Chat Transcript: Update from Alzheimer's Congress
July 12, 2000 -- In Washington, D.C. this week, representatives from three major Alzheimer's conferences are gathering to share information in the first World Alzheimer’s Congress. Almost 5,000 researchers, doctors and caregivers are expected to attend.
Among the topics covered at the conference are the results of safety trials for a possible vaccine and the latest research about the degenerative disease.
Joining us today in an online chat was William Thies, Ph.D., vice president of Medical and Scientific Affairs for the Alzheimer's Association.
Moderator at 9:16am ET
You can learn more about the Alzheimer's vaccine by clicking here now.
Moderator at 11:55am ET
Welcome William Thies.
Moderator at 11:56am ET
Could you please talk about the promise and pitfalls associated with the newly announced Alzheimer's vaccine?
William Thies at 11:58am ET
The vaccine that has received a lot of news coverage in the last couple of days is the result of a single observation that's now about one year old. That observation was that in a highly engineered mouse that had some of the biochemistry of Alzheimer's disease, immunizing that mouse with a purified protein could decrease some of the altered biochemistry. Since that initial observation, there have been a number of studies in other animals, and we are now in the very earliest stages of clinical trial in humans.
To date, the clinical trials in humans have been aimed at establishing the safety of this intervention, and we anticipate trials for the effectiveness of this intervention starting within the next eight to ten months. We are cautiously optimistic about this development, but we recognize that there is still a lot of work to be done before this becomes a practical, available clinical intervention.
Moderator at 11:59am ET
Penny Folden asks:I heard today that people who are genetically predisposed to Alzheimer's disease should avoid high-fat diets. Could you please explain. Thank you.
William Thies at 12:01pm ET
The work that was reported today is based on an observation of a relatively large number of patients, where they were asked how much fat they ate when they were in their 20s through their 40s. The results said that people who had reported a higher-fat diet in their early life had higher incidence of Alzheimer's disease at this time.
While this kind of study does not prove causation, it is the kind of observation that ought to lead us to further investigation. It is premature at this point to make a broad public health statement about preventing Alzheimer's disease by lowering the fat in one's diet. There are, however, a variety of other health reasons that suggest that a low-fat diet can be beneficial.
Moderator at 12:03pm ET
Susan Holtry asks:My mother developed Alzheimer's at age 60. Should and can I be tested? Should I be taking precautions now (e.g., Gingko, Advil, vitamin E)?
William Thies at 12:04pm ET
There is no single genetic test that defines whether an individual will develop Alzheimer's disease or not. Without a specific clinical preventive intervention, it is not necessary to do broad screening for genetic risk for Alzheimer's. For individuals that particularly want information about their risk, there is a test available for one gene — the apoE4 gene. That can give some information about one's risk.
The second part of the question is whether she should be doing something now. At this point in time there is no definitive information that has established the value of any preventative therapy. There is suggestive evidence that a number of compounds, like Vitamin E, Gingko, estrogen and ibruprofin, may help prevent the disease. In that setting, we do not recommend that people necessarily take any medication to prevent the disease.
There also is really no lifestyle change that we are sure can prevent the disease. However, a program that leads to healthy aging, that includes not smoking, eating a low-fat diet, getting some exercise, controlling one's weight, and not drinking to excess, will give one the best result that they can have, whether they develop the disease or become a caregiver.
Moderator at 12:07pm ET
Should any particular population be tested for the apoE4 gene?
William Thies at 12:09pm ET
Our recommendation is that the question of apoE4 testing is one that is best answered by the patient and their family in consultation with their physician. Some people want to know whether they carry a potentially high-risk form of the apoE4 gene, and some people do not want that information. We feel that personal choice should be respected in this setting, and that blanket recommendations, either for or against testing, are inappropriate.
Moderator at 12:09pm ET
How will the need for more caretakers of Alzheimer's sufferers be met in the future?
William Thies at 12:12pm ET
That's a very good question. The aging of the American population suggests that we are about to have an explosion of Alzheimer's disease. The numbers suggest that by 2040 we may have more than three times the number of cases we have currently. This will require economic and emotional resources that may simply be beyond our reach.
If we are going to support this large number of cases with professional caregivers, the cost will be very great. If, as is the case now, much of the care is given by family members, we are going to have to have much better community resources to support those caregivers. Finally, the best thing we can do is find a definitive, preventative treatment for the disease, so that we can drastically reduce the number of cases.
Moderator at 12:12pm ET
What are some of interesting new protocols being discussed at this meeting?
William Thies at 12:14pm ET
At this particular meeting, there have been clinical trails reported — the vaccine that we talked about earlier. Tomorrow there will be a discussion on a clinical trial of new a class of medications that affect the symptoms of Alzheimer's disease. And we are learning increasing amounts about how to best manage patients with our current medications, and how to do the best possible job of patient selection for medication.
In the second half of our conference, there will be a significant number of reports on better caregiving techniques, that include ways to manage the patient more effectively and maximize their quality of life.
RHM at 12:14pm ET
Once a person is diagnosed, on average, how fast does the person move through the various stages of the disease? On average, how long does the person live?
William Thies at 12:16pm ET
The course of Alzheimer's disease is highly variable. The deterioration of memory functions may occur fairly rapidly, over a matter of just a few years, or take as long as 10 or 12 years. The life expectancy after a diagnosis, similarly, is variable, and is often dependent on the overall health of the individual. Certainly, people with fewer health problems will live longer. People that have concomitant heart disease, kidney disease, lung disease, cancer, etc., will likely have a shorter life span.
Moderator at 12:16pm ET
What is the theory connecting severe head trauma to Alzheimer's?
William Thies at 12:18pm ET
There have been a number of studies that suggested that people who suffer severe head trauma have a higher incidence of Alzheimer's disease. Most of those studies have been small, but their consistency suggests that older people in particular should be careful about head injuries. A major risk for injury in the elderly are falls, and there are a variety of good pieces of advice to avoid such things, such not getting up in a high place without support. Maintaining muscle tone around the joints can also be highly protective against falls.
Moderator at 12:19pm ET
Linda asks:What is the possibility of this (vaccine) being tested for other diseases, such as multiple sclerosis?
William Thies at 12:20pm ET
The vaccine is highly specific for Alzheimer's disease, and would be an unlikely candidate for testing in other diseases. However, the technique may, in fact, be useful in other diseases that may be due to an accumulation of abnormal protein.
Moderator at 12:20pm ET
Walky asks:Will someone who has Alzheimer's ever be able to take a drug to reverse the effects? Or for the people with the disease, is it too late?
William Thies at 12:22pm ET
Some of the medications currently available do improve the symptoms of Alzheimer's disease. They do not reverse the disease, but they can improve the symptoms. The likelihood that we will be able to treat someone with well-developed Alzheimer's disease and return them to normal is not high at this time. That will require techniques and technologies that we do not understand at this point, and so, lies some distance in the future.
Sandi from stl.express-scripts.com at 12:22pm ET
I have read that keeping mentally active (reading, writing, research, puzzles, etc.) may help prevent or delay the onset of Alzheimer's disease. Has there been any scientifically credible research to substantiate this claim?
William Thies at 12:23pm ET
No. There has been some suggestive work that keeping active, keeping attached to society, continuing to use one's mind, may be beneficial. But that has not been tested in the rigorous setting required of modern clinical trails.
William at 12:23pm ET
What is the difference between Alzheimer's disease and dementia?
William Thies at 12:25pm ET
Dementia is a description of symptoms that is characterized early by loss of memory and difficulty with what are sometimes called executive functions — that is, the ability to do complex mental activities like complex arithmetic, reading, that sort of thing. Alzheimer's disease is a specific form of dementia. It is the most common form of dementia, and represents 60-70% of all the forms of dementia one sees in most studies. Other causes of dementia include vascular dementia and a variety of relatively uncommon neurologic diseases.
Moderator at 12:26pm ET
What are the chances of us finding a cure for Alzheimer's, or just controlling the disease through drugs?
William Thies at 12:27pm ET
The most likely approach at this point appears to be treatments that prevent Alzheimer's disease. If we can develop treatments that do prevent the disease from happening, and we can give it to people early enough, we will have prevented the disease from occurring, which is just about as good as a cure.
Donna from nctsw.navy.mil at 12:27pm ET
My father has Alzheimer's. How can he become part of the study?
William Thies at 12:28pm ET
Companies that are doing clinical trails frequently have 800 numbers that aid in recruitment. If Donna is referring to the vaccine study, the company is Elan Pharmaceuticals, and I'm sure directory information can give directions for contacting them. They probably already have a Web site too. Clinical trials in your own area can often be accessed through the nearest academic medical center.
There is a list of some trails that is on the Internet at the National Institute of Health site, which is www.nih.gov.
Moderator at 12:30pm ET
Do you have any final thoughts to share?
William Thies at 12:30pm ET
There is a wealth of information available on Alzheimer's disease at the Association's Web site, at www.alz.org. We would recommend people access that site. They can also leave specific questions there as well.
Moderator at 12:31pm ET
Thank you for joining us.