— No easy fix for Alzheimer’s

If phar­ma­ceu­ti­cals can’t save you, maybe you can save your­self.

Cosmos - - Contents - NOR­MAN SWAN is a doc­tor and multi-award win­ning pro­ducer and broad­caster on health is­sues.

HOPES OF A CURE for Alzheimer’s dis­ease be­ing on the hori­zon took a blow when drug gi­ant Pfizer an­nounced in Jan­uary that, af­ter two decades and mil­lions of dol­lars spent, it was pulling the plug on Alzheimer’s re­search.

Pfizer’s re­search had fo­cused on try­ing to clear away brain de­posits of a pro­tein called amy­loid beta. Some re­searchers think those de­posits might have been the wrong tar­get. Oth­ers think tri­als failed be­cause treat­ments started too late, and be­cause peo­ple who were se­lected for treat­ment might not all have been suf­fer­ing from Alzheimer’s dis­ease.

The lat­est strat­egy is to try to select peo­ple who show di­ag­nos­tic mark­ers of an ear­lier stage of Alzheimer’s dis­ease.

It is known as the Alzheimer’s pro­drome. At this stage peo­ple ex­pe­ri­ence some mem­ory prob­lems but still fall within the norms of cog­ni­tive func­tion. There are, how­ever, clin­i­cally de­tectable changes: sam­ples of cere­brospinal fluid show raised lev­els of amy­loid beta and MRI scans show shrink­age of the hip­pocam­pus, the struc­ture cru­cial for form­ing mem­o­ries.

One great hope – for vi­ta­min fans and re­searchers alike – is that di­etary sup­ple­ments could pre­vent the wors­en­ing of Alzheimer’s dis­ease. So far an­tiox­i­dants, in par­tic­u­lar vi­ta­min E, have been dis­ap­point­ing but there has been hope for a sup­ple­ment called For­ta­syn Con­nect.

De­signed to boost brain func­tion, it con­tains a cock­tail of omega 3 fatty acids, min­er­als and vi­ta­mins (specif­i­cally DHA, EPA, uri­dine monophos­phate, choline, vi­ta­mins B12, B6, C, E, and folic acid, phos­pho­lipids and se­le­nium). The con­cen­tra­tions of these nutri­ents in the blood and brains of pa­tients with Alzheimer’s dis­ease are lower than nor­mal.

An­i­mal stud­ies show the cock­tail im­proves com­mu­ni­ca­tion be­tween brain cells, blood flow, re­gen­er­a­tion of cells in the hip­pocam­pus, and cog­ni­tive func­tion.

This hope­ful tonic, now mar­keted by Dutch com­pany Nu­tri­cia as ‘Sou­ve­naid’, had been pre­vi­ously tested in three clin­i­cal tri­als on peo­ple with mild to moder­ate Alzheimer’s dis­ease. The tri­als, last­ing three to six months, sug­gested a help­ful ef­fect only in peo­ple with mild Alzheimer’s.

So a con­sor­tium of re­searchers in Europe and the US, in­clud­ing aca­demics and peo­ple from phar­ma­ceu­ti­cal com­pa­nies, de­cided to test pa­tients at the ear­lier, pro­dro­mal stage of the dis­ease – hav­ing mild mem­ory prob­lems but de­tectable brain changes and el­e­vated lev­els of amy­loid beta in their cere­brospinal fluid.

Re­cruited from mem­ory clin­ics across Fin­land, Ger­many, the Nether­lands and Swe­den, 311 peo­ple aged 55 to 85 com­pleted the study. Half got Sou­ve­naid as a straw­berry or vanilla-flavoured daily drink; half just got a flavoured drink.

The re­sults of the two-year study were pub­lished in The Lancet in De­cem­ber 2017. Neu­ropsy­cho­log­i­cal tests showed no dif­fer­ence be­tween the two groups.

There was, how­ever, less shrink­age of the hip­pocam­pus in the sup­ple­mented group, along with a slight but sig­nif­i­cant pos­i­tive ef­fect sug­gested by a sec­ondary mea­sure of how well the pa­tients were func­tion­ing, a Clin­i­cal De­men­tia Rat­ing based on struc­tured in­ter­views.

Which may or may not mean some­thing. The trou­ble with the study was that the over­all rate of cog­ni­tive de­cline was slower than ex­pected in both groups. That sug­gests there needed to be more peo­ple in the study, and that it might have needed to go on longer. So it is still an open ques­tion whether this cock­tail has an ef­fect. Even if it does, it is un­likely to be dra­matic.

Is there any clear ev­i­dence of some­thing that can fore­stall Alzheimer’s dis­ease?

A mod­est bit of good news is that the same fac­tors that pro­tect against heart dis­ease – healthy food, keep­ing your weight down, ex­er­cise, low­er­ing high blood pres­sure, avoid­ing di­a­betes and not smok­ing – pro­tect against blood-ves­sel dis­ease in the brain, which it is thought con­trib­utes to Alzheimer’s dis­ease. This is sup­ported by sta­tis­tics from Europe that in­di­cate de­men­tia rates are fall­ing with heart dis­ease and stroke in­ci­dence.

One of the strong­est pro­tec­tive fac­tors, though, is ed­u­ca­tion. A 2014 study pub­lished in Lancet Neu­rol­ogy found the more ed­u­ca­tion a per­son re­ceived early in life, the later they de­vel­oped de­men­tia, or not at all. That fits with the ‘cog­ni­tive re­serve’ the­ory – the more ed­u­cated you are, the denser your neu­ral net­works, so you have more brain ca­pac­ity to start with.

While the ev­i­dence isn’t clear, you cer­tainly can’t do any harm by learn­ing a lan­guage or a mu­si­cal in­stru­ment in midlife, in the hope it will ex­er­cise your brain enough to keep de­men­tia at bay at least for a lit­tle longer.

The same fac­tors that pro­tect against heart dis­ease pro­tect ves­sels in the brain.

Newspapers in English

Newspapers from Australia

© PressReader. All rights reserved.