Demystifying Dementia – Part III

By ELLEN ENDO, Contributing Writer

In an assisted living facility, JoAnn doesn’t realize that it’s the third time she has asked her daughter the same question: “What day is it?”

Her daughter stifles a sigh. “Tuesday. It’s Tuesday.”

For JoAnn, the days, months, years are falling away as if through a sieve. Today, she is little more than a statistic — one of an estimated 3.4 million women (and about 2 million men) suffering from dementia in the United States. That number is expected to triple by 2050.

Today, JoAnn’s daughter has but one question: Is there hope for a cure?

In the 105 years since Dr. Alois Alzheimer discovered the disease that bears his name, no cure has been found.

Dr. Guy Eakin, vice president of scientific affairs for the American Health Assistance Foundation, reports that the first wave of post-war Baby Boomers is reaching age 65 at the rate of one every eight seconds.

To address the impact of dementia on America’s rapidly aging population, Congress created the National Alzheimer’s Project Act (NAPA), authorizing $450 million toward research, and released a draft plan last February.

The National Institute on Aging funds Alzheimer’s Disease Centers (ADC) at major medical institutions across the U.S. with the goal of translating research into improved diagnosis and care, prevention and, ultimately, a cure.

World-renowned neurologist Dr. Helena Chang Chui heads the University of Southern California-based ADC, where areas of investigation range from behavioral research to helping families cope with the effects of the disease.

“As the country gets older and grays, the frequency of neurodegenerative disorders is increasing exponentially, and these are disorders that don’t go away. In fact, it’s a disease that affects the whole family,” states Chui.

“The key to connecting to the patient is listening. The art of medicine is really the patient. I feel fortunate as a neurologist that I not only can see the scan, I can see the patient, hear the story, and I think that makes me a better physician,” the USC Neurology Department chair adds.

Chui notes that she and her colleagues are interested in maintaining the health of the blood vessel system and, therefore, the health of the brain.

At the state-funded Rancho Los Amigos/USC Alzheimer’s Disease Center, one of Chui’s colleagues, Dr. Freddi Segal-Gidan, director, provides state-of-the-art clinical services to patients and their caregivers, trains health-care professionals, and educates the community. “We are continuing to understand the disease more and are able to identify individuals with symptoms early on,” Segal-Gidan says.

“Both Dr. Chui and I guardedly optimistic,” Segal-Gidan points out.

According to a recent multi-center study led by Duke University Medical Center, brain scans using a new radioactive dye can detect early evidence of Alzheimer’s disease that may also predict future decline. Such scans are most effective among patients with mild or no cognitive impairment.

Although the scans are expensive, experts predict that the cost will eventually go down, and brain scans could become a routine part of physical exams.

Drug Companies Compete

Current drugs Namenda and Aricept only temporarily ease the symptoms. Pharmaceutical companies are hoping to come up with an effective treatment soon that can slow or even reverse the disease. Repurposing FDA-approved drugs originally intended for high blood pressure and skin cancer may hold the answer. With an estimated 15 million dementia sufferers worldwide, the financial rewards for drug manufacturers could be enormous.

In July, at the International Conference on Alzheimer’s in Vancouver, three leading pharmaceutical companies introduced products they hoped would be effective. Drugs from Pfizer and Johnson & Johnson and from Eli Lilly and Company failed in late-stage trials. The following products are showing more promise:

Gammagard — According to Business Week, Gammagard therapy has shown some success against Alzheimer’s in mid-stage human trials but may not be accessible for the average patient. “The product is an expensive, relatively scarce treatment derived from donated blood plasma that replaces antibodies in people with deficient immune systems. Results on whether it could slow or stop Alzheimer’s may be available next year,” Business Week reported.

Bexarotene — Approved by the FDA to treat skin cancer more than a decade ago, Bexarotene has been found to work quickly to stimulate the removal of harmful amyloid plaques from the brains of mice. In studies at Case Western Reserve School of Medicine, Alzheimer’s-diseased mice had lost the instinct their nest-building instinct. Just 72 hours after the bexarotene treatment, however, more than half of the harmful plaques had been cleared, and the mice remembered how to make nests.

Administration of the drug also improved the ability of the mice to sense and respond to odors. Ultimately, the drug reduced 75 per cent of the plaque. “This is an unprecedented finding,” says Dr. Paige Cramer, an author of the study. “Previously, the best existing treatment for Alzheimer’s disease in mice required several months to reduce plaque in the brain,” added Professor Gary Landreth of Case Western.

Clinical trials are under way. To volunteer for the trials, caregivers, physicians, researchers, and persons with the disease may contact the Alzheimer’s Association online at http://www.alz.org/research/clinical_trials/find_clinical_trials_trialmatch.asp  or call (800) 272-3900.

Repurposing Medications

Angiotensin Receptor Blockers — Commonly taken to control high blood pressure, this drug appears to reduce the amount of plaque in the brains of Alzheimer’s patients and could be marketed for cognitive impairment. Other FDA-approved angiotensin receptor blockers are Candesartan (Atacand), Irbesartan (Avapro), Olmesartan (Benicar), Valsartan (Diovan), Telmisartan (Micardis) and Eprosartan (Teveten).

Losartan (Cozaar) — In autopsies, patients who had previously taken this drug revealed a reduction in brain plaques. “There is a connection between blood pressure and brain health, and the choice of blood-pressure lowering drugs may make a difference in maintaining brain function,” Dr. Ihab Hajjar, assistant professor at the University of Southern California Keck School of Medicine, said in the Sept. 10 issue of Archives of Neurology.

Anatabine — While medical practitioners generally discourage smoking, the Roskamp Institute announced July 26 that it will commence the first large-scale human trial of a treatment that tests a natural substance in tobacco leaves and eggplant. So far, tests reveal reduced inflammation and a memory boost in mice bred to have Alzheimer’s. Plans call for a study involving about 200 people in the Sarasota, Fla. area with mild to moderate dementia.

After nine years of slowed research and failed experiments, Alzheimer’s studies are currently moving ahead at an accelerated pace, reports Barbara Peters Smith of the Herald-Tribune in Sarasota.

Much of the new research highlighted at last summer’s Vancouver conference indicates that no single treatment will help all cases, writes Smith. “As with cancer research, genetics may determine what works best,” she adds. The Alzheimer’s Genome Project has identified some 70 genes that provide protection or increase risk for the disease, “and this knowledge is helping to focus the current development of more than 40 compounds that could prove beneficial,” Smith concluded.

This writer is rooting for the wheels of progress to move quickly for JoAnn and others like her. JoAnn is my mother.

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Ellen Endo is a 2012 National Press Foundation Alzheimer’s Issues Fellow. Last in a three-part series.