What's your biggest worry when it comes to future health? For many adults, it isn't heart disease or cancer, but the loss of cognitive and physical function that comes with dementia. The idea of spending one's days physically present but mentally confused threatens the essence of who we are. But fortunately, drugs now in development show promise of better treatments for this condition.
While most of us experience mild memory difficulties of one kind or another as we grow older, those "senior moments" are not the same as dementia, says Theresa M. Redling, D.O., medical director of the Center for Geriatric Health and Disease Management at Saint Barnabas Medical Center. She defines dementia as cognitive impairment that interferes with daily functioning, including visual and spatial functioning. Memory loss is a symptom of dementia, she explains, but "memory loss is not dementia."
Unfortunately, dementia is both widespread and intractable. One in 10 adults over age 65 have some cognitive impairment, says Dr. Redling, and it affects almost 50 percent of those over 85. And nothing has been shown either to cure dementia or to prevent it. "I've been caring for dementia patients for more than 20 years, and the lack of progress has been disappointing," says the doctor. "The medications available now are not curative—they just slow the progression of the disease."
New medications currently in clinical trials may offer hope for better treatment. Additionally, new diagnostic tests are helping clinicians identify the disease much earlier in its course. "This is the first time in a long time we have seen some new ideas," Dr. Redling says. "I am optimistic."
There are hundreds of types of dementia, says the doctor, but a few major varieties produce the vast majority of cases. Alzheimer's disease is the most common, comprising about 65 percent of all dementia diagnoses, she says. Vascular dementia caused by atherosclerosis in the brain is another widespread type, and mixed dementia, a combination of the two, accounts for a significant proportion as well. Lewy Body dementia, in which protein deposits develop in areas of the brain involved in thinking, memory and movement, is also not an uncommon form. Dr. Redling says this type is underdiagnosed because it looks a lot like Parkinson's disease, which can also cause dementia.
New drugs are now in clinical trials around the world, she says--including in her own practice. One or more of these new drugs may help treat and may do even more than slow the progression of dementia. The already available medications used to treat Alzheimer's disease boost the deficient chemicals in the brain that are lacking due to neuronal death. One class of drugs, called cholinesterase inhibitors, boosts brain chemicals called acetylcholine, which are associated with memory. Some medications in this class are already available and frequently prescribed.
Another line of research looks at abnormal beta-amyloid proteins, which are associated with the buildup of plaque in the brains of Alzheimer's patients. A protein known as a-beta 42 has been implicated. "When there is an abnormal amount it results in cell death," Dr. Redling says. "New drugs are being developed to direct the metabolism of the protein so it doesn't get deposited in the brain to cause cell death." Although a vaccine against a-beta 42 proved unsuccessful, trials involving antibody therapy are currently under way.
Another area of research is looking at a new way to "feed" the brain. "There is a theory that there is an abnormal metabolism of carbohydrates in the brain contributing to dementia," she says. "The brain uses the most glucose of any organ, and in dementia the brain can't process glucose properly. Some have even called Alzheimer's 'type 3 diabetes.' Trials are looking for other ways to feed the brain by boosting special types of fat that the brain can use more efficiently."
On the diagnostic front, says Dr. Redling, "one more exciting thing is that the educated practitioner now can diagnose dementia even before most symptoms of impairment develop." Clinical evaluation protocols and technology such as functional brain mapping "give us a pretty good idea of an impending dementia before there are symptoms besides early memory issues."
The Center for Geriatric Health and Disease Management at Saint Barnabas Medical Center works with a neuropsychologist and his team. They perform these tests and are directly involved with the diagnosis and treatment recommendations for those with cognitive impairment, including involving individuals in clinical trials if appropriate. The center is involved with many clinical trials of new medications, and it is looking for participants. Dr. Redling strongly recommends that individuals who are dealing with dementia consider entering one. "Enter a trial," she says. "If my father had dementia I would enter him, because right now there's nothing better."
For more information, call the Center for Geriatric Health and Disease Management at Saint Barnabas Medical Center at 973.322.6457.