The efforts to understand Alzheimer’s disease are always in motion through conducting new research to unlock its biological mechanisms, improve diagnosis and create new treatments. That is why, once a year, Dr. Rachelle Doody, a leading expert in Alzheimer’s disease, hosts her signature “Update on Alzheimer’s.”
The educational symposium is hosted by Baylor College of Medicine and the Alzheimer’s Association of Houston & Southeast Texas Chapter. This event was made possible by the Moselle and Milton Pollack endowed fund at Baylor College of Medicine.
Doody, professor and director of the Alzheimer’s Disease and Memory Disorders Center at Baylor College of Medicine, presented six issues and questions that she is asked about most often.
- Who should we develop therapeutics for? Should we focus on prevention or treatment?
Everyone is potentially at risk for developing Alzheimer’s disease, Doody said, however, that does not mean that everyone will one day suffer from the illness. She also stated that the disease progresses in stages over many years, with some pathological changes beginning years before people begin to experience the tell-tale signs of dementia. With that in mind, she said focusing research on prevention is as important as research on treatments for dementia.
- Is there a treatment for one target or many targets?
Since there is not just one event known to cause Alzheimer’s disease, Doody said the focus has to be on many targets, such as the buildup of plaques and tangles in the brain, high cholesterol, and poorly controlled blood sugar levels.
“For a small percentage of people genetics are at play, but Alzheimer’s is more of a brain failure event, where risk factors and brain ability come into play,” she said.
- Is the incidence of Alzheimer’s disease going down?
Some research points to fewer cases, Doody said; however, the significance of these numbers is unclear and they cannot predict future trends in the development of AD.
“We could be seeing, 50 years later, the benefits of early life education and good nutrition, as well as public health education about blood pressure, cholesterol, sugar intake and other risk factors for AD,” she said. “A real possibility is that we may see a decline in years to come, but at this time there isn’t enough evidence to predict the numbers rising or falling.”
- How do we diagnose someone with Alzhiemer’s disease?
Doody mentioned recent studies looking into different tests such as blood tests or imaging methods, but reminded attendants that those are still in the research phase and at this time there is are no definitive lab test to detect AD.
It’s a combination of patient history, symptom review and physical and neurological examinations that must be done in a clinical setting.
- How effective are current treatments?
Being diagnosed and starting treatment early slows the progression of the disease, Doody said. However, she added that while there are not many longitudinal, double-blind, control studies examining how the disease progresses with treatment for the duration of the disease, there is mounting evidence from naturalistic longitudinal studies that early, consistent treatment with anti-dementia medications is helpful.
“The process of creating and following through with a longitudinal study can be slow, but there are currently hundreds of studies under way.”
- Are there promising therapies under development?
There are multiple studies under way specifically to test or develop new treatments, but they must go through the correct process. They begin in a lab in preclinical trials. When a study moves on to Phase 1 and 2, it is being tested for safety and efficacy. Results must be favorable and replicated before it moves on to Phase 3, which involves testing the treatment in large groups of people.
“Sometimes Phase 3 is conducted twice before drugs can be brought to the market for use,” Doody said. “In some cases, studies are stopped during an early phase when they just don’t work. While that is not the outcome we hope for, even those results are valuable. They help us fine tune the targets and therapeutics that we should be focusing on.”
Doody, who also is the Effie Marie Cain Chair in Alzheimer’s Disease Research at Baylor, followed her presentation with a question-and-answer session. Representatives from the ADMDC and the local Alzheimer’s Association were on hand to talk to guests after the event ended as well.