Brain Talk: Cracking the code of Alzheimer's and dementia
The human brain is a marvelous, complex organ. It controls so much of the body, and yet so little is known about it. But every day, new research opens doors to the brain’s inner workings, shedding light on the intricacies of diseases and disorders that affect it.
The PRA Health Sciences Brain Talk series zeroes in on three areas of mental health that have a significant impact on brain research today. Read on for part III of the series, Alzheimer’s and dementia.
With no single test for diagnosis, Alzheimer's is one of the most challenging diseases to treat. Even with more than 5 million people in the United States currently living with Alzheimer’s dementia—a number that is expected to grow—there are only a handful of drugs that are approved for treatment.
More research is needed to cure this disease, but researchers are up against significant challenges to do so. For starters, finding patients to participate in trials isn't easy. What’s more, drug development is necessary to better treat patients with Alzheimer’s and related dementias, but the process is costly.
Success begins with awareness
Part of the challenge in conducting more research for Alzheimer's is finding patients who qualify for studies.
“If you want to include patients at the very early stage, you would have to include patients you know are at risk,” says Johan den Boer, Global Science Department, PRA Health Sciences. “And if you are at risk, you’re still pretty healthy.” It’s essentially recruiting patients who aren't having many memory issues, he adds. It takes effort to persuade at-risk patients who are not yet patients, and consider themselves to be healthy volunteers.
Strides have been made in biomarker research to identify those patients who might develop the disease. “Before the full-blown symptomatology of this syndrome, there is already what we call neuro-inflammation in the brain, which are very mild neuro-inflammatory signals,” says den Boer. These signals precede the onset of Alzheimer’s disease, and it's during this stage that researchers need to recruit individuals for studies.
Awareness doesn’t end, however, with the science of self-knowledge. Public awareness is equally important when it comes to recruiting appropriate patients for trials. The Alzheimer’s Prevention Initiative plays an important role in getting the word out about trials, and the Alzheimer’s Association has an extensive ongoing public awareness campaign. But, says Bill Holt, Executive Director of Scientific Affairs for PRA, it's also necessary to find people where they are today—on social media.
PRA, Holt explains, has a group dedicated to social listening, using it to “identify people who are online, on social media, querying symptoms of memory loss, dementia, health, and disease, so we can target those particular people and direct them to clinical trial awareness.”
New focus for new treatments
When a diagnosis of Alzheimer's or related dementia is made, it can be a relief to patients and their families to finally have answers. But then they’re left with the even bigger question: How do we treat it?
While few approved drugs have made it to market to treat this incurable disease, researchers are hoping to change that. Historically, notes Holt, researchers have looked at therapies aimed at targeting the buildup of amyloid plaque in the brain. While there’s been success with vaccines that remove this plaque, and therapies that treat symptoms of Alzheimer’s, which have been shown to modestly improve cognition, memory and daily activities, they do not slow the progression of the disease.
“It’s not that we think it’s a failure of what we’re targeting, but rather we’re targeting the wrong population,” Holt says. Specifically, he adds, for patients who have developed a plaque burden in their brain, there’s a tipping point at which plaque can be removed, but the neuron in which the plaque resided might be destined to die due to pathological buildup of the protein.
The potential for new treatment discovery can also stem from a change in targeted drug treatments. Simply put, new targets are needed. “Everyone has been focusing—for sound reasons—on amyloid, or pathologically folded proteins, which cause neuronal and cellular damage.” But considering that the positive outcomes from targeting amyloids is limited, “it’s not a very optimistic story if we keep repeating trying to reduce the amyloid in the brain,” den Boer says.
Moving the needle on research
The most recent drug approved to treat Alzheimer’s dementia was approved more than a decade ago. But while there have been no significant pharmacological advances in that time, there has been an increase in the effort to educate physicians to enable them to make a diagnosis. Add to that new research and discovery, as well as new ways to recruit and educate patients, and researchers are taking significant steps toward finding a cure for this disease.
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