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RI Hospital Neurologists Attack Alzheimer’s Disease

Thursday, April 04, 2013

 

24,000 Rhode Islanders suffer from Alzheimer's Disease. RI Hospital neurologists are working on several fronts of therapy and detection.

Few diseases have put as immense a burden on overall health, the economy, and medical research as Alzheimer's. The disease incurs costs of $203 billion dollars on the economy and $216 billion on unpaid caregivers, is the only top ten fatal disease that cannot be prevented, and finds a new host throughout the country every 68 seconds. Despite the disease's staggering virulency and range, doctors are optimistic concerning progressive research that aims to detect Alzheimer's in its earliest stages.

GoLocal had the opportunity to discuss Alzheimer's with local neurological specialists Dr. Peter Snyder, Lifespan's Senior Vice President and Chief Research Officer, and Dr. Brian Ott, Director of The Memory Disorders Center at Rhode Island Hospital. Both doctors gave their perspective on how Alzheimer's affects the human brain, what new research enables doctors to detect, and finally what we all can do to reduce Alzheimer's damage on our mental and economic health.

Dr. Snyder, how will developing effective and non-invasive treatments for Alzheimer's affect the tremendous expenses Alzheimer's incurs across the nation?

Based on current population demographics and expected trends, we can anticipate that if we are able to develop a new treatment that slows progression of the disease, by even five to seven years, we can actually cut the incidence of AD in the population by nearly 50% in the year 2050! That is a huge effect, and the impact that this would have on the costs for our medical system, insurance, home health care, and the economic costs of missed work days by caregivers would all be massive. We must reach our goal of slowing the disease with new treatments, or we will face an economic disaster that is hard to imagine.

Seven years ago, doctors could only look at brain tissue under a microscope in an autopsy. Now, doctors can observe brain activity safely. Why is this now possible, and is this sense of detection continuing to advance?

This is currently one of the most exciting areas of research for Alzheimer’s disease. We are beginning to realize that patients with AD may actually have changes occurring in their brains up to several decades before they start to show clinical symptoms of the illness. That is, just like Parkinson’s disease, there may be a very long pre-symptomatic phase of the illness, and by the time patients start to show diagnosable clinical symptoms, a lot of damage to the nervous system has already taken place.

Due to very recent advances in a couple of technologies, we now have new markers – called ‘biomarkers’ – that help us to determine whether individuals have a very high risk of eventually developing the disease. We have a new imaging technology that allows us to take pictures of the living brain to see how much of a specific protein that we know is related to the disease, called beta-amyloid, is building up in the brain. We also have new tests to look at changes in CSF, the liquid that bathes the brain and spinal cord, and these changes are also related to early disease. Better cognitive tests and other measures will all help with early detection. These tests, in combination with genetic information and family medical history, all have allowed us to more confidently diagnose the disease in living patients, and to better predict risk of disease burden in people who are not yet complaining of clinical symptoms.

As we develop new treatments for AD, it is these very people who we want to target with these therapeutics. I think that, over the next several years, our ability to detect early disease will only get better. And, we are doing some very important new research – here in Providence, and in my own lab group – to tackle this problem. My own goal is to develop a “stress test” for AD that is the neurologic equivalent of a cardiac stress test for heart disease. My group is working to develop a test of risk for AD that is low-cost, minimally burdensome to the patient, and that can be done on an outpatient basis and without expensive equipment.

Rhode Island Hospital and Butler Hospital are a part of The Alzheimer's Disease Neuroimaging Initiative, which strives to determine the best biological markers of detecting Alzheimer's disease early. How important is early detection of Alzheimer's disease in light of how fatal the disease is?

We understand far more about the basic biology of the disease than we did even 4 or 5 years ago. As we understand more about how the disease develops in the brain, we also are discovering new opportunities to stop the damage at its earliest stages. These new discoveries provide hope that we are getting closer to creating one or more treatments that could slow the progression of Alzheimer’s disease, and to protect the areas of the brain that suffer damage as the disease progresses.

In fact, as a field we are currently testing several new possible therapies that may slow the disease, and if they work, we will want to identify and to treat persons at high risk, and BEFORE they begin to suffer the changes that impair their quality of life. This means that we have a classic “chicken-and-egg” problem. How do we reliably identify who should be treated, if these individuals are not yet bothered by the cognitive symptoms of the illness? We really need to tackle both problems in parallel, at the same time: we need to figure out how to identify older adults who are at risk of the disease but before they are complaining of difficulties, and we also need to discover the new treatments to slow the progression of AD. We cannot solve one of these two problems and leave the other one unsolved. That won’t work.

An estimated 5.2 million Americans have Alzheimer's disease, including 24,000 Rhode Islanders. Deaths from Alzheimer's increased 68% between 2000-2010 across the nation while deaths from other major diseases including Breast Cancer, HIV, and heart disease decreased. Dr. Ott, what are the best living habits to practice to reduce Alzheimer's?

We know of several important living habits that, together, may slow the onset of the disease in persons who are destined to suffer from AD eventually. These are also the same lifestyle habits that we know slow progression of completely normal and expected “age-related cognitive changes” that we all experience as a consequence of aging. None of these are “magic bullets” or miracle cures – but these absolutely add up and lead to measurable benefits.

The first “protective” life habit is to remain as busy and socially active as possible as we age. Engaging vigorously in hobbies, playing a musical instrument, cooking with friends, traveling, and spending quality time with loved ones is critically important for several reasons. First, an active lifestyle means that one is constantly solving problems, managing schedules, considering alternatives and navigating a complex social world. All of these behaviors keeps the brain active and engaged, and there is some truth to the “use it or lose it” concept when it comes to brain health.

Secondly, we do know that one of the significant risk factors for disease is chronic depression, anxiety and/or social withdrawal. Maintaining an active, busy lifestyle helps to protect against psychological distress and illness as we age. Chronic, untreated depression or stress, on the other hand, leads to some very specific biologic changes in the brain that increase the risk of dementia.

The next lifestyle factor to take seriously is regular, moderate aerobic exercise. Even taking brisk walks for 30-45 minutes per day, three days per week, goes a very long way in protecting the health of your brain. Again, there are some very good biologically-based reasons for why this is so important, and the evidence from clinical trials is overwhelmingly positive. Regular exercise will lead to the growth of, and connections made by, brain cells in areas of the brain that are essential for learning and memory – and we can actually see these changes within just a few short months of regular exercise!

Finally, and I’ll bet everyone can guess what the last big lifestyle protective factor is….a healthy diet. We know for certain that obesity, heart disease and metabolic disorders – like diabetes – are serious risk factors for the onset of Alzheimer’s disease. A healthy, balanced diet, to control for obesity and all the bad things for the body that come with it, are very important lifestyle protective factors for dementia.

Recent medical developments have yielded results on invasive treatments such as deep brain stimulation and non-invasive treatments such as supplements like fish oil. Dr. Ott, what are the benefits of these developments, and have they made any tangible difference in patients?

Observations made on small numbers of patients who have received deep brain stimulation so far suggest there may be modest symptomatic benefits on cognition in some cases. Therefore a clinical trial is being done here in Rhode Island as well as in several other centers across the country to determine both the safety and potential benefits of this approach. Deep brain stimulation is highly invasive as it involves drilling two holes in the skull, then inserting two metal probes deep into the brain. The probes are connected to a pacemaker like device that stimulates them with electricity. The risks include brain hemorrhage and infection.

Fish oil supplements on the other hand are a non-invasive complement to traditional Alzheimer medications that may offer some very modest benefits to brain health, particularly for those who are not clearly impaired in their cognition and those who do not carry the ApoE4 Azheimer risk factor gene. While the proof that fish oil supplements are truly beneficial for prevention or treatment of Alzheimer’s is still lacking, and therefore a subject of ongoing research, such supplements are reasonably safe and may confer additional benefits for heart health. 

 

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