head of broccoli

New research into Alzheimer’s Disease and other forms of dementia is making it easier for doctors and clinicians to detect a condition that makes it difficult for 5 million older Americans to remember details and perform certain tasks before the disease’s symptoms start showing up.

Scientists working in this field in laboratories across the country say the ability to spot the disease at such an early time could open the door to treatments that could prevent the disease or at least slow its progression.

They’re also taking a closer look at another medical condition — vascular dementia — that has been linked to Alzheimer’s disease and has been shown to make its symptoms much worse, and whether this condition could be prevented by eating salmon, broccoli or leafy green vegetables.

“There’s a lot of clinical trials targeting Alzheimer’s disease (and other forms of dementia) that are happening right now,” said Lisa Silbert, an associate professor at the Oregon Health & Science University’s Layton Center for Aging and Alzheimer’s Disease.

But even with these new breakthroughs, advocates for people with Alzheimer’s disease and other forms of dementia claim more private and public money needs to be invested into these research efforts to make sure they continue.

They fear that unless more progress is made, costs associated with Alzheimer’s disease could bankrupt the country’s health care system over the next 10 to 15 years as baby boomers get older and reach an age where they could start coming down with the disease.

The biomarker

First discovered in 1906, Alzheimer’s disease is a degenerative neurological condition where abnormal clusters of proteins known as plaques build up between the nerve cells in a person’s brain and interfere with its ability to send signals on the cellular level.

These plaques, along with tangles that form in the nerve cells that are also a hallmark indicator of Alzheimer’s disease, can interfere with a person’s ability to remember details, concentrate and plan or organize certain activities.

Over time, the neurological damage done by the disease reaches a point where, according to the Alzheimer’s Association, the person has problems controlling his or her muscles and may not be able to hold his or her head up, swallow or even smile.

Dean Hartley, the director of science initiatives for the Alzheimer’s Association, said very little is known about what causes the plaques and tangles to form in a person’s brain cells even after decades of looking at the disease and its effects.

“It’s likely there may be multiple causes of the disease,” he said.

Hartley said research has shown that genetics and cardiovascular health are two factors that may put a person at greater risk of developing the disease. But age continues to be the most common risk factor, he said.

Studies have shown that one out of every 13 people who reach the age of 65 and one out of every two people who reach 85 will develop Alzheimer’s disease or another form of dementia before they die.

This link between Alzheimer’s disease and age has the disease’s advocates worried about what will happen when the country’s 37.5 million baby boomers — a generation of Americans born between 1946 and 1964 — reach these benchmark ages over the next 15 to 20 years.

But while the root cause of Alzheimer’s disease remains elusive, Hartley said, just last year researchers at the Dominantly Inherited Alzheimer’s Network Trial Unit in St. Louis discovered a way they could detect and measure the amount of beta-amyloids — a type of protein that has been linked to the plaques associated with Alzheimer’s disease — in a person’s system at least 10 to 15 years before he or she starts manifesting the disease’s symptoms.

Hartley said this discovery is crucial to the fight against Alzheimer’s disease because it lets clinicians identify people who may be at risk of developing the disease at a very early stage when it may still be possible to address symptoms before the damage is too great.

He also said the ability to monitor the amount of beta-amyloids and tau proteins — which are associated with the tangles that form in a person’s brain cells — also makes it easier for clinical researchers to test new drugs that could prevent the disease or slow its development.

That’s because if scientists discover a certain therapy has an immediate effect on the amount of beta-amyloid and tau proteins in a person’s system, they can push it forward to other trials where it is tested on people who are at risk of developing the disease or are in its early stages.

If the drug therapy being tested does not have an immediate impact on these two chemicals, he said, it can be scrapped without going through the costly and time-consuming advanced trial process, and researchers can try something else.

“It’s kind of like plug-and-play,” said Hartley, who knows of at least six Alzheimer’s drugs that are moving through the clinical trial phases being done at the St. Louis facility and other Alzheimer’s research centers across the country.

Meanwhile, scientists at other research centers — including OHSU’s Layton Center — are investigating links between Alzheimer’s disease and vascular dementia, and looking at ways this medical condition could be prevented as well.

Other developments

Silbert with the Layton Center has focused her research on vascular dementia, a medical condition associated with strokes that is the second-most common form of dementia after Alzheimer’s disease.

“Vascular dementia can bring out the Alzheimer’s pathology (and symptoms) earlier,” she said, explaining one of the links between the two types of dementia. It can also make the symptoms of Alzheimer’s much worse and speed up their progression, she added.

Silbert said the link between the two types of dementia is important because research has shown it’s possible to modify a person’s risk factors for cerebrovascular disease, which has been linked to strokes and vascular dementia, much in the same way they can limit their risk factors for cardiovascular disease and heart attacks.

That’s why her research center is getting ready to start two studies that will look at whether two antioxidants that have shown the ability to combat cardiovascular disease would work with cerebrovascular disease.

One study will look at whether omega-3 fatty acids, which are found in foods like flax seed and salmon, can prevent the development of cerebrovascular disease in people who are 85 or older, she said. The second study will look at whether a mixture of these antioxidants and alpha-lipoic acids, which are found in calf’s liver and broccoli, can prevent the disease in middle-aged people who suffer from high blood pressure or hypertension.

“Treating or preventing vascular dementia could be very important when it comes to Alzheimer’s disease,” Hartley said. The Alzheimer’s Association will soon host a research conference that will look exclusively at what scientists know about the links between the two conditions and how new research can be targeted, he said.

Both Hartley and Silbert said they’ve also seen promising research on whether getting increased amounts of exercise or taking on mentally stimulating activities later in life could help prevent the development of Alzheimer’s disease or at least slow its progression once its early stages have set in.

“More and more we’re finding how beneficial exercise is, at least in the short-term,” Silbert said, adding several associative studies — which compare a person’s behaviors to their medical history — have shown a possible link between the two factors.

Hartley said these studies have found that continuing to exercise later in life improves a person’s cognitive abilities and can strengthen the neural connections affected by the plaques and tangles associated with Alzheimer’s disease.

He said similar research has shown that taking part in mentally stimulating activities — like learning a foreign language, playing music or working on puzzles — may also strengthen a person’s cognitive abilities and neural connections, particularly when they are done in a social setting.

But he and Silbert both said that while the research on the connection between these activities and a person’s cognitive abilities looks promising, much more work needs to be done before they can positively say whether there is a connection between them and the development of Alzheimer’s disease.

“The cognitive evidence is good, and I’m hoping to see it advance to the next levels,” said Silbert, who like Hartley still recommends that people do whatever they can to remain physically active and keep their minds sharp as they get older, even though there is no definitive link between these activities and Alzheimer’s disease.

Hartley said that in order for these studies — as well as those looking at drugs targeting a person’s beta-amyloid levels and the links between vascular dementia and Alzheimer’s disease — to move forward there needs to be money set aside to fund them.

He said a single drug trial can cost upwards of $100 million, depending on how many people it involves and how long it takes. This cost and the low likelihood of finding a successful drug to treat Alzheimer’s disease because so little is known about its cause has prompted the private sector to back away from researching the disease.

Kathleen Cody, director of the Alzheimer’s Association Oregon Chapter, said her organization has been actively working to fill this gap by raising private money and giving $315 million in grants to 2,200 research projects since 1982.

But while the association’s investment has helped researchers like Hartley and Silbert learn more about Alzheimer’s disease, she said it is nothing compared to what the federal government can do if it made the disease a priority — like cancer or HIV/AIDS — and funded it as such. She said these two diseases get billions of dollars in research spending from the federal government each year while Alzheimer’s disease gets a fraction of that amount.

“There’s a direct relationship between finding cures and treatments for a medical condition and the amount of money that’s spent on research,” said Hartley, who stressed the importance of increasing the amount of federal funding for Alzheimer’s research before boomers reach an age where their risk of developing the disease skyrockets.

Cody said there has been some progress in remedying this funding gap and pointed to the fact that the $100 million set aside for Alzheimer’s research in the National Institute of Health’s budget survived the sequester and other federal spending cuts intact.

She also said legislators on both the federal and state levels are beginning to make Alzheimer’s disease a priority. It was the only medical condition mentioned in President Barack Obama’s February 2013 State of the Union Address, and the Oregon health officials released their State Plan for Alzheimer’s Disease and Other Dementias in July 2012.

“People are beginning to understand that the more money we put into research the more likely we are to find a cure,” Cody said.

— Reporter: 541-617-7816, mmclean@bendbulletin.com