Rudy Tanzi PhD
Discovery Fit & Health
Rudy Tanzi PhD Joseph P. and Rose F. Kennedy Professor of Neurology, Harvard Medical School/Massachusetts General Hospital
I think what we're seeing is that once this pathology in Alzheimer's begins, it seems to continue. It's almost like it's spreading. It's almost like it's propagating itself, so a decade ago, I might have said, "Let's cure the disease. Stop the pathology that's there and allow the brain to come back." Kind of like when you tell somebody to quit smoking, and the first day you quit smoking your lungs will start to come back. I believed that for a long time. Now I'm not so sure, because with the newer findings that say that once this pathology begins it seems to be able to self-propagate, which is very scary, it tells me that we can't let this pathology start in the first place.
So, I now talk about eradicating Alzheimer's disease rather than curing it. Now yes, for those who have the disease, the same therapies that we'll eventually use to prevent Alzheimer's from ever striking we are confident will also help those with the disease who have it now. But the mantra is: "Early prediction, early detection, early prevention." We find all of the Alzheimer's genes so some day we can do nice, legally protected, reliable genetic testing.
We can't do that yet, so most cases of Alzheimer's, except the rare early-onset forms that strike under 60, we can't do reliable genetic testing yet. Plus, I think the legal protection for your genetics is still a work in progress. We're getting there, but some day when we can predict risk based on genetics or even more simply family history, then you can tell somebody you need to be more diligent, more vigilant about this disease coming on. That gets us to early detection. Imaging, biomarkers, looking for certain proteins in the blood or in the cerebral spinal fluid from a lumbar puncture, looking for markers that the disease has started but you don't have symptoms yet.
I would say that at that point or well before that point, if your genetics says so, you need to start taking whatever it takes -- drugs, supplements, lifestyle changes -- to prevent the disease from striking in the first place. Our model is really heart disease. I come from a family with a family history of heart disease. My dad, his dad, my dad's brother, they all died by 45 of heart disease. I'm fine, right, but what do I do? I'm playing full-court basketball six hours a week, I'm a vegetarian, my cholesterol is fine, but I'm taking a high dose of a cholesterol-lowering drug, a statin. I'm seeing a cardiologist twice a year. I'm getting stress tests.
I'm treating myself like I have heart disease, because my family history and genetics is strong enough that I practice what I preach. I have to prevent this disease from striking in the first place. The goal would be to do exactly the same for Alzheimer's. Think about the incidence of heart disease and how it's been decreased simply by modifying exercise, diet, lifestyle, and for those who aren't doing so well, putting them on a cholesterol-lowering drug, or for those who have a strong genetic history like me, put them on a cholesterol-lowering drug anyway.
Alzheimer's is a form of dementia that affects the brain, severely limiting memory and mental functioning. At its worst, Alzheimer's disease affects even the simplest daily actions of people who have it. The causes of Alzheimer's disease are unknown, but the disease likely arises from a combination of causes. Some of the known risk factors include age (risk increases after age 65), family history and genetics. The disease causes changes in the brain, mainly in the part that controls learning and memory. Amyloid plaques and neurofibrillary tangles disrupt neuron activity in the brain and cell death accelerates as the disease progresses; the paths of cell parts and nutrients are blocked by the many tangles. Levels of neurotransmitters, the brain chemicals needed for message communication from the brain, soon begin to decrease.
There is no known cure for Alzheimer's disease. The disease is fatal and many people with Alzheimer's disease die from related diseases or complications [source: NINDS]. Current treatments cannot slow the disease's progression, either. Medicines and therapies for Alzheimer's disease can help manage the disease mostly in the early stages, by improving some symptoms. Medicines called cholinesterase inhibitors and memantine help ease some of the memory loss and confusion experienced by people with Alzheimer's disease. Other treatment includes medications to treat anxiety and depression and to ward off infections.
The approach to helping ease symptoms of Alzheimer's disease includes many non-drug approaches as well. Professionals can train family caregivers on how best to deal with changing behaviors and moods and to minimize triggers.
Future medication approaches that are being researched hope to target the processes in the brain that go wrong in people with Alzheimer's disease. For example, researchers are attempting to develop drugs that can correct problems that lead to the amyloid plaques that characterize changes in patients' brains. If the medicines can block the activities of certain enzymes and prevent the plaques from forming, they may halt the disease from progressing. Another problem is a tangle that forms from tau proteins. If researchers can determine how to stop the molecules in the protein from collapsing and forming tangles, they might be able to stop another problematic Alzheimer's process. Researchers are looking at other possible solutions, such as how insulin and inflammation might be linked to the disease and biomarkers for the disease that would help them diagnose it in patients at earlier, more treatable stages [source: Alzheimer's Association].
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