Treatments Brighten Outlook for Alzheimer’s Patients

About 4 million Americans have Alzheimer’s Disease, making it the most common disease affecting the adult brain. After cancer and heart disease, it is our most common cause of death. About 30% of those older than 85 – and 50% of nursing home residents – have Alzheimer's, and more than 100,000 Americans die of it each year. The statistics on Alzheimer’s Disease frighten us, and for good reason: Alzheimer’s Disease can rob one of memory, of clear thinking, of physical function. But research into prevention and treatment are helping us to understand the disease and even alleviate its symptoms.

The Medical College of Wisconsin is one of the leading centers in the region for diagnosing and treating Alzheimer’s patients, and is one of the most active centers for research into its causes and treatments. Piero G. Antuono, MD, Professor of Neurology at the Medical College, is the Director of the Froedtert & Medical College Memory Disorders Clinic. With support from the Alzheimer’s Association and community health agencies, he works collaboratively with a team of physicians and other Alzheimer’s specialists to evaluate and treat Alzheimer’s patients.

Patients showing symptoms of the disease undergo a comprehensive clinical evaluation that includes detailed medical, behavioral, social and family histories. Although no single blood or radiological test can definitively diagnose Alzheimer's, research is underway to develop genetic and diagnostic imaging tests to identify patients at greater risk for rare forms of Alzheimer's that begin in the 40s and 50s. Typically, Alzheimer’s symptoms become apparent among older people.

“For the younger group, we are researching the use of genetic tests and functional magnetic resonance imaging (fMRI) beams to identify their risk,” Dr. Antuono says. He and a Medical College biophysics researcher, Shi-jiang Li, PhD, Professor, Biophysics Research Institute, are principal co-investigators in this one-of-a-kind study that has been awarded a grant from the National Institutes of Health. Dr. Antuono and his colleagues also use PET scans to help identify these younger patients. A PET (positron emission tomography) scan is an imaging technique that can detect subtle changes in the body's metabolic and chemical activities. These scans can be more sensitive and specific than other imaging techniques in assessing function.

Importance of Diagnosis
Correctly diagnosing the disease is essential, because other disorders can mimic Alzheimer’s symptoms. For instance, depression, which is extremely common in the elderly, may include Alzheimer’s-like symptoms such as forgetfulness and withdrawal. Conditions such as such as heart disease, hypertension and arthritis can affect an elderly person’s ability to function, perform everyday activities such as personal care, or be socially involved. Another common form of dementia among the elderly is alcohol-related. As with Alzheimer’s, individuals may become forgetful and have problems with concentration, Dr. Antuono says. “Unlike Alzheimer’s patients, however, they do not have problems with language or visual-spatial coordination. And, unlike Alzheimer’s patients, these people are aware they have memory problems.”

It’s not unusual for patients to deny they have a deficit. Dr. Antuono suggests those who are worried about a loved one’s memory loss mention the concern to the individual’s physician. Most primary-care physicians can perform standard memory tests, which could be less threatening than taking them to a specialist immediately. If the patient’s regular physician finds memory concerns, then that physician might suggest a referral to a specialist.

Disease Development and Effect on Families
Family members often notice the changes in memory function so characteristic of Alzheimer’s. “Although,” Dr. Antuono notes, “sometimes memory losses are preceded by other symptoms. There may be subtle personality changes – the patient may be quieter than usual, or more hesitant, or crabbier.” It usually takes a perceptive observer to notice these changes, he adds.

The classic changes in memory function associated with Alzheimer’s may include forgetfulness, repetitiveness, difficulty organizing thoughts, and social withdrawal. An affected individual might have difficulty processing such information as where and when an appointment is to occur. As the disease progresses, language skills diminish along with the ability to perform calculations or plan activities. The individual becomes more dependent on family members to carry out simple tasks like shopping and getting dressed.

Alzheimer’s strongly affects family members or caregivers as they gradually become responsible for the individual's entire well-being, sometimes including full-time supervision and custodial care. Family members sometimes give up their jobs to care for their loved ones. The toll can be significant: Compared with other people their age, caregivers of Alzheimer's patients themselves have 70% more physician visits, are 50% more likely to suffer depression, and use 40% more medication.

Treatment and Research
Although there is no cure for Alzheimer's, medications have become available to treat its symptoms. Some treat behavioral symptoms such as agitation or restlessness; others may help to slow the progression of the illness. Another medical intervention is the administration of high doses of vitamin E. Newer medications specifically address cognitive changes that affect memory and language. Approaches to treatment currently under development include medications that prevent protein deposits – thought to cause Alzheimer's – in the brain.

Since 1985, the Medical College of Wisconsin has been studying medications to treat Alzheimer's. Research being conducted at the Medical College includes a trial of Memantine, a drug recently approved for Alzheimer’s treatment in Europe. The Medical College is part of a multicenter study of the drug in the United States. Dr. Antuono and his colleagues are also studying the use of statins – drugs used to lower cholesterol – for their effect on Alzheimer’s.

Prevention Studies
Can Alzheimer’s be prevented? Research has not yet found an answer to that question, but Dr. Antuono observes: “There is evidence that people who are socially connected in middle age have 50% less incidence of Alzheimer’s.” People who continue to stimulate their brains and stay mentally active seem less predisposed to the disease, he says, but cautions, “it’s not certain whether their mental activity helps prevent the disease from developing or whether they are simply endowed with better brains to begin with.”

Medical College researchers are continuing their NIH-supported study to identify early-life risk factors that may predict who is likely to develop Alzheimer's. Nearly 700 nuns from the School Sisters of Notre Dame religious order were originally enrolled in the study. (The nuns' lifestyle excludes variables such as drinking, smoking and child-bearing.) Researchers have access to the nuns' health and lifestyle records, sometimes dating to childhood.

Dr. Antuono is confident that ongoing research and treatment will continue to result in breakthroughs in Alzheimer’s Disease. “I’m more optimistic all the time,” he says.

Barbara Abel
HealthLink Contributing Writer

Other members of the Memory Disorders Clinic staff - part of Froedtert & Medical College Neurology - include Malgorzata B. Franczak, MD; Diane S. Book, MD; Diana R. Kerwin, Assistant Professor of Geriatrics and Gerontology; Jan Beyer, RN; Suzanne Moser, MSW; Deb Stephens, RN; and Jennifer Jones, MA.

For more information on this topic, see the HealthLink articles With Alzheimer's, the Caregiver Is a Patient, Too