Alzheimer’s sci­en­tists gather amid signs of progress in re­search

The Washington Post Sunday - - POLITICS & THE NATION - BY FREDRICK KUN­KLE fredrick.kun­kle@wash­

More than 4,000 sci­en­tists from around the world will gather in Washington this week to share the latest find­ings and ideas on Alzheimer’s dis­ease, with some say­ing that the odds of find­ing ef­fec­tive treat­ments look promis­ing even as an ag­ing so­ci­ety in­creases the ur­gency of find­ing a cure.

The Alzheimer’s As­so­ci­a­tion In­ter­na­tional Con­fer­ence, which runs from Sun­day through Thurs­day, is ex­pected to high­light a num­ber of re­cent trends in the field.

Among them is a search for in­ex­pen­sive, non­in­va­sive di­ag­nos­tic tools that would al­low doc­tors to de­ter­mine whether a per­son’s brain has be­gun to un­dergo changes that will later lead to cog­ni­tive im­pair­ment, mem­ory lapses and other symp­toms of de­men­tia.

Re­searchers are also more aware that the dis­ease’s com­plex­i­ties sug­gest that the way for­ward will in­volve multi-pronged in­ter­ven­tions, not a sil­ver bullet. And a grow­ing body of ev­i­dence also sug­gests that those in­ter­ven­tions will not just in­volve tak­ing med­i­ca­tions, but also em­brac­ing changes in lifestyle, such as diet, sleep habits and phys­i­cal ex­er­cise.

What’s more, re­searchers more than ever un­der­stand that Alzheimer’s dis­ease and other de­men­tias pose dif­fer­ent de­grees of risks for dif­fer­ent groups of peo­ple, such as women and mi­nori­ties, and may even de­velop in their bod­ies in dif­fer­ent ways. Re­searchers are de­vot­ing more time to ex­plor­ing the role that gen­der and race might play in de­vel­op­ing de­men­tia and the best treat­ments.

Sev­eral lead­ing sci­en­tists say the field has ma­tured to the point that the pos­si­bil­ity of iden­ti­fy­ing more ef­fec­tive ways to de­tect the dis­ease in its early stages and treat, de­lay or pre­vent it seems less far-fetched — even as they also say that their work re­mains rel­a­tively un­der­funded com­pared to other dis­eases such as heart dis­ease, can­cer or HIV/ AIDS.

“This is a very im­por­tant time in Alzheimer’s dis­ease re­search. I think the tide is re­ally shift­ing now in terms of de­vel­op­ing new types of re­search as well as new treat­ments,” said Nancy J. Dono­van, an as­so­ciate psy­chi­a­trist at Brigham and Women’s Hos­pi­tal in Bos­ton. Ad­vances in the field now al­low doc­tors and re­searchers to an­a­lyze de­men­tia-re­lated changes in the brain years be­fore symp­toms ap­pear, she said. “To me, that is the most ex­cit­ing thing go­ing on in Alzheimer’s re­search right now.”

More than 5 mil­lion peo­ple are liv­ing with Alzheimer’s, a num­ber ex­pected to in­crease to 13.5 mil­lion by 2050. As the dis­ease grows more preva­lent, its fi­nan­cial im­pact is also ex­pected to soar. Alzheimer’s and other de­men­tias al­ready cost $226 bil­lion a year, an ex­pense that is mostly borne by Medi­care and Med­i­caid, and ad­vo­cates have been push­ing the fed­eral gov­ern­ment to in­vest more in re­search to­day in­stead of costly treat­ment later.

Dean Hart­ley, di­rec­tor of science ini­tia­tives at the Alzheimer’s As­so­ci­a­tion, said Congress is de­bat­ing the pos­si­bil­ity of in­creas­ing the an­nual re­search bud­get of about $600 mil­lion by an ad­di­tional $300 mil­lion to $350 mil­lion a year, be­gin­ning in fis­cal 2016. But he said that’s still less than what is spent on can­cer, heart dis­ease or HIV re­search, and well be­low the es­ti­mated $2 bil­lion that the sci­en­tific com­mu­nity has said would be nec­es­sary to try to find a cure or ef­fec­tive treat­ments by 2025.

“We’ve got to ramp up now,” said Ron­ald C. Petersen, di­rec­tor of the Mayo Clinic’s Alzheimer’s Dis­ease Re­search Cen­ter and chair­man of the na­tional Ad­vi­sory Coun­cil on Alzheimer’s Re­search, Care and Ser­vices.

The con­fer­ence was first held in 1988. The Alzheimer’s As­so­ci­a­tion, which be­gan or­ga­niz­ing the con­fer­ence in 2000, says the an­nual gath­er­ing is now the largest of its kind. This year, re­searchers are ar­riv­ing from at least 65 coun­tries; about 40 per­cent of the at­ten­dees are in­ter­na­tional, Hart­ley said.

High on the agenda among sci­en­tists in the field is the search for easily de­tectable biomark­ers of dis­ease.

At one time, for ex­am­ple, au­topsy was the only way to defini­tively di­ag­nose Alzheimer’s, by view­ing whether a per­son’s brain had been dam­aged by buildup of the amy­loid beta or tau pro­teins that cre­ate neu­rofib­ril­lary tan­gles, killing nearby brain cells. Rel­a­tively re­cent tech­no­log­i­cal ad­vances, how­ever, can ob­tain good im­ages of amy­loid beta in a liv­ing brain and are be­com­ing bet­ter at imag­ing tau. An­a­lyz­ing cere­brospinal fluid has also been shown to be a re­li­able in­di­ca­tor. But sci­en­tists hope that less in­va­sive, less ex­pen­sive ex­ams — such as an eye scan, a skin test or an ar­ray of such sim­ple tests — could al­low doc­tors to iden­tify peo­ple at risk.

As science fur­ther il­lu­mi­nates the bio­chem­i­cal path­ways that lead to de­men­tia, re­searchers are also more fo­cused on the no­tion that a multi-pronged ap­proach to treat­ment will emerge.

In­stead of a sin­gle drug, it’s more likely that peo­ple with Alzheimer’s will be pre­scribed sev­eral med­i­ca­tions at once.

“This is what we do in other dis­or­ders. HIV/AIDS gets a cock­tail. When we treat blood pres­sure these days, it’s usu­ally a va­ri­ety of dif­fer­ent mech­a­nisms,” Petersen said.

Their re­search sug­gests that the multi-tar­geted ap­proach will in­clude changes in lifestyle to re­duce the risk of de­vel­op­ing de­men­tia and main­tain a healthy brain.

One study to be shared at the con­fer­ence sug­gests that the risk of de­men­tia has al­ready de­clined for more re­cent gen­er­a­tions.

“This is one of the rare, good news sto­ries,” said Richard Lip­ton, who heads the Ein­stein Ag­ing Study at the Al­bert Ein­stein Col­lege of Medicine in New York. He said that although it still re­mains the case that the risk of Alzheimer’s dou­bles ev­ery five years for peo­ple who reach 65, his lab­o­ra­tory’s new epi­demi­o­log­i­cal study sug­gests peo­ple born af­ter 1930 have lower risk to be­gin with. The find­ings could be the re­sult of bet­ter man­age­ment of car­dio­vas­cu­lar risk fac­tors in re­cent decades as a re­sult of ad­vances treat­ing heart dis­ease, di­a­betes or high blood pres­sure, as well as peo­ple’s in­creased phys­i­cal ac­tiv­ity.

Another Ein­stein study sug­gests that psy­cho­log­i­cal stress can el­e­vate the risk of de­vel­op­ing de­men­tia — or, more pre­cisely, how one han­dles stress. Higher “per­ceived stress” is as­so­ci­ated with cog­ni­tive im­pair­ment, the study shows. But that also sug­gests that bet­ter man­ag­ing stress might be ben­e­fi­cial.

“Aswe started do­ing this work, I started do­ing yoga,” Lip­ton said.

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