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MUSC Health Doctor Discusses Alzheimer’s, Prospects For Therapies As Numbers Rise

Advance With MUSC Health
October 22, 2021
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The numbers are daunting. According to the Alzheimer’s Association, more than 6 million Americans have Alzheimer’s Disease, and the number is rising alarmingly. In fact, nearly 13 million Americans are projected to be living with Alzheimer’s by 2050. Consider this: Between 2000 and 2019, deaths from heart disease dropped 7.3 percent while deaths from Alzheimer’s jumped 145 percent.

In addition to the burden on caregivers and families, the economic toll is staggering. In 2021, Alzheimer’s will cost the nation approximately $355 million and, like case numbers, will only increase – to a predicted $1 trillion by 2050. We talked with Dr. Robbie Buechler, a neurologist with MUSC Health – Lancaster to find out the prospect for new treatments, the different types of dementia, how they differ from normal memory loss and what families can do when a loved one has the disease. Buechler also has a doctorate in pharmacology and trained at Duke University and the Mayo Clinic.

Q. What is Alzheimer’s Disease?

A. Alzheimer’s is characterized by a variety of symptoms. In its earlier stage, the most obvious ones are memory loss, confusion and muddled thinking. Other symptoms include paranoia, mood disorders, depression and physical symptoms such as difficulty swallowing and talking as the disease progresses.

Q. What causes it?

A. The causes of Alzheimer’s are not fully known. Patients who have Alzheimer’s are known to have an abnormal pattern of beta amyloid and tao, proteins that build up in the brain decades before someone develops symptoms. Beta amyloid consists of protein fragments between nerve cells; tao is tangled fibers of a different protein inside the nerve cells. This buildup is believed to start in the memory region of the brain and spread to other areas. 

Q. What is the difference between Alzheimer’s and other types of dementia?

A. There are many types of dementia, but the two most common types, after Alzheimer’s, are vascular dementia, caused by stroke, and Lewy body dementia. Vascular dementia is caused by inadequate blood flow to the brain, usually the result of a stroke. Symptoms include a decline in thinking skills. Lewy body dementia is the third-most common form of dementia and is caused by changes in a key protein in the brain. The damaged proteins build up in the memory and sleep area, causing symptoms such as a shuffling gait, acting out of dreams, a decline in memory and difficulty moving. Similar symptoms are sometimes found in patients with Parkinson’s Disease.

Q. What new treatments are available to treat Alzheimer’s patients?

A. Generally speaking, no new treatments for the disease itself have come to market in 15 years. The newest drug on the market, which was approved in June, has generated much controversy, but also excitement because it works differently. The new drug addresses the actual problem instead of symptoms and is for patients with mild to moderate Alzheimer’s. Specifically, it has been shown to clear as much as 70 percent of the beta amyloid plaque buildup and tangles. Clinical tests over 18 months, however, are not as robust.

Nevertheless, the fact that there is some proof that a mechanism believed to be a factor in Alzheimer’s can be treated is pretty revolutionary. It’s the start of something new that addresses the actual problem instead of just the symptoms.

Q. Is Alzheimer’s inherited?

A. Some evidence suggests that individuals who have a certain gene may be predisposed to Alzheimer’s. Having the gene, however, does not guarantee that someone will develop the disease. Multiple genes and groups of genes, as well as environmental factors such as hypertension, high cholesterol, can be factors, but no one trigger has been identified. No one knows the exact recipe.

Q. What is the gene?

A. The gene is APOE, which has 3 variations. The APOE protein is responsible for processing lipids (fats) in the bloodstream body and carrying amyloid. If it can’t process the lipids, the amyloid accumulates. Individuals with APO4 are at high risk. It’s important to note that someone can have the APO4 gene and not develop Alzheimer’s. People with the APO3 gene are at normal risk for developing Alzheimer’s. Eighty percent of the population have the APO3 gene. Patients who have the APOE2 gene are at lower risk. No other genetic tests are available.

Q. Who is most susceptible to developing Alzheimer’s?

A. Women have a much higher chance than men of having Alzheimer’s, probably due to hormone differences. African Americans and Hispanics are also more susceptible.

Q. When does Alzheimer’s begin?

A. Alzheimer’s is a disease of the aging brain and can start in the 50s. The incidence increases with age.

Q. How is Alzheimer’s diagnosed?

A. Unfortunately, we have no blood test and no imaging test to identify Alzheimer’s. We use neurocognitive testing with pen and paper and are moving to a computer-based model to distinguish between normal aging memory loss and dementia. We interview the patient and the family, inquire about memory problems and family history, and then we conduct tests to rule out other forms of dementia that can be diagnosed, such as vascular dementia and Parkinson’s symptoms.

Q. What do you tell Alzheimer’s patients and their families?

A. I am honest with them, but also give them hope. Not every patient progresses, especially if diagnosed in earlier stages. I talk with them about current medications that might slow progression, safety issues and the importance of planning ahead and having a support system.

Q. How can a family member prepare if someone has Alzheimer’s?

A. I discuss with family members the social and family issues and advise them to begin planning ahead. You can’t wait until someone can no longer live independently. Specifically, I emphasize the importance of planning financially, putting away car keys when the time comes, and safety precautions, such as removing firearms and installing features like grab bars. I also urge them not to take every task away. People want to feel useful. Most of the time a family can handle a memory problem, but behavioral and mood changes can create a major issue. Alzheimer’s is a progressive change, so we see patients regularly. It’s a constant balance between being supportive and maintaining a patient’s independence.

Q. What is the outcome for an Alzheimer’s patient?

A. Alzheimer’s brings about significant lifestyle changes within 5 to 6 years and is the 6th leading cause of death. The body shuts down when the brain shuts down.

Q. What would you like people to know about Alzheimer’s?

A. Alzheimer’s and dementias are a national problem, and we all share in the cost. Finding a cause and cure to reduce the impact on individuals and families, as well as the financial burden, is of utmost importance for all of us.

Q. What should someone do if concerned about a memory problem?

A. Anyone who has a concern should get in touch with their provider. I remind my patients that your brain is allowed to age just like your body. Your brain at 80 isn’t the same as at 30. Still, it’s important to distinguish between what is a part of normal aging part and what is having a functional impact on daily activities.

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Advance With MUSC Health

Keywords: Healthy Aging, Neuroscience