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Updated 5 July 2011
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What is your current research that is being conducted for Alzheimer's?
A major focus of research today is to find genes that contribute
to a person's risk of developing Alzheimer disease. Genes that cause rare, inherited
forms of AD were discovered about 15 years ago. These genes (APP, PS1, PS2) have
mutations that cause a person who has the mutation to always develop AD, typically
at an early age (30-40 years old). These are "autosomal dominant" mutations. Soon
after, the gene for ApoE was found to very strongly influence the risk of AD. People
who have the ε4 allele of ApoE have around a sevenfold increase in the risk
of developing late-onset AD. Geneticists think there are additional genes that have
weaker effects, based on the observation that a person who has a first-degree relative
with AD has a doubling of risk for AD. However, these genes have such small effects
that they are very difficult to find. One would need to study 5,000+ people who
have a relative with AD and compare them with 5,000 people who do not have a relative
with AD, to start to see the effects of these genes. This is why the Massachusetts
General Hospital's Lars Bertram collaborated with Alzforum to develop the
AlzGene database. This database lists every published genetic association
study to help researchers compare results across multiple studies on the same genes.
So far, Dr. Bertram has found around 10 genes that have small effects. One would
want to verify whether these genes do indeed increase the risk of AD in a large,
independent study.
How is this research helping with finding a cure or a better understanding of Alzheimer's?
Knowing the risk genes would indicate which biological mechanisms
are involved in the disease, and might point to possible treatments. However, this
is not easy. Researchers have known for 15 years that APP, PS1, PS2, and ApoE are
very important, but they still don't understand exactly how these genes are involved.
We have quite a lot of debates on the Alzforum about that.
How is this research being funded?
Nearly all funding comes from the National Institutes of Health,
mostly via the National Institute on Aging, National Institute on Neurological Disease
and Stroke, and the National Institute of Mental Health. Charities such as the Alzheimer's
Association, and foundations, also fund the research. Research on drugs is funded
through biotechs and pharmaceutical companies.
What are the future prospects for finding a cure?
Researchers today are hoping to develop treatments that will slow
down the disease, rather than "cure" it. Alzheimer's develops undetected over many
years, and if it were possible to know who is on their way to getting AD, it might
be possible to give them a drug or other treatment that will slow the disease process
down enough to keep that person from ever having AD (because the disease mainly
affects those who are older). There is optimism that such treatments will be developed.
Many scientists believe that successful treatments will involve cocktails of drugs
and supplements that together will have protective effects.
My grandfather is 83 years old and I think he's showing signs of senile dementia.
He has a lot of memory loss, likes to talk about the past, throws valuable objects
away, doesn't go to the bathroom and will urinate anywhere in the house, becomes
aggressive (trying to hit somebody) and is disoriented. Are these symptoms of Alzheimer
disease? What kind of therapy is available or what can be done to maintain control
of a patient with this behavior? -- L.C.
Your grandfather certainly appears to have symptoms of dementia,
but he needs a proper neurological examination to confirm a diagnosis and to rule
out other medical conditions, such as depression, thryoid disorders or reactions
to medicines can cause similar behavior. Also, if he has dementia, a neurologist
can determine whether it is of the Alzheimer's disease type or some other type.
It's important to find out, because this will affect the treatment course and outlook
for disease progression. The best place for your grandfather to be evaluated is
at an Alzheimer Disease research center. For information about the one nearest to
him, please consult the Alzheimer's Disease Education & Referral Center.
What are the most commonly used treatments for Alzheimer disease?
The most common medication prescribed for Alzheimer's disease is Aricept (donepezil),
which is moderately effective in some people who have early or mid-stage AD. Exelon
and Reminyl are similar to Aricept and may be prescribed as an alternative. More
recently, Namenda (memantine), a drug that has a different mode of action, has been
approved for patients with more advanced AD. In addition, there are probably many
patients taking Vitamin E or selenium, both of which are antioxidants believed to
combat the damaging effects of oxygen radicals, and women taking estrogen, which
has been shown to reduce the RISK of getting AD among elderly women. Nonsteroidal
anti-inflammatory drugs are also of interest, because they may reduce inflammation
in brain tissue, which is theorized to contribute to brain degeneration in AD. Whether
antioxidants, estrogen or NSAIDs are helpful to patients who already have developed
AD is not yet known, but this question is being addressed now in clinical trials.
There are currently no medications or other treatments that are known to cure or
prevent Alzheimer disease.
Our Treatments section
includes a comprehensive list of approved and investigational therapies, and also
discusses nonpharmacologic approaches to managing AD.
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