"Rescuing Cognition": California Versus Alzheimer's Disease

In the classic comedy Splash, an old woman comes to work oddly dressed: her bra on the outside of her sweater.

In the movie it was just a funny moment, never explained.

But if the film had followed her life from then on, it would have ceased to be a comedy.

Forgetting the order of putting on clothes is a symptom of dementia, the most common form of which is Alzheimer's disease. The woman might have been a trusted executive in the company for many years. Now, her career was over. She could no longer be trusted to write checks, because she might pay bills two or three times each, or not at all. At home she would forget who her husband was, and her children, and her name. At night, she might be locked into her bedroom, so she would not wander away, and forget how to find her way home. She would need to be watched and cared for 24/7, and the only end would be her death.

This dreaded condition is now sweeping America.

Jump to January 11, 2011: President Barack Obama has just signed the National Alzheimer's Project Act (NAPA) into law. It was a bipartisan effort, passed by both houses of Congress.

"NAPA's aim is to create a coordinated national strategy that deals with Alzheimer's, a brain-wasting condition (with an annual medical cost of) $172 billion..."
--Mary Brophy Marcus, USA Today, January 11, 2011

The program was the result of a dedicated effort by many patient advocate groups, including a petition signed by more than 110,000 citizens, gathered by the Alzheimer's Association. It was spearheaded by champions like Maria Shriver, Sandra Day O'Connor, and Newt Gingrich. All deserve much credit for bringing the issue to national attention.

Unfortunately, it comes with no money: no accompanying budget.

Alzheimer's disease costs America more than many wars -- and we're not funding the program to fight it?

Cost estimates of Alzheimer's run from a "low" of $100 billion a year, to the middle-of-the-road estimate of $172 billion dollars, to a high of $300 billion. (If that cost were divided equally among our population of three hundred million, it would mean a thousand dollars from every man, woman and child.)

Even the lowest figure, one hundred billion -- is one sixteenth of the national debt! ($1.6 trillion in 2009.)

These are not empty statistics; these are our loved ones, your family and mine.

Five million Americans have Alzheimer's today: one out of sixty. And as more and more people stay alive longer, that number is skyrocketing. Among those of us who are 65 and older, one in 10 have AD today.

How are we going to take care of them? A live-in attendant costs five to seven thousand dollars a month.

Since we don't have that kind of money, most families try to provide for AD members at home, dividing up the endless care-giving chores. Everything that has to be done for a baby may need to be done for an Alzheimer's sufferer -- some may be physically aggressive toward those who are trying to provide for their needs -- people they no longer recognize.

Marriages break up in exhaustion; people lose their jobs when they take too much time off work to look after their loved ones.

Some caregivers become so stressed out they die before the person they are caring for.

And now we have a national Alzheimer's program -- with no funding?

That is unacceptable.

California is only one state, but we are fighting Alzheimer's right now, and we intend to win.

To find out about it, let's visit with Leeza Gibbons.

If you watch TV, you know Leeza, for ten years the host of television's Entertainment Tonight and other shows; but what you may not know is that she has dedicated her life to defeating Alzheimer's.

"I remember being in my mother's house in South Carolina, helping her make the bed, and she was watching my every movement closely and trying to mirror what I was doing. Then she stopped and looked at me, and I said, "What's the matter, Mom?

"She said, 'You're a very nice lady. How do I know you?" And I just smiled and said, "You know me because today I am your daughter, yesterday I was your daughter, and I'll always be your daughter."

"And she said, "Oh."

--Camille Peri, Caring.com features editor, "Talking with TV Personality Leeza Gibbons: Providing Support for Alzheimer's Caregivers". Downloaded 1/4/2011

Leeza is the driving force behind a beautiful charity, Leeza's Place, which seeks to aid and comfort Alzheimer's caregivers.

Ms. Gibbons is also a board member of the California stem cell program. To find out what that is all about, just click on www.cirm.ca.gov.

At the website, if you hunt around a little bit, you will find a list of diseases and "incurable" conditions California is attempting to research and cure. Click on Alzheimer's disease, and you will find five teams of scientists working to solve the puzzle, one piece at a time.

One champion is Dr. Larry Goldstein at UC San Diego. If you ever have the chance to hear Larry Goldstein speak, don't miss it. He makes the research understandable, while never sugar-coating the tremendous difficulties of research for cure.

Using embryonic stem cells, he is working to develop a cellular model of Alzheimer's in a Petri dish. Think what this could mean. Right now scientists can only learn from patients when they are in the advanced stages of the disease -- their disease may have begun decades earlier -- not to mention it is unlikely for anyone to volunteer to donate a piece of their living brain.

But if the disease could be followed and studied cell by cell at every stage, we might be able to find its weak spot, and prevent, cure or delay the onset of AD.

The Goldstein work could be like finding the "black box" in the wreckage of an airplane. That box records pilot information on the plane, vital clues into what went wrong, so we can find the causes of the crash, and fix them, and prevent such tragedies in the future.

Even delaying the onset of the disease by five years would be hugely helpful both to affected individuals, and to the economy, saving literally hundreds of billions of dollars...

Now, here's a project that makes the hairs on the back of my neck stand up.

Dr. Frank La Ferla leads a dream team of scientists-- Mathew Blurton-Jones, Mark Tuzynski, Jean Loring, and more-- friends from multiple fields) who will be using stem cells in an attempt to "rescue cognition"--and reverse the damage of Alzheimer's memory loss.

Here is my layman's attempt at explaining Dr. La Ferla's approach.

First, his lab developed an animal "model" of Alzheimer's: a mouse species which would develop the physical symptoms of AD (including plaques and tangles on the surface of the brain) as well as the inability to remember... called 3x-tgAD, this is the only animal model of the disease in the world. It is already famous, in use by over 120 scientists in more than 20 countries.

How to test memory loss -- and hopefully, the recovery of the ability to remember?

The Morris Water Maze is a tiny swimming pool, just a few feet across, with a crawl-out platform at water level, and with obstacles in way. A mouse in the water has to find its way to the resting spot, and remember how to get there later on. A "normal" mouse will remember its way after some trial and error. The "AD mouse" basically can't do that -- finding the crawl-out platform by accident, it is unable to follow the same route again. Every time it is put in the water, it is like the first time.

But when that "AD mouse" is given one specific type of stem cells, it recovers the ability to remember, and navigates the water maze as skillfully as the" normals".

Interestingly, the plaques and tangles of its brain remain the same. Until now, most scientists felt that these disruptions on the surface of the brain were the problem, and focused on getting rid of the. But what if that was not the case?

The transplanted cells secrete what Dr. La Ferla refers to as "brain fertilizer", BDNF (Brain Derived Neurotrophic Factor) in a steady and continuing supply.

This apparently increases the connections between the nerves. With that increased communication, comes the return of memory.

Rescuing cognition...

The California stem cell program is funding the LaFerla effort: a grant of $3.6 million.

This is how it must be done.

Dollars to our scientists are like weapons to our soldiers; they cannot fight without support. If we want to win the war against Alzheimer's, we must spend money to do it. Short-changing research for a cure condemns millions to suffer, and forces the nation into unsustainable medical debt.

Some say we cannot afford cure research; the truth is just the opposite -- we cannot not to afford it!

The last word should go to three individuals whose work was cited:

Larry Goldstein:

"We are woefully underinvested in the fight against disease, given its cost and burden on families....I am hopeful that we can make progress with new stem cell-based tools, given the complexity of the Alzheimer's problem. But we need many more approaches to solve this terrible and growing problem."

Matthew Blurton:

"The NIH budget is not able to fund enough AD research. The current outlook is that only about 3% of grants reviewed by the national institute of aging (the primary funding source for AD research) will be funded." (see: http://www.alzforum.org/new/detail.asp?id=2616 )

Leeza Gibbons:

"Regarding the lack of a budget for the Alzheimer's program...Without putting dollars behind the awareness, our national program for Alzheimer's is at risk of being just hype and very little help.

"In the fight against Alzheimer's, we need three things: awareness, care and a path to cure... The California Institute for Regenerative Medicine (CIRM) is systematically using stem cells as a sword to slay the dragons of disease and life-limiting illnesses, including the thief of memory called Alzheimer's.

"Frank La Ferla's project is exciting to all of us who care about the devastation of memory loss... It is unique, creative, and promising.

"It is part of the California commitment to attacking neurological disease, so one way we will be able to say: this assault on millions is just a memory."