Still Alice was Brilliant!

A Look at Alzheimer’s Disease

On Wednesday, June 10, 2015 I hosted a viewing of the movie Still Alice in my office as a vehicle to broach the subject of Alzheimer’s disease (AD) with my community.  The movie was absolutely riveting and Julianne Moore’s portrayal of an intellectual woman succumbing to early-onset AD could not have been more poignant.  In the movie Ms. Moore portrays a linguistics Professor who teaches at Columbia (the Ivy League position supports her academic prowess).  During the course of the movie she gradually loses her ability to recall course material, encounters with new people (eg. her son’s new girlfriend), the location of the bathroom in her summer home and eventually, her ability to recognize one of her own daughters. As a college professor myself, I found it particularly straining to see her lose her faculty position after her students submitted a complaint for delivery of confusing lecture content and lack of preparedness.

 

Although Alzheimer’s disease is a concern for all aging populations the Early-Onset or Familial form of the disease is relatively rare, accounting for only 5-10% of all Alzheimer's cases.  It is caused by genetic mutations that accelerate the production of plaques in the brain, ultimately leading to profound neurodegeneration.  As we learn in the movie genetic testing is available so two of Alice’s three adult children get tested.  Her youngest daughter learns that she is a carrier which means that she too, will be affected by this form of Alzheimer’s disease, and her children will have a 50% chance of inheriting the disease as well.

Since there is no cure for Alzheimer’s disease the decision to be tested is not an easy one.  Even James Watson, a Nobel Laureate, who co-discovered the structure of DNA, refused to divulge his AD status after publishing the entire sequence of his genome.  During the movie I could not help but notice that we never really observe any significant therapeutic intervention for Alice.  There is a brief mention of some of the therapeutic targets that are the focus of current R&D efforts but the actors never show Alice undergoing any sort of treatment.  Having spent decades working in the Pharmaceutical Industry on these targets, I can assure you that we are a long way off from developing a treatment that can reverse the neurodegeneration caused by plaque buildup in the brains of AD patients.

The two main pharmaceutical agents currently prescribed for AD are Aricept and Namenda, agents that are vaguely palliative but certainly not curative.  Recent clinical trials on drug entities that inhibit plaque buildup have not demonstrated measurable efficacy in patients with frank AD.  Clinical efforts are now focused on treating patients who are “prodromal” i.e. before they are cognitively impaired.  However, this can be as long as 30 years before Alzheimer’s disease is officially diagnosed. Prodromal treatment is a perfectly fine option for someone like Alice’s daughter who carries the gene for Familial AD but not an acceptable option for the majority of cases.