Staying current on advances made in Alzheimer’s disease, the most common type of dementia, is difficult because findings are reported nearly every day in scientific journals and the media.
One of my favorite resources for evidence-based information is the Alzheimer’s Association International Conference. Each year, the conference provides an overview of the year’s best research from world-leading experts with more than 2,000 presentations on the study and treatment of Alzheimer’s. The 2016 meeting was held in Toronto, Canada, and here are some of the conference highlights:
New Protective Factors Identified
Among people diagnosed with mild to moderate late-life Alzheimer’s (onset after age 65), about 60-70 percent test positive for a genetic variant called ApoE4. This means that there are both genetic and environmental reasons people develop Alzheimer’s. However, having one or more of the genetic variants does not mean someone will definitely get the condition. It means that if someone is exposed to certain risk factors in the environment, the gene can “turn on” and cause the disease processes of Alzheimer’s to begin.
Identifying environmental risk factors for Alzheimer’s has been the focus of much research in the past 10-20 years. Health conditions that affect the cardiovascular system seem to have the most influence to “turn on” Alzheimer’s genes (most notably type 2 diabetes, high cholesterol and hypertension).
Researchers are now studying “protective factors” that may buffer these effects. Data presented at this year’s conference suggested that people whose occupation in mid-life required complex thinking and activity had a greater ability to fight the effects of Alzheimer’s and that working with people, rather than data, provided the greatest defense.
“Early” Treatment Redefined
Despite many promising starts, translating laboratory findings into patient treatments is painstakingly slow. Unfortunately, this year’s meeting brought news of another failed late-phase clinical trial for a medication called “LMTM” (TauRx Therapeutics). Many researchers said that the lack of a cure or highly effective medication to date is because treatments begin too late. The disease processes that cause Alzheimer’s start many decades before any of the learning, memory, word-finding and personality changes that characterize Alzheimer’s begin.
A theme at this year’s meeting was the importance of detecting the earliest brain changes—even in young and middle age. It was discussed that future treatments will need to be started many years before someone starts showing the symptoms. This will involve identifying people at genetic risk for Alzheimer’s in early and mid-life with DNA testing and proactively treating them before any observable symptoms.
“De-prescribing” Shows Promise in Treating Behavioral Symptoms of Alzheimer’s
So-called “behavioral disturbance” in Alzheimer’s disease is fairly common, with estimates of about 40-45 percent of people exhibiting agitation and issues, such as paranoia and wandering.
Many of us who have cared for people with Alzheimer’s know these symptoms are often more difficult to manage than problems with memory. While there are likely biological reasons for these symptoms, they are also certainly related to social, and therefore treatable, factors including a lack of stimulation, social isolation and difficulty with communication.
Unfortunately, many healthcare workers are not properly trained to know how to deal with these issues, and more than 25 percent of patients in residential care facilities in the U.S. receive powerfully sedating medications as the first-line treatment.
At this year’s conference, Australian researchers presented results from a project where they dramatically reduced the use of anti-psychotic medicines in 75 percent of study participants after six months through a process of “de-prescribing.” This included training staff in non-pharmacological and person-centered approaches to dementia care, including engagement in therapeutic activities and helping to reduce stress in the environment.
Memory Testing in Older Adults’ Health Exams
The importance of an early and accurate diagnosis in Alzheimer’s continues to be emphasized. It was once believed that Alzheimer’s could only be diagnosed at autopsy; we now know that this is not true. An evaluation by a neuropsychologist using comprehensive pen and paper testing to assess learning and memory and sophisticated types of brain scans usually only offered in research settings remain the best tools to diagnose all forms of dementia.
An early diagnosis allows the person to get the most benefit from the memory-enhancing medications on the market (Aricept and Namenda are the most common). One study at this year’s meeting showed that patients treated with these medications are hospitalized less and have lower mortality rates compared to untreated patients. This is in addition to the already known benefits of slowing down the symptoms from the point when the person starts to take the medications.
Getting older adults to undergo memory testing that is both sensitive and comprehensive enough to diagnose dementia continues to be a worldwide challenge. There are not nearly enough medical providers specializing in geriatric medicine to meet the demand. Researchers made the recommendation that memory testing should be a part of all older adults’ health care after the age of 65 due to the expense—financial and emotional—of undiagnosed and untreated dementia. Many people are surprised to learn that Medicare and many other insurances cover the majority, if not all, of the costs for these evaluations.