Sunday, July 25, 2010

Alzheimer's Research

So it appears the thrust of research at the recent consortium is to take all the research that has gone on at various facilities and share and combine and put something together meaningful. The criteria for diagnosing and staging Alzheimer's and mild cognitive impairment is being reevaluated for the first time in years. When you think about it, this is crucial. There has been a certain way of diagnosing the disease definitely by looking at microscopic tissue under a microscope. That has not changed and we still can't do that on live human beings. However if there was a way to predict or even diagnose the disease much earlier, even before it starts to clinically show itself and manifest, this may have clinical implications for treatment, as well as prevention. Seemingly the earlier you can intervene or even prevent the better.
Hence emerges the concept of biomarkers. This is not a new phenomenon. The biomarkers we are talking about are more than testing for the genes that definitely predict who will get the disease.
The well known presenilin and APOE genes. The hereditary links are somewhat better understood, however the overall genetics are still not clear. There are very rare instances where there is a direct hereditary link, which account for a small number of AD cases, relative to all the cases.
But what about the vast majority of AD. Emerge biomarkers.
There are a couple that can be evaluated looking at CSF. CSF is cerebrospinal fluid. This is the fluid that baths the brain it runs down throughout the spinal cord. It is in the ventricles of the brain, Everyone has it.
Most people have heard of an LP or lumbar puncture or spinal tap.
A spinal tap is most commonly known as a diagnostic intervention for example when it is suspected that a person has meningitis. That is an inflamation of the tissues covering the brain and spinal cord. The CSF is sort of a purified version of fluid sort of like plasma but different. Sometimes you get an infection in there and you can look at the fluid , sort of like a blood test. You get the fluid through a needle in a spinal tap. Now meningitis or infection like that has nothing to do with AD. however you can do this spinal tap and look at fluid and analyze it, like a blood test.
It does appear people with Alzheimer;s have some proteins and chemicals in the spinal fluid which would be changed and possibly a good marker for AD.  Hence the biomarkers. It is possible some of these protein fragments are related to the Amyloid the develops in the brain of AD patients. now it may also be possible that these molecules that are too high or low in the CSF, indicative of AD, show up maybe much earlier than the cognitive and behavioral changes of AD. Not really totally clearly understood, but getting there.
Hence the consideration of new diagnostic criteria, and maybe someday the analysis of these biomarkers being used not in research but in everyday clinical practice.
Getting somebody to pay for this testing on an everyday basis is another story. Remember, since AD is fatal and it affects mostly older adults it is not a politically or economically popular thing to fund.
If some of this testing ever becomes more mainstream, it will be new cutting edge and therefore expensive. sort of like when a new electronic computer or phone type thing comes out.
but it is crucial because I think the research is on to something, we really have been trying to understand and treat or prevent it, once it is so full blown and that is probably way to late.
The research is fragmented, it does need to come together and share ideas, I still think it is misguided and stupid to have meetings in such elaborate places as Hawaii, but we somehow have to bring people together. The greatest minds working on this stuff. Remember in research, there is a ton of collaboration and collegiality. There is also a ton of competition. People fighting for grant money, for recognition, for the first to be published on something. Research has always been that way. It is just human beings. The motivations between altruism and notoriety get sometimes blurred.  Again something very real but taboo to discuss.
Some key thinking and thinkers coming together happened.
With the asinine health care climate in the everyday world, I hope and pray some of the forward thinker of the greatest research minds will trickle down to everyday mainstream clinical practice, and suffering families, who really don't give a damn about who gets published first, or the terrbile health care climate, they just want hope and treatments, preventions and cures.

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Talking about the book with the Lake Superior wind....... a calm day