Novel Approaches to Alzheimer's: Innovative or Overrated?
By Liz Sempio Sunga
Alzheimer’s and other forms of dementia can be a scary and intimidating topic to explore. For me, one of the more distressing aspects of the condition is that there is no known and definitive cure.
Alzheimer’s often occurs among older people and its progression can be very fast. In its earliest stages, the primary symptom of Alzheimer’s, forgetfulness can be mistaken for expected and normal signs of aging. Thus, it is key to try to pinpoint the disease as soon as possible to make accommodations for its natural progression.
My grandmother’s Alzheimer’s was first noticed by my grandfather. He noticed that she was forgetting names and places, and that she would lose her weekend mahjong games because of simple mistakes that were caused by lapses in her memory. This prompted us to increase my grandmother’s check-ups, engage her in mentally stimulating conversations about past knowledge, and watch her more carefully when doing daily activities.This was helpful for a few years and the progression of the disease was not too noticeable. Looking back, my family was very lucky to have the resources and hindsight to detect early signs of the disease, especially as others may not be as lucky.
However, my grandfather’s passing had an incredibly significant effect on my grandmother’s dementia.
He was an irreplaceable part of my grandmother’s life and routine for over fifty years--his absence meant a shift in her life that likely negatively contributed to her memory’s downfall.
After this happened, the progression of the disease became something largely out of my family’s control. Although we kept her healthy and continued to stimulate her as much as we could, it became more and more evident that her Alzheimer’s progression would only become worse over time. As she lost control of her mobility and as her engagement with people receded, the best course of action we could take was to provide her around the clock care that kept her safe and as healthy as possible. This meant round the clock care where her caretakers progressively assisted her more with her daily tasks such as eating, brushing her hair, and eventually even walking.
Today, she is in the late stages of the disease and my family makes our best efforts to give her the support she needs to survive every day. We want to give her a fighting chance at life. As long as she is still fighting, so are we. This means having to be incredibly vigilant of her condition’s progression day to day, adjusting care as needed. Some days she is happy and lively, responding to our questions and even playing mahjong with us. Other days, she is quiet and less responsive. On these days, we are most concerned, time seems slow, and the impact of Alzheimer’s really becomes tangible to us.
As a family now with a history of Alzheimer’s, it is really important for me to research about what ways we can make my grandmother’s condition less burdensome, and what steps we can take in the event that someone else is diagnosed.
Traditional and conventional treatment is mostly not invasive nor time consuming: it is a matter of creating a comfortable and well-prepared environment that accommodates the increasing incidence of the disease’s symptoms. Although billions of dollars have been invested in research and drug trials, to date there is still no drug that guarantees disease-modifying treatment. It will likely still take many years before these types of treatment become widely available.
But because time is often the biggest enemy of people dealing with Alzheimer’s, the demand for more innovative and life-style focused preventative treatments is high. Emerging in the field of Alzheimer’s treatment are unorthodox treatments that are increasingly involved and intensive and meant to significantly decrease the effects of dementia and its symptoms.
The Bredesen Protocol by Dr. Dale Bredesen is a therapeutic, personalized program that identifies, targets, and treats the root cause of cognitive decline and Alzheimer’s disease. It claims to take on a “functional” approach by identifying a person’s metabolic imbalances. Metabolic imbalances cause metabolic syndrome which is a cluster of conditions that occur together and increase your risk of heart disease, stroke, diabetes, and other such diseases. As such, the intensive program is highly specialized in that it makes comprehensive changes in nutrition, targeted supplementation, sleep hygiene, stress management, and much more. This is hoped to truly target an individual’s root cause of Alzheimer’s. The Protocol even has a catchy name for the lifestyle switch: "Keto/FLEX 12/3."
In my opinion, the Bredesen Protocol’s most alluring selling point is that it moves away from a broad, one size fits all management of symptoms and attempts to really pinpoint what makes an individual susceptible to the effects of Alzheimer’s. By closely observing one’s personal genetic variants and metabolic activity, it seems as though this treatment plan will cater to fine tune any errors or predispositions that lead to Alzheimer’s.
Although the results of the Bredesen Protocol are very hopeful, with real-life evidence of its positive effects on 100 patients and a credible publication in the Journal of Alzheimer’s Disease and Parkinsonism, there are many critiques of the treatment plan.
There is a significant economic barrier that prevents most people from using this treatment. At $1,399, an individual pays for access to protocol assessments, lab tests, and contact with Bredesen Protocol practitioners (who may charge additional fees for consultation). The papers published showing evidence for the Protocol are also criticized for having major flaws such as design error, lacking methodology, and financial conflict of interest. As a middle-income student with experience in research validation, these flaws make me skeptical of the treatment plan. Furthermore, knowing my grandmother’s old age and her own dislike for intensive treatment, I may recommend my family away from attempting it unless my grandmother herself shows her own interest in taking on the commitment the Protocol requires.
The Bredesen Protocol is a new type of treatment plan that has to prove its scientific validity to the wider medical community. Even though it still requires fine tuning and further research, the Protocol has potential to help the progression of Alzhimer’s, especially to those who have the resources to spare to have it.
Another novel treatment that is gaining popularity is medication that specifically targets root causes of the disease, an especially popular one being Adulhem. Adulhem is an experimental drug used to target toxic beta-amyloid proteins, preventing the growth of plaques in the brain which are believed to cause cell death and atrophy leading to the loss of cognitive abilities . This medication was only approved for use by the FDA in June 2021. Adulhem is believed to be most effective in the earliest stages of Alzhmer’s and is controversial for its narrow trials among mild Alzheimer’s only.
Similar to the Bredesen Protocol, many experts are divided on its effectiveness, especially as testing for its effectiveness is not conventional, being relatively premature in the completion of its trials. After the drug’s approval, Dr. Aaron Kesselheim, a member of the FDA approval panel called it “the worst decision in recent US history.” Another similarity with Bredesen is the medication’s expensive cost at $56,000 per year. As someone living outside of the US, if my family were to pursue this treatment, it is likely that the cost would increase ten-fold and importation may not even be possible due to the larger controversy that surrounds it.
Even though both novel treatments do not necessarily fit the conventions of orthodox medical intervention, both have shown positive reactions in patients (Stat News (Aduhelm) and The Well for Health (Bredesen)), suggesting that even if these treatments are not necessarily in their best and finalized state, they are a good starting point for further research and discussion.
Although unconventional and even controversial, it is clear that time and effort should be put into researching the effectiveness of new treatments for Alzheimer’s. An increase in dedication towards innovation will make progression towards new ideas and possibly life-altering treatments more attainable; specially for people like me who wish that traditional treatment plans could have done more for the people I love, innovation and novelty brings new hope and optimism that may make the disease less intimidating and more manageable.
In my own research for this article, I have allowed myself to thoroughly examine two extremes of Alzehimer’s, conventional and unorthodox treatment plans. By doing this, I feel more knowledgeable and more understanding of how complex the disease is. This complexity further fuels my passion for learning about this disease as I feel like the more I know, the better support system and caregiver I can be.