Losing Alois

    The first name you may not recognize, at least in the common world.  What about this name: Auguste Deter?  Don't worry if neither of them sound familiar, the latter name being the first recognized patient, and the first being that of her doctor.  As a patient, Auguste Deter was delusional, forgetful, her short term memory basically diminished to minutes.  But it was her doctor, Dr. Alois Alzheimer, who later looked at his patient's brain after she had died, and found the plaques so common in today's diagnoses of the condition.

    The statistics are shocking.  Within 35 years, an estimated 150 million people will have the condition...40 million have it now.  This was presented in a TED talk by scientist Samuel Cohen: If you're hoping to live to be 85 or older, your chance of getting Alzheimer's will be almost one in two.  In other words, odds are you'll spend your golden years either suffering from Alzheimer's or helping to look after a friend or loved one with Alzheimer's.  Already in the United States alone, Alzheimer's care costs 200 billion dollars every year.  One out of every five Medicare dollars get spent on Alzheimer's.  It is today the most expensive disease, and costs are projected to increase fivefold by 2050, as the baby boomer generation ages...Today, of the top 10 causes of death worldwide, Alzheimer's is the only one we cannot prevent, cure or even slow down.  We understand less about the science of Alzheimer's than other diseases because we've invested less time and money into researching it.  The US government spends 10 times more every year on cancer research than on Alzheimer's despite the fact that Alzheimer's costs us more and causes a similar number of deaths each year as cancer.

    At the National Institute of Health, a study is linking people who are overweight at age 50 to having a higher risk of Alzheimer's and could possibly develop it at an earlier point in their lives than peers with less weight.  For every step up on the Body Mass Index chart, people tested who had developed Alzheimer's developed it 6.5 months earlier, according to CBSNews.com: Additionally, the study authors looked at 191 autopsy results and found that higher BMI in midlife was associated with a higher amount Alzheimer's-related beta amyloid plaque in the brain at the time of death.  This study "adds to body of evidence linking midlife obesity and later life risk," Dr. Heather Snyder, Director of Medical and Scientific Operations at the Alzheimer's Association, told CBS News.   "Understanding those connections and the overall health of the cardiovascular system is important for brain health," she said.

    A related condition, according to Scientific American Mind, is called Lewy body dementia: Lewy bodies are protein clumps that kill neurons.  Depending on where they cluster in the brain, they can cause either Parkinson's disease or Lewy body dementia, although the two conditions tend to overlap as they progress.  Lewy body dementia is more difficult to diagnose and treat, in part because the earliest warning signs have remained unknown.  Now a new study finds that certain sensory and motor symptoms can help predict who will acquire the disease, paving the way for targeted studies...Researchers at the Center for Advanced Research in Sleep Medicine (which is associated with the University of Montreal) and at McGill University followed 89 patients with a history of acting out their dreams—not sleepwalking but moving or vocalizing in bed during rapid eye movement (REM) sleep.  The failure to suppress such nighttime activity can be an early sign that something is going wrong in the brain; past studies have shown that up to 80 percent of patients who act out their dreams will eventually develop some form of neurodegeneration...They found a cluster of symptoms—abnormal color vision, loss of smell and motor dysfunction—that doubled the chance that a person with the REM sleep disorder would develop Parkinson's or Lewy body dementia within three years, according to the study published in February in Neurology.

Graphic from Alzheimer's Association: www.alz.org

    Turns out that there are several other forms of dementia (of which Alzheimer's is the most common form, accounting for between 50 and 80% of all cases), from  "vascular dementia, dementia with Lewy bodies and frontotemporal dementia. In some cases, a person may have more than one type and are said to have mixed dementia.  But browse the pages of the Alzheimer's Association and the facts begin to pop out at you somewhat scarily: Of the 5.3 million Americans with Alzheimer's, an estimated 5.1 million people are age 65 and older...Almost two-thirds of Americans with Alzheimer's are women...older African-Americans and Hispanics are more likely than older whites to have Alzheimer's disease and other dementias.

    Almost surprisingly, scientist Samuel Cohen says that a discovered protein shows promise for a possible preventative cure (his TED talk gives you an exclusive peek into the results of their research after 10 years searching for this protein): There are many steps, and identifying which step to try to block is complex -- like defusing a bomb.  Cutting one wire might do nothing.  Cutting others might make the bomb explore.  We have to find the right step to block, and then create a drug that does it.  Until recently, we for the most part have been cutting wires and hoping for the best.  But now we've got together a diverse group of people -- medics, biologists, geneticists, chemists, physicists, engineers and mathematicians.  And together, we've managed to identify a critical step in the process and are now testing a new class of drugs which would specifically block this step and stop the disease.

   

    The key will be early diagnosis, said Scientific American Mind on a blog posting about the Congressional discussion of possibly increasing the funding for Alzheimer's reasearch: PET (positron emission tomography) scanning is a brain imaging technique that can detect amyloid deposits in the brain 10 to 15 years ahead of the memory loss.  These deposits eventually damage brain cells and cause dementia.  Drugs that have been developed to attack these deposits of amyloid protein show some promise, but they don’t cure the disease. (In fact, in some cases these drugs have worsened the disease.)  The consensus of experts is that drug treatment must be started early, before years of slowly advancing pathology reach a point of no return...This is why identifying risk factors and early signs of Alzheimer’s disease at the pre-symptomatic stage is so important.  PET scanning can do this a decade before symptoms begin to appear, but the technique is specialized, expensive and invasive. Unlike MRI brain imaging,  PET requires the injection of radioactive substances into patients in order to reveal amyloid deposits in the brain.  Faster, cheaper, safer methods are badly needed, which is why there was much excitement at this week’s conference about preliminary successes with new tests that detect Alzheimer’s related proteins in cerebral spinal fluid and even saliva.  If simple, low-cost tests become available to detect pre-symptomatic changes in the brain, then treatments could be started early enough to knock out amyloid deposits before the brain becomes severely damaged.

    In the meantime, there are many people struggling out there, not only as caretakers of actual family and friends who have developed the disease, but also from worried older children feeling that perhaps their parents are showing symptoms of such.  A mother or father growing a bit more forgetful or paranoid or emotional over the months, things easy to toss off initially, until one day it becomes a bit too common.  But imagine going inside that person's mind, the feelings that they must be experiencing, the fear of laughing off a forgotten thought or fact, but realizing that you're doing it a bit too often.  Perhaps people are looking at you with confusion of their own (depicted so well by Oscar-winning actress, Julianne Moore, in Still Alice).  Perhaps you think that it's just a blip, a slip up and by tomorrow you'll be better...only you get worse.  Imagine that crushing moment of realization that you may be passing a point of no going back...that your memory clock and functional clock are giving out, and possibly sooner than you may realize.  

    The subjects of dementia and Alzheimer's and the other forms of brain diseases are things far too complicated to even begin to touch in a blog post such as this.  But a good place to start appears in under a week, on the National Geographic Channel.  You'll have a chance to see just how complicated and delicate and resilient our minds are when they broadcast an actual operation on a person's brain...while they are fully conscious.  The conundrum will come full circle, showing just how far we've come in understanding the brain...and how far we still have to go.