There have been some advancements in the study and treatment of the symptoms of Alzheimer's disease in the past 20 years, but there is still much work to be done, says Dr. Mark Pippenger, an associate clinical professor of neurology and director of the Walker Memory Center at the University of Arkansas for Medical Sciences' Reynolds Institute on Aging.
Pippenger has been practicing in this field since completing his fellowship in 2001 at the University of California, Los Angeles. Many of the patients he sees have Alzheimer's, a disease which leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.
"I wish I could say we have a great new blood test for diagnosing Alzheimer's but the truth is the basic evaluation [the Montreal Cognitive Assessment] we began with is very accurate and very important to do," he says. "And while there currently is no cure for Alzheimer's, the medicines we have to treat it are helpful."
According to the Alzheimer's Association, there are five Food and Drug Administration-approved medicines that help treat the symptoms of Alzheimer's, but none prevent or cure it. Those drugs are donepezil (Aricept), galantamine (Razadyne), memantine (Namenda), rivastigmine (Exelon) and tacrine (Cognex).
"When it comes to treatment for the symptoms, there have really been no major advancements," says Elise Siegler, executive director of Alzheimer's Arkansas, which focuses on caregiver services and financial support. The national Alzheimer's Association is dedicated to funding research. The Arkansas chapter and several
others left the national association in 2002.
"The problem with treatment is that every individual is its own case because you have to factor in other health issues such as blood pressure, nutrition, weight and more. Every treatment is very individualized," Siegler says.
Karen Hayes of North Little Rock, 60, knows that all too well. Her husband, Bob Hayes, 77, died last month. He was diagnosed three years ago.
"It all moved so quickly," Hayes says. "He took Aricept, but it made him dizzy and [nauseated]. We tried another drug, Namenda, but didn't see any change."
He was resistant to visit a doctor and it took Hayes about six months to get her husband to see a neurologist.
She started attending Alzheimer's caregivers support meetings. Throughout his illness, her husband experienced a series of ups and downs, but a continual decline.
"Everybody could see what was going on at our house," Hayes says. "Everybody gathered around and helped. I was warned, 'They don't wander until they do.'"
Bob stayed home at first. Then he attended an adult day care before moving to a nursing home with some time spent in a geriatric psychiatric unit in a Jacksonville hospital. He received hospice care in a nursing home starting in April and died in late September.
"Hospice is different with Alzheimer's patients; it stretches out because you don't know what to expect," says Hayes, who also is an Alzheimer's Arkansas volunteer. "People in every place were so knowledgeable and so kind and made everything easier in a difficult situation."
A NEW DIAGNOSTIC TOOL
"When it comes to diagnosing the disease, the latest basic diagnostic tool is the ability to image the beta-amyloid protein plaques using a PET [positron emission tomography] scan to see these proteins," Pippenger says.
Plaques and the tau protein tangles are the two hallmarks of Alzheimer's brain abnormality, according to the Alzheimer's Association's website. Researchers are studying possible ways to prevent the tau molecules from collapsing and twisting into tangles, a process that destroys a vital cell transport system, notes the website.
Pippenger adds that the PET scans have a very limited use, mostly to study the effectiveness of Alzheimer's medications. The scans also have a very limited use in the clinical setting with patients since a tracer will only stick to the protein plaques. The only way to see the tangles is under a microscope during an autopsy.
"The fact that we can see the amyloid on the PET scan is an advancement," he says.
"We've learned more about what these proteins do and are beginning to figure out what caused the proteins to form," he says, adding that the amyloid protein is basically toxic to brain cells. "We hope this new knowledge will lead to more effective treatment."
RISK FACTORS AND LIFESTYLE
Pippenger says there have also been advancements in understanding risk factors and how the risk for Alzheimer's could be lowered.
"We have determined that physical exercise and modifying our diets are key," he says, adding there has been a lot of attention focused on the Mediterranean-style diet being connected to a lower risk of Alzheimer's.
The diet, based on less meat, includes more fruits and vegetables, olive oil and foods that are higher in Omega-3 fatty acids.
"Red meat is one of the biggest factors," Pippenger says. "A lot of studies seem to agree that a diet of [less] red meat is better -- lowering the chances of Alzheimer's, stroke and heart attacks."
There have been several recent studies on the Mediterranean diet that specifically looked at olive oil, Pippenger says.
"It and Omega-3 appear to be a critical part of that. There's a place in Greece where the natives drink a small glass every day for their health and they appear to be healthier. A glass or two of wine every night with a meal has also proved to be beneficial."
"We've been telling people to exercise and eat heart-healthy diets and control their blood pressure and diabetes and we've been seeing a slight decrease in ... the disease," he says. "And the rate at which people get it appears to be slightly lower, according to studies done at the Alzheimer's Association International conference."
Exercise and diet -- especially eating more vegetables -- does more for increasing blood flow and keeping the mind active, he says.
"People tend to slow down as they get older," Pippenger says. "If you can keep people moving, it's better. In the countries where people tend to walk everywhere, they tend to be more healthy. I think the exercise is crucial. I think you could eat your steak every day if you are walking every day."
What about the belief that a couple of tablespoons of coconut oil daily helps combat the disease?
"There's been no formal research; scientific studies have not been completed," Pippenger says. "But I'm skeptical the coconut oil will have a real benefit. I have some patients who do that and I've observed no real difference in the cognitive scores, but they feel better."
MANAGING MEDICINES
Identifying dementia that is caused by prescription medications for other conditions is part of the work that Pippenger and others do at the Walker Memory Center.
"A lot of people are afraid they have Alzheimer's and discover they are on medicine that is affecting their memory," he says. "When they stop taking the drug, they improve.
"Even some kinds of over-the-counter drugs like Benadryl, sleep aids or prescribed sedatives can make people feel as though they have Alzheimer's," he says. "We take people off of those and they improve."
Some physicians trying to alleviate other health problems don't realize a medicine they might prescribe could affect a patient's memory, he says.
"We see at least a dozen people each month with drug-induced dementia," Pippenger says, adding that patients who see multiple doctors complicate the diagnosis. "Arkansas has a very high rate of antipsychosis drugs and reducing those can often allow us to be better able to manage the disease. We work really hard to make sure we know all the medicines a patient is taking."
For patients' caregivers, the struggle is often not the memory loss, but the anger and arguments that arise from it -- such as dead relatives still being alive or when the patient needs a bath.
"It's a matter of learning how to better manage those behavior symptoms," Pippenger says, adding that support for family and caregivers is crucial.
And there's the stigma associated with the disease.
"I've had patients tell me they didn't want anyone to know," Pippenger says. "A lot of family members feel that way, too."
HOPE FOR THE FUTURE
Siegler says there has been a recent breakthrough on the research side, citing a breaking news story from the day before.
"Earlier this month, researchers at Duke University developed a petri dish of human brain cells which developed the structures of Alzheimer's disease," Siegler says. The researchers did so by growing human brain cells in a gel, where they formed networks as in an actual brain. Then, the researchers gave the neurons genes for Alzheimer's disease and within weeks, they saw plaques and tangles.
In doing so, the researchers resolved a longstanding problem of how to study Alzheimer's and search for drugs to treat it; up until this point, the closest they had come were with mice that developed an imperfect form of the disease, reports an Oct. 12 story in The New York Times.
Leading researchers say the study, published in Nature, should prove to be a landmark.
"It is a giant step forward for the field," Dr. P. Murali Doraiswamy, an Alzheimer's researcher at Duke University told the Times. "It could dramatically accelerate testing of new drug candidates."
ActiveStyle on 10/20/2014