Vanishing Minds
New research is helping Alzheimer's patients cope--and hope
Imagine: Inside your head, your memory is a dark, vast lake, and the waters are receding. Ripples that used to lap steadily on shore, bringing with them the time of day, the names of coworkers, and the location of your car keys, now barely reach. As the waters retreat farther, they take with them your ability to count, to drive, and to recognize the face of your wife or husband. Soon the lake is but a distant, dim shadow, holding words you can no longer speak and bodily functions you can no longer control. You are kept from it--from what used to be you--by an impossibly wide stretch of exposed and featureless sand.
For people with Alzheimer's disease and their families, this shrinking lake is not just a metaphor but a painful reality. "Time is what this is all about," says Pierre Tariot, an Alzheimer's specialist at the University of Rochester Medical Center in New York and now a caregiver as well. "If my father-in-law knows how to flush the toilet and where to poop for another nine months, that's huge for our family."
Buying time. Tariot and other researchers are combining new and existing therapies to buy as much time as possible, staving off brain failure for months and sometimes years. Last week, at the International Conference on Alzheimer's Disease and Related Disorders in Philadelphia, scientists showed for the first time that a drug could slow the deterioration from mild cognitive impairment to full-fledged Alzheimer's. Other drugs can reduce the agitation and irritability that comes with the disease, keeping patients out of institutions. This reflects a growing awareness that Alzheimer's is more than memory loss; it is a syndrome of psychiatric disorders as well. New brain scans are making earlier, clearer diagnoses possible, and very early experiments point to drugs that may limit Alzheimer's-related brain damage. A novel regimen of task-training, reported just last month, showed that people with mild Alzheimer's could still learn new skills (box, Page 76). "We have to attack Alzheimer's in multiple ways," says Steven DeKosky, director of the Alzheimer's Disease Research Center at the University of Pittsburgh. "We have no trouble doing this with cancer. But now we're learning to apply this many-pronged approach to Alzheimer's, too."
Along with the hope, there's stark reality. Drug benefits are still modest. And there's been gloomy news on the prevention front: Vitamin E and the heart drugs called statins, which had shown some promise in reducing the risk of Alzheimer's, have flunked their most recent tests. And hardly anyone at the Philadelphia meeting was talking about magic stem cells: Though they received a burst of publicity in the wake of President Reagan's death from complications of Alzheimer's, the cells seem more appropriate for treating other brain disorders.
All this is playing out against a drumbeat of increasing urgency, as the disease makes inroads against an aging society. The rate of Medicare beneficiaries with Alzheimer's more than tripled during the 1990s, and the number of sufferers is projected to balloon from the current 4.5 million to 16 million by 2050. "Remember, for baby boomers in this century the average age of death is 85," warns Tariot. "At 85, the chance of Alzheimer's is almost 50 percent. So look to your right and look to your left. One of those two people will probably get it."
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