Alzheimer’s Disease: Are There Any Glimmers of Light?

by Michael Jorrin, "Doc Gumshoe" | August 19, 2013 1:01 am

[Ed. note: Michael Jorrin, who we like to call “Doc Gumshoe,” is not a doctor, he is a longtime medical writer who contributes pieces for us that we hope give a good background or perspective on medical issues (and marketing) for those of us who are as overwhelmed with “live to 150” promises as we are with “get rich” promises. His comments, thoughts and opinions are his own. You can see all of his commentaries here[1]. This time, he’s writing about a disease that touches almost every American at some point — and that is the focus of thousands of researchers (and investors) who are searching for cures and treatments.]

Most likely, you all know the bad news, which I will put right up front so the rest of this piece can be at least moderately upbeat.

However, the health-care community is by no means throwing in the towel. Currently there are 1,286 clinical trials under way in Alzheimer’s disease. This includes trials that are now only recruiting subjects all the way to trials that have been completed, but have yet to report the results. About two thirds of these (based on my quick survey of the National Institutes of Health Clinical Trials Registry) have to do directly with treatment, and the rest have to do with procedures that may impact the management of AD in some way.

Alzheimer’s Disease and Alzheimer’s Dementia

The popular assumption is that this is a distinction without a difference – the growth of those notorious plaques in the brain interferes with vital brain function, and people slowly lose memory, fail to recognize their most immediate family members, lose the ability to perform even the simplest tasks, stop breathing and digesting food, and die. This assumption is entirely reasonable, but in fact there are important distinctions between the disease and the dementia, and these differences can, and we hope, will, have a crucial impact on the future management of this disease.

A Bit of History

Although some old folks remain, as the pleasing expression goes, “sharp as a tack” until they are very old indeed, it has been commonly accepted since just about the dawn of time that some elderly people lose some of their mental acuity. This was commonly attributed to “hardening of the arteries in the brain.” However, Alzheimer’s disease has been recognized as a separate disease entity for over a century. A German physician named Alois Alzheimer had a female patient named Auguste Deter, who became severely demented starting at about age 50, an unusually early onset for senile dementia. Dr Alzheimer carefully followed Auguste for about 5 years, from 1901 to her death in 1906, and then he obtained permission to examine her brain, which he found had been invaded by a dense, whitish substance. Alzheimer recognized that the substance was a form of amyloid, which had been identified and named in the 19th century by the eminent scientist Rudolph Virchow. Virchow, by the way, mistakenly thought that this substance was related to starch, and named it “amyloid” after the Latin for starch, amylum. However, amyloid is not starch, but a protein, composed of chains of amino acids.

For most of the 20th century, the diagnosis of Alzheimer’s disease was applied only to persons who developed the symptoms of dementia prior to old age. Persons who developed those symptoms in old age were described as being affected by “senile dementia.” While there are many possible causes of the loss of mental capacity, old age by itself is not one of them. For about the past 30 years has it been recognized that AD is a principal cause of dementia regardless of age at onset.

Not all forgetfulness or absent-mindedness is dementia or related to Alzheimer’s disease. Being unable to summon up the name of a person you met at a party, or not remembering the precise word you want, or misplacing your cell phone, are not signs that you’re succumbing to AD. People with early AD who have memory lapses frequently forget that they had memory lapses in the first place. As time goes on, they may become confused, angry, sometimes apathetic, frightened, and paranoid. They wander, easily get lost, and may fail to recognize a spouse or a child. Ultimately, large parts of their brains essentially stop functioning. A common cause of death in AD patients is that they lose the capacity to swallow food; when they are fed, the food, rather than going down the esophagus into the stomach, is aspirated into the lungs, leading to choking or pneumonia. When the brains of AD patients are examined on autopsy, they are frequently greatly shrunken. Large parts of the brain have actually been destroyed by the disease.

What Happens in the Brain in Alzheimer’s Disease?

AD is only diagnosed definitively on autopsy. That does not mean that all persons who are presumed to have died with AD have autopsies performed, only that an examination of the brain of an AD patient is the only way to confirm for certain that the patients indeed had AD. What the pathologists are looking for is the kinds of deposits in the brain that have been found in the patients with Alzheimer’s dementia. But here’s where the confusion begins.

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There are basically two proteins that build up in the brains of AD patients, and both are thought to interfere with brain function. One is called beta amyloid (Aβ), and the other is called tau protein.

Tangles of tau protein are found in the nucleus of brain cells, and one school of AD researchers holds to the theory that it is this protein that is responsible for the failure of brain cells.

The beta amyloid theory has more adherents. The identification of Aβ is relatively recent; for a long time researchers just thought the amyloid deposits themselves – the whitish deposits identified a century ago by Dr Alzheimer – were the culprits, but they have learned since that the culprit is only a subset of the amyloid, where the amino acids that make up amyloid are folded in a certain way, which they labelled beta amyloid. And another twist – it now appears that the particularly toxic version of Aβ consists of sections that are cut into snippets that are just two amino acids longer than the usual beta amyloid sections, which are 40 amino acids long. The 42 amino acid beta amyloid sections are the ones that are thought to be damaging to brain function.

Both of these proteins affect brain function in different ways. The tau protein tangles appear to destroy the brain cells from within, while the beta amyloid surrounds the brain cells, interfering with communication among cells and eventually killing those cells Could one or both of these processes be responsible for the characteristic Alzheimer’s dementia? That’s what the researchers are trying to sort out.

There is a genetic component in AD, although, except in very few cases, the genetic component is a risk factor, but not determinative. There is a specific variant of the apolipoprotein gene, APOEε4, which is present in as many as half to three-quarters of people with AD; however, many individuals with this gene do not develop AD, so it’s not possible to establish a one-to-one correlation between APOEε4 and AD. It’s a strong risk factor, but no more than that.

Another genetic link is between Down syndrome and AD. Individuals with Down syndrome have one extra chromosome which bears a gene that stimulates the production of the precursor protein from which beta amyloid is made. By the time they are adolescents, the brains of Down syndrome patients have a large quantity of Aβ plaques, very much like the brains of persons with Alzheimer’s.

Markers of Alzheimer’s Disease

We’ve said that the only sure way of confirming Alzheimer’s disease is examination of the brain on autopsy. However, there are other ways of looking at the brain, especially PET (positron emission tomography) scans and examination of cerebral spinal fluid. PET scans can reveal deposits of tau protein and amyloid plaque, but not distinguish between normal and toxic Aβ. Spinal fluid can be examined microscopically for tau protein and toxic Aβ. Using these two modalities can give investigators a pretty good idea of what’s going on in the brains of people with possible AD.

Targets for Alzheimer’s Disease Treatment

What this information provides to the clinical researchers that are looking for a way to attack Alzheimer’s disease and prevent Alzheimer’s dementia is potential targets in the disease process.

All these, and many more targets are avenues for research.

Before we delve into AD research, we should note that there is at least one other theory, with highly qualified proponents. This theory proposes that the cause of AD is none other than inflammation, which is well known to be at the root of many other pathologies in the body, including rheumatoid arthritis and many of the autoimmune diseases. Proponents of this theory point to free radicals, which in particular attack the energy-producing parts of brain cells and impede their function. They suggest that beta amyloid growth is a protective response to free radical invasions, and that attempts to interfere with Aβ might do more harm than good.

A certain amount of research is going on in the free radical area, but the most ambitious research is directed against beta amyloid.

Two research projects in particular deserve more detailed discussion. Both of these are in populations of persons who do not have full-blown Alzheimer’s dementia, but either have early signs of Alzheimer’s disease detected by brain scans, or whose genetic characteristics and family history put them at high risk for developing AD. The objective of both projects is to find out if an early attack on the disease process can delay – or perhaps even prevent! – the development of dementia.

The Solanezumab Project

Solanezumab is an Eli Lilly (LLY) drug (LY2062430) which targets beta amyloid formation. It is a monoclonal antibody (mAb) which binds to the Aβ precursor, preventing, or at least minimizing, the formation of the toxic Aβ chains that are thought to be damaging to brain cells. Currently there are eight clinical trials in progress with solanezumab. One, funded by Lilly, will enroll 2,100 subjects ages 55 to 90, in 39 locations in 11 countries. A second trial, funded in part by the National Institutes of Health, will enroll 1,000 subjects ages 65 to 85.

The Lilly trial will run for 80 weeks and is focused on patients diagnosed with mild AD. The objective is to test whether solanezumab will slow the cognitive and functional decline of these patients. A previous trial of solanezumab, which studied patients with mild, moderate, and severe AD, was considered to have failed to meet its objectives. However, people from Lilly point out that the study design obligated them to consider the entire patient population as one group, and, indeed, in the entire patient population, the destructive effects of AD were not slowed. But in patients with mild AD, there was considerable slowing of cognitive decline. Patients taking the drug had about one-third less decline than those taking placebo. So the current Lilly trial will study only patients with mild AD, and try to determine whether solanezumab delays their decline into dementia.

The more interesting trial is the NIH trial. This trial, smaller and about twice as long-running, will enroll a different type of subjects. These are people who at this point show no signs of Alzheimer’s dementia, but whose PET scans show signs of the invasions of beta amyloid that are thought to be the hallmarks of Alzheimer’s disease. The NIH has selected solanezumab as the trial drug, and the hope is that by starting treatment well before dementia symptoms have appeared, the destructive effects of AD can be prevented. The primary investigator in this trial is Dr Reisa Sperling, director of Alzheimer’s research at Brigham and Women’s/Massachusetts General Hospital in Boston, and she points out that the beta amyloid invasions can start as early as ten years before the appearance of any signs of dementia, so why not start preventive treatment at that point?

The Crenezumab Project in Colombia

Why in Colombia? It happens that there’s an extended family in Colombia who have an extraordinarily high rate of developing Alzheimer’s disease. About 5,000 persons have been found who share the same ancestry; they are all descended from the same individual who came from Spain in the 18th century. What makes this group of people unique is that about half of them have a mutated gene, labelled “presenelin 1,” that results in the deposition of extremely high quantities of the toxic beta amyloid very early in life – as early as their mid twenties. Many members of this unfortunate family develop full-blown Alzheimer’s dementia in their 40s. This correlation is thought by most researchers in the field to be the strongest evidence yet that it is beta amyloid that causes Alzheimer’s dementia, and not one of the other putative causes.

A clinical trial, enrolling about 300 of the members of this family, will investigate whether starting treatment very early can prevent the formation of toxic beta amyloid and also prevent dementia. The trial will be placebo-controlled, and will compare two groups of family members who possess the mutated gene, as well as a third group, who do not possess the mutated gene. If persons in the placebo group begin showing signs of dementia, they will be crossed over to drug treatment.

The study drug in this trial is crenezumab, from Genentech. Crenezumab is also a monoclonal antibody, a subtype of immunoglobulin G4, and it was selected for the study from a large number of candidate drugs because it is less likely to cause immune reactions in the brain leading to edema. It is an antibody both to the 40 and 42 amino acid beta amyloid chains.

The trial is funded in part by NIH, but primarily by Genentech, which obviously has a great deal to gain by its success. It has been classified as a registration trial by NIH, meaning that if it meets the objectives of significantly preventing the onset of dementia in these subjects who are currently healthy, crenezumab is likely to be approved by the FDA. The trial is part of the Alzheimer Prevention Initiative and is also supported by the Banner Alzheimer’s Institute.

What would the failure of this trial mean? Many knowledgeable observers think that a great deal rides on this trial – much more than the fate of this one drug and the fortunes of Genentech. If crenezumab significantly slows the deposition of beta amyloid and the subjects in the trial nonetheless go on to develop Alzheimer’s dementia, the scientific community will basically have to go back to looking for an underlying cause for the disease. What this might be, who knows.

The Nun Study

And now for something completely different. The Nun Study began in 1986 as a study in aging and disability. The study population, as you will have guessed by now, consists of elderly nuns, members of an order called the Sisters of Notre Dame. When the study began, it had 678 participants between the ages of 75 and 103, with a mean age of 85. A principal reason for studying nuns, rather than a mixed population, is that many of the factors that may lead to differences in study outcomes don’t apply in a population of nuns. The nuns in the study (besides all being female) are all non-smokers, drink little if any alcohol, have the same marital and reproductive history, and have basically lived similar lives.

And one more factor of crucial importance in this study is that all the participants agreed to donate their brains for post-mortem examination.

Finally, there was information in the archives of the Sisters of Notre Dame that led to an exceedingly interesting correlation. When the young women entered the order, mostly in their early 20s, they wrote autobiographical essays. Sixty years later, these essays were examined as part of the Nun Study, and assessed for a characteristic termed “linguistic density,” which summed up a number of features of their writing including choice of words, sentence length, complexity, liveliness of expression, and fluency of thought. The extraordinary finding was that of the participants whose essays were evaluated as lacking in linguistic density, over 80% went on to develop Alzheimer’s dementia in old age. But in those whose essays were not considered lacking in linguistic density, about 10% developed dementia. Note that in comparison with the reported 45% prevalence of dementia in persons age 85 and older, the 10% figure for those nuns is a success story.

Other findings of interest were that many of the participants who continued to demonstrate good mental function into their 90s, were found on post mortem examination of their brains to have significant depositions of amyloid plaques. Some participants, whose brains had suffered the ravages of amyloid and tau protein and were considerably shrunken when they were examined on autopsy, had nonetheless continued to function, mentally and in terms of activities of daily living, well into extreme old age.

The Nun Study does not suggest that the beta amyloid or tau protein hypotheses are incorrect, or that these deposits are not the root causes of Alzheimer’s dementia. What it does suggest is that the human brain has considerable redundant capacity, and that even when parts of the brain cease to function, other parts can step up to the plate. This is consistent with the experience of rehabilitation of stroke victims, who have lost the use of parts of the brain, but whose brains can be retrained to carry on with the job.

It also suggests that a lifetime of active brain work may be one of the most effective measures against the onset of dementia, whether Alzheimer’s dementia or any other form.

Current Treatment Options

Nothing works well. A handful of drugs are FDA-approved for Alzheimer’s disease, and the best any of them can do is slow the progress of dementia. The mechanism of action of most of these drugs is inhibition of the enzyme acetylcholesterinase, which breaks down acetylcholine in the brain. Acetylcholine (ACh) is vital to brain function, and one of the things that happen in AD is a decline in the numbers of cholinergic brain cells, so any means of increasing the amount of circulating ACh is a potential boost in brain functioning, The drugs that employ this mechanism are:

Donepezil is the most widely-prescribed of these agents, and is the only one approved by the FDA for treating AD patients whose dementia has progressed to advanced stages. Rivatigmine is also approved for Parkinson’s disease.

Another mechanism being tried is the blockade of glutamate receptors in the brain. Glutamate is an exitatory amino acid, meaning that it stimulates neuronal activity, which is necessary for brain function. However, excess glutamate action may overstimulate neurons, leading to premature cell death. The one agent that employs this mechanism is memantine, marketed as Namenda by Forest (FRX), and also sold in a number of supplement forms. Memantine aims to block the N-methyl-D-aspartate (NMDA) glutamate receptor channel, and is reported to be moderately effective in mild or moderate Alzheimer’s dementia.

However, neither the acetylcholesterinase inhibitors not glutamate receptor blockade appears to have any effect on the underlying AD disease process, nor do they reverse the decline of cognitive capacity in patients. The most they can do is slow it down.

So, What Does This Tell Us?

If there’s a message in all this bad news, it’s that waiting until real symptoms of dementia start to manifest is way too late. The Colombia study and the solanezumab study may either support the beta amyloid hypothesis, or they may deal this hypothesis a severe blow. But, as I said earlier, there are 1,286 clinical trials is Alzheimer’s disease, at various stages. These investigate not only ways of stopping or even possibly reversing the brain changes in AD, but other potential ways of managing the cognitive decline. Some of these trials are not specifically drug trials, but other interventions that may support memory and cognition. There are also studies in novel ways to detect AD at ever earlier, and therefore more treatable stages.

I plan to take a close look at some of the most promising drug trials in a future note. I’ll keep you posted.

* * * * * * *

I’m keeping track of the many interesting and, in many cases, challenging comments and questions from readers. No surprise, not everyone agrees with me, and that’s not new in my life! I’m going to try to collect and summarize the themes of these challenging comments and address them in an upcoming blog, rather than responding to them separately in the comments section. One of the questions raised by several readers is, what are my credentials for sounding off about this medical stuff? After all, I’m not a real doctor. The quick answer is that I’ve been a medical writer for 30 years, I’ve written lots of continuing medical education material (CME), which is stuff that real docs use to keep their own credentials in running order, and I’ve co-written (with real docs) lots of papers in professional, peer-reviewed medical journals. So I’ll stick up for my capacity to read and understand the medical literature. Of course, the conclusions I draw from what I read are absolutely my own, and I put them out there for you all to take shots at! Thanks for your comments, best to all, Michael Jorrin (aka Doc Gumshoe).


Endnotes:
  1. see all of his commentaries here: http://stockgumshoe.com/2013/08/the-resveratrol-bust-the-arb-scare-and-other-short-takes/

Source URL: https://www.stockgumshoe.com/2013/08/alzheimers-disease-are-there-any-glimmers-of-light/


  1. Avatar
    Scott Ledgerwod
    Aug 19 2013, 10:11:01 am

    Gumshoe:

    You need to check out Australian company Prana Biotechnology. Currently doing a Phase 2b AD trial in Australian on their PBT2 drug. Prana’s approach is to control metallic ions in the brain (copper and zinc) which they believe is the real cause of AD. Stock price has more than doubled in the past month or so. US ADRs are listed as PRAN. Very active PRAN message board with some series SMEs available on Yahoo Finance.

  2. 45 |
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    Tom Deschaine
    Aug 19 2013, 10:33:13 am

    Navidea Bio has developed a process to assist in the early identification of the invasion of beta amyloid. Hopefully it will receive early approval

  3. Avatar
    Mark
    Aug 19 2013, 10:56:34 am

    I was takeing Doxazosin for Bph releif (enlarged prostrate condition). I was having Altimers like things happen to me. I would ask people the same things over and over and have no memory of the fact it was the second or third time I asked the same question. Any one taking Statins should realize, you might not really have altimers. Your meds might be causing the problem. It’s been a few months now however I beleive I’m cured now.

  4. Avatar
    Lane Simonian
    Aug 19 2013, 11:08:50 am

    Thank you for the informative article. I have been studying Alzheimer’s disease for ten years and my mother had the disease for eight year. Here is what I have learned.

    Alzheimer’s disease is caused by a toxic oxidant called peroxynitrite. Peroxynitrites via oxidation and nitration inhibit the synthesis and release of neurotransmitters involved in short-term memory, sleep, smell, mood, social recognition, and alertness. They inhibit the transport of glucose in the brain and reduce blood flow in the brain which may contribute to wandering, delusions, and apathy. And they inhibit the regeneration of neurons in the brain and cause neuronal cell death.

    Factors that cause peroxynitrite formation in the brain include but are not limited to high glucose levels, high blood pressure, presenilin gene mutations, the APOE4 gene, biphosphonate osteoporosis drugs such as Fosamax, stress, chronic bacterial and viral infections, aluminum fluoride, sodium fluoride, inorganic mercury, particulate matter from diesel exhaust, high levels of saturated fat, and very low density lipids.

    The pathway that leads to the formation of peroxynitrites is similar but not exactly the same as the pathway that leads to amyloid. Therefore, it is possible to have Alzheimer’s disease without amyloid plaques or to have amyloid plaques without Alzheimer’s disease. Amyloid plaques may contribute to the formation of peroxynitrites and peroxynitrites may contribute to the formation of amyloid plaques but neither is required for the other.

    High levels of myo-inositol (due to high glucose levels, high sodium levels and Down syndrome) and/or the inhibition of the neuroprotective phosphatidylinositol 3 kinase/Akt pathway (by presenilin gene mutations, the APOE4 gene, and biphosphonate osteoporosis drugs) are two routes to Alzheimer’s disease. Then, the main route is as follows: activation of receptor tyrosine kinase receptors–C-terminal fragment of the amyloid precursor protein and phospholipase C activation–Protein kinase C activation–p38 MAPK activation–formation of peroxynitrites. The route to amyloid plaque formation is the following: activation of receptor tyrosine kinase receptors–C-terminal fragment of the amyloid precursor protein and phospholipase C activation–intracellular calcium release–amyloid plaques.

    Tyrosine kinase receptor activation can by inhibited by phenolic compounds in various spices, essential oils (via aromatherapy), fruits, vegetables, and drinks (red wine, grape and other fruit juice, cocoa). Phenolic compounds also inhibit the p38 induction of peroxynitrites and scavenge peroxynitrites. They de-nitrate NMDA receptor inhibiting the influx of calcium further limiting the activation of p38 MAPK and the formation of peroxynitrites.

    The best peroxynitrite scavengers are methoxyphenols. They readily donate two hydrogen atoms and two electrons converting peroxynitrites into a nitrite anions and into water. Water is a de-nitrating agent. Methoxyphenols can partially reverse the oxidation and nitation caused by peroxynitrites, can inhibit the further death of neurons, and can help regenerate neurons. They can thus partially reverse Alzheimer’s disease.

    Among the methoxyphenols that have shown promise in the treatment of Alzheimer’s disease are eugenol, ferulic acid, sinapic acid, and vanillin. The following substances containing methoxyphenols have lead to improvements in cognition and/or behavior in people with dementia in human clinical trials.

    Rosemary essential oil via aromatherapy (eugenol). Improvements in cognition related to personal orientation in people with dementia and especially those with Alzheimer’s disease (Jimbo, et al.).

    Lemon balm essential oil via tincture (eugenol and ferulic acid). Improvements in cognition and behavior in people with mild to moderate Alzheimer’s disease (Akhondzadeh, et al.).

    Heat-processed ginseng (ferulic acid, vanillic acid, and syringic acid). Improvements in cognition and behavior in people with moderately severe Alzheimer’s disease (Heo, et al.).

    Angelica archagelica (ferulic acid with further ferulic acid added). Improvements in behavior in people with frontotemporal lobe dementia and dementia with lewy bodies (Kimura).

    Whether more effective synthetic or enhanced versions of methoxyphenols can better treat Alzheimer’s disease remains to be seen, but limiting and reversing the damage done by peroxynitrites is the key to treating Alzheimer’s disease.

    • 438 |
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      tanglewood
      Aug 19 2013, 10:27:36 pm

      Hi Lane, Are there any opinions that express taking methoxyphenols as a preventative therapy? Since your mother had Alzheimer’s, have you made any changes to your diet or lifestyle as a result of your studies? Re; sodium fluoride, I guess I better stop using Crest toothpaste.

      • Avatar
        Lane Simonian
        Aug 20 2013, 12:47:32 am

        I should have mentioned that curcumin is also a methoxyphenol and has been suggested as a means to delay the onset of Alzheimer’s disease as well as to treat it (Cole, et al., Prevention of Alzheimer’s disease: Omega 3-fatty acids and phenolic anti-oxidant interventions). I take curcumin as an effective anti-inflammatory for pain (due to ulcerative colitis) but hopefully it might also help my brain (the major knock on curcumin is that it does not enter the bloodstream well). I smell the essential oils inconsistently. There are studies on the effects of aromatherapy on cognition in healthy adults and in people with dementia, but as far as I know no studies on essential oils as a measure to prevent dementia. Essential oils high in eugenol do impede most of the pathways to Alzheimer’s disease, so they should be effective for this purpose.

        Another source of sodium fluoride and aluminum fluoride is in water supplies. Unfortunately, it is possible that environmental or genetic factors may lead to Alzheimer’s disease even in a person who follows a healthy diet and lifestyle.

        • Avatar
          Scott Hall
          Aug 26 2013, 01:04:40 pm

          You should look at the paleo diet for treating your ulcerative colitis. Many have found significant improvement or cessation of their colitis by removing grains, legumes and dairy from their diet.

          Thanks for the informative post and references contained therein.

  5. 82
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    Edward Maddox
    Aug 19 2013, 11:19:40 am

    Doc Gumshoe I find your writings very interesting. I read this latest and then re-read it. Keep up such interesting reporting for all of us here at Gumshoe.

    Although I am always skeptical, I study alternative medicine. Do you? On the subject of Alzheimers, a website that reports on supplementation effects is located at http://www.doctoryourself.com/alzheimer.html . The site reports quite a lot of interesting things. The quite terrible statistics on this disease are listed there. Several vitamin and nutritional shortages are discussed. Note that lead and aluminum are thought to be at blame for some dementia. Taking large amounts of vitamin C is mentioned as possibly helpful in acting as a chelating agent.

  6. Avatar
    Leo Sullivan
    Aug 19 2013, 12:18:09 pm

    Doc Gumshoe. Wow, it is really great to get an unbiased opinion on medical care. It would be very interesting to see you enter the crazy battle between both sides regarding lymes disease. It is a very depressing situation if you possibly have it. The subject is riddled with “ignorance, arrogance, and political corruption” to quote one sufferer. Would very much like you to take a crack at it. Regards and keep up the great work.

    • Avatar
      David
      Aug 19 2013, 02:26:16 pm

      I second the plea for an article o Lyme. It is destroying many lives and there is not real test for whether one has to or not.

  7. Avatar
    rob walter
    Aug 19 2013, 01:17:12 pm

    Michael:
    Thanks for a really excellent summary of the current state of AD research and drug treatments. My take on it is as follows. The story about neurofibrillary tangles in AD brains, amyloid, and a range of aggregated proteins has been touted since long before 1973 when I was in grad school. Even tau proteins have been linked to AD since at least 1986. Every new protein or compound that has been identified in these plaques has been hailed as a breakthrough in the study of AD and yet…here we are decades later with an extensive catalog of knowledge about the involved proteins, polysaccharides, genes, spliced molecules, isomers, PET scans, etc in and around AD, but no effective treatments.

    My guess is that an effective treatment for AD will arrive out of left field. It will have little or nothing to do with preventing amyloid or tau buildup and all of the current research studies and drug trials will summarily be dumped. In many respects, this would be similar to what happened with the treatment of stomach ulcers. For decades modern physicians treated stomach ulcers by many, many methods including extensive surgeries (vagotomies, etc) which were more or less effective. The cause of the ulcers was also fervently sought for decades and eventually it was decided to be stress and diet and bad behavior (alcohol, smoking). Then, an obscure and previously disregarded and entirely dismissed causative agent (H. pylori in stomach ulcers) was identified and proven to be the cause. Cheap and effective treatment followed immediately. I think a similar scenario will evolve for AD. The actual cause will be found and this will be treatable with existing or slightly modified drugs or other non-exotic methods.

    You mentioned that “The Nun Study does not suggest that the beta amyloid or tau protein hypotheses are incorrect, or that these deposits are not the root causes of Alzheimer’s dementia. What it does suggest is that the human brain has considerable redundant capacity, and that even when parts of the brain cease to function, other parts can step up to the plate.” Perhaps, or maybe it actually does clearly suggest that amyloid or tau are not at the root of the problem and the true lesson is how humans can discard inconvenient data and continue to gnaw on other theories like a favorite old bone. Decades of intensive research, billions of dollars, and thousands of man-years of effort into amyloid and tau and other aspects of neurofibrillary tangles have yielded no effective treatments for AD. That bone is never going to break probably for good reason.

    IMHO, investing based on any current big pharma ‘cure’ for AD ought to be viewed as an extremely speculative bet, a lot like roulette.

  8. 192 |
    Jim Skelton
    Jim Skelton
    Aug 19 2013, 02:36:44 pm

    Doc, based on the readings of your posts over the few months I have been a participant in the Gumshoe universe, I had concluded that you just might be something of a really intelligent guy. Now, based on this article re AD, I’ve changed my opinion. You’re not a really intelligent guy. You’re a bona fide BRILLIANT guy, which is about three cuts higher than just being intelligent.! I salute you and look forward to any and all other comments you will be making.
    Now, one question .. and since we have connected a bit before, you might expect it.
    You might recall that I am long shares in Stellar Biotechnologies, SBOTF. Their “product” if you will is KLH, the protein extracted from the Giant Keyhole Limpet that they now “farm” and derive the substance from. This, they say, is sold to Pharma companies to use in clinical trials for many of the big diseases that the medical community is constantly trying to find cures for. Things like AD and various cancers. Management says that without supplies of this KLH the clinical trials underway for new treatments and even the production of already approved drugs would grind to an immediate halt since the KLH is necessary in conducting many of these trials. That’s what driving the price of SBOTF and giving lots of hope to investors that Stellar Biotheh will indeed prove to give investors “Stellar” performance. I ask you your opinion; is KLH such a critical component for the R&D and clinical trials as they make it out to be. This is the fundamental question that must be answered if an investor is to have confidence in the company. If KLH is not that important a component of these trials and production, then the value of the company is greatly diminished. But if it is, if there is no substitute and Pharmas must have it, since Stellar is the one and only provider, then the outlook is very bright indeed. Your opinion/comment on KLH and its uses would be greatly appreciated.

  9. 416 |
    Myron Martin, Special to Stock Gumshoe
    Myron Martin, Special to Stock Gumshoe
    Aug 19 2013, 03:36:53 pm

    Thank you Edward Maddox for this compilation of documented research that counters the “someone will make billions from a CURE for Alzheimers” approach of the medical profession. Herein lies the problem, it is all about MONEY from a patentable DRUG instead of searching for the CAUSE and eliminating it. Obviously you have studied the subject in depth and you have done all readers a big favour by pointing out this website dedicated to finding causes and PREVENTING this horrible disease in the first-place by eliminating known factors and dietary changes needed to prevent deficiencies that trigger bodily malfunctions.
    Thank you also for the positive contribution by Lane who added some insightful points.
    There is no such thing as a safe, permanent cure for any bodily malfunction with some “magic pill” chemical concoction that drug companies can make a fortune on. Lifestyle diseases can only be prevented or reversed by a positive change in lifestyle that will only come about by self education and conviction that leads to the needed changes. I satisfied myself 50 years ago that heavy metals, (particularly lead, aluminum, mercury and cadmium) are prime suspects, the evidence is readily available , you just won’t likely hear it from your medical doctor. Short of posting the entire website contents the two paragraphs below summarize very well the basic truths on the matter.

    ALZHEIMER’S DISEASE: SOME ALTERNATIVE THERAPIES
    “(Research) suggests to me that if everyone started on a good nutritional program supplemented with optimum doses of vitamins and minerals before age fifty, and remained on it, the incidence of Alzheimer’s disease would drop precipitously.” ( Abram Hoffer, MD, PhD”
    Aluminum Toxicity
    Unintentional aluminum intake may increase the risk of AD as well. Aluminum cookware, aluminum foil, antacids, douches, buffered aspirin, and even anti-perspirant deodorants may all contribute to the problem.

    A single aluminum coffee-pot was shown to have invisibly added over 1600 mcg aluminum per liter of water. This is 3,200% over the World Health Organizations set goal of 50 mcg per liter. Aluminum is known to build up in the bodily tissues of persons with Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. Aluminum is a known neurotoxin. Aluminum is also a component of so- called silver amalgam dental fillings. Composite (white) fillings do not contain aluminum (or mercury, for that matter.) Most baking powder contains aluminum. Rumford brand baking powder does not, however. Neither does baking soda, which is a different substance entirely.
    Jackson, J. A.; Riordan, H. D. and Poling, C. M. (1989) Aluminum from a coffee pot. Lancet, I (8641) 781-782, April 8.
    I agree with Abram Hoffer MD and I am sure he would agree with me that eliminating ALL aluminum cooking utensils and anti-perspirant deodorants containing aluminum would go along way to curbing the scourge that are diseases like Alzheimer’s and Parkinsons. Note that these and other studies on the website were published in Lancet, a respected medical journal.

    • Avatar
      Dave
      Aug 20 2013, 07:08:21 pm

      My doctor, who is a board certified MD, did a blood test to measure my levels of heavy metals and then did a series of chelation treatments until the levels were lowered to what he thought was acceptable. If you have trouble finding a doctor who will do that , check http://www.acamnet.org/

  10. Avatar
    Solyom
    Aug 19 2013, 04:45:51 pm

    As a retired neurologist I thought I should make a few comments. Many equate dementia (a symptom) with the disease ( Alzheimer’s Disease). Alzheirmer’s is just one of several types of dementia afflicting our population. One of the most common in the elderly is Multi-Infarct Dementia (a series of small strokes); if you owe one person 10 bucks generally not a big deal. But owe 100 K people 10 bucks, it becomes a big deal. We do not do enough autopsies in this country to have accurate vital statistics (if one is moving , one should not be subjected to a autopsy). No heart beat long enough = autopsy. Mutli-Infarct Dementia is treatable/avoidable by avoiding smoking, treating hypertension and diabetes.

    In 1969 I had a patient in his 90’s who was hospitalized for seizures, these turned out to be due to an arhythmia but in discovering the cause of his seizures I figured out he was also demented. He was still teaching as a professor of music in a famous university. His classes were popular. I could not understand this so I tested him by asking questions about the Mayan history and culture as he had stated this as one of his interests. He held up well his end of the conversation. Upon confronting him, he stated that when he first started teaching he could prepare for a class in 15 minutes but now the same class takes an hour. The elderly nuns knew their brains were slowing down. But nuns never really retire; they stay active much longer than other groups. Also those nuns who were well educated in their youth (by parents for the most part) started off adult life with well developed brains. Remember if a kitten is blindfolded at birth and blindfolded removed at one year their occipital lobes are not well developed and the kittens are blind for the rest of their life. If we as a country trained/educated our children better they would have less chance of entering a nursing home for dementia. If out elderly used their brains more they would enter a nursing home for dementia later.

    Learn a new language. Tale a on-line (usually free) course in evaluating stocks, ETFs, Mutual Funds. Learn how to calculate Fair Value. Learn how to calculate Fair Value of a tech company or a biotech with drugs in the pipe line. Learn How to Weld. Watch less TV.

    Also stop smoking and never drinking in excess will help to keep one out of a nursing home. They can harm more and more often than mercury/aluminum in dental fillings or al

  11. 416 |
    Myron Martin, Special to Stock Gumshoe
    Myron Martin, Special to Stock Gumshoe
    Aug 19 2013, 05:08:49 pm

    The box near the beginning listing 5 signs you will get Alzheimer’s is also well worth watching, which I did after my original post.
    Dr. Blaylock and I would get along quite well. The additional details he adds are fantastic.
    http://w3.newsmax.com/blaylock/video_brain_intl.cfm?PROMO_CODE=140FB-1&gclid=CMmh9tehirkCFexDMgodqXwAvQ and YES, stopping smoking and never drinking in excess will also help keep one out of a nursing home. I am not so sure however that mercury/aluminum should be considered more benign, once again it comes down to MONEY!
    Eliminating the sources of aluminum in our diets, cooking utensils and everyday products we use would not be popular as it would lessen the profits of far too may corporations with strong lobbying powers. Follow the money, often somebody or organization with an axe to grind is behind research that protects the profits of big industries.

    • Avatar
      Loren Rowton
      Aug 19 2013, 07:06:49 pm

      A company called Cortex Pharmaceuticals has been developing and getting positive results from their work with Ampakines. It looks extremely favorable for many brain disorders including Alzheimer’s. They were not properly capitalized (and still aren’t) so it looks like some of their patents may run out and larger companies will be profiting off of generic versions. I bring this up to let you know that there are other options on the horizon that may have a negative impact on current drug strategies. I bought in early with high hopes in my “gambling portfolio” and now I would be happy to break even.

  12. Avatar
    russ durkovic
    Aug 19 2013, 07:10:40 pm

    Great job exploring AD Michael. It’s a very complete article.
    I have to agree with Scott Ledgerwood that (PRAN) has the most promising drug which could eliminate HD, although others sound interesting too.

    Russ

  13. Avatar
    john
    Aug 19 2013, 07:21:41 pm

    Forget about all these companies trying to control this and that..There is ONLY one company working on a cure.. Not just treating the symptoms… And that company AVXL going into phase two trails after a very successful Phase one.. I have made some vg $$$$ watching this stock go up and down..

  14. 438 |
    Avatar
    tanglewood
    Aug 19 2013, 10:49:54 pm

    Wow, thanks Michael for that great presentation on Alzheimer’s. Re; the Nun study, you had mentioned that the group of nuns with the best “linguistic density” were the least likely to get Alzheimer’s dementia. When I was in school, the best writers were the students that did a lot of reading. Can we deduce that heavy reading activity may postpone or eliminate the onset of Alzheimer’s ?

  15. Avatar
    vivian lewis
    Aug 20 2013, 05:33:24 pm

    dear Doc Gumshoe, thanks for a comprehensive guide to what little we know now, and what less we know for sure about Alzheimer’s Disease.
    Like everyone of my generation I am terrified of dementia overtaking me, and am kind of reassured by the nun’s study, not because I am confined to a convent, but because I am still in harness, still studying stuff, active in the stock market and in running my business. And I was raised to be articulate, in fact probably meant to run a blue stocking salon when I grew up, not to spend much time on my knees.
    Now what do I do to prevent stroke, I wonder, which debilitated and depressed my mom when she turned 87 1/2 and killed her at 89? My mom of course was the one who raised me to be articulate in 3 to 4 languages at once but after her stroke she could only communicate in German baby talk and gestures.
    she took statins and controlled her diet carefully. It didn’t help in the end.

    • 82
      Avatar
      Edward Maddox
      Aug 20 2013, 07:55:21 pm

      Vivian was your mother obese? Did she have high blood pressure? Do you have either of these conditions? They can be things that increase your chances of stroke. There are several types of stroke, depending on just what went wrong. As that is true, there are several causes of stroke. You might learn some about causes of stroke and get some clues as to what to correct in your lifestyle if anything seems to fit. See Mayo Clinic’s discussion at http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=causes .

    • 416 |
      Myron Martin, Special to Stock Gumshoe
      Myron Martin, Special to Stock Gumshoe
      Aug 21 2013, 10:15:06 am

      VIVIAN: You might want to do some serious research on statins. They are at the top of my list of dangerous drugs that do more harm than good. Statins have serious side-effects (as do most drugs) but on the positive side do nothing that can not be accomplished by some simple and intelligent changes in diet. That being said, a lifetime of bad eating habits can not be undone quickly, it requires perseverance and in some cases dis-ease, (particularly in the elderly) is too far advanced to be reversed completely, but it is still better than chemical alternatives that further poison the body.

  16. Avatar
    Dave
    Aug 20 2013, 07:03:50 pm

    Thanks for the very good information on AD. Several of the members of my family have had Alzheimer’s so I am constantly looking for new information on ways to avoid getting it. One very good source of treatments that are alternative and complementary to the prescription medications is the book “Awakening From Alzheimer’s”. http://www.amazon.com/Awakening-Alzheimers-Maverick-Doctors-Reversing/dp/1467523690/ref=sr_1_11?s=books&ie=UTF8&qid=1377039466&sr=1-11&keywords=alzheimers I don’t have any connection with the author or the publisher of the book other than having purchased the book.

  17. Avatar
    g pare
    Aug 20 2013, 11:33:38 pm

    Another great read from the Doc and this discussion thread is very thought provoking. By growing our own food, eating less packaged food, drinking lots of water, eating green vegies, staying away from GMO’s, staying active with physical and brain exercise… maybe we can beat this disease. I bought in on SBOTF – it’s doing well and I hope those little sea limpets multiply, prosper and make a great medicine to solve all our problems. I’m an optimist at heart.

  18. Avatar
    Chanterelle
    Aug 24 2013, 03:45:55 pm

    More than a glimmer – how about a blood test for Alzheimer’s disease!!

    Amarantus Biosciences (AMBS-OTC) will soon start Phase 2 clinical development of LymPro, the first blood test for AD.

    This is taken from a Zacks report. The link to the full report is below.

    “Amarantus BioSciences is developing a Lymphocyte Proliferation (LymPro) Blood Test for the diagnosis of Alzheimer’s Disease. The company acquired the test from privately-held Memory Dx, LLC, in December 2012. The inventors of the test, Dr. Thomas Arendt and Dr. Jens Stieler of the University of Leipzig, Germany, had
    previously published data and the mechanism of action for LymPro in NeuroReport. We note that LymPro has completed two Phase I clinical studies in over 160 patients, showing 98% sensitivity and 96% specificity for Alzheimer’s disease diagnosis.
    The next step in the clinical development of LymPro is to establish the analytical performance of the assay in an outsourced GLP laboratory, as well as to conduct small clinical performance studies to verify the previously published findings and demonstrate reproducibility of the data. Last week, Amarantus announced that it has signed a laboratory services agreement with Becton, Dickinson & Co., one of the world’s leading global medical technology companies, to accomplish this goal.
    Amarantus expects to have the data back from BD in the third quarter 2013. Assuming the previously published findings are validated by BD, the next step is to initiate a pivotal diagnostic accuracy study to generate sufficient data to support a Clinical Laboratory Improvement Amendment (CLIA) launch in 2014. We expect that BD, the independent laboratory Amarantus hired to do the analytical performance testing and validation work on LymPro, will be very interested in doing the pivotal CLIA work later this year. So in a sense, the roles will reverse. Amarantus paid BD to validate the test. Once the test is validated, it then potentially becomes the first available blood test for Alzheimer’s disease, and a $500+ million commercial opportunity. We believe BD will then in-license the test from Amarantus for significant upfront cash, backend sales and regulatory milestones, and nice royalty on sales.”

    Read the rest at: http://scr.zacks.com/files/June%2019%202013_AMBS_Napodano_v001_n50g1c.pdf

    Plus, they have the rights to something even more exciting in the treatment of Alzheimer’s disease,as well as Parkinson’s disease and concussions. Amarantus owns the intellectual property rights to a therapeutic protein known as Mesencephalic-Astrocyte-derived Neurotrophic Factor (“MANF”) and is developing MANF-based products as treatments for brain disorders.

    Yes, I own AMBS! The Board of Advisors includes Dr. Joseph Rubinfeld, one of the four original co-founders of Amgen. Also on the Board, a former Vice President of Biotechnology Research at Bayer Corporation & a former Executive Director and Co-Head of Mergers & Acquisitions at Novartis Pharmaceuticals.

    Do some DD for yourself. This is the real deal!

  19. Avatar
    Kate Richmond
    Aug 24 2013, 08:55:56 pm

    Thank you, Doc Gumshoe and readers, not only for a clear and informative survey of the state of Alzheimer’s research, but for the many thoughtful and detailed comments.

    Doc Gumshoe included results from the Nuns Study, and Dr. “Solyom” and a few other also mentioned stroke, but I didn’t see that anyone else was making any linkage between the two processes.

    It has been some time since I followed the Nuns Study, but I’m sure I recall that the damaging role of small strokes (especially in lowering the “redundancy” of the brain) was raised in discussing the perplexing finding that some nuns were found to have brains which had been functioning well in advanced old age despite moderately developed amyloid plaques, while others in whom dementia was well-advanced showed no greater physical evidence of plaques on autopsy. I understood it was hypothisized that a concurrent history of small strokes was the key difference. Linguistic density was also mentioned as a factor in the development of the plaques, but among those who developed the plaques, I thought they were saying that the physical damage from strokes was the critical difference–not in who developed Alzheimer’s (because both had developed it), but in who exhibited the conspicuous associated symptoms of dementia.

    Since Doc Gumshoe’s article was otherwise so thorough, I wonder if there has been some change of views on this point since the time I read about it. Has opinion shifted away from the “stroke theory” of accelerating dementia symptioms, and toward the “linguistic density” explanation?

  20. Avatar
    Scott Hall
    Aug 26 2013, 01:36:10 pm

    There has been more research coming out calling Alzheimer’s is Type 3 diabetes. The brain becomes insulin resistant, whether from lifestyle (an extension of a Type 2 diabetes situation) or possibly independently (genetic variation or other some other reason for a localized insulin resistance). Either path leads to a significant energy deficit in the brain, regardless or perhaps in spite or perhaps due to what is eaten. The insulin resistance reduces the amount of glucose that is able to enter the cell.

    There reports of significant cognitive improvements when some (a few tablespoons) to a lot (a cup or more) or coconut oil is consumed by someone suffering from dementia. Coconut oil is nearly all medium chain triglyceride (MCT), while most oils are short or long chain and require more digestion/processing in the body for use. The MCTs can be used as they come from the food by the cells of the body. So, it may serve as a fuel source that the brain very much needs. Also, as a fat, the transport of the MCTs into the cells is not influenced greatly by the insulin transport system that sugar requires. Thus, it can fuel the energy-starved brain even with ongoing insulin resistance. The same, positive results can be had with a ketogenic diet. That is one that is high-fat, low carb and moderately low protein.

    If this energy hypothesis is correct, once fueled, the brain can now repair itself. The presence of these harmful proteins may be a reflection of the brain in massive energy deficit that is unable to do all of its normal, ongoing maintenance.

    Dr. Terry Wahls is a proponent of the energy deficit hypothesis for many degenerative diseases. She was able to reverse her multiple sclerosis with a diet that contained all of the nutrients needed for mitochondria to function properly. She thinks her MS was due to a diet that was insufficient in these nutrients and due to her compromised digestive system that could not properly process the foods she ate (celiac or colitis). How many people have impaired digestion? We can certainly start our count with all of those feeding the multi-billion dollar anti-acid industry. Her work is really compelling and she uses her diet protocol (very whole food paleo approach) to treat post-traumatic stress disorder and traumatic brain injury patients with the VA.

  21. 416 |
    Myron Martin, Special to Stock Gumshoe
    Myron Martin, Special to Stock Gumshoe
    Aug 26 2013, 03:17:58 pm

    Excellent observation proving once again that the number one solution to such serious malfunctions of the body are rightly called “lifestyle diseases” so the best resolution is EDUCATION as to the bodies nutritional requirements. The first line of attack should be PREVENTION by positive lifestyle changes and if the dis-ease is detected early, there are natural remedies that can REVERSE the pathology when combined with a natural foods diet.
    Swallowing a pill may seem easier but it is not a solution to a self induced problem and the side effects of drugs may not show up for many years and result in even worse conditions.

  22. Avatar
    Kristen Mower
    Aug 27 2013, 05:11:44 pm

    Thanks for the great article and discussion. My dad got Alzheimer’s even though he and my mom raised us on proper diet and exercise (their mantra) since they had learned about Adele Davis’s approaches during early 1940s (college days). Nutrition was the solution to all problems for them (except broken bones :-))…no one in my family ever took drugs for an illness, etc. and my parents walked or swam every day of their lives…They were also were mentally active their entire lives. No sodas, or junk food, sugar goodies in our house….green salad every dinner etc. Only reason I wrote all that is to explain why I’m excited to have found another way than diet/exercise to increase my chances of NOT getting this scary disease…It is a simple 12-minute-a-day ‘singing’ meditation, clinically shown to help your brain & memory ! 🙂 —Check it out on this web site… :
    http://www.alzheimersprevention.org/research/12-minute-memory-exercise
    Read the author’s bio via Wikipedia…IMPRESSIVE! He also has a very interesting book etc. on Alzheimer’s as you’ll see on the site (AMAZON has it)…
    Anyway, it gives me hope as I just can’t count on my healthy diet/exercise/mental stimulation (such as this site :-)) to protect me… since that just didn’t do it for my dear dad. Hmm, I guess Luminosity exercises are next for me too … 🙂 Thanks again to the DOCTOR (Medical writer) for putting out this article and to all my fellow ‘gumshoers’ for adding to it. This is a great place to learn things besides stock picks! 🙂

  23. Avatar
    assisted living
    Sep 18 2013, 11:33:21 pm

    Great job exploring Michael. It’s a very complete article. I have to agree with Scott Ledgerwood that PRAN has the most promising drug which could eliminate the disease, although others sound interesting too.

  24. 11352
    Ben Lawrence
    Ben Lawrence
    Nov 4 2014, 02:39:10 pm

    AMBS-
    Amarantus BioScience Holdings, Inc., formerly Amarantus BioSciences, Inc., is focuses on developing intellectual property and proprietary technology in order to develop drug candidates and diagnostic blood tests to diagnose and treat human diseases. The Company owns the intellectual property rights to a therapeutic protein known as Mesencephalic-Astrocyte-derived Neurotrophic Factor (MANF), owns the intellectual property rights to biomarkers related to oncology and neurodegeneration named BC-SeraPro and NuroPro respectively, has a license to an Alzheimer’s disease blood test named LymPro, and owns a number of proprietary cell lines called PhenoGuard. MANF was the first therapeutic protein discovered from a PhenoGuard Cell Line. In December 2012, the Company acquired neurodegenerative diagnostic portfolio from Power3 Medical Products. On March 22, 2013, the Company was merged with into Amarantus Bioscience Inc.
    Dr.KSS have you reviewed AMBS science?
    Thanks for all you do for us 🙂
    Best-Ben

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