The Current State
of Alzheimer’s Disease Treatment
Is a bona fide cure for Alzheimer’s disease (AD) truly right
around the corner? Despite the glowing reports we read about from experiments
conducted in test tubes and animals, the short answer is No.
I have spent decades in the Pharmaceutical and Biotech
industries looking for the elusive small molecule or biologic to halt the
production of the plaques and tangles
that are a hallmark feature of this neurologically destructive disease. These
compounds work just fine in animals but do not improve cognitive health in
humans.
The current pharmaceutical agents to treat AD patients focus
on acetylcholine which is a neurotransmitter that supports memory. For mild to
moderate cases of AD, doctors prescribe Aricept® or Exelon®
which are cholinesterase inhibitors that prevent the breakdown of
acetylcholine. For moderate to severe AD doctors recommend Namenda®
which is a N-methy-D-aspartate (NMDA) antagonist that blocks the toxic effects
associated with another neurotransmitter, glutamate. The newest drug, Namzaric®,
is simply a combination of Aricept® and Namenda® to treat symptoms of moderate
to severe AD.
Other classes of drug treatment merely help with the
depression, aggression, restlessness and anxiety seen in AD but none of these
drugs, including the cholinesterase inhibitors, reverse neurodegeneration and
also come with numerous side effects.
Novel treatments in clinical development focus on reducing
plaques and tangles, and while several compounds have proven to be effective in
this manner they do not reverse or delay disease progression. The current theory for this lack of efficacy is
that treatment must start long before obvious symptoms of AD appear. In most cases this could be a matter of
decades, not years. As a result the
founders and active members of the AD
foundation and physicians from the Weill
Cornell Medical Center are strong
supporters of disease prevention using dietary and lifestyle intervention to
reduce cognitive decline in AD. Although statistical significance is much
harder to quantify for these remedies, since there are so many variables, the
results cannot be ignored.
Since I am a fitness enthusiast I am happy to report that
there is a wealth of data to show that exercise, weight lifting in
particular, improves cognitive health in a variety of ways. These
studies have shown that exercise increases brain size and function with measurable
improvement in memory. These changes may
be related to increased blood flow and subsequent oxygenation of the brain
along with increased delivery of glucose. Decreased glucose utilization is a
hallmark feature of Alzheimer’s disease which is why it is sometimes referred
to as Type
3 Diabetes. Also, yoga and meditation are shown to reduce the
stress hormone cortisol to improve overall well-being. These studies mirror the utility of physical therapy
used to restore neuronal function in brain
injury.
Numerous studies have been undertaken to assess the
importance of nutrients
that are critical for brain health, including vitamins B1, B6, B12 and D3 along
with Omega-3 fatty acids. Huperzine is a
moss extract that has properties similar to those of colinesterase inhibitors.
Other nutrients under investigation include coconut oil, phosphatidylserine,
and a Medical food called Tramiprosate. Coconut oil is high in medium chain
triglycerides thought to be an exceptional energy source for the brain. Phosphatidylserine is a primary component of
the membranes that surround nerve cells and Tramiprosate is rich in taurine, an
amino acid that plays an important role in creating new brain cells and is often
used to boost cardiac function.
A more practical solution to ensure consumption of all of
these nutrients would be to follow The Mind Diet which
is basically a combination of a Mediterranean diet that is rich in healthy fats
from fish, olives, olive oil, nuts and seeds, and avocados, and the DASH diet
which helps to reduce sodium levels and increase fiber from fruits, vegetables
and whole grains. These foods increase the growth of beneficial bacteria in the
gut, leading to greater production of acetylcholine. Improved gut health will also increase levels
of serotonin and dopamine to obviate the need for anti-depressant and
anti-anxiety meds. One piece of The Mind Diet that I
probably would not support is the inclusion of red wine. Alcohol is a solvent that
inhibits nutrient absorption and may interfere with digestion. It is also a
stimulant that will interfere with a good night’s sleep. Despite it’s
reputation for being heart healthy I do not believe that red wine is beneficial
in AD.
Treatment of Alzheimer’s disease is not nearly where it
needs to be, given the acceleration in aging of the World’s population (Fig. 1).
In their quest to chase down that next billion-dollar drug pharmaceutical
researchers are wasting valuable time and resources. A greater emphasis on
holistic treatments that increase memory will lead to improved outcomes with
less pain and suffering by both patients and families.
