16 September 2008: Lunch debate "Current and future treatments for Alzheimer's disease"
“The treatment of Alzheimer’s Disease: current options and future perspectives” was the focus of Alzheimer’s Europe’s 4th lunch debate. Hosted by Katalin Levai MEP (Hungary), the Vice Chairperson of the European Alzheimer’s Alliance, the lunch debate seems to have been the most successful to date with 50 attendees which included some 20 MEPs and/or their assistants, representatives of pharmaceutical companies and Alzheimer organisations attending.
Opening his presentation, Professor Kurz explained that the incidence of Alzheimer’s will double by 2050 and that the disease is a proteinopathy (a malfunction of protein): In Alzheimer’s disease there is an accumulation of two proteins (a) amyloid, which forms plaques and/or (b) tau protein which clots and builds tangles. However, the sequence of events which results in Alzheimer’s disease is a complex cascade which entails many more steps than just the overproduction of protein.
This cascade of events lasts approximately 20 years, with physiological changes in the brain starting in the entorhinal cortext and progressing to the hippocampus. It is not until these physiological changes reach the temporal, parietal and frontal cortex that symptoms (loss of memory and cognitive function) associated with dementia are evident. Therefore, dementia is at a very late stage of the Alzheimer’s disease process and Professor Kurz explained that the current treatment is only targeting these last few years.
From a medical point of view, the “threshold of dementia” is said to be crossed when the ability to perform everyday activities by people with dementia reduces significantly. (could include simplified and brilliant chart?) It should be noted that the perspective of patients maintained positive regarding their quality of life if they were able to function in everyday life, maintain social bonds, feel accepted and supported by others, participate in life and have a role in which they felt significant to others.
Although Professor Kurz believes the current drugs (for example, donepezil, rivastigmine, galantamine, memantine) we have are the best available, unfortunately their impact on the disease is limited both in terms of their magnitude and duration due to the fact they are target the disease at a very late stage in the whole cascade of events. Studies show that psychosocial treatment can be successful but only if it is individualised and tailored to the person’s needs.
Professor Kurz’ own view is that treatment should be targeted earlier on those people who are at risk in an attempt to prevent the transition to dementia, with the vision being the prevent dementia altogether by patients never reaching the dementia threshold.
New approaches to medical treatment have indeed targeted earlier stages in the cycle of Alzheimer’s disease and their results are mixed. Some were disappointing as the larger trials failed to confirm the excitement generated from the earlier trials (for example, non-sterodial anti-inflammatories, secretase inhibitors, lipid lowering agents, the removal of metal ions and amyloid immunisation trials). Some appear to be encouraging, for example a) those drugs which target amyloid, such as bapineumumab, b) the dye methylmethonium chloride which attempts to redress aggregation of the tau protein, c) a nutritional compound using a combination of vitamins and fatty acids and d) an antihistamine known as dimebon, but all require further research.
Professor Kurz finished his presentation by saying that there will be no fast track results within the next five years. More effective treatment is required but it is also necessary to take into consideration the ethical, economic issues as well as patient suffering and caregiver burden.
In the debate that followed, Sirpa Pietikänen (MEP, Finland) asked what impact dietary treatments have had. Professor Kurz highlighted two dietary benefits (i) the Stockholm study which found that significant amounts of fatty acids were good for the brain and (ii) the beneficial effects that adhering to a mediterranean diet can have.
Charles Scerri (Alzheimer Europe Board Member, Malta) believed that Alzheimer’s disease to be a disease of middle age as physiological changes occur many years before symptoms appear. Professor Kurz concurred, saying that the youngest known patient was 19, the youngest patient he himself had known was 37.
Managing patient expectations in the light of media “miracle breakthroughs” was an issue raised by Jean Georges (Executive Director, Alzheimer Europe). Alexander Kurz explained that whilst he does believe there will be better treatments in the future, he puts the “miracle breakthroughs” into context by sharing current information with people with dementia and also explaining that the press have a need to be sensationalistic so that they can increase sales.
Jennifer Johnson (Assistant to MEP Peter Stastny, Slovak Republic) sought clarification on whether Alzheimer’s disease can be identified in a living patient with accuracy. Professor Kurz said he believed that a 95% accurate diagnosis is possible in specialised centres, with the start of clinical symptoms, laboratory tests and brain imaging all aiding diagnosis.
With nearly half of the population (40%) projected to develop Alzheimer’s disease if they live long enough, Dr Sigurd Sparr (Board of Alzheimer Europe, Norway) asked Professor Kurz to give his opinion as to how we might detect a genetic tendency to Alzheimer’s disease in the future. Professor Kurz reflected that we still have the same mutations on chromosomes 1, 14 and 21 and this has made genetic research a little like driving a harvesting machine through the genome as no other chromosomal mutations have been discovered. Dr Sparr then asked for Professor Kurz’s opinion on postponing the start time of dementia by the identification of risk factors. Professor Kurz acknowledged that aside from hyperthyroidism, depression and head trauma no new item had been added and that many risk factors have proved insignificant. Further they don’t explain the 40% incidence rate of dementia at the age of 103. However, Professor Kurz said that if he were to select the single most important risk factor to focus on, it would be the prevention and/or management of vascular disorders as they are often left unrecognised.
Ms Levai thanked Professor Kurz for his informative presentation and for the strong support shown by the high numbers of attendees. Jean Georges closed the meeting, thanking both Professor Kurz and Ms Levai and reminded participants that the next Alzheimer Europe lunch debate in the European Parliament will be on 9 December..
September 2008: Lunch Debate "Current and future treatments for AD"
Last Updated: mardi 27 mars 2012