National Geographic Daily News
Photo of a woman with Alzheimer's siting on a swing shaded by an umbrella.

The latest breakthroughs in Alzheimer's may provide hope for patients.

Photograph by Lynn Johnson, National Geographic

Diane Cole

for National Geographic

Published November 1, 2013

Part of our weekly "In Focus" series—stepping back, looking closer.

Every week brings reports of research furthering our understanding of Alzheimer's disease, which affects more than five million Americans today. The number of patients is expected to grow as baby boomers age.

But applying these new findings to practical interventions to help patients already suffering cognitive impairment is tricky. "There are positive steps being taken in the field, but they are going to take years to come to fruition," says David Knopman, a neurologist and Alzheimer's disease specialist at the Mayo Clinic in Rochester, Minnesota.

Discovering ways to prevent or cure the disease will require much more research. Here are some of the studies that researchers hope will yield significant results:

Sleep and Alzheimer's

Earlier this month, a study by Maiken Nedergaard, a professor of neurosurgery at the University of Rochester in New York, and coauthors suggested that sleep can help the brain flush out and clear away damaging molecules, including beta-amyloid, whose sticky plaque formations are a hallmark of Alzheimer's.

The finding was in mice—not humans—but it provides a clue to "the brain's housekeeping" that is "really remarkable," potentially leading to ways to use sleep to improve amyloid clearance, says Randall Bateman, a professor of neurology at Washington University in St. Louis who was not involved in the study.

Other recent studies have suggested a link between sleep disorders and Alzheimer's. In one, researchers at New York University School of Medicine tied sleep apnea (also called sleep-disordered breathing) to indicators of very early Alzheimer's disease, as seen on neuroimaging and in the study subjects' cerebrospinal fluid.

Another study, by researchers from Johns Hopkins University, found an association between poor sleep and the buildup of amyloid plaque in the brain. So which came first: the sleep difficulty or the Alzheimer's indicators? No one knows yet.

Prevention

Studies have shown that Alzheimer's progresses in the brain for approximately 20 years before the all-too-familiar symptoms of cognitive decline and impairment become apparent and can be diagnosed, says Bateman.

"Not unlike cancer or heart disease, there is a long period in which there is nothing manifest, but the disease is present in presymptomatic and preclinical form," says Pierre Tariot, of the Banner Alzheimer's Institute in Phoenix.

The changes start with the buildup of clumps or plaques of beta-amyloid protein located on the outside borders of brain cells. After about ten years, the tau protein (located inside brain cells) starts to twist into tangles. Maybe another five years after that, "we detect the brain shrinking and becoming metabolically slowed," says Bateman. And there are still another five or so years before people notice clinical symptoms.

Today it's only after diagnosis that medications are available, and they are useful only to manage symptoms, not to reverse or cure them. "Trying to intervene in a process that has been going on for 20 years" is like coming in "late in the game, in the ninth inning," says Bateman. "When someone is in the dementia stage, it's not that we can't help," he continues, "but it's harder when neurons have died."

That is why researchers are trying to understand when the disease begins and what happens early on, says Dean Hartley, a director 
of the Alzheimer's Association. Scientists are working to identify possible biological markers, such as cerebrospinal fluid changes and presence of amyloid that they can track (for example, using PET scans). Additional studies are under way to develop neuro-imaging techniques to identify and monitor other brain changes associated with the disease.

 

Dr. Thomas Beach, a pathologist, dissects a brain from an Alzheimer's patient at Banner Sun Health Research Institute in Sun City, AZ. The study group hopes that computer scans while patients are alive will be able to show the buildup of plaque on the brain as a symptom of the disease.

Photograph by John Burcham, The New York Times

Upcoming Trials

Early onset. Bateman's Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU) is recruiting participants who inherited a rare genetic mutation (present in less than one percent of the population) that increases risk for early onset Alzheimer's. Because symptoms can begin to show up when they are in their 30s, participants can be as young as 18. The trial will test three different drug interventions to see if they can remove or block plaque formation. Bateman says this study is "the first prevention trial in humans targeting beta-amyloid." Some initial results may be available within two years.

Late onset. At the Banner Alzheimer's Institute, Tariot and Eric Reiman are preparing to launch the Alzheimer's Prevention Initiative APOE4 Trial to test the efficacy of an anti-amyloid drug in a group of people genetically at higher risk for the far more common late-onset Alzheimer's. The study will seek to find out if the drug can help prevent or delay onset of symptoms and of memory and cognitive impairment.

Early signs. Another study will target older adults who are asymptomatic for Alzheimer's but whose brain scans show the presence of amyloid deposits, which appear early in the disease process. Reisa Sperling, director of the Center for Alzheimer's Research and Treatment at Brigham and Women's Hospital in Boston, will recruit a thousand volunteers to test a drug designed to clear amyloid from the brain.

In addition, various studies are investigating the role of lifestyle issues, including diet, exercise, and stress. Research is also ongoing to find interventions to improve functioning for those who already have the disease.

"There are many pathways to ending up with Alzheimer's disease," says Laurie Ryan, program director for Alzheimer's disease clinical trials at the National Institute on Aging. Eventually, "we're probably going to have multiple interventions," she says.

"The big picture is that we're not there yet, but there is so much going on, we are very hopeful," she continues. "We would like to be there now."

If you are interested in participating in a study, go to alz.org for more information.

8 comments
Alexander Sandy Halperin
Alexander Sandy Halperin

I so appreciate seeing this article published by National Geographic.

With my having early-stage Alzheimer’s, I am highly eager to continue to help raise awareness about the seriousness of Alzheimer's in the US and around the world. I am also advocating to have Alzheimer's funding on a par with other major diseases (and it is not). As you know, with the baby boomers (and with individuals living longer due to medical advances with other diseases), Alzheimer's is expected to reach basically epidemic proportions in the coming years. Alzheimer's is listed as the 6th leading cause of death in the US, but it is likely much higher because many physicians do not put it as the cause of death on death certificates - rather they say that the person died of a heart attack, cancer, stroke, etc... So, it is likely a much higher cause of death.

I have started a LinkedIn Group called “De-Stigmatizing Alzheimer’s” about 4 months ago and there are over 300 members at this time.  Here is a link to the discussion area of the group: http://www.linkedin.com/groups/DeStigmatizing-Alzheimers-4964066?trk=myg_ugrp_ovr

And here is a link to a 2 minute Public Service Announcement (PSA) that was done with regards to my Alzheimer’s, etc with my daughter Laurie and me: http://www.communityfilms.com/directors/pam-thomas/commercials/sandy-psa/#playing

I want to do all that I can do to help raise awareness about Alzheimer's, to help decrease the stigma or embarrassment that is often associated with the disease, and of course do all that I can do with our nations leaders to have them declare what I would call a "War on Alzheimer’s" to bring the funding up to be relatively equal to the funding that is made available for other major diseases, yet NOT to take any money for the funding for the research on those diseases.

On another important note, Florida State University Medical School has established an “Alexander ‘Sandy’ Halperin, DDS Alzheimer’s Research Fund” to help support the important and progressive Alzheimer’s research that is being done at the medical school. I am thrilled to be of assistance to the medical school and it helps to bring me full circle back to my healthcare, research, clinical and academic roots that I had as a dentist (doing clinical work, research and teaching).  The link to the fund is: http://med.fsu.edu/?page=brainRepair.alzheimer

Much more to say, but that is it for now... I want to be able to speak out as much as I can while I am still able to before my Alzheimer’s progresses.

Best regards,

Sandy

SandyHalperin@Gmail.com

Skype Name: Sandy Halperin

I want to thank my family for their assistance with a bulk of my communications.

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M Paulin
M Paulin

The thing that stood out for me in this image, is the S shaped chain link with the smaller chain running through it on the right. Looks much like a dollar sign. And that is what holds up breakthroughs in any research :(

david morgan
david morgan

No mention at all of Prana and it's trials. Amazing

El Gabilon
El Gabilon

We did not see a study in this article relating to the correlation between the foods we are eating  and Alheizmers.  For example if this disease is increasing over the years what else has been increasing at the same time.  We would suggest fatty foods. In the case of diabetis we suggest sugar.  The question here is what is the cause of the existence of this plack?  And, how can it be prevented before it does its damage? Often the answers to these medical questions is considered complex when simplicity is the answer.  Complexity is dangerous to our welfare when simplicity will serve the purpose. For example the cost of medical care is outrageous, yet no one speaks about PRICE CONTROLS on all medical care, equipment, and products to bring costs down. A single payer health care system with everybody in and nobody out,  is the best answer to health care insurance, but no, we spend our time devising things that make it more complex and never get anywhere. A simple law requiring food manufactrers to put salt, sugar and fats  in foods only when necessary. Lard should be abolished.

Roger Bird
Roger Bird

I did not find the word "coconut" in the article.  Coconut works, but it does not garner enough money for people to research it or market it.  If you want to learn about the benefits of coconut with regard to alzheimers, google "Newport coconut".  You might also check out "water cure" and magnesium and boron.

Roger Bird
Roger Bird

@Marina Paulin   Nice!  It is all about money.  Give them unnatural substances along as they make the pharmaceutical companies plenty of money.

Roger Bird
Roger Bird

@El Gabilon   Even though you are a liberal, I tend to agree with you.  The complexity of the pre-ACA and the even worse complexity of ACA is killing us.  Most people in most doctor's offices push paper; they are not directly involved with healing.

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