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October 27, 2018

The Challenge of Alzheimer's Disease

Reuel S. Amdur

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Person A: "I've just learned that there is a new cure for Alzheimer's."

Person B: “What that might be?”

Person A: “I forget.”

In a talk at Revera’s Windsor Retirement Residence in Ottawa on October 12, Dr. Andrew Frank, Medical Director of Bruyère Hospital’s Memory Program, told the audience about new research efforts to combat Alzheimer’s.  “There have been no new medicines for the disease over the last ten years.  All clinical trials, 11 in all, have failed.”

He pointed out that, as one ages, some degree of memory loss may be normal: difficulty with names or forgetting why one has entered a room.  Then it comes back.  “Memory is intact but somewhat slower to respond.”

It is no longer normal, he explained, when the person forgets important details of recent conversations or repeats questions or statements in the same conversation or in the same day without remembering.  It is not normal “to forget that you are forgetting.” 

Memory loss begins to impair independent daily living.  The person may be unable to manage medications without help.  Other areas of impairment may include handling bills, shopping, cooking and housework, driving, dressing, and personal hygiene.

The person may forget names of close family members or simple objects, and the memory may not return.  He may become lost in familiar locations and may display significant personality change.  Eventually, he may become non-verbal.

As a result of a combination of genetic and environmental factors and age, amyloid cells are produced in the brain.  These are abnormal proteins which form agglomerations or plaques.  Amyloid cells, in turn, produce tau tangles.  They lead to neuron loss and dementia.

While Alzheimer’s is the most frequent dementia, there are others, for example, Lewy body dementia and frontal lobe dementia.  All of the three are protein-linked, but each involves a different protein.

Currently, there is no cure for Alzheimer’s, but there are medicines that can slow down the progress of the disease while it is still at the mild or moderate stage. There are global kinds of prevention that have been identified, such as control of blood pressure, reduction of high cholesterol, control of weight, smoking cessation, and prevention or control of diabetes.  Sleep apnea, depression, and anxiety may be implicated.  As well, auditory and visual deficiencies should be addressed, as these are the windows through which memory gets in.  The one environmental risk factor that seems to be borne out is air pollution.  While aluminum was formerly suspect, further investigation has not upheld this suspicion.

Frank is actively participating in investigations attempting to address Alzheimer’s by trying to prevent amyloid cells from agglomerating to form plaques and of tau cells from forming tangles.  The amyloid study is at stage 3, meaning that there are randomized control double-blind studies in a number of different centres.  Bruyère is now engaged in a phase 2 study of treating the tau factor.  In that phase, the researchers test effectiveness and side effects, prior to a full stage 3 analysis.

Frank urges caution. All experimental treatments to date have ended in failure.  Yet researchers keep trying.  With our aging population, “we desperately need new treatments in order to change the future.”

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