Scientists told the Senate Special Committee on Aging earlier this week that there many promising Alzheimer’s disease detection and treatment research projects under way right now.
Dr. Richard Hodes, director of the National Institute on Aging, said increased research budgets and new gene sequencing technology are helping researchers learn more about how human genetics — and, possibly, microbes — lead to Alzheimer’s and other forms of dementia.
“Thanks to the efforts of an expanding community of scientists, we have important progress to report,” Hodes told the committee, in a written version of his testimony. “Our hope for a cure has never been stronger.”
The Dementia Problem
About 5.8 million U.S. residents have Alzheimer’s disease, and coping with the effects of dementia cost the Medicare and Medicaid programs about $195 billion per year, according to an opening statement presented by Sen. Susan Collins, R-Maine, the chairman of the special committee.
“If we continue along this trajectory, Alzheimer’s is projected to claim the minds of nearly 14 million Americans, and surpass $1 trillion in costs by 2050,” Collins said.
A biotech company, Biogen Inc., recently canceled two major Alzheimer’s drug development projects, saying drugs that were supposed to remove beta amyloid, or waxy buildup, from the brain had no clear effect on Alzheimer’s disease.
Some people in the Alzheimer’s community have argued that the country should spend less on efforts to prevent or cure dementia, and more on trying to support the people who already have dementia, in part because many drug development projects aimed at beta amyloid, and some at a related substance, tau protein, have failed.
Other policymakers are still hoping that scientists will find ways to reduce the number of people affected by dementia.
Why This Matters to Agents and Advisors
A successful effort to reduce the impact of Alzheimer’s could lead to a sudden, dramatic improvement in the finances of long-term care insurance issuers, ease the process of planning for all sorts of long-term care risk, and sharply increase the odds that even people who will still need long-term care will be able to get that care in their own homes, without 24-hour supervision.
For the typical retirement planning client, controlling the Alzheimer’s threat might be the equivalent of putting about $50,000 in cash in the client’s asset total, and eliminating exposure to a condition that, in a worst-case scenario, without client access to long-term care insurance or Medicaid nursing home benefits, could eat about $1 million in cash, or more.
(Related: The Largest Individual LTCI Claim of 2018)
The BOLD Infrastructure for Alzheimer’s Act
Collins said the new BOLD Infrastructure for Alzheimer’s Act of 2018, which was signed into law Dec. 31, will help strengthen public health program support for people with dementia, and also increase dementia research funding by $425 million per year, to about $2 billion per year.
“While amyloid remains an important part of ongoing research, and I remain hopeful that new trials starting earlier in the disease process will produce better news, the record funding that we have provided will allow our medical researchers to pursue other promising approaches,” Collins said.
The Dementia Research Pipeline
Here are four hot areas of dementia research that Hodes and other witnesses discussed at the Alzheimer’s research hearing.
1. Alzheimer’s Blood Tests
One challenge for researchers, and care providers, is that detecting the physical presence of Alzheimer’s disease in the body has been difficult.
In the past, researchers usually had to wait until patients died, then open up their brains to look for waxy buildup, to see of the patients had really suffered from Alzheimer’s disease, rather than from some other form of dementia.
For researchers, the lack of a biologically based Alzheimer’s disease diagnostic tool has interfered with efforts to select research targets and measure the effects of potential therapies on the course of the disease.
Now, Hodes said, researchers are looking into using the ratio of traces of two different types of amyloid wax in the blood to develop an inexpensive Alzheimer’s disease detection blood test.
2. Alzheimer’s Eye Tests
Dr. Sharon Fekrat, an eye doctor at the Duke University medical school, said researchers believe that examining small blood vessels in people’s eyes may lead to another inexpensive, non-invasive way to detect Alzheimer’s.
The retinal blood vessels of people with Alzheimer’s disease are different from those of people with mild cognitive impairment, and from those of healthy controls, and understanding those differences could help doctors understand who is at risk for developing Alzheimer’s disease, and for understanding which patients are at which stage in the disease, Fekrat said.
“Everyone knows” that you can’t catch Alzheimer’s disease the way you catch a cold — except that the science behind that conventional wisdom is not all that clear.
A review of brain banks and other studies found evidence that viral species, especially herpes viruses, may have a role in Alzheimer’s disease biology, Hodes said.
“Although these findings do not prove that the viruses cause the onset or progression of Alzheimer’s, they do demonstrate how viral DNA sequences and activation of biological networks — the interrelated systems of DNA, RNA, proteins and metabolites — may interact with molecular, genetic and clinical aspects of Alzheimer’s,” Hodes said.
The National Institute on Aging plans to support research on whether microbes cause Alzheimer’s disease, or somehow contribute to the start of Alzheimer’s disease, or to the damage done by Alzheimer’s disease, Hodes said.
4. Targets Other Than Viruses, Beta Amyloid and Tau
The National Institutes of Aging is tracking about 30 drug candidates with about a dozen targets other than viruses, beta amyloid or tau protein, Hodes said.
One drug candidate, BPN14770, could help ease memory loss in people with early or moderate Alzheimer’s disease. The compound has successfully completed safety testing and is about to move into effectiveness stage testing for early Alzheimer’s disease, Hodes said.
Other studies are showing that niacin and metaformin might be helpful, Hodes said.
Links to information about the Alzheimer’s hearing, including a link to a video recording of the hearing, are available here.
— Read The Impact of Cognitive Decline on Families’ Finances: RBC Survey, on ThinkAdvisor.