With over five million Americans currently suffering from Alzheimers disease (AD), there are intense research efforts to find more effective means of diagnosis and treatment including at the Memory Center at the Miami Jewish Home and Hospital.
AD is the most common form of dementia, characterized by progressive deficits in memory, language, recognition, motor skills, and executive function. There is no way to quickly and reliably diagnose this disease in its earliest stages, and existing treatments provide only modest symptomatic stabilization or improvement, but do not modify the disease itself.
All research efforts are based on current beliefs about what causes AD. The amyloid hypothesis states that AD is caused by the build-up of a toxic protein known as beta-amyloid that occurs outside of brain cells, causing neuronal death and inflammation and leading to the formation of neuritic plaques throughout the brain. In addition, researchers know that a key protein inside brain cells called tau becomes destabilized in AD, forming intracellular neurofibrillary tangles that collapse and kill the cell. The only current means to make a diagnosis of AD with 100% certainty is to actually look at brain tissue and find a sufficient density of these abnormal plaques and tangles. But that is not a realistic means of diagnosis. Instead, we rely on clinical examinations and follow-up, brain scans, and neuropsychological testing that, when combined, bring the accuracy of diagnosis close to 90%. Once diagnosed, existing FDA-approved medications for AD help improve the levels of key neurotransmitters in the brain that are deficient in AD; they do not stop the onslaught of plaque and tangle formation.
But times are changing. Several research groups have developed new intravenous imaging compounds that can be used in PET scans to detect the presence of plaques and tangles in the brain. This technique could be likened to a virtual brain biopsy, and might allow researchers to find evidence of AD in its earliest stages perhaps even before clinical symptoms begin. In terms of treatment, there are many experimental agents being developed that may either prevent the formation of plaques or tangles in the brain, or break them up once they have been formed.
Once of the most exciting clinical trials involving immune therapy for AD is being conducted at the Memory Center at the Miami Jewish Home & Hospital, along with several hundred other sites around the United States and Canada. Subjects with mild to moderate AD who are enrolled in the ICARA Study receive intravenous infusions of the experimental anti-amyloid antibody bapineuzumab every three months. In between infusions they undergo neuropsychological testing and MRIs of the brain to look for any changes. Preliminary data from the Phase II trials of bapineuzumab look promising, although the verdict is still out. Other experimental agents currently being studied at the Miami Jewish Home include Dimebon, a novel antihistamine agent that has shown promise for individuals with AD, as well as agents to prevent production and aggregation of beta-amlyoid in the brain. The Memory Center is also starting a study of a nutritional supplement for individuals with moderate to severe AD a group often overlooked in clinical trials.
In addition to clinical research, the Memory Center at the Miami Jewish Home & Hospital offers comprehensive assessment for individuals with concerns about their memory, as well as management of associated depression and behavioral problems. Caregivers are provided with support and individual counseling, if indicated. Its motto is “Until theres a cure, theres care.” This mission infuses the work of all of its clinicians to provide the very best support as well as the latest in treatment for AD sufferers and their loved ones.
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