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New Thinking About Alzheimer's Treatment

Current therapies are the triumph of hope over experience.

New Approaches Needed

There are only five drugs approved by the FDA specifically for treatment of AD, and only four are widely used (the fifth, Cognex, has serious side effects and has largely fallen out of use). But because they work on the symptoms of Alzheimer's -- memory loss, confusion, agitation -- rather than on the actual pathology that causes the symptoms, these drugs may be a case of too little, too late.

"Everybody feels like we have to do something about this disease fast. The numbers of people who are going to be affected by it is so great, we know what a difference it could make if we could delay onset even by five years. And we also know that the disease takes a long time to evolve in the brain, so the sooner we intervene, the better," says Marilyn Albert, PhD, director of the division of cognitive neuroscience in the department of neurology at Johns Hopkins University School of Medicine in Baltimore.

The first brain changes of Alzheimer's disease may occur as early as 10 to 20 years before the first symptoms of the disease appear, Bengt Winbald, MD, PhD, professor of geriatric medicine and chief physician at the Karolinska University Hospital and Karolinska Institute in Stockholm, Sweden, tells WebMD.

Until recently, those changes have been too small or too subtle to easily detect, making it extremely difficult to identify people who could benefit from early intervention.

But that appears to be changing. A key theme at this year's Alzheimer's conference is advances in brain imaging that may make it possible to detect and diagnose early AD, leading to the development of drugs and other treatment strategies that could halt or at least slow the progression of disease.

Plaque Attacks and Tangled Webs

One of the most intriguing strategies discussed at this year's conference involves drugs or vaccines aimed at clearing deposits of an abnormal form of a protein that accumulates in the brains of people who suffer from Alzheimer's. The protein, known as beta amyloid, forms clumps or "plaques" and is a hallmark of Alzheimer's disease.

One experimental drug, called Alzhemed, has been shown in animal and human studies to clear significant amounts of beta amyloid deposits from the brain. A similar drug, known only as LY450139, has shown similar effects in humans.

Several companies are also working on vaccines that can stimulate the body to make antibodies that attack and dissolve beta-amyloid deposits. Other experimental drugs and vaccines are aimed at treating another suspected cause of AD, a different protein known as tau, which normally serves as a building block of nerves. In the brains of people with advanced AD, strands of twisted tau proteins, called fibrillary tangles, can be found inside brain cells.

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