Barcin
504241549
By 2050, Alzheimer’s disease will have developed in more than 28 million people—mainly baby boomers in their mid-eighties—according to one study. The dire situation has unleashed a flood of funding for research, however, and significant strides are being made here in St. Louis.
At Washington University, Jason Hassenstab works with patients who have or are at as great as 50 percent risk for what is known as dominantly inherited Alzheimer’s disease, which develops, tragically, as early as the thirties. “The disease they get is very similar to the one older people get, but we know with a high degree of reliability when they will become symptomatic,” he says. “That is absolutely critical information if you’re trying to prevent a disease. You have to know when people should have gotten it in order to know if your drug has worked. With an older population, that can vary by 15 to 20 years. But in DIAN, you are going to know within plus or minus two or three years. If your drug prevented it, it will be very apparent.”
The study began in 2005, after Dr. John Morris had the idea to connect the researchers and families by forming the Dominantly Inherited Alzheimer Network and DIAN Trials Unit. Today, Morris serves as the director of the Charles F. and Joanne Knight Alzheimer’s Disease Research Center at Washington University, where he’s made other significant discoveries about the genetic origins of the disease.
Morris has made a concerted effort to expand the center’s reach. When he took the helm, only 3 percent of research participants were African-American, so he worked with a diverse advisory board to recruit more research participants of color; today, participation has risen to 18 percent. This October, Wash. U. will host a workshop for Alzheimer’s researchers from around the country, who will share best practices to improve relationships and research participation specifically with communities of color.
“Genetic risk factors in one group of individuals may not work the same and may actually be quite different in another group of people,” Morris says. For instance, the apolipoprotein E4 gene variant—the biggest known genetic risk factor for late-onset sporadic Alzheimer’s in some ethnic groups—does not seem to increase risk in African-Americans. Research does suggest, however, that African-Americans are at increased risk for developing the disease. Now the goal is to learn why. Heart and brain health are partly related, he says, and African-Americans are at higher risk for such diseases as diabetes and hypertension, which he suspects as contributing factors.
At the Saint Louis University School of Medicine, Dr. George Grossberg is involved in several promising studies. The first is for patients with mild cognitive impairment who are “on the doorstep” of Alzheimer’s, he explains. These patients, who range in age from their sixties to their eighties, are participating in a two-year trial of a drug known as a BACE-1 inhibitor that shuts off secretase, the enzyme that’s involved in plaque formation in the brain.
The other study is examining subjects age 60 or older who are healthy but have a first-degree relative with the disease and are at risk for it themselves. One of the factors that led to the five-year study, Grossberg says, was the discovery of amyloid plaques on PET scans decades before the onset of symptoms.
“This is the new trend: to try to catch it as early as possible and provide intervention,” he says. “One of the things we’ve learned isn’t so much that we had the wrong medications but that we had the wrong targets. We intervened too late.”
But there’s also hope for those with advanced Alzheimer’s. Soon, SLU and a Bay Area–based biotech company will partner on a study in which blood plasma from healthy 18-year-olds will be infused into patients with advanced Alzheimer’s disease. Results in earlier mouse studies were “almost miraculous,” notes Grossberg.
“When the call goes out for studies, they’re almost always looking for people in the very early stages, or asymptomatic,” he says. “Until now, people with a family member in the advanced stages had zero hope. Now, we have something that appears to be safe and, finally, offers some hope.”
Beyond the Research
At SSM Health St. Clare Hospital in Fenton, the nursing staff has created a pilot project in which patients are given baby dolls to care for. Though it doesn’t work with all patients, those who do respond show marked relief of anxiety and a reduction in falls because they are more careful while getting up when holding the dolls.
Working in partnership with the Alzheimer’s Foundation, the Alzheimer’s Care Navigation Program at St. Luke’s provides families with an onsite social worker who educates families and connects them with local support organizations.
The SLU Memory Clinic also provides support—including free screenings, counseling, and caregiver support groups— to Alzheimer’s patients and their families. For those with milder cognitive impairment, the center offers cognitive stimulation therapy—in fact, it’s the largest CST site in the U.S. Patients work with a facilitator in a group setting to perform tasks that strengthen cognitive performance and social connections. Many participants feel better, gain confidence, and show improvement in memory and other cognitive skills, says Dr. Max Zubatsky. “They are also not feeling so isolated and lonely,” he adds. “We are seeing significant results.”
