New approach to Alzheimer's treatment might be key to a cure

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Alzheimer's disease detection should start earlier, even before loss of cognitive function, a professor of medical ethics said Monday.

During a webinar sponsored by the American Federation of Aging Research and funded by an educational grant from the Cigna Foundation, Jason Karlawish, M.D., and Richard W. Besdine, M.D., discussed new approaches to Alzheimer's treatment and prevention, which they said has drastically changed since the disease was first discovered in the early 20th century.

Alzheimer's treatment often begins after symptoms are already apparent, such as memory loss. However, medications targeting the dementia-inducing disease's signature plaques and tangles have had little success in reversing symptoms.

So doctors and investigators are developing an alternative approach: treatment before the disease takes over.

“There's a recognition that we probably need to take an approach that isn't a ‘bedside' approach of people [with dementia],” said Karlawish, professor of medicine and medical ethics at the University of Pennsylvania's Perelman School of Medicine. “We need to take a bedside to desk-side approach and go after people that are at risk for developing dementia.”

Various tests, such as spinal fluid sampling for the presence of amyloid, amyloid PET Imaging, searching for cognition biomarkers and monitoring structural changes in the brain through an MRI, allow Karlawish and other doctors to identify at-risk patients, or patients that are likely to develop Alzheimer's later in life. Thirty percent of adults age 65 and older have a brain resembling that of a patient with Alzheimer's but are cognitively normal; Karlawish said they want to help them by delaying the disease.

“Prevention is the holy grail,” said Besdine, medical officer at AFAR and a Brown University Professor of Medicine.

The physicians offered two caveats to this approach: Medicare reimbursement can be a challenge in treatment for those who haven't shown symptoms yet, and the FDA has tougher new guidelines for when a person can be given a drug when a disease is asymptomatic.

Physicians also must find a way to gently deliver the news that a patient will develop Alzheimer's, even if he or she is asymptomatic, Karlawish noted.

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