brain power
Alzheimer’s research is now aimed at treating the malady in its very early stages
Would you want to know whether you’re headed for a future that includes Alzheimer’s disease?
A lot of people come in to my office worrying if they’re in the beginning stages of the dreaded disease. Someone in their sixties or seventies sits down and mentions that they’ve recently lost their keys. Or they’ve forgotten a meeting.
“doc,” they ask me. “could it be? do I have it?”
The answer, typically, is no. There’s actually a big difference between the impaired brain function caused by Alzheimer’s, and normal age-associated cognitive decline (AAcd). AAcd can start as early as a person’s forties, and it’s characterized by a decrease in speed of recall and reaction time. Our ability to multi-task decreases as we age, as does what we retain of the incidental details of our everyday life — a young person would be more likely than her father to be able to identify the paint shade in the doctor’s office they visited the day before, for example. And that’s all normal. (Interestingly, certain aspects of cognitive function don’t decrease as we age. The attributes we consider wisdom, such as insight, judgment and decision-making, may actually improve over time.)
but what if you are headed for Alzheimer’s disease? I encountered the intriguing future of the fight against Alzheimer’s in a presentation at our clinic’s annual physician conference, one conducted by my colleague, dr. Sharon cohen, an Md and behavioural neurologist. cohen runs Toronto Memory Program, a medical facility that specializes in the treatment and care of patients with Alzheimer’s disease.
research into Alzheimer’s has revealed links to protein buildup in the brain. Our current pharmaceutical therapies are aimed at symptoms and do not slow or reverse the buildup of harmful proteins. Today’s treatments don’t go far enough. by the time a patient begins to experience clear and measurable symptoms, our current medications can offer only modest benefits.
According to cohen, a lot of Alzheimer’s research is now aimed at treating the malady in its very early stages. In September, the u.S. National Institute of Health announced uS$45-million in new funding to explore the possibilities of early intervention. And one recent article in the journal International Psychogeri
atrics estimated that 200 pharmaceuticals are in phase two or three trials, with even more headed that way.
‘We have a great window here for people to take control of their future’
The key to much of this research is early detection. cohen is excited about the use of biomarkers, which could tell a person whether he or she is headed toward an Alzheimer’s diagnosis. One of these biomarkers involves an MrI scan that assesses the size of the hippocampus, the part of the brain that processes short-term impressions into longterm memories, which begins to change long before symptoms of the disease are ever are felt. Two other methods involve testing cerebrospinal fluid to screen for elevated concentrations of the two proteins whose accumulation in the brain is tied to the disease’s onset — amyloid and tau.
What’s remarkable about these screening methods is how far in advance they can work. They could tell us whether we’re going to develop Alzheimer’s 15 or 20 years before we otherwise would have felt symptoms. We could find out in our forties whether we’re headed for the disease.
What fascinates me even further is what people could then do with that information. The National Post published a story in August about an Ontario brain Institute study that said regular exercise could help to prevent one in seven Alzheimer’s cases. In her presentation, cohen said numerous other lifestyle changes may also help stave off the disease — such as staying mentally active by constantly working to process new information or skills. Getting enough sleep helps, cohen says. So does managing your overall long-term stress, and consuming a Mediterranean diet low in saturated fats and high in vegetables and grains.
cohen believes lifestyle factors could delay the onset of Alzheimer’s by as many as five years. “We have a great window here for people to take control of their future,” she says. “It turns out there’s a lot you can do.”
The question then becomes: Will people want to know? researchers at a university in Poland released a small survey earlier this year that examined the issue. remarkably, only 32% of medical students and only 40% of elderly people surveyed would have opted to be screened in advance for the disease. Another study out of boston university published in 2008 found that asymptomatic people who were informed by a genetic counsellor that they were at an increased genetic risk for Alzheimer’s were more inclined to engage in healthier lifestyles — and did not suffer from depression or distress.
The older people who came into my office asking to be tested for Alzheimer’s were looking for peace of mind. but as screening methods and technology improves and becomes more available to younger people, I’m expecting to start dealing with a new kind of Alzheimer’s patient — courageous men and women in their forties who want to know, now, whether they’re heading for a disease-afflicted future. Then they’ll be able to begin making the lifestyle changes that will be able to stave off the disease, and live their lives to their full potentials. carpe diem.