Doc-to-Doc: Progress in Treating Dementia and Diagnosing Mild Cognitive Impairment
Geoffrey A. Kerchner, MD, PhD is assistant professor of neurology and neurological sciences at the Stanford Center for Memory Disorders. To contact Dr. Kerchner about speaking engagements, please send an email to outreach@stanfordmed.org. Patient referrals can be faxed to 650-320-9443 or call the Physician Helpline at 866-742-4811referral@stanfordmed.org.
Late-life dementia is becoming increasingly prevalent as baby-boomers age, and as cardiologists and oncologists save more lives. Despite decades of research into the pathophysiology of Alzheimer’s disease, neurologists and neuroscientists have fallen short when it comes to delivering treatments that effectively slow the inexorable march of cognitive decline.
This is going to change. For the first time, rationally-designed, molecular-based therapies are starting to emerge from Phase II and Phase III clinical trials. For instance, active and passive immunotherapies directed against the beta-amyloid peptide, the main component of amyloid plaques that litter the brain in Alzheimer’s disease, show early promise in clearing the peptide from the brain. There are problems: their efficacy at slowing clinical progression remains undetermined, and there are potentially serious side effects that must be worked out. We will hear about the results of these and other trials over the next few years. Some of these trials will undoubtedly fail, but it is encouraging that a lot of good ideas are finally reaching advanced stages of drug development.
Another change will be increasingly reliable methods of early diagnosis. Not only are healthy patients starting to ask you and me about their future risk of dementia, but there is also evidence that earlier intervention may be more effective. Advanced structural and functional MRI techniques, biomarker detection in serum and spinal fluid, and genetic analysis may one day help to identify patients in the preclinical stages of a neurodegenerative illness. Early diagnosis will be essential once better drugs are available.
This is the reason to pay close attention to any patient’s complaint of mild memory loss. Mild cognitive impairment, in which subtle changes in short term memory or other aspects of cognition occur without any functional consequence, is increasingly being recognized as a prodromal phase of dementia. Alzheimer’s disease and other neurodegenerative conditions probably begin before any symptoms manifest, and patients often detect slight changes in themselves before their loved ones notice. These patients sometimes benefit more from a referral to a memory disorder clinic than advanced patients.
At the Stanford Center for Memory Disorders, we try to help patients in several ways. With the benefit of a multidisciplinary team of behavioral neurologists, psychiatrists, neuropsychologists, pharmacists, a nurse, and a geneticist, and by making full use of appropriate state-of-the-art diagnostic tools, we attempt to localize the cause of a cognitive decline, sifting through medication side effects and other potentially reversible conditions to arrive at the most accurate clinical diagnosis possible. Second, for what we currently lack in effective therapies, we make up for in education, by spending time with patients and their loved ones to answer questions, to help them to plan for the future — and most importantly to teach lifestyle skills that may slow functional decline. Finally, we provide interested patients with access to a wide variety of research opportunities, from clinical trials to tests of new diagnostic technologies. I am optimistic that we will soon have more to offer patients with age-related cognitive illnesses.
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