Many Treatments but No Cure for Alzheimer’s Disease

There is a certain degree of helplessness that a person can feel when reading about dementia. After all, there is no cure. There is no precise understanding of the cause. There is not even a way to delay the disease. From time to time, there are fun articles that do assuage our fears about dementia, like “Alcohol Intake in the Elderly Affects Risk of Cognitive Decline and Dementia” that allow us to think, Oh, drinking wine helps stave off dementia! But even those are to be taken with a grain of salt.

There is certainly a perception that exists that there is nothing to be done to deter the onset of dementia, and perhaps in the end, that is true. Researchers believe pretty firmly in some risk factors that may increase the chance of developing dementia.

Kenneth Rockwood, a practicing physician and a professor at Dalhousie University’s Department of Medicine and Canada’s Centre for Health and Aging, has studied the epidemiology of dementia for many years. A study that Rockwood and his team conducted in 2010 implicated old age and frailty as the highest risk for dementia, which may perhaps be unsurprising.

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More surprising, perhaps, was his and his team’s usage of a frailty index. The team invoked potential risk factors such as eye health, ear health, and the fit of respondents’ dentures. When they compiled their data, they found that individually, such factors indicated nothing. Put together, they increased the risk of respondents’ development of dementia exponentially.

Why? Says Rockwood, “When people are unable to repair their deficits generally, it is an indicator of inability to repair deficits in the brain. Whenever one system goes awry, it impacts the ability of another system to operate at optimal capacity. When one thing goes wrong, that’s enough [for the body to handle]. Some of them add up to be bad for you. What we could be witnessing is the variability in intrinsic risk of aging, [which just might be the] accumulation of deficits in cellular levels.”

Hypertension, high cholesterol, smoking, obesity, diabetes, and sedentary lifestyles are all considered to be risk factors for dementia – but such conditions have been implicated to almost every disease under the sun. Plentiful research exists about cognitive exercise and their own positive benefits in regards to dementia development.

Rockwood says, “The things that work best for frailty in general are physical exercise and overall maintenance of health.”

Undoubtedly, physical exercise and good health is helpful for anyone’s health, and probably does have an immeasurable benefit in the fight against dementia but studies suggest that the simple maintenance of health may not be the entire story. Indeed, Rockwood mentions other risk factors: farm neurotoxins and parental age at birth. Lawrence J. Whalley talks about place of birth and fathers’ with occupations as coal miners as being implicated as risk factors for late-onset dementia.

Whalley is the emeritus professor of mental health at the University of Aberdeen. About 15 years ago, he stumbled upon an archive of 90,000 Scottish students who were born in 1921 and whose IQs were tested in 1932 at school. He later found an additional sample of 70,000 children born in 1936 and tested in 1947. From it, he discovered a correlation between low childhood intelligence and dementia. In an email sent to me, he said,

“I can safely conclude that childhood IQ works as a proxy for childhood disadvantage, which slows mental development and constrains the development/acquisition of cognitive resources that in late adulthood reduce or delay dementia incidence. In adulthood, higher mental ability contributes through more intelligent use of health advice/services and when health risks are identified help reduce risks through behaviour cessation ([e.g.] smarter people stop smoking more successfully than less smart).  Similar finding were linked to diet and assortative relationships – smart people tend to socialise, marry each other and have smart families etc.”

“The findings fit with a substantial body of evidence that demonstrates that childhood adversity impairs ‘cognitive reserve’ with which to buffer the presence of dementia. Our most recent data shows that the complexity of brain cortical structure is less in those who are most mentally impaired by aging.”

If low economic income plays a role in the development of dementia, then, maybe obesity, diabetes, and smoking may not necessarily be risk factors of dementia, as much as symptoms of the same problem. Only 13 percent of smokers make over $90,000 annually, a third of smokers barely hover just around the federal poverty line, making less than $12,000 a year. Similar statistics exist with links for obesity, diabetes, and poverty.

Of course, exercise and healthy living helps. But with risk factors as diverse as parental birth age to the fit of dentures late in life, it certainly is tempting to throw up our hands and give up in the face of a formidable enemy like dementia.

There is, however, hope on the horizon. Researchers seem to making headway on discovering biomarkers that can indicate whether a person would be at risk for developing dementia. But, with dementia being the second-most feared disease after cancer, would people want to know?

Treatment

Andrius Baskys, the director of the Alzheimer’s Disease Prevention and Treatment Center in Orange, California and a psychiatrist at the Tyler Village Wellness and Recovery Clinic in Riverside, California, has studied pharmacological approaches to dementia.

“As physician, if a patient comes to my office with complaints of memory problems and is diagnosed with vascular dementia, should I aggressively treat underlying factors?” he posits. “Will treatment improve memory condition?”

He and Dr. Jin-Xiang Cheng sought to answer exactly that question, by studying data from trials on the various pharmacological effects of drugs prescribed to patients with vascular dementia. They found that, while there was slight cognitive improvement, it was not very significant. However, hypertension treatment in the early stages had the most effect on symptoms of dementia. Baskys also cautioned: “Maybe because of short duration, maybe we do not see as much benefit with other treatment modalities.”

Perhaps more uplifting is the case of Souvenaid. Richard Wurtman is a practicing physician and the Cecil H. Green Distinguished Professor of Pharmacology at MIT. He devised a nutrient mixture that combined choline, uridine, and DHA, with a few add-ons like folic acid and B-vitamins to improve intake. In studies with animals, as he says, “gerbils got smarter with it.”

Two trials conducted by Danone provided their researchers and Wurtman with another success. He says, “After six months, the double-blind study converted to open-label, and all the participants, even those on the placebo, were allowed to get Souvenaid for a full year. Cognitive scores continued to improve even between six and 12 months. This indicated that we had not reached a plateau even after a full year.”

Wurtman cautioned that the mixture would not reverse the overall disease progression, but it would help with the onset and symptoms. He also said that it would not work for people with late Alzheimer’s disease, adding to the need for early and timely diagnosis.

But Wurtman was pleased with the mixture’s performance, and hopes that it can be used for people with other diseases like Parkinson’s. He says, “For the drugs that do exist, they have loads of side effects, so many people can’t take them. But with Souvenaid, there were no side effects in either study. All the major constituents are already in the blood stream, so the body knows how to handle them.”

Medical Daily had also previously reported on a recent drug that halted disease progression in a three-year trial. According to Christine Hsu’s report, “Gammagard is an immunotherapy made up of a collection of antibodies from blood donations given as infusions every two weeks. Researchers believe that the antibodies may help destroy the sticky plaques accumulating in brains of patients.”

Despite the lack of a cure yet for dementia, it is important to realize that does not mean that nothing can be done. Martin Prince is the professor of Epidemiological Psychiatry at the Institute of Psychiatry, King’s College London and the Co-Director of the new KHP/ LSHTM Centre for Global Mental Health. He says, “The quality of life for people with dementia can remain reasonably good.”

Adds Jacob Roy, the chairman of Alzheimer’s Disease International headquartered in London in an email sent to me, “Even in high-income countries like the UK, there is a section of the medical community who [carries] therapeutic nihilism on dementia. Their attitude is that nothing much can be done even if you make a diagnosis. Again, it is not enough to have medications available for treating dementia. It is equally important to convince the practising physicians [of] the advantage of using these medications.”