Q. It seems like there’s a new Alzheimer’s “breakthrough” almost every day. My husband and I often follow the headlines and in our attempt to pull together the true, reputable research, we have seen everything from the relationship of drinking coffee to stave off Alzheimer’s to people in the Midwest and South being more susceptible to the disease to new drugs that have worked on mice. I know you do a lot of research on this topic. What highlights should we pay attention to regarding Alzheimer’s and dementia research from 2019?
A. Alzheimer’s disease is a form of dementia — a mental condition characterized by issues in cognitive functioning and difficulties with daily activities.
You are correct that when it comes to Alzheimer’s, there are new headlines just about every day about promising research, new medications, and ways to stave off the disease. Through all of the new “breakthroughs,” we have learned that many of the “probable causes” of the disease have been debunked.
The Prevalence of Alzheimer’s
One thing we do know about Alzheimer’s is that it is estimated to kill a third of US seniors, which is more than breast cancer and prostate cancer combined. It is estimated that every 65 seconds, a person in the U.S. develops Alzheimer’s, according to the Alzheimer’s Association. And, while deaths related to heart disease — the nation’s leading killer — have been on a decline over the past several decades, Alzheimer’s-related fatalities have increased nearly 150%.
Within the next 30 years, the number of Americans living with Alzheimer’s will likely grow by an estimated 240%. By the end of that 30-year mark, Alzheimer’s and other dementias will cost the United States nearly $1.1 trillion.
Despite the urgency of the situation, however, efforts to treat Alzheimer’s, much less cure it, have produced few gains due to the complexity of the disease.
The Sad Truth Still Prevails
There currently is no effective treatment for Alzheimer’s disease, the most common cause of dementia. The blood-brain barrier, a network of blood vessels and tissues that keeps foreign substances from entering the brain, presents a challenge to scientists researching treatments, as it also blocks potentially therapeutic medications from reaching targets inside the brain.
Several of the world’s largest and most successful pharmaceutical companies have sought to tackle the disease. Unfortunately, nearly all of them have been met with insurmountable setbacks that ultimately led to discontinuing their clinical trials. This year alone Roche, AC Immune, Biogen, and, most recently, Amgen and Novartis have all halted their experimental Alzheimer’s treatments due to poor clinical trial data.
Alzheimer’s Highlights from 2019
Over the past year, however, there have been some advances made in the understanding of and the approach to a disease that currently has no cure. These are some of the major findings from this year’s Alzheimer’s Conference and other reputable sources about Alzheimer’s and other forms of dementia:
- More proactive treatments: For the most part, past efforts from researchers have focused on creating a drug that will effectively treat or cure Alzheimer’s when the disease has already manifested itself and progressed too far. Now researchers have started to appreciate that fighting Alzheimer’s requires a field-wide shift in approach and thinking.
- Detection before symptoms show up: Changing how doctors interact with patients and detect traditional signs of the disease well before it takes hold may lead to early detection and create opportunities to develop new treatments or determine which drugs – perhaps even some that were previously shown to be ineffective – may become relevant if given to patients earlier. “Underpinning the hundreds of studies that have failed is the fact that we have been unable to see Alzheimer’s pre-symptomatically,” said David Knopman, a professor of neurology at the Mayo Clinic
- A promising drug?: Biogen surfaced new data supporting its previously failed Alzheimer’s drug, aducanumab, and announced plans to seek its approval from the Food and Drug Administration (FDA). Although preliminary, these findings are a critical step toward addressing the disease.
- Rethinking the original theory: For decades, the prevailing theory behind the root cause of Alzheimer’s has been the amyloid hypothesis, which posits that the disease evolves from a build-up of a protein fragment called beta-amyloid in the brain. The amyloid hypothesis has come under question and has even been outright abandoned by some researchers and leaders in the field.
- Biomarkers to detect Alzheimer’s: As news of failed drug trials made headline after headline, the medical community has begun to witness an awareness of a new way to detect Alzheimer’s years before symptoms, and potentially track how effective treatments are at halting or reversing the disease: biomarkers. Doctors use common biomarkers such as temperature, blood pressure and cholesterol to monitor overall health. Today, researchers are applying this idea to proteins in the body. By measuring concentrations of these biomarkers, most recently with less invasive blood tests, researchers can better understand how diseases such as Alzheimer’s manifest, progress, and respond to medications. The use of biomarkers to diagnose and track Alzheimer’s has gained support from visionaries including Bill Gates and Jeff Bezos, both of whom invest heavily in the Alzheimer’s Drug Discovery Foundation’s Diagnostics Accelerator, a program dedicated to advancing digital tools that could lead to a viable treatment.
- Focused Ultrasound: According to EurekAlert, “(f)ocused ultrasound is a safe and effective way to target and open areas of the blood-brain barrier, potentially allowing for new treatment approaches to Alzheimer’s disease, according to initial study results presented at the annual meeting of the Radiological Society of North America (RSNA). Studies on animals have shown that pulses of low-intensity focused ultrasound (LIFU) delivered under MRI guidance can reversibly open this barrier and allow for targeted drug and stem-cell delivery.” Read more here.
- Age Raises the Risk of Dementia More Than Family History: According to Harvard Health, age raises the chance of dementia more than family history. People in their 70s are more than twice as likely as those in their 60s to get the disease. Dr. Gad Marshall, assistant professor of neurology at Harvard Medical School said, “(e)ven though family history adds to the overall risk, age still usually trumps it quite a bit. It means your risk is higher, but it’s not that much higher, if you consider the absolute numbers.”
- Symptoms Show Up Earlier for Those Who Have Relatives with Dementia: Researchers from Washington University in St. Louis studied a large group of people with dementia who had at least one parent who had been diagnosed with the disease. Using medical records and interviews with participants and knowledgeable friends or family members, the researchers determined the age at onset of dementia for each participant and his or her parent or parents. Those with one parent with dementia developed symptoms an average of 6.1 years earlier than the parent had. If both parents had dementia, the age at onset was 13 years earlier than the average of the parents’ ages at diagnosis.
- Apathy plays a role in MCI becoming full-blown dementia: Mild cognitive impairment (MCI) is typically marked by memory loss, confusion, mood swings, and other challenges that can disrupt daily life. At least 15% of people with MCI who are age 65 and older eventually acquire full-blown dementia. If someone with MCI also suffers apathy, that person is up to seven times more likely to develop dementia, compared to those without apathy, says Dr. Prasad Padala, a geriatric psychiatrist for the Department of Veteran’s Affairs (VA) Healthcare System.
- A chemical found in algae (BMAA) may be linked to harmful brain conditions in dolphins. Researchers say BMAA is being absorbed through the mammals’ food. Dolphins consuming fish laced with BMAA caused the toxin to accumulate in their brain, leading to Alzheimer’s-like symptoms.
- LATE Can Often be Confused for Alzheimer’s Disease: Some people who have been diagnosed with Alzheimer’s may actually have a newly defined type of dementia that mimics the disease’s symptoms but is caused by another mechanism in the brain. In April 2019, a research team led by scientists at the University of Kentucky discovered yet another condition that causes dementia. They call it LATE, or limbic-predominant age-related TDP-43 encephalopathy.
There is Still Hope of a Cure for Alzheimer’s
Despite the setbacks in the past, patients and loved ones should take solace in the fact that few people are giving up hope. The challenge ahead is to change the way we approach treating disease and deliver patient care, to a more proactive way before the dementia actually takes hold. Hopefully, we can report even more promising news next year!
For now, be sure to take advantage of your annual preventative doctor’s visits and continue to maintain your cardiac health. It still holds true that exercise is good; smoking is bad; and developing diabetes or obesity increases the risk. These recommendations, as most people know, are true for any disease.
Planning for a Loved One with Alzheimer’s
Do you have a loved one who suffers from Alzheimer’s or another form of dementia? Persons with Alzheimer’s disease and their families face special legal and financial needs. At the Farr Law Firm, we are dedicated to easing the financial and emotional burden on those suffering from Alzheimer’s and their loved ones. Through the process of Life Care Planning and Medicaid Planning (also called Medicaid Asset Protection Planning), we help protect a family’s hard-earned assets while maintaining your loved one’s comfort, dignity, and quality of life by ensuring eligibility for critical government benefits such as Medicaid and Veterans Aid and Attendance. If your family is facing a diagnosis of Alzheimer’s disease or any other type of dementia, please call us as soon as possible to make an appointment for an initial consultation:
Medicaid Planning Fairfax, VA: 703-691-1888
Medicaid Planning Fredericksburg, VA: 540-479-1435
Medicaid Planning Rockville, MD: 301-519-8041
Medicaid Planning Washington, DC: 202-587-2797
About Evan H Farr, CELA, CAP
