The Tangled Neuron

What's the Best Alzheimer's Care? Disappointing Results from a French Study

Summary:  A recent French clinical trial found that a standardized special care plan at memory clinics did not help people diagnosed with Alzheimer’s maintain functionality.  Other approaches or care plans might be more successful, but have not been tested in a study of this size.

There is a great need for the kind of research carried out by this French team.  The worst thing that could happen is that the negative results of this trial give governments, healthcare professionals and laypeople the impression that care doesn’t matter.

What should be the gold standard for the care of people diagnosed with Alzheimer’s?  And who should provide that care?  A team of researchers led by Dr. Fati Nourhashémi at the University Hospital in Toulouse, France set out to answer those questions.

Controversy over the Causes of Alzheimer's

Summary:  Dr. Rudy Castellani of the University of Maryland has received the 2010 Journal of Alzheimer’s Disease outstanding contribution award for his article criticizing the popular hypothesis that a protein called beta amyloid causes Alzheimer’s.  The award highlights the growing disagreement about the causes of Alzheimer’s.

Alzheimer’s is caused by plaques and tangles in the brain, right?  Wrong, says a group of researchers who believe that focusing on these abnormal proteins is keeping scientists from investigating other potential causes. 

In a 2009 article in the Journal of Alzheimer’s Disease, they wrote that the popular hypothesis that beta amyloid (the protein found in plaques) causes dementia is flawed. This flawed hypothesis is why potential Alzheimer’s drugs continue to fail in clinical trials, they said, and has caused unnecessary suffering for patients and families.

Rudy J. Castellani, Jr., MD

Last month, the 300+ Associate Editors of the Journal of Alzheimer’s Disease voted to give Dr. Rudy Castellani, the lead author of this article, the Journal’s annual award for outstanding contribution.  The award highlights the growing disagreement about the causes of Alzheimer’s.

Dr. Castellani is Professor of Pathology and Director of Neuropathology at the University of Maryland.  The two Editors-in-Chief of the journal, Mark Smith and George Perry, are co-authors of the paper, and with Dr. Castellani, have long hypothesized that events earlier in the disease process, not beta amyloid, cause Alzheimer’s.   Their logic goes something like this:

1. Abnormal accumulations of beta amyloid (the protein in plaques) and tau (the protein in tangles) are not harmful, and are simply end-stage signs of earlier problems
2. Recent research indicates that beta amyloid may be protective – a normal immune response and an anti-oxidant
3. The accumulation of beta amyloid that can be seen at autopsy (and on new brains scans) is not well correlated with dementia
4. The focus on these abnormal proteins has crowded out funding needed to research other hypotheses.