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The total damage caused by Alzheimer’s can be difficult to conceptualize. Neurodegenerative disease a The leading cause of death in America, Killing over 100,000 people each year. And as Alzheimer’s progresses in the brain, it not only Erases memory But it also causes disturbing symptoms such as agitation, paranoia and aggression.

This burden falls not only on the patients but also their loved ones, doctors and caregivers. Financially, the cost of caring for Alzheimer’s patients in 2020 was an estimated $ 305 billion, a Report from the Alzheimer’s Association . And this figure No The unpaid care provided by family and friends includes an estimated $ 244 billion.

The number of Alzheimer’s patients in the US is expected to double by 2050, affecting it. About 14 million people. This is why hospitals and health professionals are already working on how to take care of the elderly and Alzheimer’s patients. New treatments take 15 years to develop, so today’s research requires substantial funding.

“Taking care of our older adults is a big responsibility, which we take pride in,” Said} Michael Dowling, President and CEO of Northwell Health. “Our aging population will face health problems, including especially Alzheimer’s, which will require the right care at the right time. So we have increased our services at Glen Cove Hospital, and the Feinstein Institute for Medical Research Has done research in. ”

… real pain comes from changes in personality …

What causes Alzheimer’s disease?

Although the cost of Alzheimer’s is clear, its exact reasons remain hopelessly mysterious. Currently, there is no cure for the disease, nor treatments that inhibit its progression.

“Alzheimer’s is a brain problem, and everyone knows what is probably the problem, but no one is able to do anything about it.”, Dr. Jeremy Koppel, a geriatric psychiatrist and co-director of the Litwin-Zucker Alzheimer’s Research Center.

But in recent decades, researchers have zeroed in on the potential contribution of the disease. The brains of Alzheimer’s patients reliably show two abnormalities: abnormal tau and the formation of a protein called beta-amyloid. As these proteins accumulate in the brain, they disrupt healthy communication between neurons. Over time, neurons are injured and die, and brain tissue shrinks.

Nevertheless, it is unclear whether these proteins, or other factors such as swelling , Can drive Alzheimer’s. <। p>

“We are working with very complex components,” Dr. Said Philip Marambud, a professor at Feinstein Institutes and co-director of the Litwin-Zucker Alzheimer’s Research Center. “The actual culprit is not clearly defined. We know that there are three possible culprits. [tau, beta-amyloid, inflammation]. They are working in concert, or perhaps in isolation. We do not know exactly. “

Many Alzheimer’s researchers have spent years developing treatments targeting beta-amyloids, which can accumulate in the brain to form plaques. Alzheimer’s Association Writes :

“According to the amyloid hypothesis, these stages of beta-amyloid aggregation disrupt cell-to-cell communication and activate immune cells. These immune cells trigger inflammation. Eventually, brain cells are destroyed. “

Unfortunately, clinical trials of therapies that target target-amyloid are not effective in treating Alzheimer’s.

Anti-Tau Immunotherapies: The Holy Grave of Alzheimer’s?

In brains with Alzheimer’s disease, tau proteins lose their structure and form neurofibrillaries. Tangents blocking communication between the sinks.

Credit: Adobe Stock

In Feinstein Institutes, Drs. Marambud and his colleagues have focused on Alzheimer’s less-explored component: unusual tau. In healthy brains, tau performs many important functions, including stabilizing the internal microtubules in neurons. But in the brains of Alzheimer’s patients, a process called phosphorylation alters the structure of tau proteins. This inhibits synaptic communication. Maramude said that there are good reasons to think of anti-tau treatments that can effectively treat Alzheimer’s. [anti-tau therapies] What may be more beneficial is that we have known for a very long time that tau malformation in the brain of an Alzheimer’s patient has a better relationship with disease progression, and neuronal substance impairment in the brain, “compared to beta-amyloids,” Dr. Marambud said. “The second strong argument is that there is an inherited dementia called tauopathis, which is caused by a mutation in the gene coding for tau proteins. Therefore, there is a direct genetic connection between dementia and tau pathology.” To better understand this For this protein Alzheimer’s, Dr. How he interacts with Marambud and his colleagues, who is developing immunotherapy, acts like an abnormal tau. Such as vaccines, usually target infectious diseases. , But it is also possible to use the body’s immune system to prevent or treat some non-infectious diseases. Scientists have recently succeeded in treating some forms of cancer with, for example, immunotherapies. “We have developed a series of monoclary antibodies, which are basically. When you want to do immunotherapy, therapeutic therapy is needed.

Currently, researchers at the Feinstein Institute are promising ongoing clinical trials with anti-tau antibodies, some of which are in Phase III trials under the Food and Drug Administration. Patients receive these treatments intravenously over several hours and must undergo several rounds of treatment. It is similar to chemotherapy.

In the short term, it is more likely that anti-tau treatments will help stabilize Alzheimer’s, not cure it.

“The progression of the disease will only be stabilized.” Dr. Marambud said that to save a huge social, but also financial, burden. “As research progresses, we will improve these stabilization approaches to make them more effective.”

Even though anti-tau therapy may not prove to be the sacred grave of Alzheimer’s treatment, they can potentially alleviate severe behavioral symptoms of the disease, and possibly illuminate some of the mechanisms behind psychosis.

Alzheimer’s and Psychosis

Sincerely: Getty Image

When most people think of Alzheimer’s, they focus on memory degradation. But the deepest effects of the disease often result in psychological symptoms such as agitation, aggression and paranoia, Drs. According to Koppel, who, in addition to researching Alzheimer’s, has treated Alzheimer’s patients as a physician for decades. “My research focus is out of 20 years. Dr. Koppel said that sitting with Alzheimer’s families and hearing what the primary problem is.” It’s never a memory. It begins with memory as a clinical issue. But the real suffering comes from changes that occur in the personality and belief system that “irritate Alzheimer’s patients” or become violent towards their loved ones. The Feinstein Institute, Dr. Koppel’s research through anti-tau immunotherapy Focuses on alleviating Alzheimer’s-related mental symptoms. “It’s our hypothesis that abnormal tau protein, downstream, in the brain somehow affects people’s way of thinking,” said Dr. Koppe. “And its The effect that follows is this paranoid, agitated, mental phenotype. “Supporting this hypothesis is research on chronic traumatic encephalopathy (CTE), a degenerative disease involving the accumulation of abnormal tau. CTE, common in professional football players, Also causes psychotic symptoms such as agitation, aggression and paranoia. What’s more, research shows that as Alzheimer’s patients accumulate more abnormal tau in their brains, as measured through cerebrospinal fluid, They exhibit more mental symptoms, and less Patients with abnormal tau are more likely to die sooner. Take advantage of these strong connections between mental and abnormal tau, Drs. Koppel and his colleagues hope that anti-tau immunotherapies will reduce psychosis in Alzheimer’s patients, who currently lack safe and effective treatment options and are often given medication to reduce psychosis in people with schizophrenia. is. “We are giving drugs to Alzheimer’s patients that reduce their cognitive decline and lead to bad outcomes, such as stroke and sudden death,” Koppel said. “Nonetheless, schizophrenia medications treat some of the psychological symptoms and aggressive behavior related to Alzheimer’s disease, and are important to many families. We don’t have a lot of options, and we are in dire need.” Beyond treating Alzheimer’s patients. Anti-tau immunotherapies may shed light on other mental illnesses. “Alzheimer’s can provide us with a window into the brain that makes people mental,” Dr. Koppel said. “Once you have a biologic treatment for psychosis, which results in an underlying pathophysiology, trust me, you can look at schizophrenia in new ways. Maybe it’s not going to be tau, but it’s mental There may be a paradigm for the treatment of the disease. “

Future of alzheimer’s treatment

Dr. Maramud said that the long-term goal of anti-tau immunotherapy is to prevent Alzheimer’s. But this is currently impossible because scientists lack the necessary biomarkers and diagnostic tools to detect the disease before cognitive symptoms appear. It can take decades before prevention occurs, if it ever happens.

In the short term, the more realistic goal is to stabilize Alzheimer’s.

“Our hope is that the treatment will happen. Aggressive enough that we can stabilize the disease, at least in patients already affected by dementia, with cognitive tests that can be done by physicians,” Dr. Marambud Said. “And even better, perhaps reduced cognitive impairment.”

Dr. Marambud said he encourages the public not to lose faith.

“Be patient. It’s a very complicated disease,” he said. “A lot of labs are really committed to making a difference. Congress has also realized that this is a big priority. In the last five years.” [National Institutes of Health] Funding has increased significantly. Therefore, the scientific field is working very hard. Politicians are behind us in funding this research. And it is a complex disease. But we will make a difference in the coming years. “

Meanwhile, the Alzheimer’s Association Note That physical activity and a healthy diet may reduce the likelihood of developing Alzheimer’s, although more extensive studies are needed to understand how these factors interact with the disease.