In 1908 Dr. Alois Alzheimer discovered a memory erasing, attitude destroying and human dignity stealing deadly disease coined after his name, researching on a patient in a mental asylum.
The disease, in the absence of still any effective treatment, converts a lively human being gradually into a vegetative state, ruthlessly, though the life keeps ticking erratically before it finally extinguishes.
Despite advancement of medical science at a break neck speed, is it not quite surprising that it took 90 years, from 1908 to 1998, to formally accept the root cause of Alzheimer’s disease in the medical science?
Still the greatest mystery of this disease is why it strikes mostly at an advancing age. Other risk factors include ailments such as, diabetes, depression, cardiac conditions and sedentary life style.
I deliberated on this issue in one of my earlier blog posts titled, “Alzheimer’s Disease: Robs Memory: Steals Dignity: Escapes Treatment” of August 11, 2014, though on a different perspective.
A flash back on the disease:
A September 2014 article of Dr. Rod Tanchanco, published in the ‘History News Network’, elucidates how Dr. Alzheimer discovered this deadly disease in a Mental Asylum.
As Dr. Rod Tanchanco narrated, the germination of this discovery started with an orderly and industrious homemaker Auguste, a 50 year old housewife, who started making uncharacteristic mistakes in preparing home meals – a task in which she had been quite proficient for long.
With the progress of time, Auguste gradually started wandering aimlessly around the apartment, leaving many unfinished work in the house. Her attitude and behavioral pattern also started changing noticeably. Concerned with these changes, her husband Carl had no other choice but to take her to the local mental asylum.
The physician’s in the asylum described her as suffering from a weak memory, persecution mania, sleeplessness, and restlessness that rendered her unable to perform physical or mental work. However, the psychiatrist sensed that there was something special about Auguste and Dr. Alois Alzheimer decided that he should see Auguste for himself. The limited treatments included the use of sedatives and warm baths.
After thorough examination, what struck Dr. Alzheimer was Auguste’s relatively young age (51) as he had seen many cases of mental deterioration in much older patients that prompted him to theorize that age-related thickening of the brain’s blood vessels led to brain atrophy.
After about five years of progressive mental and physical decline, Auguste died in 1906. The official cause of death was stated as blood poisoning due to bedsores. However, Dr. Alzheimer suspected that behind her mental illness was a strange disease and perhaps examining her brain would offer some clues.
Discovery of the disease:
When Dr. Alzheimer examined Auguste’s brain sections under the microscope, his inkling was proved to be a reality. He described changes in the neurofibrils – the protein filaments found in brain cells. He also saw peculiar deposits that he referred to as “millet seed-sized lesions.” These pathologic findings, which are now known as neurofibrillary tangles and amyloid deposits, characterize the brains of patients suffering from Alzheimer’s Disease.
Skeptical initial response:
As Dr. Rod Tanchanco highlights, Dr. Alzheimer’s discovery was not immediately well received, as correlating mental or neurologic disorders with histopathologic findings was not firmly established nor accepted by his peer groups at that time.
Acceptance after long 90 years:
Ninety years later, in 1998, researchers re-examined Auguste’s original brain sections and confirmed the presence of neurofibrillary tangles and amyloid plaques. There is still no cure of this life-threatening disease, and the burden on the afflicted continue to remain mind-boggling.
According to Dr. Tanchanco, one of the most prominent psychiatrists in the early 1900s called Emil Kraepelin, first mentioned the term ‘Alzheimer’s Disease’ in the 1910 edition of his textbook on psychiatry. The disease was still poorly understood, but one of the most famous medical eponyms was born with it.
Where are we today?
All current treatments for Alzheimer’s cannot stop the underlying decline and death of brain cells. Thus, as more cells die, Alzheimer’s continues to progress.
Experts are cautiously hopeful about developing Alzheimer’s treatments that can stop or significantly delay the progression of Alzheimer’s. A growing understanding of how the disease disrupts the brain has led to potential Alzheimer’s treatments that short-circuit fundamental disease processes.
A laudable initiative has come to the fore recently in this arena. Having experienced something like the ‘law of diminishing return’ in pursuit of high resource intensive R&D projects aimed at critical disease areas such as Alzheimer’s, 10 big global pharma majors reportedly decided in February 2014 to team up with the National Institutes of Health (NIH) of the United States in a ‘game changing’ initiative to identify disease-related molecules and biological processes that could lead to future medicines.
This Public Private Partnership (PPP) for a five-year period has been named as “Accelerating Medicines Partnership (AMP)”. According to the report, this US federal government-backed initiative would hasten the discovery of new drugs in cost effective manner focusing first on Alzheimer’s disease, Type 2 diabetes, and two autoimmune disorders: rheumatoid arthritis and lupus. The group considered these four disease areas among the largest public-health threats, although the span of the project would gradually expand to other diseases depending on the initial outcome of this project.
New drug development concepts:
A. Two new treatment approach strategies:
The protein beta-amyloid (plaques) has long been considered a sign of Alzheimer’s disease. Some of the new Alzheimer’s treatments in development target microscopic clumps of plaques.
According to Mayo Clinic, beside other studies, following are the two newer strategies aimed at beta-amyloid (plaques):
- Immunization strategies:
Most current immunization studies focus on administering antibodies against beta-amyloid from outside sources instead of enhancing a person’s immune system.
One large research effort is exploring the value of intravenous (IV) infusions of a product derived from donated blood. This product contains naturally occurring anti-amyloid antibodies from the donors.
Some other studies are investigating laboratory-engineered (monoclonal) antibodies.
- Production blockers:
This may reduce the amount of beta-amyloid formed in the brain. Research has shown that beta-amyloid is produced from a “parent protein” in two steps performed by two different enzymes. Several experimental drugs aim to block the activity of the two enzymes.
B. The concept of heart-head connection:
Another interesting area, among many, that the Mayo Clinic highlights is the concept of heart-head connection.
Growing evidence suggests that brain health is closely linked to heart and blood vessel health. Our arteries nourish our brain. The risk of developing Alzheimer’s appears to increase as a result of many conditions that damage the heart or arteries. These include high blood pressure, heart disease, stroke, diabetes and high cholesterol.
In addition, a strong genetic Alzheimer’s risk factor is one form of a gene for a protein that carries cholesterol in the blood (apolipoprotein E). Strategies under this concept include:
- Available drugs for heart disease risk factors: Researchers are investigating whether drugs now used to treat high blood pressure, diabetes and high cholesterol may also help people with Alzheimer’s or reduce the risk of developing the disease.
- Drugs aimed at new targets: Additional projects are looking more closely at how the connection between heart disease and Alzheimer’s works at the molecular level to find new drug targets.
- Lifestyle choices: Researchers have explored whether lifestyle choices with known heart benefits, such as exercising on most days and eating a heart-healthy diet, may help prevent Alzheimer’s disease or delay its onset.
A large new database of Alzheimer’s disease patients:
Meanwhile, the Coalition Against Major Diseases (CAMD), which is a formal consortium of pharmaceutical companies, research foundations and patient advocacy/voluntary health associations, with advisors from federal agencies, has released a new database of more than 4,000 Alzheimer’s disease patients who have participated in 11 industry-sponsored clinical trials.
According to the Critical Path Institute, which oversees the coalition, this is the first database of combined clinical trials to be openly shared by pharmaceutical companies and made available to qualified researchers around the world. It is also the first effort of its kind to create a voluntary industry data standard that will help accelerate new treatment research on brain disease, as patients with other related brain diseases are expected to be added.
A large number of researchers believe that sharing these data from more than 4,000 study participants will speed development of more-effective therapies.
CAMD is funded by a cooperative agreement with the USFDA and a matching grant from the Science Foundation Arizona.
Conclusion:
It took 90 years to accept the cause of this memory erasing, attitude destroying and human dignity stealing deadly disease that was first discovered in a mental asylum by Dr. Alois Alzheimer.
Thereafter, discovering a safe an effective medicine for the treatment of Alzheimer’s disease has rather been very slow, if not frustrating, especially for the afflicted patients and their families. Some global pharma majors have even announced jettisoning research initiatives in this area.
Even with the application of modern day’s cutting edge science and technology, it is still difficult to fathom, how many years would still remain in waiting for a breakthrough treatment option for Alzheimer’s disease.
In a scenario like this, even today, the very thought of becoming a victim of this life-threatening disease sends shivers down the spine of many.
By: Tapan J. Ray
Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.