Push for Alzheimer's treatment grows along with numbers

Washington -- More than 5 million people in the United States have Alzheimer's disease -- a 10% increase over the past five years. The number is guaranteed to grow as baby boomers bump into the disease's greatest risk factor: increasing age.

Those figures are from a new report by the Alzheimer's Assn. released at a March 20 Senate hearing. It includes the estimate that someone in America develops Alzheimer's disease every 72 seconds. Without a cure or at least treatments to slow the progress of the illness, the rate could accelerate to one every 33 seconds by mid-century.

Given the growing incidence, the pressure is on to develop effective treatments and even better, a cure, said researchers testifying before the Senate subcommittee on retirement security and aging. Panel Chair Sen. Barbara Mikulski (D, Md.) introduced legislation the previous week to boost funding for Alzheimer's research at the National Institutes of Health.

New drugs are in the pipeline and could arrive at the Food and Drug Administration by fall for possible approval next year, Sam Gandy, MD, PhD, director of Thomas Jefferson University's Farber Institute for Neurosciences, in Philadelphia, told the Senate panel. Dr. Gandy's laboratory is participating in clinical trials for two of the new drugs.

So far, the FDA has approved several drugs that temporarily slow symptoms in some people, but the medicines being tested are intended to attack the disease directly. Among them are two that target the amyloid plaques that are a molecular hallmark of Alzheimer's, Dr. Gandy said. Reports on the new entities are very encouraging, he added. "These drugs are safe. Patients tolerate them well. And they appear to show significant positive impact, slowing progression of the disease."

The drugs could transform Alzheimer's from a death sentence to a manageable chronic illness, he told the Senate panel.

Lifestyle matters

In addition to new drugs, lifestyle changes could reduce the risk of the disease and limit its impact on individuals and their families, said Marilyn Albert, PhD, director of the division of cognitive neuroscience at Johns Hopkins University School of Medicine in Baltimore.

The body of knowledge linking cardiovascular risks with Alzheimer's is rapidly growing, she said. Plus, evidence supports the notion that healthy diet, exercise and social engagement might lower risk. "We have only scratched the surface of these issues, and we still don't know, for example, how much exercise, or which kinds of social engagement, or which specific dietary changes will have the greatest impact on the disease."

But the evidence was sufficient to inspire the Alzheimer's Assn. and the Centers for Disease Control and Prevention to launch a "Maintain Your Brain" campaign to address cognitive health, Dr. Albert noted. The campaign stresses the benefits of mentally challenging activities; social and physical activities; and a low-fat, low-cholesterol diet rich in antioxidants.

This approach was supported by Gary Small, MD, professor on aging at the David Geffen School of Medicine at the University of California, Los Angeles. Dr. Small, who is also the author of popular books on the brain, including The Memory Bible, spoke at a March 14 congressional briefing on Alzheimer's early detection and treatment. The event was sponsored by the Joint Steering Committee for Public Policy, a consortium of five science research groups.

Dr. Small's Dec. 21, 2006, paper in the New England Journal of Medicine provided evidence that positron emission tomography scans of the brain can help differentiate among people with varying degrees of cognitive impairment and are useful in singling out those who could benefit most from early treatment. "Use it or lose it" does pertain to brains, Dr. Small said. Even though family history increases risk, it's not the entire story, he said.

Studies show that college graduates have lower dementia risk than do non-graduates and that leisure activities that involve mental effort lower risk. Heightened stress is also a risk factor, and studies on cardiovascular conditioning link improved conditioning with improved frontal lobe function, he said.

Dr. Small conducted a small study showing that after two weeks of a healthy lifestyle program that combined mental and physical exercise, stress reduction and a healthy diet, volunteers with mild, self-reported memory complaints showed significant improvements in cognitive functioning and brain metabolism. Those results were in the June 2006 American Journal of Geriatric Psychiatry.

He goes so far as to hypothesize that if everyone in the nation adopted one regular and beneficial lifestyle change, the prevalence of dementia could decrease by perhaps 1 million cases within five years.

Not only would this bring relief to many individuals and their families, but the cost savings to the economy also would be welcome.

"Alzheimer's disease already costs the nation $148 billion a year," said Harry Johns, president and CEO of the Alzheimer's Assn., who testified at the Senate hearing. Plus, the disease is overwhelming the health and long-term-care systems. And at least 50% of people in assisted living facilities and adult day care have Alzheimer's or another dementia.

The disease also is taking a huge toll on families, he said, a situation Mikulski was all too familiar with, as her father died from the illness.