More than 4,000 scientists from around the world will gather in Washington this week to share the latest findings and ideas on Alzheimer’s disease, with some saying that the odds of finding effective treatments look promising even as an aging society increases the urgency of finding a cure.
The Alzheimer’s Association International Conference, which runs from Sunday through Thursday, is expected to highlight a number of recent trends in the field.
Among them is a search for inexpensive, noninvasive diagnostic tools that would allow doctors to determine whether a person’s brain has begun to undergo changes that will later lead to cognitive impairment, memory lapses and other symptoms of dementia.
Researchers are also more aware that the disease’s complexities suggest that the way forward will involve multi-pronged interventions, not a silver bullet. And a growing body of evidence also suggests that those interventions will not just involve taking medications, but embracing changes in lifestyle, such as diet, sleep habits and physical exercise.
What’s more, researchers more than ever understand that Alzheimer’s disease and other dementias pose different degrees of risks for different groups of people, such as women and minorities, and may even develop in their bodies in different ways. Researchers are devoting more time to exploring the role that gender and race might play in developing dementia and the best treatments.
Several leading scientists say the field has matured to the point that the possibility of identifying more effective ways to detect the disease in its early stages and treat, delay or prevent it seems less far-fetched — even as they also say that their work remains relatively underfunded compared to other diseases such as heart disease, cancer or HIV/AIDS.
“This is a very important time in Alzheimer’s disease research. I think the tide is really shifting now in terms of developing new types of research as well as new treatments,” said Nancy J. Donovan, an associate psychiatrist at Brigham and Women’s Hospital in Boston. Advances in the field now allow doctors and researchers to analyze dementia-related changes in the brain years before symptoms appear, she said. “To me, that is the most exciting thing going on in Alzheimer’s research right now.”
More than 5 million people are living with Alzheimer’s, a number expected to increase to 13.5 million by 2050. As the disease grows more prevalent, its financial impact is also expected to soar. Alzheimer’s and other dementias already cost $226 billion a year, an expense that is mostly borne by Medicare and Medicaid, and advocates have been pushing the federal government to invest more in research today instead of costly treatment later.
Dean Hartley, director of science initiatives at the Alzheimer’s Association, said Congress is debating the possibility of increasing the annual research budget of about $600 million by an additional $300 million to $350 million a year, beginning in fiscal 2016. But he said that’s still less than what is currently spent on cancer, heart disease or HIV research, and well below the estimated $2 billion that the scientific community has said would be necessary to try to find a cure or effective treatments by 2025.
“We’ve got to ramp up now,” said Ronald C. Petersen, director of the Mayo Clinic’s Alzheimer’s Disease Research Center and chairman of the national Advisory Council on Alzheimer’s Research, Care and Services.
The conference was first held in 1988. The Alzheimer’s Association, which began organizing the conference in 2000, says the annual gathering is now the largest of its kind. This year, researchers are arriving from at least 65 countries; about 40 percent of the attendees are international, Hartley said.
High on the agenda among scientists in the field is the search for easily detectable biomarkers of disease.
At one time, for example, autopsy was the only way to definitively diagnose Alzheimer’s, by viewing whether a person’s brain had been damaged by buildup of the amyloid beta or tau proteins that create neurofibrillary tangles, killing nearby brain cells. Relatively recent technological advances, however, can obtain good images of amyloid beta in a living brain and are becoming better at imaging tau. Analyzing cerebrospinal fluid has also been shown to be a reliable indicator. But scientists hope that less invasive, less expensive exams — such as an eye scan, a skin test or an array of such simple tests — could allow doctors to identify people at risk.
As science further illuminates the biochemical pathways that lead to dementia, researchers are also more focused on the notion that a multi-pronged approach to treatment will emerge.
Instead of a single drug, it’s more likely that people with Alzheimer’s will be prescribed several medications at once.
“This is what we do in other disorders. HIV/AIDS gets a cocktail. When we treat blood pressure these days, it’s usually a variety of different mechanisms,” Petersen said.
Their research suggests that the multi-targeted approach will include changes in lifestyle to reduce the risk of developing dementia and maintain a healthy brain.
One study to be shared at the conference suggests that the risk of dementia has already declined for more recent generations.
“This is one of the rare, good news stories,” said Richard Lipton, who heads the Einstein Aging Study at the Albert Einstein College of Medicine in New York. He said that although it still remains the case that the risk of Alzheimer’s doubles every five years for people who reach 65, his laboratory’s new epidemiological study suggests people born after 1930 have lower risk to begin with. The findings could be the result of better management of cardiovascular risk factors in recent decades as a result of advances treating heart disease, diabetes or high blood pressure, as well as people’s increased physical activity.
Another Einstein study suggests that psychological stress can elevate the risk of developing dementia — or, more precisely, how one handles stress. Higher “perceived stress” is associated with cognitive impairment, the study shows. But that also suggests that better managing stress might be beneficial.
“As we started doing this work, I started doing yoga,” Lipton said.