Alzheimer's Disease (AD) inches the brain insidiously towards oblivion, and it sometime seems like researchers are moving just as slowly and bereft of hope towards an effective treatment. Most of the success has been in figuring out how to detect AD or prevent it from striking in the first place, but a dramatic case-study published today in the Journal of Neuroinflammation may signal that a treatment has finally been found.
Dr. Edward Tobinick began this case-study after he noticed some amazing results in a 2006 study. In that study, subjects with everything from mild to severe AD were given an injection of etanercept, a drug that decreases the amount of tumor necrosis factor-alpha and has shown some success combating diseases that rely on inflammation. AD patients show 25 times more necrosis factor in their cerebrospinal fluid, so it is likely that it has some connection to the disease. Subjects were tested a month after injection, and a significant number of them showed improved cognition. This is exciting, but what most shocked Dr. Tobinick was that many subjects seemed to recover their faculties within minutes. Family members confirmed that they saw an immediate and marked improvement, but unfortunately the objective tests were only administered a month after injection because of the study design.
Scientists cannot rely on impressions alone, especially with results this extraordinary, so Dr. Tobinick set up a rigorous analysis of another patient to see if rapid improvements could be confirmed by objective tests. The patient, an 81 year old doctor, had been diagnosed with AD 18 months ago and it was clear that he was very confused as he could not remember the name of the doctor that he was introduced to four times, or even the city or date when brought into the office. He was given an extensive battery of cognitive tests. To list just a few: On the Boston Naming Test, he was only able to name one of ten objects. He could only name two animals, dog and cat, when given 60 seconds. He scored only 7 out of 30 on the Montreal Cognitive Assessment test, indicating medium to severe dementia.
Then the patient was given a 25 mg dose of etanercept. Ten minutes later he was suddenly able to correctly give the date and his location. Two hours later, he was given the same battery of tests, and the improvements were impressive. He got 9 out of 10 pictures on the Boston Naming Test. He was able to name 5 animals in 60 seconds. He got a 15 out of 30 on the Montreal Cognitive Assessment test, more than doubling his score. If you examine the less objective assessments, you can quickly see a dramatic change. When asked to draw a clock pointing to ten past eleven, the pre-medicated patient drew a square with a horizontal line from the center to the side. After the medication, he drew a circular clock with numbers in the correct order and two hands pointing vaguely towards the right time. Not perfect, but much, much closer.
Not all of the patient's abilities improved. For example, he was still unable to perform arithmetic, and he still showed many gaps in memory. But observers and tests clearly report that the patient improved significantly in a short amount of time. When questioned a week later, the family reported that the benefits of the shot were still apparent. No one is sure exactly how etanercept produces such rapid results, but a number of theories are presented for consideration in the study. Hopefully, these encouraging results will spur other researchers to quickly find out which one is correct.
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