We do a lot of postings on dementia, in no small part because adults rank it as their number one concern, just above running out of money or dying. I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know – but should know – about the evolving science around Alzheimer’s disease and treatment options. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management. He reports in this post on what may be a “light at the end of the tunnel we call Alzheimer’s disease.
What is the first thing you learn when you are admitted to a hospital, and this can be for outpatient or inpatient procedures? ONE SIZE DOES NOT FIT ALL!
That applies to Alzheimer’s disease as well. There has been no blockbuster fix for Alzheimer’s, to date, but on closer examination of how people with different genes or with different make-ups respond, scientists are finding they react differently to medications. We already have seen this in cancer treatment, and it is a broad and promising side of medical care called genomics…sometimes called pharmacogenomics when referring to medicines and nutrigenomics for foods or supplements. When physicians look to a person’s specific genes, they can find people who may respond a lot better than someone without those genes. They call it “personalized medicine,” and it is showing some real promise.
Let’s start with a clinical failure that may actually be something else altogether: tramiprosate (an antiaggregation of amyloid agent). Earlier this year results from a phase 3 clinical trial (this is the final phase for a drug to be up for possible approval by FDA) for tramiprosate showed no appreciable improvement, on average, for Alzheimer’s subjects in the trial versus those on placebo. I said, “On average.” When scientists later looked more closely at the genetic makeup of patients in the trial, they found that those patients with two copies of the APOE4-gene had markedly better results than those with only one or no copies of this gene. Scientists are reassessing how these patients and those with the APOE3 gene respond, especially since these latter are at greater risk for developing Alzheimer’s disease. Worth a second look, for sure.
I also mentioned nutraceuticals. In a European study some time ago, there seemed to be some promise for vitamin D as a protective agent against Alzheimer’s. As scientists looked specifically at the patients with two copies of the APOE4 gene and taking vitamin D, they found those patients had better memory scores than those on placebo or without the gene. Vitamin D in the absence of the two gene copies did not seem to do as well.
Scientists are also looking more closely at omega-3, what we sometimes refer to as fish oil (it is only in the fish oil, because that is where it is stored after fish eat the algae that contain the omega-3). And there are multiple types of omega-3, two of which are particularly “brain-healthy.” Scientists have a couple challenges here. One, the brain’s absorption of the healthy omega-3 takes a few years, and there also is a difference in the genes I mentioned above. This may take longer to get good evidence, but it also is promising.
There also is research into limiting environmental risk for developing Alzheimer’s that is linked to both the APOE4 gene and the presence of pesticides like DDT and its metabolic cousin, DDE. While DDT has been banned in America for some time, its metabolite, DDE, is still around. Preliminary research suggests that it is not just the DDE or just the APOE4 gene, but the presence of both that is associated with higher incidence of Alzheimer’s.
While these early findings will not tell you what to ask your physician about diet or medications, it is a cautionary note for all who live in or near agricultural regions. The lesson learned again is that we likely have just begun to tap the genotypic profiles that may lend themselves to less versus more risk or less versus more success. The oncology field has begun to get better and better results in their fights across a number of cancer types by paying attention to genes that can predispose individuals to either greater risks or to better outcomes. It just may be that Alzheimer’s disease can follow the same model.
Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to firstname.lastname@example.org