal.
The scientific understanding of Alzheimer's is at a point where radical therapies are in development. Human experiments with a vaccine against the toxic amyloid protein have resulted in a tragic failure and the trial was halted for safety reasons, according to a report released last month. A handful of patients developed an allergic response within the brain after vaccination. The brain of a patient who died from this reaction, an inflammation, showed that much of the amyloid had been removed, stimulating new research into this approach.
Furthermore, drugs that block the brain's ability to produce amyloid are about to be tested in humans after years of basic and animal research. Gene therapy for Alzheimer's also has begun to drive increased production of a factor important to brain cell growth and survival.
The greatest potential for the cure of Alzheimer's may be embryonic stem cells, but they are the most difficult form of treatment to apply. Research is just beginning into the complex process needed to engineer embryonic cells reliably as replacements for the wide variety of brain cells lost in Alzheimer's.
These radical experimental treatments with wide-ranging potential benefits are unlike any form of current medical therapy; their chances for success or serious side effects are difficult to predict.
Borrowing from Reagan and his reference to the Soviet Union, I have my own "evil empire" - made up of neurodegenerative diseases, with Alzheimer's as its most heavily populated republic. Like Reagan, I am prepared to persevere in a long battle with a formidable enemy but would gladly welcome its abrupt collapse.
Paul S. Fishman is a professor of neurology and director of the Division for Neurodegenerative Diseases at the University of Maryland School of Medicine.
(Los Angeles Times - Washington Post Service)