Alzheimer’s Disease Update (2005)

Alzheimer’s disease update (2005)

by Fred Lane PhD
The Alzheimer’s debate continues and it remains an important issue for ever-increasing numbers of retired and elderly people in Australia. Last year (2004) Australian scientists were loudly hailed on TV after reporting a new intervention that looked good, theoretically, and even seemed to work with specially bred mice. Another group announced that a non-invasive blood test would predict Alzheimer’s disease some two years before behavioural signs appeared.

Failed promise

Unfortunately, the history of Alzheimer’s research is littered with such claims. The late 1990s drugs, like Aricept, Reminyl and Exelon, introduced with such high hopes, have proven once more to be of limited value. Some demonstrate small changes early on, but none provide significant long term benefit. Non-invasive CAT-scans were detecting the early signs of brain atrophy that go with Alzheimer’s disease in the 1980s, but that discovery has led to little substantive progress towards a cure.

The first and most important point to be made is that, contrary to official death rate data, there is little difference in Alzheimer’s incidence rates in any society, other than what can be explained by simple age demographics. A stigma still attaches to mental disorders in our society. People who die, incontinent and bed-ridden with Alzheimer’s disease, are frequently listed as dying from pnuemonia or other disorder that their immune system, virtually destroyed by Alzheimer’s, could not fight.

However, since Ronald Reagan’s candor, Nancy Reagan’s strong support over her husband’s 10-year course of the disease and the publicity associated with Hazel Hawke’s dementia, the Alzheimer’s stigma is gradually wearing away. This should lead to better reporting and, more importantly, better research.

Perhaps one of the most persistent myths is that exposure to aluminium causes Alzheimer’s disease. Except for a very rare Guam-related Parkinsonian dementia, there is no difference whatsoever between the age-corrected rates of Alzheimer’s in societies that have never seen an aluminium cooking pot and individuals who both cook with aluminium utensils and use heavy applications of aluminium-based deodorants.

Prevalence claims untrue

The doomsayers’ claim that half those over 80 years of age have Alzheimer’s is simply not true. Official dementia death rates of around ten per cent certainly suggest a much lower figure, but these data are not accurate. Probably only one in four people over 80 nowadays is likely to have dementia of any kind and only about half of these will have Alzheimer’s disease. Alzheimer’s is just one of 200 or more disorders that contribute to both the benign (potentially treatable) and malignant forms of dementia in the elderly and there is no certainty at this stage that what we call Alzheimer’s is in fact a single entity. Because of the many variations in the progress of the disease and because of its chequered treatment response history it is possible that there are many different diseases lumped into the one diagnostic “Alzheimer’s” category.

Simple tests

Another serious problem is that although simple and fairly reliable pencil and paper dementia tests have existed for years (e.g., the Mini Mental State Exam), some GPs seem reluctant to use them. Misdiagnosis, especially in the early stages, is not uncommon.

The American National Institutes of Health report that research funding has increased from US$298 million in 1994 to US$680 million ten years later. Additionally, Americans spend US$1 billion or more a year on dementia-related drugs, many of which have demonstrated little efficacy in properly controlled tests. Recent discoveries, including research in Australia, are at last claiming causal links between the well-known amyloid plaques and neurofibrillary tangles found in the atrophied brains of demented people at autopsy. Identifying the precursors and finding substances that will control them safely will advance the science markedly.

The statins?

There are suggestions that statins, the cholesterol lowering drugs, may be effective in reducing the numbers of people contracting the disease. The anti-inflammatory properties of ibu-profen and aspirin also show promise, at least for some forms of dementia.

The injection of processed stem cells into diseased brains is also showing encouraging results. However, it is the advocacy of people such as Nancy Reagan and Christopher (Superman) Reeve for stem cell investigation that is equally important because it has increased interest in that very promising line of research.

Vitamins E, C, B-6 and B-12, a regular fish diet and even a plant-derived traditional Chinese herbalist supplement, huperzine, are all subjects for ongoing investigations, but none have yet demonstrated robust long term efficacy.

Use it or lose it

What can be done by us all right now, in the early stages or before the disease manifests itself? The “Use it or lose it” philosophy remains sound. Keep physically and mentally active. Don’t use arthritis or other infirmity as an excuse not to keep fit. Join a gym.

Do crosswords, learn a new skill, join a bridge club, play chess, learn to surf the internet, sign up for a university or TAFE course. Eat a low fat balanced diet, rich in fruit and vegetables, and include an omega 3-rich fish meal, such as tuna, salmon or mackerel, at least once a week. Ensure you maintain correct levels of folic acid and vitamins C, E, B-6 and B-12, but for best results, do this through diet rather than pills. Reduce linoleic acid intake, such as that found in margarine, butter and dairy products. Eat plenty of darkly coloured fruit and vegetables. Keep blood pressure in check.

Unfortunately, one important aspect of Alzheimer’s treatment is showing little advance, because it is poorly funded and there is practically no research into the problem. This is the education and support of carers. It may be strongly argued that many Alzheimer’s patients in the latter stages of the disease know little about what is going on and care even less. It might be the person attempting to care for a patient at home who requires a stronger focus of support and assistance.

If the carer network fails because of lack of support, the Alzheimer’s patient must enter a hospital or nursing home of some sort, but this can be expensive, wasteful of trained staff and is perceived by many to be less than humane. Certainly, a time will come when such care becomes essential, but the longer an Alzheimer’s patient can be cared for at home, the better it is for all concerned.

Websites:

Try www.alz.org, www.aarp.org/ life/cargiving, or www.alzheimers. org.au for further information.

Reference:

Pieters-Hawke, S. and H Flynn. Hazel’s journey: A personal experience of Alzheimer’s. Pan Macmillan: South Yarra. 2004