Doctor says new Alzheimers treatments can add years to patients' lives

A leading Alzheimer's disease expert said there is new hope for treating the deadly diagnosis that previously meant a 'death sentence' for patients. 

Doctor Marc E. Agronin, who has been a geriatric psychiatrist in Miami since 1999 and is an advocate for purposeful aging, claimed that a host of new methods of treating Alzheimer's disease may add years to patients' lives. 

Advances in early detection and management have changed the way patients can live with the disease. The shifting methods include new treatments, therapies, medication and lifestyle adjustments.  

'Thanks to new developments in the early detection and management of Alzheimer's, as well as new medications, many patients can slow the course of the disease and boost their well-being,' Dr. Agronin wrote in the Wall Street Journal. 

'The result is that more Alzheimer's patients are able to live relatively normal lives for much longer than previously—several years, at least, and often longer.' 

Previously, a diagnosis often signaled the beginning of a swift decline, but now, patients can seek interventions to prevent or alleviate symptoms.

The shift is largely prompted by emerging research on the cognitive benefits of lifestyle adjustments. 

'Until just a few years ago, the typical work-up for Alzheimer's disease began when someone walked into my office with noticeable symptoms,' Agronin said in a Wall Street Journal article. 'The advice: Get your affairs in order, and fairly quickly.' 

'But now, many work-ups begin with patients seeking to improve their lives by either preventing or lessening mild symptoms, prompted by a host of new findings about the cognitive benefits of lifestyle interventions, as well as conditions that can exacerbate decline.'

The lifestyle changes patients are encouraged to take include quitting smoking, moderating alcohol consumption, improving diet, regular exercise, managing depression, and keeping mentally active.

'That different face is increasingly the face of Alzheimer's - the result of a quiet revolution in the way doctors treat the disease, as well as the way patients live with it.'

Agronin's message to his patients is that treatment is not a race but a marathon. 

'Preventing or ameliorating mild symptoms isn't a race but a marathon over decades, and it requires consistent, longstanding lifestyle changes starting as early as possible in adulthood,' he said. 

'What's more, thanks to our newfound ability to detect the disease early, we can start that marathon far sooner than in the past.' 

With a focus on early detection and management, patients now have the opportunity to slow the disease's progression and improve their well-being significantly.

Biomarker tests can provide early indications of Alzheimer's, allowing for advanced interventions and participation in clinical trials for potential treatments. 

'If someone in her situation had come to me at the start of my career, there wasn't much I could do at such an early stage other than speculate on the diagnosis and monitor symptoms as they unfolded,' Dr. Agronin said. 

'Now there are tests for several physical indicators of Alzheimer's, called biomarkers, that can reveal whether there are the telltale toxic proteins of beta-amyloid and tau in the brain.'

Dr. Agronin explained:  'When combined with other information, these results can provide a relatively definitive diagnosis of early-stage Alzheimer's disease and enable the person to make lifestyle changes, as well as start new treatments or clinical trials right away to attempt to alter its course.' 

New immunotherapies, like lecanemab, also offer promise in slowing cognitive decline, creating optimism for a more extended period of quality life for patients.

In addition to lecanemab, there are many other novel treatment approaches in clinical trials that show hope in changing the course of the disease, he noted.  

'The discussion we have about what a diagnosis of Alzheimer's means in such an early stage is shaped by the fact that many affected individuals are still working, traveling, parenting and even taking care of their own aging parents, and they want to continue engaging in all of these roles and activities as long as possible.'

'I now tell my patients that by slowing the course of an already slow-moving disease, these new treatments could extend their current quality of life even longer.'

Patients are seeking help at younger ages and reshaping conversations around Alzheimer's to focus on maintaining an active and fulfilling life for as long as possible.

The growing awareness and treatment evolution also helps foster a collaborative and hopeful approach between patients, families, and healthcare providers, Dr. Agronin emphasized. 

'This hopeful message often prompts a more engaged and happier partnership with the patient and family, since we are shifting from an era of passively watching the disease's inexorable decline to one in which we are actively altering its course until, we hope, something better comes along.'

 'As this early detection and new therapies become more refined and widely known, I am seeing more people come to me in their 50s and 60s—much younger than the average patient I saw when I first started our memory clinic over 20 years ago.'

In February, a study in mice suggested that zapping the brain with electrical currents could prevent dementia symptoms up to 20 years before they start.

Researchers in Tel Aviv, Israel, found they could stop the decay of brain cells and prevent memory loss and cognitive decline when they targeted the areas of rodents' brains that are damaged during Alzheimer's.

Once a month, electrodes that were surgically attached to their brains, the team delivered low-level electrical waves to stop harmful proteins from forming in the brain and the brain's memory center from shrinking.

Study author Dr Inna Slutsky said: 'This indicates a potential for predicting the disease in the dormant state, before the onset of cognitive decline.'

The team analyzed changes in the brain that occur during sleep, which they said is often when early signs of the condition develop.

To test this, the researchers put the mice to sleep with anesthesia to study changes occurring in the hippocampus, the brain's memory center.

What is Alzheimer's and how is it treated? 

Alzheimer's disease is a progressive, degenerative disease of the brain, in which build-up of abnormal proteins causes nerve cells to die.

This disrupts the transmitters that carry messages, and causes the brain to shrink. 

More than 5 million people suffer from the disease in the US, where it is the 6th leading cause of death, and more than 1 million Britons have it.

WHAT HAPPENS?

As brain cells die, the functions they provide are lost. 

That includes memory, orientation and the ability to think and reason. 

The progress of the disease is slow and gradual. 

On average, patients live five to seven years after diagnosis, but some may live for ten to 15 years.

EARLY SYMPTOMS:

• Loss of short-term memory
• Disorientation
• Behavioral changes
• Mood swings
• Difficulties dealing with money or making a phone call 

LATER SYMPTOMS:

• Severe memory loss, forgetting close family members, familiar objects or places
• Becoming anxious and frustrated over inability to make sense of the world, leading to aggressive behavior 
• Eventually lose ability to walk
• May have problems eating 
• The majority will eventually need 24-hour care   

HOW IT IS TREATED?

There is no known cure for Alzheimer's disease.

However, some treatments are available that help alleviate some of the symptoms.

One of these is Acetylcholinesterase inhibitors which helps brain cells communicate to one another. 

Another is menantine which works by blocking a chemical called glutamate that can build-up in the brains of people with Alzheimer's disease inhibiting mental function. 

As the disease progresses Alzheimer's patients can start displaying aggressive behaviour and/or may suffer from depression. Drugs can be provided to help mitigate these symptoms.   

Other non-pharmaceutical treatments like mental training to improve memory helping combat the one aspect of Alzheimer's disease is also recommended. 

 Source: Alzheimer's Association and the NHS

The team used anesthesia based on data suggesting that anesthetics can lead to a buildup of toxic proteins that can lead to Alzheimer's.

Study author Dr Inna Slutsky said that these signs of decline could appear years before symptoms of dementia. 'Anesthesia reveals a pathophysiology in the brain activity in the animal model,' she said.

'We think that there are mechanisms that compensate for that same pathology while awake and thus prolong the pre-symptomatic period of the disease.'

The researchers found that the mice experienced 'silent seizures' in the hippocampus while sleeping, which look like seizures on brain scans but don't cause any outward symptoms. Healthy mice, however, had reduced activity.

They said that the silent seizures could be signs of the brain deteriorating.

To prevent this excess activity, the team used deep brain stimulation (DBS), a surgical procedure where electrodes are placed in specific areas of the brain. These electrodes are connected by wires to a device placed under the skin near the chest.

The device sends electrical pulses any time the brain produces abnormal signals, such as those that result in memory issues, balance problems, and speech difficulties.

The team noted that patients with Alzheimer's have several signs of deterioration in their brains. This includes the build-up of the proteins amyloid-beta and tau, which can destroy brain cells responsible for memory.

Additionally, the brain's memory and learning center - the hippocampus - shrinks, and there is increased activity in it during sleep. This leads to memory loss.

The researchers focused on finding protective measures against this decline.

Shiri Shoob, lead study author and a doctoral sudent at Tel Aviv University, said: 'As early as 10-20 years before the appearance of the familiar symptoms of memory impairment and cognitive decline, physiological changes slowly and gradually occur within the patients' brains.'

In the study, published in November in the journal Nature Communications, Ms Shoob's team found that DBS suppressed that excess activity, preventing cognitive decline as early as 20 years before Alzheimer's onset.

In the study, researchers connected the electrodes to the nucleus reuniens, a small part of the brain that connects the hippocampus to the thalamus, which regulates sleep. This was done once per month.

DBS has also been used in the US to treat neurological disorders like Parkinson's disease, epilepsy, essential tremor, dystonia, and obsessive-compulsive disorder.

'When we tried to stimulate the nucleus reuniens at high frequencies, as is done in the treatment of Parkinson's, for example, we found that it worsened the damage to the hippocampus and the silent epileptic seizures,' Ms Shoob said.

'Only after changing the stimulation pattern to a lower frequency were we able to suppress the seizures and prevent cognitive impairment.'

'We showed that the nucleus reuniens had the ability to completely control these seizures. We could increase or decrease the seizures by stimulating it.'

The team plans to pursue human clinical trials next.

Alzheimer's disease is the most common form of dementia, an umbrella term used to describe a range of progressive neurological disorders (those affecting the brain), which impact memory, thinking and behavior.

Common symptoms include memory loss, poor judgment, confusion, repeating questions, difficulty communicating, taking longer to complete normal daily tasks, acting impulsively, and mobility issues.

According to the Alzheimer's Association, more than six million Americans have the condition, and 73 percent are age 75 or older. 

In January, scientists introduced the latest medical breakthrough in diagnosing Alzheimer's — a simple blood test that can seemingly spot signs of the disease in the brain up to 15 years before symptoms strike.

Diagnosing the disease is tricky - currently, patients must undergo a swathe of tests, including scans and a lumbar puncture, with some facing waits of up to four years for their diagnosis. Others die before being told they have the condition. 

Now, while blood samples in that study were pored over in labs, researchers hope to turn the test into a finger prick — binning the years-long agonizing waits that some patients are forced to endure.