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No Cure Yet, But Reasons for Hope

By Abigail Trafford
Washington Post Staff Writer
Tuesday, November 7, 2000

You come out a different elevator in the underground parking lot and can't find your car. . . . And then you don't recall the names of the actors in "Chariots of Fire," even though you can still hear the clack-clack-clack of the music in your mind. Another time, you misplace your glasses.

First you make a joke of it.

Then you get worried. Is this the beginning of Alzheimer's disease?

For so long Alzheimer's has been the Land of Darkness on the disease map, the dreaded diagnosis in which the mind is slowly looted of reason and affection, and patients and their families are trapped in a downward spiral.

But now this bleak image of Alzheimer's is changing. In the last few years, the disease has shed its shadow of hopelessness. There is no cure, but there is hope. In rapid fire, better tools to detect and treat this disorder are coming out of medical research centers.

The latest is a report published yesterday in the Journal of Nuclear Medicine, demonstrating the effectiveness of PET scans to diagnose Alzheimer's. Other imaging methods such as functional MRI and SPECT are also being used to detect brain diseases.

Imaging technologies make it possible to diagnose Alzheimer's months or even years before telltale symptoms appear.

Why, you might ask as you look for your car keys, would you want to know if Alzheimer's was laying siege to your brain before it was really noticeable?

A decade ago, a "there's nothing we can do" attitude prevailed in the treatment of Alzheimer's. But today, therapies are available, and early diagnosis opens the door to early treatment that can slow down the onset of symptoms and postpone the need for nursing home care.

Several drugs--tacrine, donepezil and rivastigmine--have shown benefit to some patients. To be sure, these first-generation drugs have side effects and their usefulness is limited. But they are increasingly prescribed to treat mild to moderate cases of Alzheimer's.

Meanwhile, the ability to diagnose the disease early puts pressure on the scientific community to deliver better therapies. A vaccine, for example, has been successfully tested in mice, according to a recent report in the Annals of Neurology. It's a nasal spray that reduced potentially damaging Alzheimer's-like plaques in the brains of the experimental mice. A similar injected vaccine developed by scientists at Elan Pharmaceuticals is being tested to see if it's safe for use in people. In addition, an agent aimed at blocking the underlying mechanism of Alzheimer's is being tested in human studies, with results expected next spring.

The hope is that effective early treatment will stall or prevent the progression of the disease and enable people to lead healthy, independent lives for an extended period "By the time [Alzheimer's] is full-blown, a lot of nerve cells have been lost. We don't want to wait until it's full-blown. We want to take a step back," says Marilyn Albert, professor of psychiatry and neurology at Harvard Medical School. "Because we think there are better medicines coming down the line, we're trying to figure out how to diagnose it early."

Or as psychiatrist Gary Small, director of UCLA's Center on Aging, puts it: "The goal is to try to delay the onset of the disease long enough so more people die of other causes."

That goal is still far off. But developing the technologies to diagnose Alzheimer's before debilitating symptoms occur is a turning point for the disease. It changes Alzheimer's persona from being an inevitable disintegration to a lifelong illness. Like other chronic diseases such as diabetes and cancer and Parkinson's, Alzheimer's has to be managed with a range of therapies and social supports. The focus shifts from dying of the disease to living with it.

The medical evolution of Alzheimer's can't happen soon enough. About 4 million Americans have the disorder, from the high-profile case of former president Ronald Reagan to the people we care about in our ordinary lives--a next-door neighbor, the mother of an old friend, a former mentor. We know what the disease feels like, and we know that its incidence increases with age. About half of those over 85 suffer from some form of dementia--two-thirds of them from Alzheimer's. By the time the baby boom gets into full geriatric gear in mid-century, the dementia ranks are projected to swell to some 14 million.

Of course, just because you can't find your car keys doesn't mean you should get a PET scan to see if you have Alzheimer's. But if you are at high risk for the disease because of a family history or because your memory lapses are wreaking havoc with your life, you can now get answers and get help. "It's very exciting," says Harvard neurologist Dennis Selkoe. "The new idea is to combine imaging with genetic knowledge. That would give us a chance to identify people in the early stage when treatment is most effective."

These days, you want to know. If you have Alzheimer's, you want to know because there is hope. That's a huge difference from just a few years ago.

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