Check Up: Expert: 'Everything has changed' in Alzheimer's research
So far, the search for a treatment that will save our oldest generation from the scourge of Alzheimer's disease has been a long, frustrating slog.
So far, the search for a treatment that will save our oldest generation from the scourge of Alzheimer's disease has been a long, frustrating slog.
Paul Aisen, an Alzheimer's expert from the University of California, San Diego, explained why.
For decades, researchers were dealing with a deadly disease that had no apparent symptoms for the first 15 years or so. When the symptoms started, they were not specific to Alzheimer's. By the time they got bad, the brain was already severely damaged. There was no way to be sure people had Alzheimer's until they died and a pathologist could search their brains for the hallmark clumps of amyloid and tangles of tau that characterize the disease.
"So we failed over and over again," said Aisen, a co-organizer of the International Conference on Clinical Trials for Alzheimer's Disease, which met Nov. 22 in the Loews Philadelphia Hotel.
Aisen said he was now "truly optimistic" about where things were headed. "Everything has changed."
Scientists now have imaging techniques that allow them to watch changes in amyloid and tau while people are alive, even well before they have symptoms. There are other "biomarkers" as well.
Researchers also have created tests that can show changes in memory and thinking ability even before most people are aware that they're declining. For the first time, this is making it possible to test drugs and other treatments - one trial that uses exercise is on the way - before Alzheimer's has destroyed crucial parts of the brain.
"The biggest single reason why I think we've failed over the last decade is we are trying to slow down a disease process that has already been damaging the brain for 15 years," Aisen said. "We've been treating much too late."
Aisen said the meeting, which drew close to 700 people to Center City, was important because it focused only on clinical trials. Thousands of other researchers are doing bench science or studying the impact of the disease in other ways. This was a chance for scientists to talk about topics that probably wouldn't turn most of us on, but may speed discovery, including things like trial design, data sharing, collaboration, and statistical approaches.
One of the group's big initiatives, for example, the Collaboration for Alzheimer's Prevention (CAP), has worked to share some study-design elements among multiple early trials. That should make results easier to compare and build upon.
Speakers who described the prevention trials talked about the challenges of working in many countries with different regulations. It's complicated to figure out what constitutes risk, when to intervene, and what aspect of disease progression to target.
Rachelle Doody, a Baylor College of Medicine researcher, said the field was still wrestling with how to categorize patients and exactly how to use biomarkers, which don't always agree with one another. Good science needs well-matched comparison groups, and that's tricky with this population. Patients don't progress at the same rate, a factor that may need to be considered. Some things that may affect prognosis are previous treatments, IQ, and the presence of Parkinsonism and psychosis.
Aisen said there was nothing in the works that would make a big cognitive difference in the next year for someone with Alzheimer's, but he was hopeful there would be "effective disease-slowing agents" within 10 years.
"It's not just one shot on goal," he said. "We've now launched a number of trials, and many more are coming soon, and we really think we're getting somewhere."
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