Article of Interest: Progress in Alzheimer's Testing

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By Erin Allday
New York Times Syndicate
10-18-10

San Francisco -- If doctors are ever going to find a way to attack and even cure Alzheimer's disease, they first need to know how to diagnose it -- ideally years, maybe even decades, before patients are symptomatic and their brain has been irreparably damaged.

That's why researchers around the country are intrigued by several promising new studies that highlight techniques for identifying Alzheimer's in the body long before people show the classic signs of memory loss and confusion.

A study that was released in August to much excitement among researchers suggested that a spinal fluid test could be very effective in identifying abnormal levels of amyloid, a protein that forms plaque buildups in the brains of people with Alzheimer's.

In the Bay Area, researchers at the University of California at San Francisco and Stanford are studying drugs that would serve as biomarkers in the body, attaching themselves to proteins like amyloid and letting doctors find those proteins more easily using imaging tests.

"It's exciting that we will likely soon have new tools that will allow us to detect Alzheimer's changes very early, even in people who are cognitively normal," said Dr. Adam Boxer , director of the Alzheimer's disease and frontotemporal dementia clinical trials program at UCSF's Memory and Aging Center. "If there were a treatment that could remove amyloid from the brain, then it would really be an exciting and powerful combination."

People are currently tested for Alzheimer's using a fairly lengthy, somewhat subjective process that starts with simple memory tests and interviews with patients and their family about problems they may be having from day to day. Those tests are accompanied by a physical examination, more thorough cognitive testing, and blood analysis and a brain-imaging scan.

The process is more about ruling out other diseases with similar symptoms -- such as a stroke or a benign brain tumor -- that may be easily treated. After the testing is over, doctors can reliably diagnose Alzheimer's with about 90 percent accuracy, but it can only be confirmed after death, when brain tissue can be studied under a microscope.

For patients and the doctors treating them, it's not necessarily important to definitively diagnose Alzheimer's because for now there's no cure for the disease. But for researchers, it's essential to be able to identify test subjects who have been diagnosed with Alzheimer's so that they can focus on potential treatments.

Researchers hope that if doctors can find abnormal buildup of proteins before people become symptomatic, it may be easier to find effective treatments. Most studies of potential drug treatments for Alzheimer's have had disappointing results.

"Many (researchers) believe these studies may have failed because we started treating people too late," Boxer said. "The majority of people in studies have full-blown Alzheimer's disease, and it's a tall order to get treatments to work in these people.

It's hoped that by developing biomarkers, we could find it much earlier."

Most research into early diagnosis of Alzheimer's disease is centered around two proteins: amyloid beta, which is distinctive for the way it clumps up in the brain like plaque, and tau, which forms tangled strands in the brain when neurons die. Buildup of these proteins is common in the brains of deceased people who had Alzheimer's.

At Stanford, a team of researchers is participating in a national study of the drug florbetaben, which would act as a marker for amyloid and allow doctors to find the protein using certain imaging techniques. UCSF researchers, meanwhile, are looking for similar drugs that might be used a biomarkers for the tau protein.

The spinal fluid test, which was studied primarily at the University of Pennsylvania, involves performing a spinal tap on patients to look for signs of both proteins.

Dr. Marci Teresi , clinical lead of the Kaiser Permanente Santa Clara Memory Clinic, said doctors are enthusiastic about the current research, but she doesn't expect such testing to be made widely available outside of research studies any time soon.

"It's mostly useful for investigational purposes, for finding people who want to participate in research studies," Teresi said.

"I don't think it's as practical for the large number of patients that are out there seeing their regular doctors."

In other words, patients with no Alzheimer's symptoms shouldn't start asking their doctors for advanced imaging tests any time soon. In fact, early testing could do more harm than good, some doctors say, if it causes patients anxiety and depression before they're showing signs of Alzheimer's. Some people with protein buildup in their brains never get Alzheimer's at all.

Still, there are advantages to screening older people who may be showing the first small signs of illness, said Dr. Catherine Madison , medical director of California Pacific Medical Center's Memory Clinic.

Several drugs can make life for patients more comfortable and slow down some of the worst effects of the disease, especially if the treatment is started early. Patients can also benefit from therapy and anti-depressants.

"There's no magic cure out there. Even if I could tell you that you were going to get dementia, would you want me to?" Madison said. "But we have medications that can help. We can slow the course of this and make it a whole lot better for patients and families."