Rethinking a Cure for Alzheimer’s Disease

A recent article in Journal of Alzheimer’s Disease discussed several inconvenient facts on the state of Alzheimer’s research, namely that the almost singular focus on amyloid beta protein as the cause of Alzheimer’s Disease (AD) has produced a remarkable string of failures in drug trials that target removal of amyloid beta in the brain.

Authored by Daniel George, a research professor at Penn State, the article points to a tentative but growing belief that the medical research and pharmaceutical industries might need to take a step back and look at the AD problem from a fresh viewpoint. The details on why amyloid beta may only end up being a moderately useful biomarker for AD and nothing more, I’ll save for a future story.

What I will do is try to describe what the two main parts of a new conceptual framework could look like:

1. Alzheimer’s Disease is an age-related broad spectrum condition, not a single disease.

The “upstream” factors that can contribute to AD include personal genetics, lifestyle choices (diet, exercise, smoking, etc), plus a history of brain injuries and other maladies that produce long term brain inflammation. In other words, a person’s lifestyle and medical history over several decades will greatly influence the chances of Alzheimer’s.

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2. Alzheimer’s Disease may end up being a chronic but manageable condition, much like diabetes or hypertension.

This is a positive way of saying that an outright cure for AD may never happen, but that (future) medications could reliably slow or delay symptoms of cognitive decline for, say 8-10 years. Imagine a patient at age 70, on the edge of Alzheimer’s, being able to take a new medication that gives her the ability continue to live independently for several more years. The potential for an improved quality of life is huge, not to mention the enormous taxpayer savings through Medicare if millions of seniors do not require full time care.

The medical device industry has started to put more resources into developing early detection and screening tests for Alzheimer’s. There are several computerized cognitive health screening tools that can be used in the doctor’s office, which will become more prevalent now that the Medicare Annual Wellness Visit benefit is in place.

There are also several biomarker tests in development, including spinal fluid and blood tests. However, these tests are experimental and have significant drawbacks and/or conflicting results at this point. I believe it will take a few years to shake out what a “routine” screening process for AD could look like.

In the meantime, the Alzheimer’s research community and pharmaceutical companies have their work cut out to figure out a way forward after several disappointing Phase III drug trial results.