President Obama targets 2025 for effective Alzheimer's treatment

Effective treatments for Alzheimer’s by 2025? That’s the target the government is eyeing as it develops a national strategy to tackle what could become the defining disease of a rapidly aging population.

It’s an ambitious goal — and on Tuesday, advisers to the government stressed that millions of families need better help now to care for their loved ones.

“What’s really important here is a comprehensive plan that deals with the needs of people who already have the disease,” said Alzheimer’s Association president Harry Johns, one of the advisers.

Already families approach the advisory committee “reminding us of the enormity of our task,” said Dr. Ron Petersen, an Alzheimer’s specialist at the Mayo Clinic who chairs the panel.

The Obama administration is developing the first National Alzheimer’s Plan to address the medical and social problems of dementia — not just better treatments but better day-to-day care for dementia patients and their overwhelmed caregivers, too.

The plan still is being written, with the advisory panel’s input. But a draft of its overall goals sets 2025 as a target date to have effective treatments and ways to delay if not completely prevent the illness.

Some advisory members said that’s not aggressive enough, and 2020 would be a better target date.

“We want to be bold,” said Dr. Jennifer Manly of Columbia University. “We think the difference of five years is incredibly meaningful.”

Regardless, an estimated 5.4 million Americans already have Alzheimer’s or similar dementias — and how to help their families cope with day-to-day care is a priority, the advisory committee made clear Tuesday.

The disease is growing steadily as the population ages: By 2050, 13 million to 16 million Americans are projected to have Alzheimer’s, costing $1 trillion in medical and nursing home expenditures. That doesn’t count the billions of dollars in unpaid care provided by relatives and friends.

Today’s treatments only temporarily ease some dementia symptoms, and work to find better ones has been frustratingly slow. Scientists now know that Alzheimer’s is brewing for years before symptoms appear, and they’re hunting ways to stall the disease, maybe long enough that potential sufferers will die of something else first. But it’s still early-stage work.

Meanwhile, as many as half of today’s Alzheimer’s sufferers haven’t been formally diagnosed, a recent report found. That’s in part because of stigma and the belief that nothing can be done. Symptomatic treatment aside, a diagnosis lets families plan, and catching Alzheimer’s earlier would be crucial if scientists ever find a way to stall it, the advisory panel noted.

Among the goals being debated for the national plan:

Begin a national public awareness campaign of dementia’s early warning signs, to improve timely diagnosis.

Give primary care doctors the tools to assess signs of dementia as part of Medicare’s annual check-up.

Have caregivers’ health, physical and mental, regularly checked.

Improve care-planning and training for families so they know what resources are available for their loved one and themselves.

A training program in New York, for instance, has proved that caregivers who are taught how to handle common dementia problems, and given support, are able to keep their loved ones at home for longer.

Such programs “are dirt cheap compared to paying for nursing home care,” said David Hoffman, who oversees Alzheimer’s programs for the New York State Department of Health.

But hanging over the meeting was the reality of a budget crunch. The government hasn’t said how much money it will be able to devote to the Alzheimer’s plan, and states have seen their own Alzheimer’s budgets cut.

“We’re not going to fix this without substantial resources,” Hoffman said. “In New York, we’re hanging on by our nails,” he added.

Thinner might not be better when it comes to Alzheimer's disease

New research suggests that the outer edges of the brain are thinner in older people who may be destined to develop Alzheimer's disease, but there's currently no way to use the information to help people fend off dementia.

Still, the findings could help researchers test Alzheimer's medications by allowing them to track the progression of the disease, said study co-author Dr. Brad Dickerson, an associate professor of neurology at Harvard Medical School.

Alzheimer's disease is the sixth leading cause of death in the United States, according to the Alzheimer's Association, and the number of deaths has risen in recent years. There's no cure for the disease.

In the new study, researchers focused on the thickness of the edges of the brain, known as the cortex. "We're looking at the parts of the cortex that are particularly vulnerable to Alzheimer's disease, parts that are important for memory, problem-solving skills and higher-language functions," Dickerson said.

Previous research found that several areas of the cortex were smaller in people with dementia from Alzheimer's. "It's like an orange that's shriveling. The thickness of the outer skin might get thinner as it dries out," Dickerson said.

In the new study, researchers examined the MRI brain scans of 159 people with an average age of 76; about half were men. Three years later, the participants took tests designed to measure how their brains were functioning.

The findings appear in the Dec. 21 online issue of the journal Neurology.

The 15 percent of participants with the thinnest brain areas performed the worst on the tests: About one in five of them experienced cognitive decline. They also showed increases in signs of abnormal spinal fluid, a possible sign of developing Alzheimer's disease.

"That suggests they may be developing symptoms," Dickerson said.

A lower number -- 7 percent -- of the participants in the middle range of brain thinness experienced cognitive decline. None of the people with the least thin brain areas developed problems.

So are the scans appropriate as tools to figure out whether patients are on the road to Alzheimer's?

Cost doesn't appear to be a major challenge at this point. It's not clear how much the MRI scans might cost at doctor's offices, Dickerson said. However, they're only a few hundred dollars each in the research world.

Also, many older people already receive MRI scans of the brain for other reasons, said Dr. Raj Shah, medical director of the Rush Memory Clinic, in Chicago.

But with no cure for Alzheimer's, the best use for the scans will be to help researchers figure out if medications work, Dickerson said.

Cathy Roe, an assistant professor of neurology at the Knight Alzheimer's Disease Research Center at Washington University School of Medicine, in St. Louis, said the findings could have value down the line. "Right now, there is not much we can do to delay the progression of dementia," said Roe, who's familiar with the findings. "But once effective treatments are identified, this research could help to identify which patients should receive that treatment and when they should receive it."