The Latest In Treating, Diagnosing Alzheimer's

NPR's Melissa Block talks to Dr. Marilyn Albert, professor of neurology and director of the Division of Cognitive Neuroscience at Johns Hopkins, about the latest in treating and diagnosing Alzheimer's disease. Albert says she and her colleagues are disappointed that Eli Lilly stopped its clinical trials of an experimental treatment, but that many other drugs are currently in development. While no one expects any of those to be a cure, the hope is that there will be a drug to delay the progression of the disease.

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MELISSA BLOCK, host:

As we're thinking about the stresses on primary care, let's think about this: It's estimated that by the year 2050, 16 million American may have Alzheimer's dementia. It's a disease that threatens to bankrupt Medicaid and Medicare.

We're going to talk now about some recent developments in the diagnosis and treatment of Alzheimer's. And Im joined by Dr. Marilyn Albert, director of the Alzheimer's disease research center at Johns Hopkins University. Welcome back to the program, Dr. Albert.

Dr. MARILYN ALBERT (Director, Division of Cognitive Neuroscience, Johns Hopkins): Glad to be talking to you again.

BLOCK: We've been hearing some good news and bad lately in this field of Alzheimer's research. And let's start with, I guess, the good news. It's a study of the spinal fluid test that shows great accuracy in identifying patients who will later develop Alzheimer's. Whats the significance of that study, do you think?

Dr. ALBERT: What we're hoping is that in the not too distant future, there'll be more effective treatments for Alzheimers disease than what we have now. And we know that the disease takes decades to develop. And what we'd like to do, in the best of all possible worlds, is to treat people before dementia occurs but when we know that they have the disease.

So there's a major effort to try to figure out how to identify people as early as possible, so that when we have better treatments we can intervene.

BLOCK: Aha, the keyword there would be when we have better treatments. Those treatments are not optimal right now and that really leaves patients in a bind. Since there is no cure, would they want this test? Do they want to know? What good would a diagnosis do?

Dr. ALBERT: We're not recommending tests of this sort for patients right now. But the reason that this sort of work is getting so much attention is because it has to go along in parallel with the development of better treatments.

So you sort of have two lines of research going on. One to find the better treatments, and the other to get better at accurate diagnosis as early as possible. And at some point, when the better treatments come along, then we really will want to identify people very, very early.

BLOCK: Okay, well, let's move on to some discouraging news. The drug company Eli Lilly recently stopped two late-stage clinical trials of an experimental treatment for Alzheimer's. They found that patients on the drug were actually doing worse with cognition and daily functioning.

What does that failure tell you, and how big a setback is that?

Dr. ALBERT: It's quite discouraging that the trials were stopped. The approach to treatment was a relatively novel one, and we knew that Lilly had worked hard to develop it. So we were all disappointed.

But there are lots of others drugs that are being tested right now that work by different mechanisms. And I think we just have to hope that one of those is going to be effective.

BLOCK: And when you talk about a drug that may be effective, what's your best hope right now? Is it a drug that would stop symptoms, delay symptoms, or are we really thinking there may be a cure out there?

Dr. ALBERT: I think that nobody anticipates the first new drug that is developed will be a cure. What everybody is assuming is that it will slow up the progression of the disease.

So right now, the drugs that are on the market make people slightly better than they would be without them, but the disease progresses at the same basic rate.

And what we're hoping the new drugs would do would be to slow up the progression so that, for example, if you intervened when people were extremely mild, they might stay mild for a decade or so.

That would be really wonderful because you don't want to prolong life in people who are very advanced, but you'd love to be able to prolong high-quality function.

BLOCK: Dr. Albert, what do you tell patients who are looking at the timeline and are frustrated by how slow progress has been, even though it may seem quick to you in a lab, that for them, in their daily life, there is no great hope on the horizon?

Dr. ALBERT: I tell patients that we don't know when the next effective treatment will come about. The other thing that we tell patients is that they should really consider participating in clinical research in general because that will help to speed the day when we have better treatments.

You know, we have come an enormous way in the last 30 years, and it's really because the entire community has been working together: the patients, the caregivers and the researchers, as well as the people in pharmaceutical companies trying to develop better drugs.

BLOCK: Dr. Albert, thanks again for talking with us.

Dr. ALBERT: Good to talk to you.

BLOCK: That's Dr. Marilyn Albert. She's professor of neurology at Johns Hopkins, where she also directs the Alzheimer's Disease Research Center.

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