Dear Dr. Roach: My wife has had dementia for more than two years. There is an ad in our local paper for an Alzheimer鈥檚 disease study. It says: 鈥淭his study will assess how safe and effective an investigational drug is at slowing the progression of early (prodromal) or mild Alzheimer鈥檚 disease.鈥� Is this protocol legit? I don鈥檛 trust this type of ad not coming from a hospital. I couldn't find any information about the sponsors of the research.
J.N.
I was able to find the trial, called the Graduate II trial, which is sponsored by the manufacturer of the drug being tested, gantenerumab. This drug is designed to reduce the size of the amyloid protein plaques in the brain, which are suspected of being the underlying cause of Alzheimer鈥檚 disease, and to prevent new ones from forming. It is, indeed, a legitimate trial. The best place to find out about these is on the clinicaltrials.gov website.
The trial is in phase 3. The drug has passed both phase 1 trials, which are designed to look at safety, and phase 2, which looks at both safety and effectiveness.
Now the investigators are studying the effectiveness of the drug in a larger population, usually for a longer period of time. Drugs that do well in phase 3 clinical trials could be approved by the U.S. Food and Drug Administration. Alzheimer鈥檚 drug trials are difficult, because the disease often progresses slowly, and large, time-consuming trials are necessary.
In general, I encourage people to consider participating in clinical trials, as they are essential for clinical advances. For gantenerumab in particular, phase 1 and 2 trials did show that the drug is effective at reducing the amount of amyloid plaque in the brain. However, clinical trials did not show improvement in memory and brain function.
The new trial is using a higher dose and recruiting patients with earlier-stage illness.
I don鈥檛 have enough information to answer whether your wife, having had symptoms for two years, might be eligible for this trial, but I would certainly encourage you to find out more about it.
Dear Dr. Roach: My wife had a heart attack. They did what they could for her, but she had a 100 per cent blocked artery. They did clean it out, but a week later she had a fatal heart attack.
Five or six months earlier, she called me quite often by a former friend鈥檚 name. I am wondering if blood was not getting to her brain or if she was starting to get dementia.
G.M.
I am very sorry about your wife.
People who have blockages in the heart often have blockages in other blood vessels, such as those in the leg, but also those going to the brain. Poor blood flow to the brain can cause changes to memory and other specific problems.
A stroke is very much like a heart attack. Most strokes are caused by poor blood flow to a specific area of the brain. If it is severe enough and long enough, brain tissue will die, causing loss of function. People who have had several strokes are more frequently affected by dementia, called vascular dementia or multi-infarct dementia.
I don鈥檛 know if this was the case for your wife, but it is certainly plausible. People who notice loved ones having memory lapses should get an evaluation sooner rather than later, as sometimes there are therapies that work better when started earlier.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
