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September 23, 2014

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Only working together can we successfully fight Alzheimer’s

Most of the major news recently surrounding Alzheimer’s disease has been focused on the lack of success in discovering effective therapies for the disease. Even the major theories of what causes Alzheimer’s disease are being questioned and re-examined.

However, as World Alzheimer’s Day nears — Sept. 21 — there is much optimism and good grounds to predict eventual success in our fight against this killer of minds. Nevada — and Las Vegas in particular — should be very proud to be standing at the forefront of this fight with the Cleveland Clinic Lou Ruvo Center for Brain Health.

First, while many of the current pharmaceutical treatments have failed, the drugs being tested today are based on the science of 7-10 years ago (that is how long it takes for a drug to be approved by the complex testing process and into large clinical trials).

Our science is now much stronger, our targets better defined, and our methods more advanced. We now have a much better idea of the precise processes that generate the abnormal brain proteins, how they lead to cell death, and how they might be modified or arrested with treatment. If we can stop the cell death, we can stop Alzheimer’s disease.

Second, new brain imaging techniques and spinal fluid tests will affect drug development in a major way and are revolutionizing the way we think about Alzheimer’s disease. These tests allow scientists to see the accumulation of the protein in the brain even before symptoms develop.

Moreover, the new tests allow researchers to determine who among those with memory complaints have the earliest form of Alzheimer’s disease — not every older person who forgets where his car is parked in the mall garage has Alzheimer’s disease, but some do. These biomarkers will transform drug testing because we can identify patients early in the course of Alzheimer’s disease, when treatment has the greatest effect and is most likely to succeed.

Third, early diagnosis is a major goal, and we have made great strides in being able to identify people in the earliest stages of Alzheimer’s disease. With the assistance of brain scans and spinal fluid tests, we now can confidently diagnose Alzheimer’s disease in persons with mild cognitive impairment. This allows patients to participate in critical life decisions before their intellect has declined or their judgment becomes compromised.

Early diagnosis also allows families to understand the changes they observe in a spouse or parent, to participate in counseling, and to make their own life-cycle decisions. In short, the advances have been so great that we have redefined Alzheimer’s disease, no longer requiring that the patient must meet criteria for “dementia” before we can diagnose her as having Alzheimer’s disease. We believe this change contributes greatly to quality-of-life issues.

Despite the failure of several promising drug therapies, we are making genuine progress in developing new remedies. The brain is extraordinarily complex and there are many barriers to the development of new treatments. Only a few drugs will pass these hurdles — but we need only a few drugs to succeed in order to make a major impact on Alzheimer’s disease.

We don’t even need a “cure”: If we delay the onset of Alzheimer’s disease by five years, we can reduce the prevalence by 50 percent; a 10-year delay would make Alzheimer’s disease as unusual as polio is today.

There are 5.3 million Americans with Alzheimer’s disease (including 29,000 people in Nevada). This number is estimated to reach 16 million by 2050.

Patients themselves can help cure Alzheimer’s disease. Scientists and doctors can study Alzheimer’s disease and can develop new treatments, but they cannot test the drugs without the help of patients. Clinical trials, like those we are conducting at the Lou Ruvo Center for Brain Health, are the only way of generating information acceptable to the FDA.

The FDA is the only agency empowered by the U.S. government to approve new treatments for any disease. Patients must participate in trials if there is to be any progress in developing new treatments for Alzheimer’s disease. Trials are critically important partnerships among patients and families, doctors, and scientists to advance new treatments for Alzheimer’s disease.

Our progress can be sustained only with federal funding; that is why the Alzheimer’s Breakthrough Act (H.R. 3286/S. 1492), which is before Congress, is so important. Just when we are on the verge of major advances and new therapies for Alzheimer’s disease, federal funding is faltering.

We must have more research, more equipment, more laboratories, more centers and more young scientists coming into Alzheimer’s disease research. Without this investment we cannot hope to sustain the momentum that has brought us this far and that is required to win the war on Alzheimer’s disease.

Jeffrey Cummings, a medical doctor, is director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

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