Samuel Gandy, MD, PhD
Samuel Gandy, MD, PhD, associate director of Alzheimer’s Disease Research Center, Mount Sinai, New York City, chairman emeritus of the National Medical and Scientific Advisory Council of the Alzheimer’s Association.
After decades of research, Alzheimer’s disease remains a medical mystery, which is bad news for the estimated five million or more Americans who now have it… and the numbers are expected to soar as we baby boomers age. Early detection is critical to slowing the disease’s pace of destruction — the earlier diagnosed, the more treatment options are available. Fortunately, recent research on early diagnosis of Alzheimer’s has been fruitful. To get the latest information on what people can and should do if they’re concerned about Alzheimer’s, I called neurologist Samuel Gandy, MD, PhD, associate director of the Alzheimer’s Disease Research Center at Mount Sinai in New York City and chairman emeritus of the National Medical and Scientific Advisory Council of the Alzheimer’s Association.
According to Dr. Gandy, the gold standard for AD diagnosis remains in-depth neuro-psychological testing that takes several hours to perform. Though primary care doctors may be able to do this, it’s best done at an Alzheimer’s center, by specialists in the disease. Through a complete battery of tests including everything from card sorting ability to MRI brain scans, doctors can determine a person’s level of impaired cognitive functioning as well as distinguish mild cognitive impairment (MCI) from early AD. Also, Dr. Gandy adds that in his experience, most patients who test positive for MCI eventually progress to AD, generally within five years.
Researchers continue to explore other avenues for diagnosing AD, including tests to identify those at risk for developing it well before symptoms arise. Both academic and biotech companies are “furiously searching” for ways to not only identify the disease early on, but perhaps one day, be able to stop it altogether. Some of the intriguing areas of study include a change in brain size… biomarkers of AD (in much the same way they look for markers of heart disease risk)… and sophisticated brain imaging techniques (PET Scan) to monitor abnormalities.
At present, drugs continue to be a primary tool in the treatment plan for early-stage Alzheimer’s, even though they’re not effective for all.
More good news on the drug front: Dr. Gandy says a drug called Dimebon, used as an antihistamine in Russia for many years, had “remarkable” success in a large clinical trial for mild to moderate AD, improving patients for several months and then stabilizing them over the course of a year. A second trial for purposes of replicating those results is now underway and Dr. Gandy says if this is positive, as it is likely to be, the drug could get approval in the next year or so.
People with AD benefit most from treatment at a major medical center with specialists in the disease. These facilities have large support staffs for patients and families including social services as well as medical ones. Also, Dr. Gandy says that the best chance for early-stage AD patients to have access to the latest drug options is by taking part in a clinical trial of which there are many — if you are interested, look at www.clinicaltrial.gov, which lists both federally and privately supported clinical trials.
Looking ahead, Dr. Gandy foresees routine screening for AD through biomarkers and with PET scans, in the same way we now routinely screen for breast cancer with mammograms. His hope is there will be drugs available for people in whom such screening tests detect beta-amyloid build-ups in the brain. While this is very much in the arena of future-speak, thousands of people are working to solve the mystery of AD… and “the future” may be closer than we think.