Northwestern Medicine Central DuPage Hospital Chief Medical Officer Dr. Kevin Most joins the Steve Cochran Show to discuss the discovery of Alzheimer’s disease, how to tell the difference between old age forgetfulness & dementia, and treatments to slow the progression of this disease.
Read all of Dr. Most’s notes below and listen every Tuesday morning for more medical news.
June is Alzheimer’s Awareness month
- Alzheimer’s is named after Dr. Alzheimer, who in 1906 had a patient who died with what was then unusual mental illness- after she died he examined her brain and found abnormal clumps, now known to be amyloid and tangled fibers
- Alzheimer’s is the most common cause of Dementia, accounting for 60-80% of all dementia cases-
- Close to 7 million Americans are living with dementia, 230,000 in Illinois alone
- Alzheimer’s is the 6th leading cause of death
- The number of cases is felt to be much higher as many cases will go undiagnosed and untreated
- There is no blood test or screening test to predict Alzheimer’s , the diagnosis is made after symptoms are noted, by this time the disease has caused significant damage
- The age group of over 65 is growing dramatically so the number of cases of dementia is expected to rise. 1 in 9 adults over the age of 65 is in some stage of Alzheimer’s
- We do not have enough long term care facilities or care givers for the expected increase in cases.
- It is thought that Alzheimer’s begins 20 years before memory loss or other symptoms begin, stressing how important it is for research to work on early detection
- Alzheimer’s moves thru stages-
- Mild- some memory loss- cognitive function decreases- wandering- getting lost- paying bills a problem- personality and behavior changes
- Moderate- loss of language control, sensory processing- memory loss is worse- difficulty learning new things- difficulty carrying out multitask steps- getting dressed-
- Severe- loss of ability to communicate- completely dependent on others for their care- mobility is limited
- The greatest risk factor is age, but Alzheimer’s is not a part of normal aging
- Rosalynn Carter shared diagnosis of Dementia this past week
10 Early Signs of Alzheimer’s
- Memory that disrupts daily life- forgetting recently learned information- asking the same question over and over. With age related change- we will forget names or events but remember them later
- Challenges in planning or problem solving- signs include things as common as following a recipe, or keeping track of monthly bills
- Difficulty completing familiar tasks- like driving to a familiar location, organizing a grocery list
- Confusion with time and place- lose track of dates and seasons, forgetting where they are or how they got there
- Vision problems that may lead to difficulty with balance or reading, difficulty judging distances
- Trouble following or joining a conversation. Stop in middle of a conversation and have no idea how to continue, Difficulty naming a familiar object
- Misplacing things or placing objects in unusual places and then be unable to retrace steps
- Poor judgement or decision making- may notice this with money decisions or even grooming
- Withdrawal from work or social activities- unable to converse in a group, or keeping up with a team activity
- Changes in mood/personality- confusion- suspicious- depressed- fearful
Basics of the brain
- Made up of 3 main parts- Cerebrum-memory- problem solving- thinking- feeling- movement- vision. Cerebellum- coordination and balance Brainstem- connects the brain to the spinal cord- controls breathing- heart rate- blood pressure
- The brain uses a lot of energy and oxygen- it uses about 25 % of oxygen and fuel, yet doesn’t weigh much as a percentage
- The brain works with chemicals and electrical activity- amazing- think about it, you see something or read something and an electrical and chemical activity stores that in your brain for future use. Your brain tells your arm to move whether you are doing surgery, playing an instrument or taking out the garbage. It tells you what to do and how to do it.
- In Alzheimer’s we see brain cell death and plaques and tangles making the communication between cells impossible
- When these healthy connections are stopped those brain cells then die
- In Alzheimer patients proteins called beta amyloid clump together and build plaques- these block the areas where the signals in the brain occur.
- The progression of this illness follows a pattern of spread in the brain.
Cause of Alzheimer’s
- There is not a single cause of Alzheimer’s that has been identified.
- There are risk factors- age- family history-head injury- heart/head connection
Treatment options for Alzheimer’s
- Recently there have been medications that have shown to slow the pace of Alzheimer’s by a third
- There are 2 that are close to approval- ADUHELM and LEQEMBI – these are placed on an accelerated approval
- The most recent medication is an antibody that is designed to attack beta amyloid- DONANEMAB- they also are looking for accelerated approval.
- Medicare announced Thursday that it will cover drugs that are granted full approval. For a drug to go from accelerated approval to full approval more clinical trials are required.
- RUSH and U of C, are all participating in current trials, awaiting now to see what trials will open for more patients
- Each of these medications is expected to cost over $25,000 a year, placing them out of reach for most patients.
- Will Medicare be able to push for a lower cost?
- These medications appear to slow the build up of the amyloid, thus slowing the progression of the disease
- The latest drug from Lilly— Donanemab, was given to 1700 individuals, it was given as a monthly infusion- pace of disease was slowed by 30-35%, it also improved daily functions
- The medication is given once a month by infusion.
- The medication worked so well that over half of the individuals were able to stop the medication within one year.
- The patients who stopped taking the medication are continued to be monitored to see if the amyloid returns and at what rate
- Plaque buildup of amyloid is the hallmark of Alzheimer’s, it was unclear what role amyloid played.
- There are individuals with no signs of dementia yet still have significant amyloid
- Many drugs are in development focused on slowing amyloid, or breaking down amyloid, even though the link is not clear, it is part of the of the development it appears
- This study shows that removing the amyloid, slows the cognitive decline in patients with early Alzheimer’s
- Lilly plans on filing for approval within the next 2 months and will be asking for accelerated approval
- This is exciting as other drugs are in the pipeline also looking at the slowing of amyloid plaque as well as removing plaque.
- Now that we have 2 drugs that attack beta amyloid with some success it has convinced scientists they are on the right track
- These drugs work in the early stages of Alzheimer’s, so now we know the key to success here will also be in early diagnosis.
- Studies are now going on using Artificial Intelligence looking at MRI scans and other medical data points and identifying Alzheimer’s before symptoms or at an early stage,
- Studies are being done at Mass General, Emory and University of Florida
- Once the algorithm is set and tested this could be expanded across the country.
