A heterogeneous condition

One of the distinctive aspects of Alzheimer’s is that no two people exhibit the precise same symptoms. That was one of the key points in a speech by Dr. Brad Dickerson, a behavioral neurologist at Massachusetts General Hospital. I understand Dickerson’s comment pertaining to the complexity of the human brain and the nervous system, compared, to, say, heart disease, which in recent decades has become a far more manageable condition.

Dickerson, this year’s Simons Symposium speaker in Newton, Massachusetts, touted the promise of “precision medicine” as a possible fruitful means of curbing Alzheimer’s. A key element in this quest are biomarkers, which are defined by one source as a “broad subcategory of medical signs—that is, objective indications of the medical state observed from outside the patient—which can be measured accurately and reproducibly.”

In a practical sense, Dickerson noted that biomarkers can help doctors determine whether patients will stay in the mild cognitive decline or advance into full-blown Alzheimer’s disease. “We actually do a pretty good job with the tools that we have now,” Dickerson noted. And there are now specialized amyloid PET scans involving biomarkers. In some cases, people have a 90 percent chance of  developing Alzheimer’s. But if individuals knew well ahead of time that they were at risk of Alzheimer’s, they could change their lifestyles in terms of exercise, diet, sleep habits and other factors.

One question asked of Dickerson concerned the very broad life range, post-diagnosis. “And as anyone who has spent time in a support group for people with Alzheimer’s, or in a group for their care partners, the progress of the disease can vary widely. “The bottom line is that Alzheimer’s is a heterogeneous condition,” Dickerson stated. “The speed can be very different among individuals.” The amount of shrinkage in the brain varies widely as well.

Dickerson also noted, pointedly, that no new Alzheimer’s drug has been approved for roughly fifteen years, despite the substantial money that has been raised, from both private and public sources. And, as we learned about  a year ago, there was hope that an Eli Lilly drug candidate might slow the pace of the disease. That, in itself, would have been a very encouraging step. But that, too, went by the boards.  Still, for those of us in a relatively early stage of the disease, there is still hope for a breakthrough.