Prospects for the Future

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- Only thirty years ago Alzheimer's disease was regarded as a hopelessly untreatable condition. Except for a handful of investigators, the area attracted little interest and virtually no support for research.

- Twenty five years ago, the essential clinical infrastructures for longitudinal studies of well-characterized patients did not exist.

- Twenty years ago, ideas about "cure" and "prevention" were unconceivable; such things as diagnostic criteria, standardized assessment instruments, cadres of specialized professionals, memory disorder clinics, family support groups or outreach programs, all taken for granted now, were not fully developed.

- Fifteen years ago, the knowledge on biological underpinnings and the genes associated with the disease had not been identified.

- Ten years ago, animal models of the disease were not available.

- Five years ago, persons risk for the disease could not be identified and the concept of clinical trials to delay the symptoms was unconceivable.

- Until 2004, the Ap protein, hallmark lesions of the disease, could not be directly visualized in patients.

Today, the field is on the brink of major breakthroughs that may lead to more effective treatments and, ultimately, to prevention. A great deal has been learned about the pathogenesis of neurodegeneration, after less than three decades. Novel intervention strategies are being developed to ameliorate the neuro-toxicity caused by abnormal metabolic products and prevent processes that lead to cell death. A large number of clinical trials are underway, both industry and government (NIA-ADCS) sponsored studies, with widely-used drugs (e.g., antioxidants, anti-inflammatory agents, statins, vitamins and folate) that might reduce the risk ofAlzheimer's disease. Intensive studies are underway on multiple fronts, from basic science to genetics to drug therapy to care giving.

The remarkable progress towards understanding AD and the improved the prospect of discovering disease modifying therapies will not have been possible without the: 1) worldwide network of investigators working closely and collaboratively, 2) research infrastructure established by NIA and, 3) the successful partnership between the NIA Alzheimer's Association. Now these partnerships need to be expanded to include industry, foundations and individual philanthropists. The goal for such public-private working partnership is to mobilize all the necessary national resource for a new initiative to discovery [and/or develop] of interventions to prevent the disease. Time is running out; the epidemic of AD will completely overwhelm the health care system; due to the substantial growth the numbers of people with AD. The demographic changes, resulting from the continuing increases in the life expectancy of the oldest-old, are going to have their full impact in 20 to 30 years from now. The projected costs in human suffering and lost opportunities will be incalculable and unthinkable.

Ultimately, investment in brain research is the only cost-effective means to avoid the pending public health catastrophe facing countries with aging populations. Now it is essential to reevaluate priorities in all developed countries with resources with the goal of significantly expanding the world commitment to support research on disorders of the aging brain. The ultimate aim of such an international initiative should be the reduction of the: duration of illness, numbers at risk or affected by AD and, cost of care. Fortunately, the necessary scientific leads and the technical information are at hand to launch a bold initiative. A delay in the onset of disabling symptoms will allow patients to continue functioning independently for longer periods. An initiative aimed at mobilizing the necessary resource to delay the onset of the disease by five years for all age groups over 65 would reduce nearly half the total number of individuals with the disease. But, we need to act quickly. In 20 years, attempts will be too little and too late, because the healthcare needs of nearly 8 million people will overwhelm the available resources. It is no longer a question of whether the scientific community has the knowledge base to insure the success of such an endeavor; it is more a question of whether political leaders and policy formulators around the world have the vision and the will to move forward.

Acknowledgements. During my tenure at the NIA (1978-1995) as the Associate Director, Neuroscience & Neuropsychology Program and the Director, Office of Alzheimer's Research, Ihad thegood fortuneofreceiving thefullsupport of successive Directorsofthe Institute-Robert N. Butler, T. Franklin Williams and Richard J. Hodes. Theyprovided not only encouragement but also gave me the freedom to plan, develop, administer and lobby for various initiatives. However, the successes of NIA programs would not have been possible without the dedicated effort of many colleagues at the Institute; special gratitude is due to Teresa Radebaugh, Andy Monjan Creighton Phelps, Stephen Snyder, Neil Buckholtz and Marcelle Morrison-Bogorad. The comments and suggestion of John Trojanowski, John Morris, Leon Thal, Yves Christen and, Ara Khachaturian were invaluable in the preparation of this article. This author is solely responsible for any errors or omissions in recounting this story of AD research.

"Reprinted from Alzheimer's and Dementia: The Journal of the Alzheimer's Association, Vol 2 Number 4, Khachaturian, Z, A chapter in the development of Alzheimer's Disease research: A case study of public policies on the development and funding of research programs, In Press Article, Copyright (2006), with permission from The Alzheimer's Association.

Anatomy & Neuropsychology

Bradley Hyman
Bradley T. Hyman

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