‘Insights’ lecture in La Jolla sheds light on Alzheimer’s disease

The Sanford Burnham Prebys (SBP) Medical Discovery Institute’s Insight Series brings together a scientist, a doctor and a caregiver to share their reflections on the multiple facets of a given disease. As June is “Alzheimer’s Disease and Brain Awareness Month,” the topic June 5 was Alzheimer’s.

Moderator Kristen Cusato, a spokesperson with the Alzheimer’s Association, opened the presentation by sharing stories of her mother’s battle with Alzheimer’s and how the Association is partnering with organizations like SBP to raise awareness.

“We are focusing on the importance of early diagnosis and how to keep your brain healthy. Every 65 seconds, someone develops Alzheimer’s in this country. It is the only top-10 cause of death that has no cure, no effective treatment, no way to prevent and no way to slow down,” she said.

Each of the speakers offered insights and took questions from the audience.

Dr. Michael Lobatz, medical director of the Rehabilitation Center at Scripps Memorial Hospital, discussed the different types of dementia, the pathway to diagnosis, and advances in imaging technology. “If dementia is like fruit,” he said, “Alzheimer’s disease would be like an apple. There are other kinds of dementia, but the most prevalent form is Alzheimer’s disease,” he said.

The exact cause of Alzheimer’s is only theorized, and many clinical trials have been “disappointing,” he added.

Preceding some cases is what Lobatz described as “mild cognitive impairment,” through which a person may have “memory impairment, noticeable to themselves or to others in their lives, but they are able to function normally otherwise.”

However, this mild cognitive impairment “will progress to Alzheimer’s at 12-14 percent per year. So after five years, as many as 60 percent have developed a diagnosis of Alzheimer’s. But that also means 40 percent may not,” he said.

To keep the brain sharp, he advocates for healthful eating, moderate exercise a few times a week, and (he joked) “avoiding television at all costs.”

Cusato added: “Anything that is good for the heart is good for the brain,” and she suggested puzzles and taking different ways home from work to keep one’s brain actively engaged.

When it comes to diagnoses, which starts with the 10 Signs for Early Detection (see sidebar), Lobatz said doctors use “informants” in the family. “Most people who have the onset of dementia are not aware of it. When people come to me with worries they have Alzheimer’s, they almost never do. If you can remember that you forget, you are probably OK,” he said. “When a person says there is nothing wrong, and their spouse, child or caregiver rolls their eyes — that is the most reliable sign.”

Reflecting on new technologies, such as a “brain volume study,” Lobatz said: “We can measure the volume of the brain, especially the memory centers of the brain, and this can be an indicator that there is something wrong that we can pick up early.”

These images, and early monitoring of mild cognitive impairment, are “of great interest” to researchers, he concluded.

Dr. Jerold Chun, professor and senior vice-president of SBP neuroscience drug discovery, analogized the neurons of the brain — including those that are damaged or inhibited by Alzheimer’s — to a car.

“There are 100 billion neurons present in your brain,” he said, “different makes, models, colors, performance aspects and more. That constitutes a normal brain. We need to have a flow of cars through your brain in order for it to function on a daily basis. Some of these neurons are like a Trabant car, not what one would call a performance vehicle, it goes 0-60 in 30 seconds.”

He asked the audience to imagine a multi-car pile-up accident. “Some still look like cars, but they are damaged. Others are completely scrunched. Others are surrounded by debris,” he said. Whether it be a traffic jam or traffic accident, “this type of information flow is what’s affected when one looks at Alzheimer’s.”

But the overarching question in terms of research is: What about the drivers?

“We’ve got these cars, and we’ve got these wrecks, but if we actually look at what is producing these accidents, shouldn’t we be looking at what is controlling these ‘cars’ to begin with? It turns out, in our brains, we have different genomes, neuron to neuron. So we need to understand what that difference is.

“In Alzheimer’s,” Dr. Chun continued, “we’ve found that a perturbation of that mosaic of cars is occurring at the level of these DNA drivers that are present in the individual neurons. So it’s our belief, if we can understand what the sequence changes are, then we can really get at real therapies that could modify the disease process. We believe we are on the right track.”

Serena Reid, a retired U.S. Marine Corps captain, recalled “not knowing what it was and not knowing what it was called” when her great-grandmother and grandmother experienced the effects of Alzheimer’s.

“My great-grandmother could not speak, so my grandmother would feed her, bathe her and help get her ready for bed,” Reid explained. “And we would just jump in and help. Eventually, my great-grandmother passed away and my grandmother moved into her house in Florida.”

Soon, Reid started to notice that conversations with her grandmother would be repeats of previous conversations.

“One day, we got a call from her neighbors saying my grandmother was at the playground, looking for her mother. My grandmother moved in with my mother, and I think my mother felt obligated, watching her mother (my grandmother) take care of her mother (my great-grandmother). She did that until the stress of it all took its toll. My mother now has mild cognitive impairment and she lives with me,” she said.

Relying on local support groups and the Alzheimer’s Association for resources, Reid said there are programs that assist with patient care.

All SBP Insights forums include a Q-and-A, so attendees can quiz the experts. This night, an audience member asked Reid what a caregiver can do for a reprieve.

Reid explained there are programs a patient can attend for a few hours, a few days a week. “I get a lot done in those three days,” she joked. “The best thing that can be done is have a routine. It helps the person to not be confused, because when something out-of-the ordinary comes up, it really throws them.”

— Breast Cancer will be the topic of the next SBP Insights presentation, 5:30 p.m. Thursday, Oct. 25 at Sanford Burnham Prebys Medical Discovery Institute, SBP Auditorium, 10905 Road to the Cure. Free registration: sbpdiscovery.org/Insights