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HOUSE CALL WITH DR. SANJAY GUPTA
A Look at Treatments for Alzheimer's Disease
Aired July 24, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HOLLY FIRFER, CNN ANCHOR: Good morning and welcome to HOUSE CALL. I'm Holly Firfer, in for Dr. Sanjay Gupta.
Alzheimer's disease can strike people with no warning, no history of the disease. It can steal your memories and rob you of your future, but new studies out this week are offering hope to millions of people affected by Alzheimer's disease.
FIRFER (voice over): German physician Alois Alzheimer noticed strange behavior by a 51-year-old woman in a Munich mental institution. The year was 1901. More than a century later the degenerative brain disorder named for that doctor still baffles researchers.
DR. PAUL AISEN, GEORGETOWN UNIVERSITY: Unfortunately, today the drugs that we have improve symptoms but do not stop progression of the disease.
FIRFER: Until now. Dr. Aisen and his colleagues are studying one of the most promising treatment yet, a drug called Alzamed.
AISEN: It's not directed at the symptoms. It's directed at the cause of the disease so what we expect is not an improvement in symptoms over the short term but a stabilization in the course of the disease over the long-term.
FIRFER: They're targeting brain plaque that ultimately disrupts communication between bring cells in Alzheimer's patients. These plaques are formed when enzymes clip off and part of a protein called amyloid. Those clipped off fragments clump up together around the brain cells interrupting communication between them. And those brain cells eventually die.
Alzamed targets the amyloid to try to keep it from sticking together and forming these plaques and potentially clear it from the brain.
Libby Monroe suffers from moderate Alzheimer's .
BILL MONROE, WIFE HAS ALZHEIMER'S: We decided to get involved in the trial because we knew that Libby had Alzheimer's . Alzheimer's patients go downhill. We wanted to prevent that if possible. Alzamed seemed to offer us a possibility to stop the decline of memory.
LIBBY MONROE, ALZHEIMER'S PATIENT: I thought Mariah was coming.
FIRFER: Although she's had a hard time remembering dates or names, or even some words, Bill says he notices she seemed to be declining at a much slower rate.
B. MONROE: She's got a lovely, sunny, cheerful temperament. And that has not changed. I think I'm very fortunate in that respect.
FIRFER: Alzamed is going into a final 18-month testing period. Once the data is complete and FDA reviewed it could be on the market by 2007.
FIRFER: The Alzamed trial is just one of the encouraging studies unveiled at this week's Alzheimer's Association Conference.
In another, researchers looked at the popular Alzheimer's drug called Denepozil or Aricept. And they found that people with mild cognitive impairment who took the drug were able to slow the onset of Alzheimer's by six months within the first 18 months of the disease. Good news for those suffering from MCI, since as many as 80 percent may go on to develop Alzheimer's disease.
The bottom line, there's no cure yet. But new treatments look promising.
And with us to talk about what all of this new research means for you is Dr. Antonio Convit. He is the medical director for the Center for Brain Health at NYU School of Medicine, and a psychiatrist with Nathan Kline Institute.
Welcome, we're glad to have you here.
DR. ANTONIO CONVIT, NYU UNIVERSITY: Thank you, pleasure to be here with you.
FIRFER: What can people dealing with Alzheimer's take away from all of these studies, new hope, perhaps?
CONVIT: Definitely new hope. These are fledgling advances. We're not near a treatment that can be used clinically yet. The Alzamed trial, although as hopeful as it is and it is completely novel in its approach to the development of a treatment, was in a small group of people. And now that needs to be replicated in much larger groups to see if it's still effective.
FIRFER: Do you think we're far from finding perhaps some kind of a therapy for Alzheimer's, not even talking about a cure, but at least a therapy that's effective over a long period of time?
CONVIT: Yes, I think that we're still quite a few years away. The current treatments we have are nowhere near there yet.
FIRFER: We have a lot of questions from our viewers lined up. So let's start with our first one, from our roving camera, take a listen.
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UNIDENTIFIED MALE: Can you tell me what the recent research is on Aricept as it affects memory and memory loss?
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FIRFER: I guess this is where things may get confusing. We have this new study out saying Aricept can delay the onset of Alzheimer's, but just last month a British study showed Aricept really had no effect on the progression of the disease.
Doctor, what are you telling your patients who may be confused with all of this information?
CONVIT: The large scale multi-site study done on Aricept actually showed that at the beginning of the trial, for the first 18 months or so, there was a slowing in decline in the people who were taking the Aricept. But it was a three-year trial. And at the end of the three years there were actually no differences between the group that took placebo and the group that took Aricept in terms of how many converted to Alzheimer's disease.
FIRFER: Would you recommend that people talk to their doctors about their individual situation? You don't want to put a blanket on and say it may or may not work for everybody?
CONVIT: Absolutely. I think it's something that needs to be individually tailored to the person and I think that working closely with your physician is the way to go.
FIRFER: Terrific. Let's get to an e-mail from Brandon in Michigan and Brandon wants to know: "Although the new study claims that vitamin E does not help slow the progression of Alzheimer's, does it still help in basic memory loss or in helping to boost your memory?"
And as Brandon points out the new study in Aricept also looked at vitamin E and the progression of Alzheimer's. And they found that the supplement did not delay the onset on its own.
So, Doctor, there have been a lot of conflicting studies on vitamin E as well. What is your opinion?
CONVIT: Vitamin E is effective as an anti-oxidant. So it's a very good anti-oxidant. The doses that were used in the trial that you just mentioned, that Brandon mentioned, were rather large. They were like 2,000 units, which is a little larger than I would recommend anybody take on their own. I think that people should be taking less than 800 units per day.
But it is an anti-oxidant and as that, it protects the brain as well as the rest of the body from the wear and tear of everyday.
FIRFER: Good to know. We've got time for another e-mail from Tom in New Orleans.
And he writes: "What's the likelihood that some of the new drugs such as Memandine, Aricept and vitamin C and E mega dosages can be synergistic and more effective if administered in combination as a 'cocktail'?"
And Doctor, you have done plenty of drug research as well. So what would you say to Tom about these combinations, these cocktails, so to speak?
CONVIT: Well, Memandine was used in people who have moderate to severe Alzheimer's disease. And it didn't really affect their cognition. It affected the way they behaved everyday, which made life a little easier for their caregivers.
That drug has not yet been tried in people at earlier stages of Alzheimer's disease or MCI. So there's no individual drug that's been proven to be very effective and vitamin C and E are in that same category.
I'm not sure that putting them together would be a good idea at this point. We really don't know enough to suggest something like that.
FIRFER: Good information.
Are you having trouble perhaps remembering things? We'll give you the warning signs of Alzheimer's when HOUSE CALL continues.
(BEGIN VIDEO CLIP)
ANNOUNCER: If you're forgetting things like your keys and where you parked, normal forgetfulness, or the early stages of Alzheimer's? We'll tell you how to tell the difference.
UNIDENTIFIED MALE: I think he really hopes there will be a cure for the future. I think he figures there's nothing he can do for himself. He hopes to make lemonade out of this lemon through research.
ANNOUNCER: One man's fight against this memory-robbing disease helps bring new report for diagnosing and treating Alzheimer's.
Plus take today's quiz. We asked: What is the greatest risk factor for Alzheimer's disease. The answer after the break.
ANNOUNCER: Checking "The Daily Dose" quiz, we asked: What is the greatest risk factor for Alzheimer's disease?
The answer, increasing age. Nearly half of people over 85 may get the disease.
FIRFER: We're going to talk more about risk factors for Alzheimer's a little later in the show, but first, more of your questions. And joining to us answer them is Dr. Antonio Convit, medical director for the Center for Brain Health at NYU School of Medicine.
Doctor, let's jump back in with an e-mail from Fran from Oregon.
And she asks: "Is there any way to positively detect Alzheimer's before a brain autopsy at the time of death?"
Fran, that's a great question. Doctors can make a diagnosis of Alzheimer's disease but they cannot confirm that diagnosis until they do an autopsy, but a new technology that can see inside the living brain may change that.
FIRFER (voice over): Richard Johnson painted these paintings, but he can hardly remember.
UNIDENTIFIED MALE: This is the -- uh...
FIRFER: He lost the memory of creating his art to Alzheimer's disease.
LILIANE JOHNSON, WIFE: The longer I knew him from the time we were married the more I fell in love with him. I just got to know this person who developed and all of that is gone.
FIRFER: Researchers were interested in seeing exactly what was going on in Richard's brain. So they enrolled him in a study, testing a new imaging system that would allow them to follow a radioactive tracer through his brain to see the plaque that has built up around the nerve cells.
This buildup of amyloid plaque, you see here lit up in red and yellow, damages the nerve cells so they can't talk to each other, interrupting the transfer of information through the brain. By looking at that plaque researchers hope to be able to scan the brain while testing new drugs.
DR. STEVE DEKOSKY, UNIV. OF PITTSBURGH: It does provide what is an absolutely vital baseline from which to say this drug works or this drug doesn't.
FIRFER: Researchers say this is the first time they've been able to see the disease in a living brain. They add this could also eventually be used for diagnosing Alzheimer's and distinguishing it from other forms of dementia.
DEKOSKY: We wouldn't have to spend years looking at people over time to see if they stopped their decline. We'd simply be able to give the medications, look for what we hope would be a more quick decline in the amyloid in the brain, and say OK, we're having the desired effect.
FIRFER: Although this is a breakthrough and in diagnosis and imaging, researchers say it will be a few years before they are able to routinely use this tool on Alzheimer's patients.
But it's too late for Richard.
L. JOHNSON: Come on, you handsome dude.
FIRFER: Liliane will have to put Richard in a nursing home soon, but says she hopes his involvement with this research may help someone else the way he has helped her.
L. JOHNSON: He gives me grace. I am going to miss that so much. He's helped me become more than I ever thought I could.
FIRFER: Dr. Convit, I want to ask you how important you feel this new technology is. It seems like a big breakthrough and a lot of people are very excited about it.
CONVIT: Well, it's definitely a breakthrough. There's a lot of controversy in the Alzheimer's field as to what the real pathology is. So, not everybody agrees that the real pathology is beta amyloid. It's one of the two pathologies. This will only image one component of what people believe is at the core of Alzheimer's disease.
However, I think that from your setup piece, it's very clear that it can be used as a diagnostic tool, to monitor treatment. So if one can see reductions in beta amyloid in the brain as a result of a treatment, then that tells you that the treatment may be doing something that may be effective in the long run and can affect cognition perhaps.
FIRFER: Right, let's take another question now from our roving camera again.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: I was just wondering the difference between Alzheimer's and just old age forgetfulness. Is there a distinguishing factor that you can determine that, or whether you're actually having the onset of Alzheimer's?
(END VIDEO CLIP)
FIRFER: And the answer there is, yes. There are symptoms of Alzheimer's that distinguish it from normal memory problems and from other forms of dementia. So look for permanent memory loss, difficulty performing everyday tasks, and language problems like forgetting common words.
Disorientation is another hallmark of Alzheimer's disease, along with poor judgment and misplacing things in unusual places.
Rapid mood changes altering personalities could also be common, as is a loss of initiative. Someone suffering from Alzheimer's may become very passive, sitting in front of the television for hours, for instance. So, Doctor, what should somebody do if they suspect maybe one of their loved ones has this disease, if they see these signs?
CONVIT: Well, you know, the disease has to start somewhere, so generally it starts much more subtle than that. But if they see those signs that you're describing, that's already a fairly easily diagnosable presentation of the disease.
I think that the challenge is really to try and pick it up earlier, when there's been less brain damage inflicted on the individual. And that's where the research and the art of diagnosis comes in.
FIRFER: When HOUSE CALL returns, what role does family history play in your chances of getting Alzheimer's? Stay tuned.
ANNOUNCER: From genetics to diet and exercise, are there steps you can take to help prevent this disease?
Plus a new use for Botox, just in time for the sweaty days of summer. We'll explain.
FIRFER: Welcome back to HOUSE CALL. We're talking about battling a heart-wrenching disease that leaves the body but takes the mind. We're talking about Alzheimer's.
Although doctors aren't sure what causes a person to develop this disease, there are some risk factors, like getting older. Alzheimer's usually strikes people over 60. Also, your family history can put you at risk along with your overall health.
We're talking with Dr. Antonio Convit, medical director for Brain Health at NYU School of Medicine.
And, Doctor, many people fear if they have a family member, a father, a mother or a sister with Alzheimer's that they also might get the disease. So how likely is that really?
CONVIT: It does increase your risk slightly if you have a family member, first degree relative with Alzheimer's disease. However, it doesn't increase the risk tremendously. Having lower education, not being intellectually engaged, for example, is probably as much of a risk as having a family history of Alzheimer's disease.
That only applies to the sporadic variety of Alzheimer's disease, which is like 95 percent of the cases. But for the early onset ones, it's a different story, having a family history does make a huge difference.
FIRFER: Let's get to another question now from Atlanta.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: What are the preventative things that I can do from a cognitive standpoint or from a health and nutrition standpoint what can I do to prevent it as well.
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FIRFER: A new study out of Sweden showed people who were obese in middle age were twice as likely to develop dementia later in life. So watching your weight, cholesterol, your blood cholesterol and blood sugar are all a good way to help stay healthy as you age.
So Doctor, what are your prevention tips? What can you tell our viewers?
CONVIT: I think things that are commonsensical for cardiovascular disease also apply here. People who exercise, that's quite important, people who actually use their mind, so stay engaged in life, go to shows, read, take courses, if they have access to those. Anything that really engages your mind, it's sort of the "use it or lose it" proposition.
So taking anti-oxidants, like vitamin E, vitamin C perhaps, eating healthy, those are all things that can actually help.
FIRFER: Great advice. We've got time for another e-mail from Julie in Texas.
She writes: "Besides exercise and eating dark green vegetables and staying mentally active, if you had a parent with early Alzheimer's and you are nearing the age of when your parent exhibited symptoms, would you taking vitamin E, Ibuprofen, and a statin?" A heart drug?
What do you say, doctor?
CONVIT: Well, I think that there isn't very much evidence that statins actually help prevent Alzheimer's disease. If you don't have to take the statin for cholesterol reasons, I would probably not advise to you do that.
I'm not sure that I understand what this person wrote in terms of early onset. Is this a genetic variety or is this the, just somebody who has sporadic Alzheimer's disease, the parent has a sporadic Alzheimer's disease, with a somewhat early onset? So there are genetic tests that can be done, if indeed her parent has early onset.
FIRFER: OK. And I want to tell our viewers to grab a pen, because when we come back we'll give you some Web sites where you can find more answers to your questions. Stay tuned.
ANNOUNCER: From supporting caregivers to finding the newest clinical trials we'll show you how to surf for the latest Alzheimer's news.
And stay tuned for medical headlines. A new use for Botox, and some bad news for light cigarette smokers. That's all ahead on HOUSE CALL.
(COMMERCIAL BREAK) FIRFER: Welcome back to HOUSE CALL. Let's take a look at some of this week's medical headlines in today edition of "The Pulse."
FIRFER (voice over): The FDA approved the cosmetic favorite Botox this week to treat extreme underarm sweating. Botox injections can now be used to treat a condition called primary auxiliary hyperhidrosis, which causes underarm sweating so severe that it cannot be controlled by antiperspirants. Botox has been approved for other uses since 1989.
Smoking light cigarettes may not reduce your nicotine as much as you think. A study conducted by Japanese researchers found that although some light cigarettes have 11 times less nicotine, heavy smokers only get a two-fold decrease in the amount of nicotine they take in. The researchers say that taking more puffs per cigarette or inhaling more deeply when smoking the light cigarettes may be to blame.
Holly Firfer, CNN.
FIRFER: Now for more news on Alzheimer's, click on www.alz org. That's the Alzheimer's Association's Web site. You'll find listings of local chapters that can help you find specialists in your neighborhood. Plus they have an entire section to help caregivers deal with issues surrounding this disease.
Also try www.alzheimers.org. Besides being a source of general information you can search for current clinical trials you might be interested in.
Before we go, Dr. Convit, I wanted to ask you, from all we've heard today about the new test trials for drugs and the new imaging, the technology that we're starting to see, where are we in the fight against Alzheimer's and how far have we come?
CONVIT: Well, it's a very exciting time to be a researcher or a clinician, because we have made great strides. However, we still don't have anything that we can offer substantial to individuals affected and to their families. We do still have a long way to go.
FIRFER: That's hour show for today. Thank you very much, Dr. Convit. We appreciate your time.
CONVIT: Thank you.
FIRFER: And thank all of you for your e-mails. And be sure to watch next weekend. We're going to take on hospital safety from wrong prescriptions and unnecessary operations, to overworked residents. And we're talking about the steps that you can take to stay healthy when you visit a hospital.
E-mail your questions on hospital safety to email@example.com. Remember, this is the place for the answers to all of your medical questions. Thanks so much for watching. I'm Holly Firfer. Stay tuned for more news on CNN.
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