Saturday, September 24, 2016

Alzheimer's Strategy Upcoming

The head of our Geropsych department spoke briefly about where he believes treatment will trend for the next decade or two.  He doesn't see much on the horizon that cures or even slowly reverses the symptoms, but there is increasing evidence of things that slow the progression. Inflammation in the brain is one of the problems because it interferes with amyloid clearance. (I mostly understand that, but if you want more you should go ask your mother.) Acetaminophen isn't great for inflammation in general, but it's pretty good for brain inflammation. It might slow the progress of the illness 20%. So that goes into the cocktail when you start showing symptoms. Vitamin E, maybe another 5%, Fish Oil, another 5-10% - he blithely said "and there's a half dozen other things that might or might not have a small effect." Always the problem at this stage, when many things look plausible and promising, but somehow don't pan out.

So we get that up to 40%, which doesn't sound huge, but actually, it is.  If you can slow dementia, people can live at home a little longer. If you show symptoms at 90, it can be the difference between having to go to assisted living at 96 instead of 94. As there is general deterioration anyway, that might mean you get to die at home, which is what most people want; or in assisted living with more freedom instead of a nursing home. Slowing the symptoms means the mind stays ahead of the body, and you have your wits about you.

As I am overweight and smoked for 35 years I can be pretty sure my body is going before my mind, but this may apply to the rest of you.

So why not start on prophylactic tylenol now?  Because it's bad for your liver, and 40 years of it is a burden you don't want to put on it.  Some parts of any Alzheimer's cocktail will be similarly problematic over decades - but as a few-years strategy when you're already showing symptoms, the balance of risks shifts quickly.


james said...

On the other hand, there are probably a few things that didn't look promising, but on closer inspection might have a _small_ positive effect.

Interesting observation about acetaminophen. Are there environmental factors that increase, even slightly, brain inflammation? It wouldn't need to shift the mean much to cause a lot of grief in the tail of the distribution.

Assistant Village Idiot said...

No idea. I should be back on that unit late in the week and I'll ask. I suppose I could do some research on my own, but...

Donna B. said...

A very low dose of acetaminophen -

Retriever said...

It terrifies me, having seen the deterioration over years of two in laws. And having two bosses in early stages (total denial)of family members at whom bosses scream abuse, forget things, bully etc. I tell my kids "put me on an ice floe if I ever behave like X"

Because I want you all around to talk with online a long time, let me suggest that fish oil supplements are increasingly being discredited for prevention of various ills. What you have to do is eat oily fish. And NOT farmed fish. As the daughter of a fish farmer, I can't ever recommend eating anything except wild fish. I know what the farmed ones eat, and their growing conditions. So eat kippered herring or wild salmon. The frozen or canned salmon are just as good for you (if wild) as the fresh and much cheaper. Ya, they don't taste as good, but that's why we make salmon cakes...IMHO there will soon be detail on how it is a miscellany of stuff in those fish, and not just extracted oil, that help. Remember when we thought that Vitamin C pills were enough? And Tang was a health food? Now we know that the pith on the Orange has other stuff in it that helps us as well. So eat a semi Mediterranean diet and enjoy cooking it at home.
I theorize that eating rancid fat in fried fast food or trans fats in processed food promotes inflammation.
Then again, some of us just may be genetically loaded to have more inflammation going on. It's linked to depression, arthritis, etc which we know have genetic elements. With Alzheimer's, it seems anecdotally and in laws, that heavy alcohol consumption over many years may contribute. Then again, maybe the people I knew were self medicating some unexpressed depression and anxiety (classic repressed WASPs) that some say contribute to earlier onset of Alzheimer's. I read somewhere that lithium is a good lessener of people's chances of getting dementia. Low doses, as in the natural water supply. But how to tease that out from genetics? Maybe some tribes are just naturally less susceptible.

With all this, I think it gets harder and harder to figure out causation. We move more, adopt more,and lose touch w more relatives so it's harder to know if something is inherited or from chronic exposure or some one time insult (slow virus type thing)

I used to like the idea that people who were well read and intellectually curious didn't get dementia. Ha! One Inlaw had a phi beta kappa in physics fr an Ivy, and a law degree, and wealth of artistic and intellectual interests lifelong. Mind you, died at 95--we all get it if we live so long..

Assistant Village Idiot said...

Yes the oil in the fish is what is key, or so they tell me. My two Romanians are way up north - Nome and Tromso - and eat enormous amounts of such fish. The rest of us, not so much. I suppose we should have another go at salmon cakes.