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In Search of the Alzheimer's Aha! Moment

Even delaying the onset of the disease by a few years would be a significant step

As an Alzheimer’s researcher, I hear a lot about the need for new approaches to a disease that hasn’t seen a fresh treatment since 2003 and that has never had a drug that does much beyond alleviating symptoms along its devastating and fatal course.

That need echoes across my lab and others like it around the world. Yes, we desperately seek new approaches and treatments, but I can tell you from decades of working on this disease that we just as desperately seek money to attract the next generation of researchers to the field. And today’s announcement of a $60 million investment by AARP (I’m chair of its Global Council on Brain Health) to the Dementia Discovery Fund is a major step that should help both goals.

But we need all of these things not because we think we will find a single miracle pill but because we need to stimulate the linkages, the insights, the aha! moments within a vast and only partially explored network of possible approaches.

Without them, promising recent insights — such as that Alzheimer’s actually begins in middle age; that it’s influenced by lifestyle factors, such as mental activity and physical exercise; that it can be tracked by the buildup of proteins in brain scans; and that it may be preceded by things like changes in the connections between nerve cells (known as synapses) — won’t nudge us any closer to what one day could be a multipronged prescription for patients: "Mrs. Jones, we’ve seen from your blood test that you have the earliest indications of Alzheimer’s disease. You need to check in at the clinic to get a plan for how to increase your mental and physical activity, and you need to fill this prescription to increase your brain synaptic markers."

We’re clearly not close to this yet, but we’re far enough along to see that prevention probably looks more like managing a heart condition than getting a vaccine to prevent polio. Heart disease, in fact, makes a useful metaphor for describing many possible interventions — for one thing, starting earlier. After all, if you have high blood pressure or high cholesterol, doctors don’t wait until you have a stroke or heart attack to treat you. There’s also reason to believe that earlier intervention could be even more important for brain cells that don’t respond so well once they’ve withered and died.  

But while investment is critical to making this happen, we also need an understanding that although progress has not been fast enough, hope is not lost. My research, for example, follows people beginning at middle age to see if we can predict who will be at the greatest risk for developing the disease a decade later. It offers us the promise of finding the ideal window to intervene, but the answers will take time to find. The same is true of other researchers’ efforts to understand things like how amyloid and tau proteins interact over time to destroy nerve cells or how to tease out all the specific effects of different lifestyle factors that we know are related to the disease.

If the goal with heart disease is to prevent a stroke or heart attack — something we’ve had great success at doing with lifestyle changes and drugs — the goal for Alzheimer’s might be delaying its onset.  If not new, that’s a more radical and encouraging concept than it may sound. Given that this disease affects older people, it’s been found that if you could delay its start by five years, you could cut its prevalence in half.

Imagine if we could prevent half of the current patients from crossing this great divide. Imagine the pain it would save their families. Now that, when it happens, will be a breakthrough of its own.

Marilyn S. Albert, Ph.D., is the director of Cognitive Neuroscience in the department of neurology at Johns Hopkins University School of Medicine and the chair of the AARP Global Council on Brain Health, an international collaborative of scientists, health professionals, scholars and policy experts convened by AARP to help older adults maintain and improve their brain health.