STAT, the on-line health publication covering medicine, science and health issues, recently sponsored an hour on-line “chat” with Reisa Sperling, the head of the Center for Alzheimer’s Research and Treatment at Brigham & Women’s Hospital. Dr. Sperling answered questions about the state of Alzheimer research and STAT reporters filled out the dialogue by posting links to other research developments. Here is an summary of the hour long discussion:

 

The ABeta/Tau Debate

The clinical trials that have targeted the reduction of amyloid in the brain have failed to demonstrate efficacy. There is growing frustration that researchers are too narrowly focused and need to explore other factors that may cause Alzheimer’s.

Dr. Sperling continues to think that amyloid plays an active role in the early stages of Alzheimer’s, but its importance decreases as the disease progresses. She also thinks that treatments are not likely to be effective unless they are started prior to the onset of symptoms; by then, the disease process is too advanced to be treated.

 

The Cocktail Approach

Some researchers now think that there will be no “silver bullet” – a single drug – that will cure Alzheimer’s. They think a combination therapy will be needed to successfully treat such a complex disease, similar to HIV, which is now successfully managed with a cocktail of drugs.

Commentators observe that before work can begin on a combination therapy, there has to be one drug that has proven to be effective to some degree. Once such a drug is identified, researchers can combine it with other drugs to improve its efficacy. Until that one effective drug is identified, work on the cocktail theory remains just a theory.

 

Screening Tools

Several participants asked about the development of better screening tools (also known as biomarkers) to identify those who are at high risk for developing Alzheimer’s. Currently, researchers use PET scans that map the location of amyloid in the brain. These scans are very expensive, and not everyone who has amyloid will develop Alzheimer’s. The inability to clearly identify those at risk makes the outcomes of clinical trials more difficult to interpret.

Dr. Sperling reported that new screening approaches include the use of computerized cognitive testing, which is thought to be more accurate, more sensitive blood tests, and the use of genetic screening . She thinks these new techniques alone or in combination, will result in more accurate identification of at risk individuals.

 

Active Research Areas

There are 105 clinical trials that are currently studying Alzheimer’s disease.

Dr. Sperling is encouraged by the breadth of these studies, and she specifically mentioned several new promising areas of research, including:

• The role of brain inflammation in Alzheimer’s
• Determining which forms of amyloid are most associated with development of Alzheimer’s
• The link between diabetes and Alzheimer’s
• Protecting against Alzheimer’s by preserving of the health of synapses in the brain
• The role of infection in Alzheimer’s

 

Increasing Public Awareness

Researchers are concerned that there is not enough public awareness about the extent to which Alzheimer’s will impact the country on the one hand, and that people think that the disease is incurable and thus are unwilling to support research efforts. The hope is that increased awareness will lead to more financial support and more people willing to participate in clinical trials. New efforts are underway to enlist primary care physicians to educate their patients about Alzheimer’s and to encourage those who fit research protocols to volunteer for clinical trials.

 

If you want to read the entire transcript of this hour-long online chat, you can find it here.