Dr. Kevin Most: Alzheimer’s

Dr. Kevin Most

I doubt no one will disagree that Alzheimer’s is a top healthcare concern facing us. Some may say it is the top concern, even over Cancer. In Cancer and Heart Disease we are making advancements in early identification, prevention and treatment something we are not seeing in Alzheimer’s. If you look at the Top 10 causes of death in this country, Alzheimer’s sticks out as the one where we have not seen meaningful treatment advances, early identification or preventative treatments.

We all cringe when we hear that a friend has been diagnosed with Alzheimer’s. We cringe because we have an idea of what lies ahead for that individual, just that statement alone says more than we think. That statement alone shows us that we all have been impacted by Alzheimer’s, we all know someone who has suffered from this disease. In the US alone we have close to 6 million individuals suffering from Alzheimer’s, the majority of them are over the age of 65, but we also have close to 250,000 under the age of 65 suffering from younger onset Alzheimer’s. The impact in our lives is impossible to measure but we know the impact is not only on the patient but also on the caregivers who provide care and support to the patients. From a financial view it definitely will get your attention. In 2017 the cost to the nation for Alzheimer’s will approach $260 billion dollars, what is more concerning is the prediction that this will rise to $1.1 trillion dollars over the next 30 years.

1 out of every 3 seniors dies with Alzheimer’s or some form of dementia. We talk often about heart disease and various cancers, and the advancements we have made. Since 2000 we have seen heart disease deaths drop 20% but we have seen Alzheimer’s deaths increase by 90%. Alzheimer’s kills more than Breast Cancer and Prostate Cancer combined. It is the 6th leading cause of death and expected to move up that list. With statistics like that you would think this would be a major aim in research dollars. Would it surprise you that NIH FY17 funding for HIV/AIDS is 3.3 times higher than NIH funding for Alzheimer’s and that we spend 7 times NIH dollars for Cancer than we do on Alzheimer’s. With the trend we are seeing and with the number of cases skyrocketing, we need more money for research. The Alzheimer’s Association has invested over 400 million. Drug companies have invested billions.

On Sunday, Bill Gates announced he would be placing $50 million dollars to support research in Alzheimer’s disease. He was clear to point out that this was not funding from his foundation, it was his direct personal funds that he was investing. Mr. Gates has had family members suffer with Alzheimer’s so it is an interest of his. You can sense his frustration as the advancement of treatment has been slow. In true Bill Gates style he is looking at this from a different view. His pledge has certainly raised awareness on a national level.

His pledge is interesting as it actually is an investment in a London based fund called the Dementia Discovery Fund. This fund invests venture capital money for companies that are developing innovative treatments for Alzheimer’s. It is probably subtle but this investment is a bit different from a donation to basic research, this fund actually looks at companies and their novel ideas and then invests in the companies that they think have great ideas. He is looking for companies that have more diverse ideas than the common ones many researchers are looking at now. This fund is investing in less mainstream ideas, many are novel ideas that begin to look for early detection or a blood marker that will show that medications are in fact working.

Now the cynic may say he is just trying to invest in good companies in order to make more money, but in fact it is not true. This fund actually takes a different angle to research, it pairs science with business. It allows for the fund managers to understand what a company is attempting and making sure that their funding is in line with the specific needs of the company. This is a global effort that allows for funding from charity, industry and the private sector as well. Mr. Gates has also stated that he will put another $50 million in private investments and $50 million in grants. He is hoping his grants will help organize and analyze all the data coming from all the research labs around the world, help expedite clinical trials and work on ways that pharma companies will be able and willing to share information and data.

This fund has made investments in 12 companies since it started in 2015. It has a Scientific Advisory Board, which includes the head of neuroscience and R and D from seven major pharma companies. They offer insight and review companies that are looking for investment from this fund. The unique thing about this fund is that they are looking at companies that have unique or novel ways to treat dementia. Historically companies have looked at ways to attack the sticky amyloid plaques that we see in patients with Alzheimer’s. This fund is looking at companies that are studying how to stop or slow the process that leads to dementia and ways to perform diagnostic blood testing. We still have no treatment that impacts or slows the underlying process of Alzheimer’s and we have not found a blood marker that allows us to track or identify the illness.

So what exactly is Alzheimer’s? It is a type of dementia that initially causes problems with memory, thinking and behavior. The onset is gradual in most cases and continues to worsen over time as the disease progresses. Now, dementia can be caused by other diseases, however Alzheimer’s makes up about 80% of all dementia. Many may think this is just a part of aging, in fact it is not. As we age we may notice some slower thinking and an occasional “Senior Moment” when we forget something, but these are minor and not advancing. Alzheimer’s is a specific illness where we see advancement of those symptoms and unfortunately it also impacts younger patients, in fact a large number of young individuals are found to have this disease. Age is certainly a risk factor but Alzheimer’s is not a normal aging process. It is a progressive disease that advances with worsening symptoms over a number of years. In early stages we see mild memory loss but this advances to a point where a patient is unable to participate in a conversation. It goes on leading to physical decline as well.

On Monday we discussed Epilepsy and how in those patients we see a short circuit in the brain causing a seizure. In Alzheimer’s patients brains, they have a gradual buildup of a protein substances called amyloid and tau. These substances prevent the brain cells from communicating and doing their jobs. In epilepsy we see uncontrolled communication between brain cells in Alzheimer’s we see a decrease or stoppage of brain cells communicating at all and it is seen in the memory initially before spreading to other regions. This buildup of protein causes the brain cells to die as we see the progression worsen. The death of the cells is what causes the problems of memory loss, personality changes and even the body remembering to do daily activities.

So how are we doing with research? Some would say awful, others would say we are making strides. Probably one of the biggest things we have to understand is that although we have known about this disease for over 100 years, the advances in research have mainly come about in the past 10- 15 years. Yes, Alzheimer’s was first noted in 1906 by Dr Alzheimer. He studied the brain of one of his patients who died from what he thought was an unusual mental illness. He noted in autopsy that her brain had unusual clumps and tangled bundles that he had not seen in other autopsies. The timing of the studies is important as we expect the number of patients with this illness to triple as we extend the lives of Baby Boomers.

So do we have anything for treating this awful disease? Not really, we have some medications that help the brain cells communicate by helping with the chemicals needed for brain cells to communicate. You may have heard of Aricept or Exelon as well as Namenda. These drugs help with thinking and with memory but often their success wanes as the disease progresses. The behavioral symptoms are also able to be treated with medication and this is as important for the caregiver as it is for the patient. Patients with Alzheimer’s may not sleep well, they have a tendency to wander and in some cases get angry or agitated. Controlling these symptoms will give relief to both the patient and for those caring for the patient.

There are many treatments being studied. Some include the possibility of immunization therapy, where we teach the body’s immune system to see the amyloid as foreign and prevent it from building up. Many other medications are being looked at as well as cognitive therapy. Many doctors are promoting apps for patients to use, some of these include Luminosity, Happify and Brain Fitness Pro are just a few. Seniors should be encouraged to use these. Luminosity is a good one that tracks how well you have done, encourages you and has a variety of tools that you use daily. The daily exercise takes about 5 minutes, I recommend all to use them daily.

A few myths to eliminate

1.) Memory loss is a natural part of aging- occasional senior moments where you forget a name are normal but Alzheimer’s is more than occasional memory loss
2.) Only older people can get Alzheimer’s – over 200,000 patients under the age of 65 are suffering from Alzheimer’s
3.) Drinking out of aluminum cans will cause Alzheimer’s, this was thought in 1970 but numerous studies have not shown this to be true
4.) Flu shots increase the risk of Alzheimer’s- False and has never been shown in any study to increase the chance of Alzheimer’s or Autism
5.) Silver Dental fillings cause Alzheimer’s- numerous studies have this not be true.

Final thought, it is great that we in medicine are extending the life expectancy of all patients, but living longer should not be the only measure we use. Quality of life should carry more weight than quantity in many cases.