Unfortunately, despite extensive research, we are still far away from finding a cure for Alzheimer's. But here's what you can do in the meantime

Do you remember Rita Hayworth, Charles Bronson, Rosa Parks and Ronald Reagan? Whether it’s a family member, a friend or a famous celebrity, almost everyone has been touched by Alzheimer’s disease (AD).

Okay, so we forget things from time to time. It can be due to a lot of causes. Fatigue. Stress. Or age. Our mental capabilities and cognitive function decline with increasing age, thus, the common belief that forgetfulness is normal. Or it could something else, something permanent, something irreversible. What if forgetfulness occurs prematurely and progresses rapidly? What if it is dementia? 

Dementias are a group of neurological disorders characterized by the progressive decline of cognitive function. The most common form of dementia is Alzheimer's which accounts for up to 70% of dementia cases. Dementia may also result from an acute cardiovascular event such as stroke or heart attack (vascular dementia) or manifest as Creutzfeldt-Jakob syndrome and Parkinson's disease. 

18 million worldwide are afflicted with AD according to the World Health Organization  and the number is expected to double by 2025 with over 50% living in developing countries. [1] According to the Alzheimer's Association 5.4 million in the United States or 1 in 8 Americans are afflicted with 98% over the age of 65.

Every 69 seconds, someone in the U.S. develops AD. It's the 6th leading cause of death and is the 5th among those 65 and older. In 2008, official figures showed more 82,000 people died from AD. However, this is an underestimation as AD is not always listed as the cause of death. AD costs the United States 183 billion with about 15 million people involved in giving care who are usually unpaid 

So, what makes Alzheimer's so formidable? 

AD is a progressive neurodegenerative disease - It starts with mild lapses in memory but eventually the afflicted loses full memory plus the ability to reason and make judgments. In its advanced stages, AD patients lose all ability to communicate or carry out normal daily tasks, including personal hygiene and eating. 

Experts have arbitrarily set the different stages of AD as follows:

Stage 1: No impairment

Stage 2: Very mild decline

Stage 3: Mild decline

Stage 4: Moderate decline

Stage 5: Moderately severe decline

Stage 6: Severe decline

Stage 7: Very severe decline 

Certain people are more susceptible to AD than others - Advancing age is the biggest known risk factor for AD. The majority of those who are afflicted are 65 years and older. Next to age, familial history predisposes people to develop AD. Those who have close family members and relatives with AD are more likely to develop the disease.

Several genes have been identified and are categorized as risk and deterministic genes. Risk genes increase your chances for developing a disease whereas deterministic genes are those which directly cause a disease. And chronic health issues especially diabetes and heart disease, exposure to certain toxins and pollutants and head trauma can increase the risk of having AD. Additionally, even osteoarthritis has also been shown to accelerate the progression of AD in mouse studies. [2][3]

There is currently no reliable diagnostic procedure for AD - The only confirmatory test that can distinguish between AD and other forms of dementia is by autopsy. By the time the symptoms manifest clinically, the damage has already happened.

According to Dr. Michael Rafii, MD, PhD, co-director of the Memory Disorders Clinic at UCSD Perlman Ambulatory Care Center in La Jolla, “Current research indicates that AD may in fact be silently developing in the brain over 10-20 years, BEFORE its key symptom of short term memory loss even shows up in patients.  The idea is that a protein called beta-amyloid is slowly accumulating in the brain, first damaging brain cells, and then depositing into plaques. Many drugs, some of which target amyloid, have been tested in the symptomatic phase, which is likely too late in the course of the disease to have a tremendous impact.” 

There is no known prevention or cure - Essentially, current management is directed primarily at providing a safe environment and tempering the symptoms. All around us, we see many wonder drugs claiming to be the ultimate cure for AD. But there are none. 

Several clinical trials on AD drugs are currently ongoing (and not only in Grey's Anatomy). Many of these trials are testing drugs which are targeting the disease at its earliest stages. The challenge of developing drugs to cure AD is to find the target – be it part of the brain, receptors or neurotransmitters that cause the disease. Some of the drugs being tested for AD are rivastigmine, donepezil and dimebon. 

OK what's modern medicine doing besides making drugs?  

Biomarkers - The field of neuroproteomics is promising. Researchers at the Institute of Psychiatry at King's College London have identified a protein called Clusterin which is thought to be indicative of brain shrinkage and rapid memory loss. What makes clusterin a special biomarker is that it may be able to predict the onset of AD up to ten years before the symptoms appear.

According to lead author Dr Madhav Thambisetty: “We are very enthusiastic about these results because they identify a strong signal in blood from clusterin protein that appears to be relevant to both pathology and symptoms in patients with Alzheimer's disease, adding further evidence to the role of clusterin in Alzheimer's disease… A primary goal in Alzheimer's research is to develop an inexpensive, easily administered test to accurately detect and track the progression of this devastating disease.  Identifying clusterin as a blood biomarker that may be relevant to both the pathology and symptoms of the disease may bring us closer to this goal.” Along the same vein, the Alzheimer's Disease Neuroimaging Initiative, using both biomarkers and brain imaging is following a cohort of AD patients. [4]

Bio Banks - An example is the Brain Bank of the Brazilian Aging Brain Study Group, which by 2007, “included samples and data from more than 1,600 individuals. Today, the archive includes samples from more than 2,500 donors. These samples support studies under way at over a dozen research laboratories.” [5] 

Bio Metrics - Research is also ongoing in the field of medical devices, the so-called “neurocognitive prosthetics comprised of direct brain–computer interfaces.” This may seem like science fiction but this may be where the future cure for AD may well lie. [6] Devices that help AD patients may come in different forms, from the very simple to the highly sophisticated, from the non-invasive to the invasive.

• A simple memory book or PDA to help trigger memories.
• Virtual reality and entertainment tools.
• Cognitive training using electronic tools such as computer games.
• Transcranial stimulation either by magnetic technique or by direct current application. “Transcranial direct current stimulation over the motor cortex, premotor cortex, visual cortex, and left dorsolateral prefrontal cortex may improve working memory, implicit learning and verbal fluency in healthy adults.”
• Implanted electrodes that induce localized brain stimulation.
• Neural prosthetics that can improve brain connectivity.
• Other brain microimplants. 

Genetic testing - In the future, genetic testing will be able to identify risk and determinant genes early enough so that those who are at risk can take preventive measures. And those who are mostly likely to have it may be able to take steps slowing the disease. The question is: would you want to know? 

If there's no cure what can we do in the meantime? Not much! But here's the good news.

Support groups - Those who engage actively in social communication are more likely to maintain their mental faculties and as a result may slow down AD progression.  

Healthy lifestyle – There are suggestions that controlling your chronic health issues and living healthy may slow down the manifestation and progression of AD. However, according to Dr. Rafii: “The jury is still out on this.  There have been many studies showing certain types of diets, including the Mediterranean diet, regular physical exercise, and staying cognitively active, may all contribute to lowering the risk of developing AD.  This is an area of tremendous research activity.”

Nutrition - Strangely enough, not all promising drugs originate from the laboratory.  Curcumin or curcuma is a substance found in the Indian root crop turmeric used widely as food condiment in the region. A curcumin-rich diet has been shown to be beneficial in decreasing toxicity, oxidative stress and DNA damage in the brain. It is no wonder that Indians have relatively low AD rates. [7] 

Coffee - Yes, your morning coffee supposedly may help prevent AD. At least, this was what a mouse study conducted by researchers at the Florida Alzheimer's Disease Research Center has found. Mice were given either plain water or caffeinated drink. After 2 months, the caffeinated mice performed better in memory tests. In addition, their brains showed nearly a 50% reduction in levels of beta amyloid. [8] In humans, this was investigated by the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study and the results showed that caffeine does have positive effects on cognitive functioning. “This finding might open possibilities for prevention or postponing the onset of dementia/AD.” [9]

Aspirin - There have been reports that the wonder drug aspirin may also be a potential treatment for AD. After all, aspirin is used as prophylactic agent in cardiovascular disorders. However, in depth studies showed that low-dose aspirin did not benefit cognitive function. However, we must not forget that aspirin with its anti-coagulatory properties, increases the risk for bleeding, even into the brain. [10]

Nutritional Supplements especially omega-3 fatty acids from fish oil, may slow down the progression of AD. Unfortunately, a recent study reported this is not the case. The study evaluated the effect of DHA on memory retention. No effect was observed. According to researcher Joseph Quinn of the Oregon Health and Science University:“Once somebody has a diagnosis of Alzheimer's disease, there is probably not a value in giving them Omega-3 supplements for the sake of slowing down Alzheimer's disease.” [11]

The Bottom Line 

Current research is primarily aimed at earlier diagnosis and slowing the progression of this devastating forgetting disease. Eventually, we will find a cure. But, perhaps in the meantime, you can make a difference.  

Staying healthy and remaining socially interactive appears beneficial. And maybe that cup of Joe in the morning can give you a heads-up on Alzheimer's. And always remember that September 21 is the day to “go purple.” 

Published January 10, 2012, updated August 2, 2012

References

1. Alzheimer's Disease : The Brain Killer, Facts and Figures, Mental Health and Substance Abuse, WHO
2. Levesque S et al, Air pollution and the brain: Subchronic diesel exhaust exposure causes neuroinflammation and elevates early markers of neurodegenerative disease, J Neuroinflammation. 2011 Aug 24;8(1):105
3. Kyrkanides S et al, Osteoarthritis accelerates and exacerbates Alzheimer's disease pathology in mice, J Neuroinflammation. 2011 Sep  7;8(1):112
4. Aisen, P.S, Q & A: The Alzheimer’s Disease Neuroimaging Initiative, BMC Med. 2011 Sep 1;9(1):101
5. Grinberg L, Banking on Understanding the Aging Brain, Alzheimer's Association
6. Serruya MD et al, Techniques and devices to restore cognition, Behav Brain Res. 2008 Oct 10;192(2):149-65. Epub 2008 Apr 20. Review
7. Gude D, Remembering what's new in Alzheimer's management, J Pharma Pharmacother. 2011 Jul;2(3):194-5
8. Arendash GW et al, Caffeine and coffee as therapeutics against Alzheimer's disease, J Alzheimers Dis. 2010;20 Suppl 1:S117-26. Review
9. Eskelinen MH et al, Caffeine as a protective factor in dementia and Alzheimer's disease, J Alzheimers Dis. 2010;20 Suppl 1:S167-74
10. AD2000 Collaborative Group, Bentham P et al, Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial, Lancet Neurol. 2008 Jan;7(1):41-9.
11. Omega-3 and Alzheimer’s, HHS HealthBeat, HHS.gov, September 7, 2011