Refining the Amyloid Hypothesis

Contributed by: Dennis Fortier, President, Medical Care Corporation

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A leading theory about Alzheimer's Disease (AD) suggests that toxic plaques of beta-amyloid protein accumulate in the aging brain, destroy neurons, and cause declining cognitive function. This theory has been deeply scrutinized and modified over the past two decades of intensive research.

The notable, but poorly understood role of amyloid has driven both treatment strategies and diagnostic strategies for Alzheimer's Disease. In fact, a great majority of efforts to treat Alzheimer's disease have been based on agents that either slow production of amyloid, alter the form of amyloid, or remove amyloid from the brain. Likewise, many diagnostic approaches have been driven by measures of the amount of amyloid in the brain or spinal fluid.

New research from the Penn Medicine Department of Radiology, published in the Neurobiology of Aging, suggests that the location of amyloid plaques in the brain may be more important that the amount of amyloid in the brain. In fact, it has been widely observed (but as yet unexplained) that many older adults, who died with complete cognitive integrity, were shown at autopsy to have massive amounts of amyloid plaques in their brains.  Evidence favoring amyloid location over amyloid burden in diagnosing Alzheimer's disease offers a potential explanation for these puzzling observations.

The amyloid hypothesis has evolved considerably since it was first introduced.  This research may offer a further refinement and a better understanding of the complex pathology of Alzheimer's Disease.

How Long Does a Concussion Last?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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How long does a concussion last? This is a common question.

Historically, science has tried to answer this question by measuring the duration of concussion symptoms. Often, depending on the severity of the concussing event, symptom such as dizziness, blurred vision, and interrupted sleep are completely resolved within a few days or a couple of weeks.

However, we also know that many injuries, to various tissues in the body, are not completely healed until long after clinical symptoms have faded. This may also be true of injuries to the brain.

In fact, new research from the Mind Research Network in Albuquerque, N.M. supports such thinking. In a paper published in the online edition of Neurology, researchers showed that physical changes to concussed brains persisted for many months after symptoms had resolved.

One implication is that the brain needs longer to heal than the period demarcated by clear symptoms.

A second, and perhaps more important implication, is that brain injury and symptoms of brain injury may not be always correlated. In that regard, the constant, low-impact collisions of many sports may be injuring the brain in ways that are not obvious in terms of symptoms, but are injurious just the same.

No symptom of brain injury doesn't necessarily mean no brain injury.

Perspective on "A Cure for Alzheimer's"

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Sometimes the facts are very misleading.

For some reason, when Alzheimer's Disease is discussed in the popular press, the discussion often includes a reference to the fact that "there is no cure" for this disease. This is a true statement, but somewhat misleading.

This is misleading because it establishes "a cure" as the appropriate frame of reference for evaluating our ability to fight against this disease.

However, in medicine, we know this is not true. For example, we have no cure for hypertension, but we treat it effectively for most people. Clearly, the "no cure" frame of reference is not the most meaningful perspective on hypertension.

Also, we have no cure for diabetes, but like hypertension, we control it to a large extent for very many years.  We have no cure for the common cold, eczema  asthma, allergies, migraine, anxiety, heartburn, cancer, osteoporosis, depression, lupus  or a thousand other common, and sometimes deadly, medical ailments.  The truth is, cures are very rare in medicine.

To be clear, everyone would love to have a cure for Alzheimer's. It would greatly improve the world and eliminate much tragic suffering  But "no cure" is not the same as "no treatment", and we should not allow the "no cure" label to fill us with pessimism.

In fact, with an early Alzheimer's diagnosis (prior to the dementia stage), doctors can often delay disease progression through a robust regimen of proper diet, physical activity, tight control of chronic conditions, and poly-therapy with approved drugs.

At present, we should not despair that there is no cure. Rather, we should keep searching for a cure while embracing the reality that, like so many other medical conditions, Alzheimer's must be vigilantly diagnosed in its earliest stages and treated to the best of our current abilities.

The cure may or may not come, but initial treatments have arrived, and better treatments will follow.