A road map for Alzheimer's
Where are you right now? What city, what state? What is the year, season, month, and day? Spell world backward. Memorize the names of three unrelated objects, such as pen, apple, and chair, and when you have finished reading this column, recall them from memory.
You have just completed most of a "mini-mental" exam that clinicians and researchers have used for years to screen for Alzheimer's disease. And you can better grasp the loss that bedevils those who flunk this exam because of this cruel and most common of progressive dementias, which now threatens 1 in 10 to 20 people who live beyond age 65 and nearly half of those who reach the age of 85. As we craft our New Year's wishes for 2005, many of us would certainly want solving the Alzheimer's puzzle high on that list.
Unless one has been a caregiver or a nearby family member or friend, there is little sense of Alzheimer's human face. Alzheimer's is more than the loss of memory. It damages the body, mind, and spirit, and its toll is exacted year by year. Depression is present half the time, often with anxiety and irritability. Psychoses erupt, with paranoid delusions or hallucinations. Speech becomes impaired; eating and sleep disorders emerge. Muscles become rigid and slow; the body stoops, and the feet shuffle and grow unstable until walking is impossible. In time, patients struggle to swallow and lose bladder and bowel control. By then, perhaps blessedly, victims have lost the ability to reason or experience, to give or receive love, to have hope or faith. Weak and physically debilitated, most Alzheimer's patients slip away with pneumonia or some other fatal infection. Little wonder that this long and gruesome illness takes a heavy toll on the health of caregivers and loved ones.
The toll on our society is great as well. More than 4 million Americans have this disorder, and that number is slated to triple by midcentury. Research has taught us much since 1906, when neurologist Alois Alzheimer first described the postmortem of the brain of a demented woman who had been in his care. Under the microscope, he identified unusual clumps of protein, called amyloid plaques, and noted damaged nerve cells bearing tangled fibers. But a century later, we haven't yet figured out what causes this brain damage or whether the process can be reversed or the damage mended. We are further handicapped in patient care and research by an inability to diagnose the disease easily and with certainty during life. Add to this a muddled Alzheimer's literature, with conflicting claims about the benefits or harm of everything from estrogen to vitamin E to Celebrex to the notorious nicotine. We know that risk factors like high cholesterol, diabetes, obesity, and female gender feature in the disease but haven't figured out why. Needless to say, a near-term cure is not on the radar screen.
Here and now. What we have been able to offer Alzheimer's victims in recent years are limited forms of symptom control. There are now five Alzheimer's drugs available that beef up the brain's memory chemicals. The latest psychiatric drugs have also become a staple of Alzheimer's care. But these many treatments bring at best moderate respite. Several basic discoveries have been lauded as treatment breakthroughs, such as the ability to block enzymes that process amyloid or to stimulate the body's own cells with vaccines to vacuum it up. But none have translated into near-term treatments.
Some scientists have grown impatient with the way the government doles out its money for what should be targeted medical studies. Historically, research funded by the National Institutes of Health has been driven mostly by the curiosity of basic scientists seeking money for relatively small, free-standing grants, with little truck for the goal-oriented, big-science approach we associate with a Manhattan Project, a shot to the moon, or even the mapping of the human genome. But NIH's current leadership is working to initiate big-science "road maps" that should speed the pace of practical discovery. Let's hope a 21st-century road map for treatment and cure of Alzheimer's disease emerges soon, before too many more millions of people fail that mini-mental exam.
This story appears in the December 20, 2004 print edition of U.S. News & World Report.
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