Planning the Future of Alzheimer’s

But while there are currently no drugs to halt or reverse the spread of dementia, medications would give sufferers and their families time to cope. Currently, researchers from leading universities and pharmaceutical companies are working on multiple vaccines and drugs that target Alzheimer’s at different stages in its progression. Though effective treatments may still be years or even a decade or more away, there is now hope that they may someday be able to alleviate the guilt associated with these wrenching family decisions.

Currently, there are several promising avenues of attack against Alzheimer’s: drugs that prevent the disease from developing and vaccines that prevent the cognitive decline from getting worse. One strategy is to try to clear toxic aggregates of a small sticky protein called amyloid-beta, or A-beta, from the brain. The amyloid aggregates, called plaques, build up in the brain and disrupt communication between neurons, killing brain cells and eventually interrupting all critical functions like movement, speech and long-term memory.

A new vaccine has shown early signs of success and minimal side effects in mice that were genetically altered to make amyloid-beta. Developed by a team of neurologists at the University of Rochester led by William Bowers, the vaccine uses a herpes virus stripped of its viral genes. The inactive herpes virus is loaded with genes encoding A-beta and a protein that stimulates antibodies to recognize and clear A-beta from the brain. While the results are promising (the mice showed improved memory and minimal side effects), the vaccine still needs to be tested in humans.

Other promising avenues for fighting Alzheimer’s include preventing A-beta from forming in the first place. While scientists don’t yet understand what triggers its formation, the protein arises after a larger protein in the body is snipped by two enzymes into the smaller, sticky A-beta fragments. Wyeth and Eli Lilly are among the companies testing whether inhibiting the enzymes that make A-beta will prevent its production.

Although good ideas in theory, these proposed treatments still face big hurdles. It is difficult to create a therapy that specifically targets the brain, and such therapies may be highly toxic. A previous Alzheimer’s vaccine failed in trials in 2002 because several patients experienced severe brain inflammation.

A cocktail, unlike a single drug, may be the best way to improve cognition because it could target many different points of Alzheimer’s progression and can be customized to an individual patient’s needs, says Wolfe of Harvard University.

“We need a number of interventions to treat the disease,” agrees Dr. John Trojanowski, a neurologist at the University of Pennsylvania.

If effective, a blend of treatments could reduce some of the emotional strain family members experience when they care for a parent or sibling with the condition. For now, though, caretakers such as Mary Irwin and Ellie Wirzburger continue to encounter difficult decisions as the disease progresses.

Toward the end of his life, Franklin Sommer was moved to a hospice so he could be as comfortable as possible in his last few months. At that stage, his physical appearance mimicked his mental state—shriveled and close to death. He weighed just 140 pounds and was so hunched over that his once six-foot-tall frame reached only five feet six inches. “He looked like a concentration camp victim,” Irwin says.

Irwin knew her father would not want to continue living as a vegetable—unable to comprehend the world around him or remember his loved ones—but she couldn’t bear the thought of letting him go either. When her mother asked if he should be placed on a feeding tube to prolong his life for a few more days, Irwin said no. They would just be postponing the inevitable. Even so, she came home crying the day she signed the ‘do not resuscitate’ forms.

While Irwin has already struggled with making these choices for her father, Ellie Wirzburger can only anticipate the decisions she will soon need to make for hers, and she can only hope that someday families won’t have to make them at all.

“It is weird to be parenting your parent,” Wirzburger says. “It’s just going to get worse, and that’s what sucks. There is nothing that is going to be easy about the next five to ten years.”

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