A tailored approach to Alzheimer’s
By Jan Jarvis
| How Alzheimer’s care is different at UNTHSC
UNT Health Science Center draws together physicians, nurses, social workers and psychologists to make life better for those already living with Alzheimer’s disease.”A typical model of care is a doctor fixes the problem, but that’s not going to work with dementia,” said Dr. Janice Knebl, Chief of Geriatrics and Dallas Southwest Osteopathic Physicians Endowed Chair in Geriatrics. “Early diagnosis and the team approach gives families more options.”Alzheimer’s is a chronic disease, and families are going to be dealing with it every day for many years.
One day, Ellen Brown was sitting with her mother, when she reached for her handkerchief, the one monogrammed with her initial.
Gently her 77-year-old mother took it in her hand.
“E,” she said clearly. “E for Ellen.”
It was the first time that Sue Smith had said her daughter’s name in at least six months. It also was the last.
Today Brown remembers that day as a poignant reminder of how much Alzheimer’s disease has stolen from her family.
First her grandmother, then her aunt, a cousin and her mother have battled the disease. She may be next.
“I have a daughter and this is not the legacy I want to pass on,” she said.
Sid O’Bryant, PhD, who lost his grandmother to Alzheimer’s, understands this all too well.
He is one of a team of UNT Health Science Center researchers tackling Alzheimer’s disease from a radical perspective.
“Traditionally, science takes one small step at a time,” he said. “But we want to push at a faster pace, given the urgency of the situation.”
Today, the standard approach to Alzheimer’s is to find one drug to treat everybody, said Dr. O’Bryant, Director of the Center for Alzheimer’s & Neurodegenerative Disease Research.
“We want to determine which specific patients will benefit the most, from which specific therapies,” he said.
It’s a dramatic approach that puts UNTHSC among the few research institutions in the world looking at Alzheimer’s in such a way. Rather than seeking a single magic bullet, UNTHSC’s approach is to tailor the therapy for each individual.
“It’s what worked for cancer and heart disease,” Dr. O’Bryant said. “Alzheimer’s is 20 years behind.”
“It’s what worked for cancer and heart disease.”
Helping make this approach possible is the Health & Aging Brain Study, a project that has tracked the medical history of 700 community members for four years.
The study functions as a translational platform for researchers investigating different pathways to Alzheimer’s, including diabetes and depression. Understanding those pathways could lead to a new age in Alzheimer’s prevention and care.
“We’re not just working to find better therapies to treat Alzheimer’s,” Dr. O’Bryant said. “We’re also working toward prevention in people who are cognitively normal but at risk.”
When Sue Smith first began forgetting things, her family attributed it to a recent move.
“Once she was diagnosed, I recognized the signs for what they were,” Ellen Brown said. “I knew in my heart, before my brain.”
Diagnosing Alzheimer’s earlier could improve prospects for Brown and for future generations.
With the introduction of a blood test, developed at UNTHSC and poised to become the first screening tool for Alzheimer’s, early diagnosis would be possible. With 90 percent accuracy, it could one day become part of a routine check-up.
But this breakthrough comes with a catch.
One of the biggest fears people have is they’ll find out they’re going to get Alzheimer’s but there won’t be anything that can be done about it, said Meharvan Singh, PhD, Dean of the Graduate School of Biomedical Sciences.
Still, early diagnosis may allow existing drugs to work better, which in turn may slow the disease’s progression and push back when symptoms appear, he said. By the time someone has symptoms, the disease could have been running its course for 20 years. By then, it may be too late.
“You can treat sick brain cells, but you can’t treat dead ones,” he said.
Urgency to the work
For years, scientists have explored the link between dementia and diabetes, knowing the public health implications are great for both.
By 2050, it’s predicted that 1-in-3 people will have diabetes. For diabetics, the risk for developing Alzheimer’s is doubled.
The numbers add urgency to the work of Prashant Nedungadi, PhD, Assistant Professor of Integrative Physiology and Anatomy. He’s studying blood markers that could predict which diabetics are most likely to get Alzheimer’s.
“If people knew they were at high risk, they could start treatment and make modifications to their lifestyle that could prevent Alzheimer’s symptoms.” he said.
A higher risk
Just being a woman puts Ellen Brown at a higher risk for developing Alzheimer’s.
Almost two-thirds of Americans with the disease are female. The higher prevalence may be attributed to women living longer, although there is also evidence to suggest that women simply may be at higher risk, apart from increased longevity. The significant decrease in hormones like estrogen and progesterone following menopause may be a risk factor.
“We know these hormones are important for the brain, and their loss at menopause may help partially explain why the brain becomes more vulnerable,” said Dr. Singh, whose research has focused on the relationship between hormones and the brain.
He said he sees a window of opportunity immediately after menopause when hormones could improve brain health and stave off Alzheimer’s.
A link to depression
Unlike many Alzheimer’s patients, Sue Smith does not appear to suffer from depression.
But for one-third of those with Alzheimer’s, depression is a symptom of the disease. It’s also a risk factor.
Researchers have tried using anti-depressants to prevent Alzheimer’s symptoms, but results have not been promising.
Leigh Johnson, PhD, Assistant Professor of Internal Medicine, is trying something different.
“We don’t want to treat everybody the same,” she said. “We want to find out which individuals are most likely to respond and treat them.”
“We want to find out which individuals are most likely to respond and treat them.”
Her research has led to the discovery that specific symptoms of depression – including crying and feeling worthless – are more linked to memory than other symptoms. By targeting patients with these specific symptoms and treating them with antidepressants, Dr. Johnson believes there will be an improvement in memory.
Such studies support the idea there’s no one-size-fits-all treatment for Alzheimer’s.
But more research is needed to find out what will work, said Ellen Brown, who keeps hoping for the best.
“No matter how far gone my mother gets, I’m a firm believer that somewhere inside, she always knows me,” she said. “I just have to go with that.”