New Year, New Hope – Alzheimer’s disease

Let us start by wishing everyone a Happy New Year!

As we bid adieu to 2016 and enter into 2017, almost all of us do so with hope. Hope for better social status, closer relationships with loved ones, better economic prospects to name a few. But what does the New Year entail for victims of Alzheimer’s disease? It is challenging for us to understand the mind of an Alzheimer’s patient. But, a pretty accurate guess would be that for these patients, hope for the New Year means being able to remember where their belongings are in their homes. It means helping set up the table for dinner without a struggle. It means recognizing their loved ones at first glance.

The Alzheimer’s Association defines Alzheimer’s disease as ‘the most common form of dementia.’ It is a ‘general term for memory loss and other intellectual abilities serious enough to interfere with daily life.’

What causes this disease that so easily creates dysfunction in a complex and integral organ such as the brain? Alzheimer’s disease develops due to the build-up of amyloid plaques and neurofibrillary tangles in the brain. In their villainous nature, they are responsible for the loss of memory and decline in cognitive function. They form between neurons and become a dense cluster of toxic and sticky molecules. The less popular ‘sidekick’ in the onset of this disease are neurofibrillary tangles. They form inside neurons in the brain due to defective tau proteins that clump up and become a thick insoluble mass blocking tiny microtubules that are necessary for the transport of nutrients and organelles.

Demographically speaking, how bad is it? Unfortunately it’s more common than we expected. An article published in 2016 by Science Alert reported that Alzheimer’s disease ‘affects 50 million people worldwide.’ As for us in the Asia Pacific, it isn’t any better. A report by Alzheimer’s disease International in 2014 on Dementia in the Asia Pacific Region said ‘the number of people with dementia is estimated to increase from 23 million people in 2015 to 71 million people by the year 2050.’ A country profile for Sri Lanka was contributed to this report by the Lanka Alzheimer’s Foundation (LAF). They reported that ‘50 people living with dementia attended/attend the Activity Centre on a weekly basis since the opening in January 2012’ and they ‘had direct contact with an audience of 4,850 in a caring role, or with an interest on this topic and the work they offer.’

Forbes magazine describes Alzheimer’s disease as a ‘humanitarian crisis’ that, much like other mental illnesses, requires constant all-round care and asylum. The Alzheimer’s Association also says those aged 65 and beyond have the ‘greatest risk of developing the disease.’ In a conventional society such as Sri Lanka, where extended families are still considered to be the norm, the relatives of the patient, knowing what’s best for them, is overcome with guilt at the thought of them going to adult-care or assisted-living homes. Relatives are burdened with many doubts; ‘What if it is an awful place?’ ‘What if abuse and control by the caretakers are the underlying norms?’ ‘Are we making the right decision?’

Let us restore hope back into the hearts of the oppressed by reviewing the research milestones that were achieved in the treatment and prevention of Alzheimer’s disease.

June 2016: A team from the Rowan University School of Osteopathic Medicine and Durin Technologies Inc. conducted a trial for a new blood test using autoantibody biomarkers that can detect the early stages of Alzheimer’s with “unparalleled accuracy.’’ The results of the study showed a 98.7% accurate detection of moderate Alzheimer’s along with other diseases such as Parkinson’s (98.0%), multiple sclerosis (100%) and breast cancer (100%).

September 2016: Researchers from the Butler Hospital in Providence Rhode Island tested a new drug based on the antibody aducanumab that targets neurotoxic amyloid deposits. The results of the study were described by researchers as ‘the most promising yet in the fight against the disease.’ Out of 103 patients recruited for the trial, researchers reported slower cognitive declines in 91 patients treated with the drug and wish to replicate these results in a larger group of patients.

October 2016: A team at Imperial College London carried our new research involving gene therapy treatment that could prevent the formation of beta-amyloid deposits. Tested on mice, they carried out memory tests to generate results. The results showed ‘a 19.1% reduction in beta amyloid peptides in the cortex and 30% reduction in the hippocampus.’ Beta amyloid plaque buildup was reduced by 43% in the cortex and 51% in the hippocampus. These show potential in using gene therapy for the treatment of Alzheimer’s disease.

November 2016: A reputed pharmaceutical company developed and tested a new drug that ‘can be proven to slow the devastating mental decline that’s associated with Alzheimer’s.’ In Phase 1 of the clinical trial the drug, called Verubecestat, seemed to have blocked the activity of the enzyme BACE1, which facilitates the production of toxic amyloid proteins, without any major side effects. Neuroscientist John Hardy from the University College London, who was not involved in the drug development, says the results ‘are looking very promising so far.’ However the first trial was too short to detect any amyloid plaques build-up in the brain scans, even though compounds that generate abnormal amyloid proteins in the surrounding brain fluid had decreased. The study is now moving into Phase 2 and the results of the first trial are expected in mid-2017, and the second, in 2019.

Though research efforts for the treatment and prevention of Alzheimer’s is rampant, the need for awareness in the most hard-to-reach areas, and the engagement of relatives, volunteers and caregivers is crucial. Understanding Alzheimer’s disease helps us see through a victim’s perspective a life of frustration and lost ability resting on hope. However with the extensive efforts that have been put into treatment and prevention of the disease, it is safe to say that the coming year shows prospect in lifting these victims from a situation of crisis and burden, to having a reason to live their lives to the fullest.

Written By: Sadiya Badurdeen