Alzheimer's expert is optimistic

More than 4 million people suffer from Alzheimer's disease, according to the Chicago-based Alzheimer's Association. The progressive dementing illness gradually robs its victims of mind, independence and identity.

Such figures, staggering though they may be, represent only the tip of a coming iceberg. Many more millions of people have the illness and won't exhibit visible symptoms for years or decades to come, according to Zaven Khachaturian, Ph.D., who directs the Ronald and Nancy Reagan Research Institute, the association's research arm.

Khachaturian is widely regarded as the chief architect of the National Institute on Aging's Alzheimer's disease program. He also played a central role in developing a national scientific infrastructure to combat Alzheimer's disease.

Khachaturian recently spoke with Pharmaceutical Representative Contributing Editor John O'Connor about the latest developments in Alzheimer's research - and what's at stake for patients, manufacturers and the nation.

Pharmaceutical Representative: How promising is Alzheimer's research?

Khachaturian: At present, no permanent cures have been found. But prospects are very promising that treatments will become available in the near future.

One medication - Cognex - has received Food and Drug Administration approval. It's a first-generation product that helps people for up to a year, but the medication doesn't appear to help everyone. [Editor's note: Please see Late Breaking News on p. 2 for information on an Alzheimer's treatment from Eisai.]

There are several second-generation drugs that are about to be submitted to the FDA for approval. These drugs will likely be more effective and cause fewer side effects.

A third generation of treatments also looks promising. These remedies include non-steroidal anti-inflammatory drugs, estrogen and antioxidants. If approved, these drugs may be able to delay the onset of Alzheimer's for five to eight years.

Is most research focusing on so-called miracle cures, or is it broader based?

Alzheimer's research is being applied very broadly. We're hoping that this approach will lead to better diagnostic measures.

Another arena - the care aspect - is also being viewed through a wide lens. For example, we're finding that it's important not just to treat the patient, but to also consider the family. We often find that by helping family members, patients also benefit.

Giving caregivers information about what to expect arms them with knowledge. And that knowledge gives them strength to tolerate the pain and frustration that can accompany providing care. We are finding that these low-tech approaches are extremely beneficial and produce immediate results.

Is there any indication that people can make lifestyle changes to reduce their chances of acquiring Alz-heimer's?

There is no indication right now. But we hope to develop that knowledge. One prospect is that certain dietary changes may help. For example there is some evidence that antioxidants - such as vitamin E - may delay the disease.

Keeping one's mind busy also helps. There is evidence that people who are better educated or have more challenging occupations tend to get the disease later. That doesn't mean that education or occupation prevents the disease. But it may be that people who are keeping their minds active are forming more contacts and increasing the number of contacts in their brain.

Currently, how close are researchers to definitively stating the root cause or causes of Alzheimer's?

At this point, I think most people agree that nerve cell dysfunction is the cause of the disease.

But there are many ways that the problem manifests itself. That's where you hear differing discussion in the scientific community.

We know that there are different forms of the disease and that different genes can be affected. We also know that genes do not act alone to cause Alzheimer's: They need "something else." But we don't yet know what that "something else" is.

What are the major obstacles preventing more effective research?

The lack of funding for research has always been and remains an obstacle.

In the past two or three years, research funding has begun to get flat. In general, scientists are encountering more problems getting their projects funded.

Right now, we're sort of like a team that risks losing its star players. Scientific work depends on creativity: you can't turn it on or off like a faucet. If you don't support researchers, they go somewhere else.

That's why it's important to get the word out that we are at a critical juncture: We have a solution within sight, but we're not going to get there if we don't support the players.

Perhaps because Alzheimer's symptoms typically become apparent in people who have lived 60 or more years, there appears to be some sentiment that research dollars might be better spent on illnesses that typically affect a younger population, such as finding a cure for HIV/AIDS. In fact, former Colorado Governor Richard Lamm has been quoted as saying the elderly have a "duty" to die. Are you troubled by such views?

I don't think that anyone is entitled to make a judgment that life is worth less because a person is older. Life is valuable regardless of age. If we are going to put a value on life as a society, it should be for the entire lifetime. Who is to say at what point a person should die?

It should be noted that Alzheimer's is also a disease of youth. A person who is 20 now probably has Alzheimer's already and does not know it. By the time that 20 year old gets to be 80, he or she is going to need long-term care, and we as a nation will not be ready to afford care. We need to do something now. PR