Doctors, scientists adopt new approach to Alzheimer’s care

A new way of looking at Alzheimer’s disease emerged at meetings here this week of nearly 4,000 scientists worldwide trying to unravel the causes of the health epidemic.

"We’re moving in a direction in which we’re not going to think of Alzheimer’s disease as a person who has dementia," said Dr. Maria Carrillo, senior director of medical and scientific relations at the Chicago-based Alzheimer’s Association.

The future of Alzheimer’s disease, a disease of the brain, is to think of it as similar to other diseases — for example, cardiovascular disease such as atherosclerosis, where signs and symptoms are treated before a heart attack or cardiac arrest occurs, she said.

"This is a huge change for the field," Carrillo said. "It is very exciting."

There is evidence that the Alzheimer’s disease process begins perhaps more than 10 years before it is diagnosed, scientists said at a news briefing, stressing the importance of identifying people at risk as soon as possible for interventions.

"We’re thinking of the development of Alzheimer’s disease much like other diseases, as an elaborate process over a long period," said Dr. Marilyn Albert of the Johns Hopkins University School of Medicine.

Inadequate funding and lack of participants in clinical trials to find out whether drugs work are two major obstacles to progress in diagnosing and treating the disease, Carrillo and other scientists said.

More than 100 clinical studies are going on, and experimental compounds are moving into clinical testing from laboratories in dozens of others, she said. But general practice physicians do not have experience with clinical trials in Alzheimer’s and generally are not referring patients to them, Carrillo said.

To deal with that, the Alzheimer’s Association has started a clinical trial matching service, called TrialMatch, for people with Alzheimer’s disease and related dementia. The service was introduced during the Alzheimer’s Association’s six-day International Conference on Alzheimer’s Disease at the Hawai’i Convention Center.

It can be accessed at www.alz.org/trialmatch or by calling 800-272-3900.

Alzheimer’s disease "is clearly the No. 1 public health challenge of the 21st century, and research is the only way to solve this problem," said Dr. William Thies, the association’s chief medical and scientific officer, urging participation in the clinical trials to improve diagnosis, treatment and prevention.

He said more than 5 million Americans have the debilitating disease, which causes memory, thinking and behavior problems, and the number is expected to triple by 2050. The global cost of dementia is estimated at $315 billion annually.

The researchers said they have learned enough about biomarkers that they can begin to identify people with mild symptoms who are likely to have underlying pathology of Alzheimer’s disease. But not all people with risk factors for the disease or early pathology will manifest symptoms, they said.

Three work groups updated diagnostic criteria for Alzheimer’s disease for the first time in 25 years to better reflect various stages of the disease and include Alzheimer’s biomarkers.

Elizabeth Stevenson, executive director of the Alzheimer’s Association, Hawaii Chapter, said a new cognitive impairment test, replacing the current "mini mental exam," is a big advance. "It’s going to improve early diagnosis, and the earlier people can get a diagnosis, the better we can help improve quality of life."

There is a concern that most trials are being conducted in which people are too impaired, scientists said. They hope in the next year to use biomarkers to identify people who could be enrolled in clinical trials and respond to treatment.

Among other developments reported at the meetings:

» The first clear link between vitamin D deficiency and development of cognitive problems, a key feature of dementia, was shown by a University of Exeter research team.

» An antioxidant-rich diet with walnuts improved memory and learning in mice with Alzheimer’s.

» Physical activity and certain dietary items such as tea and vitamin D were found associated with maintaining cognitive ability and reducing dementia risk in older adults in three long-term, large-scale studies.

» A species of jellyfish found on Oahu called Aequorea victoria contains a protein that is a potential therapeutic for Alzheimer’s disease.