Vanishing Minds
New research is helping Alzheimer's patients cope--and hope
Calming effect. Fortunately, there have been some real advances in the treatment of agitation, depression, and other symptoms in people with dementia. Doctors have tried using traditional antipsychotics, but they have unpleasant side effects like heightened cholesterol levels and movement difficulties akin to Parkinson's disease. Worse, recent studies have indicated a higher risk of stroke. In Philadelphia, Tariot presented the results of a trial of a newer drug, quetiapine, sold as Seroquel. In a 10-week study of about 300 patients in nursing homes, the medication reduced agitation and aggression by about 20 percent, but with few of the side effects seen in other drugs. The medication also alleviated depression. The National Institutes of Health is currently sponsoring a longer trial of the drug, along with another medication called risperidone and several other antipsychotics. The results should be available next year.
But drugs are only useful with an accurate diagnosis. For the Lafsers, that diagnosis came courtesy of a PET scan of Frank's brain. Because he started showing problems at such an early age, doctors didn't think Frank had Alzheimer's. They diagnosed serious depression, but antidepressants were no help. His performance on cognitive tests--remembering shapes, repeating lists of words--didn't fit the standard Alzheimer's profile. Finally, Janelle insisted on a PET scan, and it showed reduced activity in brain regions typical of Alzheimer's. "It's devastating to hear that, but it also felt like a ton of bricks being lifted off my shoulders," says Frank. Janelle noticed the difference immediately. "He stopped blaming himself. And I stopped being angry with him, because I realized it's not his fault."
"PET is a direct way to look inside a person's skull to see activity, more direct than a battery of psychological tests," says Daniel Silverman, a brain-imaging specialist at the University of California-Los Angeles. The scan measures the energy used by brain cells; damaged cells, in an Alzheimer's patient, use less energy, and the loss usually shows up in particular brain regions. Standard neurological workups are highly accurate--on the order of 90 percent--but when PET scans are added to standard tests, the rate of missed Alzheimer's diagnoses falls from about 8 percent to about 3 percent. PET scans also help doctors distinguish Alzheimer's from other types of dementia, another study has shown. Such results recently prompted the federal government to announce its intention to expand Medicare coverage to PET scans for Alzheimer's testing.
A step backward. The news about preventing Alzheimer's, however, is not as good. Statins, the cholesterol-lowering drugs, had been linked to a lower incidence of Alzheimer's in several small studies. Researchers speculated that the drugs prevented some inflammation in the brain that led to cell damage. But in Philadelphia, data from three trials that followed about 8,300 people for several years showed no protective effect. Says Doody: "I see patients who come in who have statin prescriptions purely for their Alzheimer's. We have no evidence to support this. Nor evidence supporting antioxidants." Petersen's study of MCI patients also looked at the effects of the antioxidant vitamin E and found no benefit.
So most of the new hopes center on new approaches to therapy. One drug, called Alzhemed, appears to reduce levels of the protein beta-amyloid, which forms the plaques seen in dying regions of the brain. But no one has yet shown the drug eliminates the plaques, or if it slows or prevents actual memory problems. Another compound, an antibody to beta-amyloid, does appear to reduce plaques--but only in three patients so far. And again, this may not affect the course of the disease. Researchers think it will be at least six or seven years before they have better answers. "These are promising avenues," says Reisberg. "But we just don't know where they are going to take us."
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