Thursday, December 16, 2010

Will baby boomers be the last generation to experience AD?

At this point, with so many threads of research pointing to so many ideas about Alzheimer’s, everything is a target for treatments to prevent or slow the disease — enhancing the brain’s beta amyloid disposal system, interfering with nerve cells’ feedback loops, blocking tau, protecting the brain’s default network by focusing on its unique metabolic properties.

But researchers say the best hope for the immediate future is with experimental drugs, now being tested, that slow beta amyloid production. The hope is that if the flow of amyloid into the brain is slowed, levels can go down even if the amyloid drain is slightly clogged. The drugs might work even if the problem is with the drain, not the faucet.

The trick in Alzheimer’s, though, might be to start treatment before too much damage is done. (from a recent article in the N.Y. Times by Gina Kolata)

It is a lengthy and fascinating article, well worth reading. While many questions remain unanswered, clearly our understanding of the cause or causes of AD is advancing, and it is not unreasonable to think that we are drawing closer to the ability to delay, minimize or even prevent the symptoms it ultimately brings, whether “closer” is measured in mere years or in decades. A consensus appears to be rapidly building in the research community that a critical key to any such intervention will be “to start treatment before too much damage is done,” meaning detecting AD long before symptoms first appear. Oh, and good luck should you be so unfortunate as to develop a form of dementia that is drawing less attention and far fewer research dollars than AD.

Whenever this “breakthrough” occurs, it will likely come too late for the baby boomers. This may put the largest generational cohort in American history in the interesting position of being the last generation in which as many as half of us will experience AD as a part of our aging process. Smallpox is the only disease has been officially “conquered," with polio and guinea worm disease on the verge of being vanquished. Could AD one day be added to that list? I count myself a skeptic, but it would be a wonderful accomplishment.

One wonders how we boomers, often characterized fairly or unfairly as carrying a sense of entitlement with us as we have aged, would respond if we learned that it was possible to delay or prevent the onset of AD, but only for those younger than ourselves. And one wonders how the manner in which younger folks relate to our generation, particularly those among us living with progressive memory loss, would change should they have grounds to believe “but it can’t happen to me!” Would we become objects of curiosity? Of sympathy? Of scorn?

My hope is that younger generations, freed from the fear of developing AD themselves, would be more comfortable having us as their friends and neighbors, taking us on our own terms, being present to us, and willing to enter our world for a bit of time. If it is a world they will never need to inhabit themselves, it becomes a less threatening world to visit. Could I dare to hope that they would insist we receive the care that we need, knowing that the costs will ultimately be contained by our mortality? Could “conquering” AD be a good thing not only for those young enough to benefit directly, but also for those already living with it? The crystal ball is cloudy, but any time we remove a fear from the world, the world becomes a better place.

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