Expert Sees Hope and Challenge in Treating Alzheimer's NPR's Jennifer Manly is Associate Professor of Neuropsychology at Columbia University's Taub Institute for Research on Alzheimer's Disease and the Aging Brain. She speaks to Tony Cox about the science behind the human face of Alzheimer's.

Expert Sees Hope and Challenge in Treating Alzheimer's

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TONY COX, host:

This is NEWS & NOTES. I'm Tony Cox.

We just spoke with members of the Gram family out of Atlanta, Georgia. They are dealing with Alzheimer's in a painful, personal way. For more on how exactly the disease works, I am joined now why Jennifer Manly. She is an associate professor of neuropsychology at Columbia University. Professor, welcome.

Professor JENNIFER MANLY (Neuropsychology, Columbia University): Thanks. Good to be here.

COX: Let's talk first about the hereditary aspects of Alzheimer's. What do we know about that?

Prof. MANLY: Well, we know that as in the story we just heard, the Graham family, that people with a family history of Alzheimer's disease are about one and a half to two times more likely to develop the disease. This actually doesn't differ across ethnic groups. There are some very rare forms of genetic - determined early-onset - Alzheimer's disease. You may have heard of some of these genes - the PS1, PS2 and APP genes. But most of the cases of Alzheimer's disease occur after the age of 65, and this is called late onset Alzheimer's disease.

There's only one gene that's been found in - and replicated in studies to put people at higher risk for developing for Alzheimer's disease, and that's the ApoE-E4 allele. And this alelle, interestingly, doesn't seem to have the same effect in African-Americans. It seems to have less of an effect on risks for Alzheimer's disease among African-Americans. There are other genes that have been found - probably around 120 genes in various studies. And these - most of them haven't been replicated as much as the ApoE-E4 gene.

COX: What about the risk factors that are involved, professor? What can we say about those, particularly as it relates to black Americans and also, in addressing that, talk about whether or not environment is a legitimate factor.

Prof. MANLY: Sure. We know that African-Americans are about two to three times more likely to develop Alzheimer's disease than Caucasians. This has been found in a few studies across the country. And first I want to say that there is - there are no risk factors that seem to be unique to African-Americans that have been found yet. But as you'll see there are some risk factors that are more prevalent in African-Americans. So that may explain the higher risk for developing the disease.

The number one risk for developing Alzheimer's disease is age. We know that about one in 10 people older than age 65 have Alzheimer's and nearly half of those people over 85 years old have Alzheimer's. I think the other thing to discuss here, an important thing, is that the things that keep your heart healthy seem to keep your brain healthy. So several studies show that diabetes or high blood sugar is a risk for developing Alzheimer's - high blood pressure, high cholesterol, overweight.

So now you can see that because these cardiovascular diseases are more prevalent in African-Americans, this may explain the higher rates in African-Americans.

COX: Let's talk about treatment for a moment. We heard the drug Aricept mentioned in the Gram family case, and it's described as the number one drug prescribed for Alzheimer's.

Prof. MANLY: Right.

COX: What exactly does it do?

Prof. MANLY: Well...

COX: Well, maybe another - let me interrupt to say, instead of telling us necessarily what it does, how does it work and what's the impact of it? Perhaps that's a better way of looking at it.

Prof. MANLY: Okay. Well, it - Aricept is an anticolinergic drug. It seems to improve the amount of neurotransmitter in the brain that seems to be depleted. I misspoke. It's not anticolinergic. It's a colinergic drug. And what we try to do is where this neurotransmitter has been depleted, we want to try to replace it. And what - about half of the people who go on Aricept experience a modest improvement in cognitive symptoms. We prescribe these medications to manage symptoms. Rights now, there is no cure for the disease.

And there are some side effects, but I wanted to tell you that with Aricept, there's only been one trial that has taken place with African-Americans. It's a clinical trial, an open-label trial...

COX: Let me just say this before you finish. I'm sorry to interrupt you, except to say that we only have about a minute left. I thought you should know that. Go on.

Prof. MANLY: Okay.

COX: Okay.

Prof. MANLY: That is a very small trial, and I wanted to say that disease-modifying drugs are coming down the pipe, so that African-Americans really should look into calling the Alzheimer's Association to look to see if there are trials in their area that are taking place.

COX: I appreciate it very much, Professor Manly. Jennifer Manly is an associate professor of neuropsychology at Columbia University's Taub Institute for Research on Alzheimer's Disease and the Aging Brain. She joined us from NPR's New York studios. Thank you again, Professor Manly, very much.

Prof. MANLY: Thanks for having me.

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