Is there hope on the horizon for people with Alzheimer’s?

FEDERAL funding for Alzheimer’s disease is pitiful, especially compared to funds allocated to other diseases, although local experts here express cautious optimism about new treatments.

As the country’s largest Alzheimer’s research funder, the federal government allocates about $670 million, in contrast to allocations of $2.3 billion for heart disease, $2.9 billion for HIV/AIDS, and $5.5 billion for cancer.

The Alzheimer’s Association urges the federal government to allocate at least $1 billion annually, said Elizabeth Morancy, executive director of the Rhode Island chapter of the Alzheimer’s Association.

Plain and simple, more funding is desperately needed.

Research initiatives also get funding from the Alzheimer’s Association, private foundations and drug companies, and many medications are being tested locally. “One of the most promising is the amyloid vaccine, an antibody given by infusion to bind and remove amyloid,” said Butler Hospital’s director of the Neurology and Memory and Aging Clinic, Dr. Stephen Salloway, M.D. M.S.

“The new medicines will have the greatest impact when given early, when nerve damage is low and symptoms are still mild,” he said. “Other recent advances include new diagnostic tests such as genetic markers and amyloid brain scans.”

The goal? Delay the onset of serious stage Alzheimer’s for as long as possible.

“It’s critically important that we make some inroads into curing Alzheimer’s,” Morancy said. “Today, there’s no cure, and as our population ages, we’ll see more and more people with Alzheimer’s. It will completely overwhelm our already burdened health care system.”

How does a healthy brain, one free of Alzheimer’s symptoms, work? When you were younger, you learned to cook without a recipe or drive a standard transmission by practicing those skills day in, day out.

Performed repeatedly, those experiences were imprinted as patterns into your brain’s 100 billion nerve cells or neurons, 100 trillion synapses connecting the neurons, and dozens of neurotransmitters.

Your healthy brain, with those patterns firmly entrenched, allows for easy recall of those skills.

Those 100 billion neurons are interconnected in a network of dense branches that the scientists call “the neuron forest.”

When tiny electrical charges or signals travel through the forest, your brain establishes patterns of memories, thoughts and emotions. When those charges reach other cells, tiny bursts of chemicals or neurotransmitters are released, further strengthening the neuron forest’s connections.

The more you expose your brain to complex new skills and experiences, the more complex your neuron forest is and the more powerful your brain’s neurotransmitters, said Dr. Salloway. Unlike tendons or ligaments, one’s brain can’t be damaged by repeated exertion. More, not less, brain stimulation, should be the goal.

So, what happens with Alzheimer’s? As a power outage disrupts our access to all things electric, Alzheimer’s disrupts the brain’s electrical charges and efficiency of the neurotransmitters.

Though they vary in intensity, these disruptions all involve changes in brain chemistry. In fact, these changes can begin 20 years or more before a mild case of Alzheimer’s is diagnosed

Those first changes involve deposits of a protein, beta-amyloid, that create sticky plaques in the brain.

The brain of an individual with Alzheimer’s has: fewer nerve cells and synapses (than that of a normal brain); beta-amyloid plaques that build up between nerve cells, and dead and dying nerve cells that contain twisted strands of another kind of protein, tau, that form tangles.

These plaques and tangles – brain cell damage – initially appear in parts of the brain governing learning, memory, thinking and planning.

As Alzheimer’s progresses from mild to moderate, plaques and tangles spread to other parts of the brain, including those that impact talking, comprehending speech, and sensing your body in relation to objects around you. The spread blocks healthy cell-to-cell communication and impairs cells’ access to essential nutrients.

With advanced Alzheimer’s, most of the brain’s cortex (that governs memory, attention, perceptual awareness, thought, language and consciousness) is significantly damaged. Cell death leads to brain shrinkage.

“Patients with very advanced Alzheimer’s typically cannot talk, recognize close family members, or manage even rudimentary self-care,” said Dr. Salloway.

Problems with cognition and symptoms of agitation, suspicion and depression are likely to appear during some or all stages of Alzheimer’s.

What to do?

An alphabet soup of medicines, approved by the Food and Drug Administration (FDA) for patients with Alzheimer’s, offer some hope for stabilizing the symptoms, though certainly not for all patients, said Morancy.

One family of drugs, called cholinesterase inhibitors, increases the levels of a brain chemical, acetylcholine, to address cognitive problems. These include Aricept (also approved for severe Alzheimer’s) Exelon and Razadyne for individuals with mild to moderate Alzheimer’s. Namenda regulates glutamate, a brain chemical involved in information processing, for those with moderate to severe Alzheimer’s.

Antidepressants that increase serotonin, such as Lexapro or Zoloft, may be prescribed to stabilize mood swings and anger. Risperdal and Seroquel are sometimes used to reduce psychotic symptoms and agitation in Alzheimer’s patients. Any prescription medication may not work for a specific patient, may have unacceptable side effects and should be carefully monitored.

If you fear that you or a loved one has symptoms of Alzheimer’s, don’t panic.

First, check out the information on the Alzheimer’s Association web site, www.alz.org, for a checklist of warning signs.

Still concerned? Review the story in the last edition of The Voice & Herald (www.jvhri.org) for caregiver information and resources.

Contact your primary care physician or Butler Hospital Memory and Aging Program (401-455-6403) for information and a thorough evaluation.

“It’s no surprise that people with moderate Alzheimer’s may be angry or depressed,” said Morancy. “Alzheimer’s can turn your life upside down. If you can’t do what you used to do and can’t remember what you used to remember, it’s entirely predictable that you’d be sad or angry.”

Nancy Kirsch can be reached at nkirsch@cox.net