Not all of Dr. Richard Mayeux's elderly patients have Alzheimer's disease; not all will even go on to develop it. Most of them are still leading full, healthy lives, interacting with their families and contributing to their communities. But Mayeux, an Alzheimer's researcher and physician at Columbia University, asks them all anyway: Will they help him in his war against the disease? It's been a long and disappointing campaign so far. Alzheimer's disease the degenerative brain condition that is not content to kill its victims without first snuffing out their essence has for decades simply laughed at such efforts.
More than 5 million Americans currently suffer from Alzheimer's disease, a number that will grow to 13.4 million by 2050. There is no cure. The therapies that exist drugs and lifestyle behaviors such as keeping the mind sharp with enriching social relationships and stimulating the brain with games and puzzles can only delay, not stop, the onset of memory loss, confusion and cognitive decline that generally extend over a period of several years or, more often, decades. There isn't even a definitive test for Alzheimer's.
Mayeux knows that defeating Alzheimer's means first recruiting volunteers to join a study that can help identify who is at greatest risk of developing the condition. The results could paint a clearer picture of the factors that put people in danger. A disease that gives up clues to those factors is one that has revealed its weak spots and that, perhaps, can lead to better treatments. Mayeux deeply believes this, and that's what he tells his patients, but still, they take some convincing. Said one prospective participant: "The way I see it, even if you predict when I will get Alzheimer's, you haven't got anything that I can do for it."
The patient has a point. Who in his right mind would want to know he had a disease that would inevitably rob him of that mind? But a lot of us may eventually find ourselves slipping away in that sad fashion. Health experts estimate that a 65-year-old has a 10% risk of developing Alzheimer's and that baby boomers currently approaching peak age for the disease (60 to 80) will add $627 billion in Alzheimer's-related health care costs to Medicare. There is a considerable psychological price tag too, for patients and caregivers alike and a fear factor. In a recent poll conducted for The Shriver Report: A Woman's Nation Takes On Alzheimer's, 84% of adults surveyed were concerned that they or someone in their family would be affected by the disease.
That fear is compounded by the belief that research for Alzheimer's is lagging behind that for other diseases. While 81% of those polled saw great progress being made in curing heart disease and 74% said the same for cancer, only 48% felt researchers were making strides against Alzheimer's. Money is partly why. "We spend $5.6 billion a year funding cancer studies, $1 billion a year for heart disease ... and $500 million to study Alzheimer's," says Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer's Disease Research Center. "Yet what is going to get most of us in the next few years is Alzheimer's."
Over time, the feeling has taken hold that beating Alzheimer's is the cold fusion of medical research: everyone agrees it would be great, and everyone who tries it fails. And yet maybe, just maybe, that's changing. For the first time since the disease was identified more than a century ago, doctors are closer to uncovering its secrets. Alzheimer's, like all other degenerative ills, is driven by genes, and in the past year, scientists have come up with a suite of relevant ones. The disease is thought to be caused by a buildup of protein-based plaques in the brain, and investigators now believe they have an understanding of possible ways to interrupt that process. Technology is helping too, as researchers exploit new ways to scan the brain and detect the first signs of trouble, peering deeper into human and animal neural tissue to pinpoint the very molecules that give rise to the disease.
"Our understanding of Alzheimer's is better than it looks based on the clinical trials," says Lennart Mucke, director of the Gladstone Institute for Neurological Diseases and a neurologist at the University of California, San Francisco (UCSF). "Despite all the reports about how dismal the situation is, it is probably more hopeful in some respects now because there are more candidate [treatments] in the pipeline."
Treatments and hope are the two things people are looking for most, and if you've listened to Alzheimer's experts over the years, you haven't heard them speak much about either. They are doing so now cautiously, tentatively, promising nothing yet, but the change is real. And the reason is the research.
If even the most optimistic scientists are still talking only warily about progress, it's no wonder. The Alzheimer's field has until now been a graveyard of hope. In 2002 a promising vaccine caused dangerous inflammation in the brain and spinal column and had to be abandoned after years of research; last August, a highly anticipated drug worsened rather than improved cognitive symptoms.