Alzheimer's progress 100 years on
One hundred years since Alzheimer's disease was first described, scientists are still struggling to find a cure for it, a group of experts has said. There is much that can be done to dampen its effects, but the prospect of defeating the disease remains elusive, they say in the Lancet medical journal.
The core principles of care remain the same - support and compassion, the article says. But scientists remain hopeful that a cure is around the corner.
One hundred years ago, German neurologist Alois Alzheimer described the case of his patient Auguste D, a woman who developed dementia in her 50s and died in 1906.
He documented: "Auguste D suffered from constant restlessness and anxious confusion. At night she was usually put in an isolation room because she could not fall asleep in the main ward; she went to other patients' beds and woke them."
His care plan included "afternoon rest, early dinners and evening bowel evacuations", as well as soothing baths and alcohol and mild sedation to aid sleep, all given in a tolerant and appropriately stimulating environment.
A century on, experts understand more about the disease and can spot it earlier. There is even promise of an Alzheimer's blood test. But there is still no cure, or way to prevent the onset of the disease.
The practice of care may also have changed, but the core principles remain the same, Professor Alistair Burns, from the University of Manchester, and international colleagues argue in The Lancet.
Professor Burns explains: "The main differences from the care delivered in Frankfurt 100 years ago would result from the diagnostic precision now available, the evidence-based drug treatments developed over the past 20 years, and the availability of support to educate and advise carers. Nevertheless, in 2006 disease management would hinge, as it did 100 years ago, on the effects of a compassionate team of professionals' working with the patient and her family to achieve the best possible outcome."
Professor Simon Lovestone, chairman of the Alzheimer's Research Trust's scientific advisory board, is optimistic that the disease will soon be curable.
He said: "In our lifetime, some level of cure is possible. "While we may not completely regain what has been lost in brain function, some effects of Alzheimer's disease will be reversible. And many, many more lives will be vastly improved."
But Dr Hugh Pearson, from the University of Leeds, says major obstacles to curative treatments exist.
ALZHEIMER'S DISEASE FACTS
A progressive, degenerative and irreversible brain disorder
Symptoms include memory problems and difficulty performing everyday tasks
There is no single diagnostic test
He explained: "These are lack of a very early diagnosis of the disorder and the fact that the death of neurones in the brain cannot easily be reversed. If these two obstacles can be overcome then the disease can be beaten."
Professor Seth Love, director of the South West Dementia Brain Bank in the University of Bristol, is also cautious.
He believes that because of the complex nature of Alzheimer's disease, it is unrealistic to expect that a single drug or other intervention will be effective in preventing or curing the disease.
"However, by encouraging people to make changes to their lifestyles, such as diet, to lower their risk, and by targeting interventions against the final common pathways involved in the development of Alzheimer's, I believe we shall steadily make progress in preventing and treating the disease."
In Science Magazine, US experts say many new therapies directly targeting the mechanisms underlying Alzheimer's disease are in the pipeline. These include drugs to block the formation of the protein-rich brain lesions or plaques that characterise the disease.
Rebecca Wood, chief executive of the Alzheimer's Research Trust, says much research now is focused on how to prevent Alzheimer's.
"We are doing two big studies on diet. One is looking at B vitamins for lowering homocysteine levels, which appear to be linked to Alzheimer's as well as heart disease. The other is looking at omega three fish oils. Also there is a lot of work showing that exercise, particularly being taken in middle age, can make a difference. "If we can persuade people to have a much better diet and increase their exercise level and keep their brain active by doing things like crosswords, that will help to stave off the risk of Alzheimer's."
With aging populations, particularly in the UK, the need to prevent and find a cure for Alzheimer's has never been more pressing, she said. "The number of people with Alzheimer's is going to double in the next 20 to 30 years," she warned.
An estimated 25 million people worldwide have Alzheimer's disease.