Small trial shows memory loss from Alzheimer`s disease can be reversed
"All of these patients had either well-defined mild cognitive impairment, subjective cognitive impairment, or had been diagnosed with Alzheimer’s disease before beginning the program," says one of the team, Dale Bredesen, University of California, Los Angeles. "Follow up testing showed some of the patients going from abnormal to normal."
The study investigated the effects of a new kind of personalised treatment on the cognitive abilities of 10 patients who were experiencing age-related decline.
The treatment - called metabolic enhancement for neurodegeneration, or MEND - is based on 36 different factors, including changes in diet, exercise, and sleeping habits, plus the integration of certain drugs, vitamins, and brain stimulation therapy to their regular routine.
These lifestyle changes and treatments were sustained for five to 24 months, and the team from UCLA and the Buck Institute for Research on Ageing in California reports that many of the patients showed real, life-altering improvements as a result.
According to the researchers, this is the first study to objectively show that memory loss in patients can be reversed, and improvement sustained.
"The magnitude of improvement in these 10 patients is unprecedented, providing additional objective evidence that this programmatic approach to cognitive decline is highly effective," says Bredesen.
Publishing their results in the journal Aging, the team hasn`t gone into much detail about how MEND works, probably because each treatment involves a complex combination of factors that has been specifically designed to treat just one individual, as each person`s version of Alzheimer`s appears to be different.
But they do mention something that all but one of the patients have in common - they are all at genetic risk for Alzheimer’s disease, carrying at least one copy of the APOE4 allele. Five of the patients are carrying two copies of APOE4, which gives them a 10- to 12-fold increased risk of developing the disease, the team explains.
This means there could be some benefit in getting tested for this genetic risk, because patients might finally be able to do something to stall the progression of the disease. Around 65 percent of Alzheimer`s cases in the US involve APOE4.
"We`re entering a new era," says Bredesen. "The old advice was to avoid testing for APOE because there was nothing that could be done about it. Now we`re recommending that people find out their genetic status as early as possible so they can go on prevention."
The team has split the 10 patients up into individual case studies, which you can read about in their open access paper.
One is a 66-year-old man who was still working when he showed signs of early Alzheimer’s. MRI scans revealed that his hippocampal volume had reduced to only the 17th percentile for his age.
After 10 months on the MEND program, his hippocampal volume had increased to the 75th percentile, with an actual physical increase in volume of nearly 12 percent, and he reportedly experienced improvements in memory and cognitive ability.
"[T]o our knowledge the magnitude of hippocampal volume increase that occurred with this patient has not been reported previously," the team reports.
Another patient, a 69-year-old professional and entrepreneur, was about to shut down his business after experiencing progressive memory loss over the past 11 years. Tests revealed that he had the hallmarks of early Alzheimer’s.
After 22 months on the MEND program, the man increased from 3rd percentile to 84th percentile in a particular cognitive test, and was able to go back to work and expand his business.
"The neuropsychologist who performed and evaluated his testing pointed out that his improvement was beyond that which had been observed in the neuropsychologist’s 30 years of practice," the team reports.
One woman was barely able to do grocery shopping on her own before the treatment, but showed "marked improvement" that has now been sustained for 3.5 years.
Another patient regained her ability to speak two different languages after nine months of taking the treatment. "She remains asymptomatic after one year on the program," the team reports.
The researchers report that by the end of their treatment, most of the 10 patients had returned to the normal range for their cognitive testing.
As incredible as these results sound, there are some caveats here that we should take into account. It looks like the treatment needs to be continued to ensure the improvements are sustained, as the first patient mentioned above experienced rapid declines when he stopped the treatment after three months.
The team also says that as long as the patients kept up the treatment, their improvements were sustained, but it’s not yet clear how long this will last. They’ve so far been monitoring the 10 patients for up to four years.
The researchers have yet to publish a comprehensive analysis addressing why their treatment appears to work so well, but Bredesen says the fact that it’s so comprehensive, and addresses so many different factors at play in Alzheimer`s progression, is likely the key to its success.
"Imagine having a roof with 36 holes in it, and your drug patched one hole very well - the drug may have worked, a single `hole` may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much," he says. "We think addressing multiple targets within the molecular network may be additive, or even synergistic, and that such a combinatorial approach may enhance drug candidate performance, as well."
Let’s also be clear that 10 patients is an extremely small sample size, so we need to be careful not to jump to any conclusions based on this one study alone.
But the team now plans on starting a much larger study using the MEND treatment, so hopefully in the coming years we’ll see positive results for a lot more patients, and get a better understanding of exactly what’s going on here. We cant wait to see where this research goes next.