One could argue that those who must watch a loved one with Alzheimer’s disease decline suffer more than the patients do.
“It’s a slow slipping away of someone who is still breathing, but is a different person,” says Columbus resident Lezlee Knowles, whose mother-in-law started showing signs of the degenerative disease in 2001.
Alzheimer’s disease is the sixth leading cause of death in the United States, with the average patient living eight years after symptoms become noticeable to others. There were 4,109 Alzheimer’s deaths in Ohio in 2010, a 79 percent increase compared to 2000, according to the Alzheimer’s Association.
Though the cause of Alzheimer’s is not fully known, it is associated with two types of protein build-ups in the brain, known as plaques and tangles.
“You have these abnormal proteins that accumulate more than they should and they’re toxic to nerve cells,” says Dr. Douglas Scharre, neurologist and director of the division of cognitive neurology at The Ohio State University Wexner Medical Center. “They start in a very particular part of the brain and they accumulate gradually” in the parts of the brain that control memory and cognitive function.
There is no cure, and treatments can only temporarily stabilize cognitive symptoms, not delay damage to brain cells, says Mari Dannhauer, clinical director for the central Ohio chapter of the Alzheimer’s Association.
Aricept (donepezil), Exelon (rivastigmine) and Razadyne (galantamine) are all cholinesterase inhibitors – they prevent the breakdown of acetylcholine, which supports communication among nerve cells to treat memory, thinking, language and judgement symptoms. In some patients, they can delay the worsening of symptoms by six to 12 months.
“They don’t allow the person to improve,” Dannhauer says. “It kind of holds them where they’re at … but it doesn’t really slow down the disease process at all.”
Another type of drug, prescribed for more advanced Alzheimer’s, is Namenda (memantine), which blocks glutamate receptors. High levels of glutamate can kill brain cells.
Trials for new treatments, some of which treat symptoms, are underway. Others take aim at plaques and tangles themselves, trying to prevent them from forming in the first place, Dannhauer says.
Phase 3 trials study large groups of patients to monitor side effects and confirm that the drug is effective.
Two new trials, one of promising new drugs and one of a surgical treatment, are currently recruiting participants.
The Dominantly Inherited Alzheimer’s Network Trial Unit (DIAN TU) study, a Phase 2/3 study, is testing the safety and efficacy of two drugs, gantenerumab and solanezumab, in those who have – or might have – a genetic mutation that causes Alzheimer’s disease. The drugs, which are given through either injection or intravenous infusion, designed to bind to the proteins that form plaques and tangles and remove them from the brain. Participants should either be cognitively normal or have only mild impairment or dementia at the start of the study.
The trial started in December 2010 and is expected to end December 2015. Other studies testing the same drugs have found possible improved function in patients with mild Alzheimer’s symptoms.
A new trial at OSU is studying whether deep brain stimulation (DBS) – using a brain pacemaker – can improve the functions of the frontal lobe, including decision-making, organization, planning and judgment, as well as short-term memory.
“DBS is not designed to get rid of or prevent the formation of these toxic proteins,” says Scharre, who is conducting the study along with Dr. Ali Rezai, a neurosurgeon and director of the neuroscience program. “We decided (to) stimulate those neural pathways that are more toward the front of the brain, the part that is still working well, but is not getting clear messages from the temporal lobe.”
The study is enrolling those with mild or early-stage Alzheimer’s, and Scharre hopes that the surgery will maintain those frontal lobe functions for longer, even as the disease progresses.
“Even if you have early Alzheimer’s, you may forget what happened yesterday, but if you’re still able to make good judgments and have good problem solving, that’s a heck of a lot better,” Scharre says.
Three patients have participated in the study thus far, and the university is allowed 10 patients total. The first surgery took place a little more than a year ago.
“So far we’ve been cautiously optimistic that patients have had some help with their attention and focus,” Scharre says. “The surger(ies) went well and we’re not seeing adverse events.”
Other clinical trials are in progress as well. The Alzheimer’s Association website, www.alz.org, offers a search engine to allow patients to search for clinicals they may qualify for in their area. Patients can also ask for trial matching by calling 800-272-3900, Dannhauer says.
Due to the prevalence and devastating effects of the disease, Alzheimer’s treatments are on the fast track through the Food and Drug Administration, Dannhauer says. Long term, Scharre and other doctors studying Alzheimer’s are hoping for a treatment or combination of treatments that can stave off the disease for four to five years.
“We’re looking for anything we can do to help these individuals and their families that have this condition,” Scharre says.
In 2010, Knowle’s mother-in-law was placed in Forest Hills Center in north Columbus, a nursing and rehabilitation center that specializes in caring for Alzheimer’s patients.
“When I walk the halls there, there are times that I pray that someday the building will be completely empty – that there will not be a need for that building,” Knowles says.
Lisa Aurand is a contributing editor. Feedback welcome at laurand@cityscenemediagroup.com.
