Unraveling the Mystery

By Perry, Patrick | The Saturday Evening Post, September/October 2008 | Go to article overview

Unraveling the Mystery


Perry, Patrick, The Saturday Evening Post


As Robert C. Borwell Professor of Neurological Sciences and director of the Rush Alzheimer's Disease Center, David A. Bennett, M.D., is a nationally recognized authority on Alzheimer's disease (AD) and other neurologic conditions. Dr. Bennett is principal investigator of several studies funded by the National Institute on Aging, including the Rush Alzheimer's Disease Core Center, the Religious Orders Study, and the Memory and Aging Project. The Post spoke with Dr. Bennett about diagnosis, causes, and prevention of AD.

Q: When and how often do doctors suggest autopsy for confirmation of Alzheimer's disease?

Twenty years ago, we did it all the time. Today, we are so good at clinical diagnosis that we only recommend autopsy when unsure of the diagnosis or as part of a research study. To confirm a diagnosis of AD, a silver stain of brain tissue is performed, which shows the plaques and tangles. If at a specialized center, this test is routine.

Q: Is a blood test available?

No. Specialized centers offer highly experienced clinicians. If a specialist clinically diagnoses someone with AD, more than 90 percent of the time that individual has the disease. All other tests being done-brain scans, blood tests, genetic tests, PET and MRI scans-are either to search for another cause of dementia such as a stroke, brain tumor, or fronto-temporal dementia, or are research tools.

Q: How can people locate specialized centers?

The National Institute on Aging at the NIH hosts a website (http://www.nia.nih.gov/Alzheimers/ Researchlnformation/ResearchCenters) listing specialized Alzheimer's Disease Centers (ADCs). Another website is called the Alzheimer's Disease Education and Referral Center (ADEAR) at the NIH (www.nla.nih.gov/alzheimers), which offers information on where people can volunteer for research trials, publications, newsletters, and other information.

People who don't live near an ADC can contact the Alzheimer's Association (www.alz.org) with chapters across the country that can steer you to the most reputable person in your area.

Q: Is brain donation important in helping AD researchers?

Running two of the largest studies in the world with organ donation, I can tell you organ donation is very important. The field has moved toward larger epidemiologic studies. In my studies, we have more than 2,300 older people without dementia, who agree to be tested every year. To enter the study, you agree to become an organ donor. Over time, study participants remain normal, develop mild cognitive problems, or full-blown AD. Through these types of studies, we can better understand what causes subtle memory problems in people without dementia-what occurs during normal aging.

We can also see how different structures in the brain interact. While AD changes are common, strokes and Lewy bodies which are usually seen in Parkinson's disease both contribute to memory loss.

We want to figure out how a risk factor causes AD. For example, if you have a genetic factor associated with the risk of AD such as ApoE4, we study what ApoE4 is actually doing in your brain to cause the development of the plaques and tangles. If we can understand those mechanisms, we might be able to intervene and prevent the development of the pathology of AD and the cognitive loss due to the pathology. …

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