Butler Hospital research seeks to identify people in pre-clinical stage of Alzheimer’s

Athene Lee, Ph.D, licensed neuropsychologist at Butler Hospital Memory & Aging Program (MAP)

Currently, 5.8 million Americans are living with Alzheimer’s disease. By 2050, that total is expected to increase to nearly 14 million. Between 2000 and 2017, deaths from heart disease decreased by nine percent; deaths from Alzheimer’s increased by 145 percent.Butler Hospital in Rhode Island is among the institutions working to shrink those statistics. Butler has been researching dementia for 25 years.

In the last several years, research at Butler Hospital Memory & Aging Program (MAP) has shifted to identifying people in the pre-clinical stage of dementia, even individuals who are at risk but haven’t developed symptoms yet, said Athene Lee, Ph.D, a licensed neuropsychologist at the program.

Lee’s doctoral degree is in clinical psychology and neuropsychology from Suffolk University in Boston.

This detection is vital because people with Alzheimer’s can show signs of degeneration in the brain without any outward symptoms for decades—creating an uphill battle once someone is officially diagnosed. Consequently, MAP researchers are focusing on biomarkers that can detect risk.

Currently, the main way to detect Alzheimer’s brain-related changes is through a costly, not-covered-by-insurance, slightly invasive PET scan. (Before that, it was through an autopsy of the brain). MAP’s goal is to develop tests that are easier to administer, have a lower cost, and can be done at a doctor’s office, Lee said.

For example, they’re examining the utility of a blood test in predicting brain amyloid levels. Amyloid, a natural protein, isn’t completely metabolized in Alzheimer’s, and fragments are left behind, Lee said.

These fragments accumulate and form hard plaques in the brain, she said. Scientists believe these plaques may lead to memory loss, and are a hallmark of Alzheimer’s.

In addition, MAP researchers are testing preventative medications that decrease amyloid in order to decelerate memory loss. An almost five-year, multi-site trial that started in 2015, known as the A4 Study, is examining the efficacy of a monthly blood infusion.

Other trials that are currently enrolling will test a daily pill, Lee said.

Some pharmaceutical companies have already tested amyloid-targeting medications with failing results. According to Lee, these trials “were all focused on treating symptomatic individuals: people with mild cognitive impairment or dementia.” In contrast, the participants in current trials have normal memory and a buildup of amyloid plaques, she said.

“The hypothesis is that starting the treatment earlier, before the emergence of symptoms, will maximize the potential effect of the drug,” she said.

Another hallmark of Alzheimer’s is the presence of tau tangles in the brain; it’s possible a combination treatment targeting both amyloid plaques and tau tangles will be effective, Lee said. She noted that trials testing a combination treatment are in the works.

MAP researchers also are exploring the retina in predicting Alzheimer’s risk. Because the retina is part of the brain, it may reflect Alzheimer’s-related changes. This fall, they’re conducting a study to identify what retinal changes can predict risk 10 to 20 years before memory symptoms, and develop a 3-D imaging atlas of these changes for other researchers to use.

Lee is conducting quantitative and qualitative research into people’s reactions after learning they’re positive on amyloid PET scans, and carry the APOE4 allele, which increases Alzheimer’s risk.

“Preliminary results show that most people receive the results well and are enthusiastic about joining a prevention trial if they are positive on the biomarker,” Lee said. People “are more likely to share results with family and others if their PET results were negative.”

Lee also works extensively on Butler’s Alzheimer’s Prevention Registry, which matches 50- to 85-year-old volunteers with normal memory or mild memory loss with Alzheimer’s research studies.

Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.