YOU ARE HERE: LAT HomeCollections

A Road Without Signposts

There's still no way to detect Alzheimer's before damage to the patient's brain is done. But experts at UCI's Institute for Aging say that research will lead to treatment, if not cures.


Friends say Robert Citron, the former county treasurer who only two years ago was leading Orange County into bankruptcy, nowadays has periods when his mind fails him.

At age 71, "he has . . . "lapse[s] that go on for quite a while," says one friend, who asked not to be identified. "He can't remember names, can't end sentences, can't complete conversations. It is quite pronounced and severe when it does occur, and it's been getting worse over the last year or so."

One friend says Citron's case is the perfect example of why we should medically test public officials to weed out the ones headed for dementia, what used to be called senility.

Carl Cotman, director of UC Irvine's Institute for Brain Aging and Dementia, says the question often pops up when he speaks publicly. "I've had several workshops, and someone always says, 'Shouldn't Bob Dole be tested?' "

For the Record
Los Angeles Times Tuesday August 20, 1996 Orange County Edition Life & Style Part E Page 5 View Desk 1 inches; 29 words Type of Material: Correction
Alzheimer's test--In Friday's Life & Style, a word was omitted from one of the tests in the feature titled "Testing for Alzheimer's." The list of words titled "Recognition" should include the word "Key."

Well, why not?

Kansas Sen. Bob Dole, the Republican Party's presidential nominee, is 73 years old, nearing the age in which the odds are about one in five of developing dementia.

Ronald Reagan's Alzheimer's symptoms were diagnosed when he was 83, five years after stepping down as president. Most researchers believe the disease is at work many years, perhaps decades, before symptoms become obvious.

But the question of testing politicians is moot, Cotman says. You can't screen them for Alzheimer's, because you can't screen anyone for Alzheimer's. For now there is only one conclusive test: an autopsy. It reveals the Alzheimer's-ravaged brain, shrunken and shriveled by a mass suicide of its cells.


Even though genes have been found that seem related to Alzheimer's, they do not necessarily doom a person to the disease. They indicate only that the people who carry them, about 4% of the population, are at five times greater risk. Many people with the genes never develop the disease, and 40% of Alzheimer's victims do not have the high-risk genes.

This lack of a medical test is the sorest point in Alzheimer's treatment. A prescription drug, commercially known as Cognex, can lessen Alzheimer's symptoms in about 30% of cases, and many more drugs are becoming available. But until a reliable diagnostic test is developed, the disease cannot be targeted at its earliest, symptom-free stages, when drugs would do the most good.

The root of the problem is that unlike other organs, the brain is isolated, physically and chemically, and cannot be probed for tissue or fluid samples. Encased in bony armor and walled off by the so-called blood-brain barrier, few of its chemical byproducts leak out. So far, those that do have not proved useful for diagnosis.

Instead, Alzheimer's now is diagnosed only after symptoms such as memory loss and disorientation have become undeniable. By then, much irreversible damage has been done to the brain. Typically, Alzheimer's patients are dead within four to eight years after the diagnosis, although some live as long as 25 years.


"Various people are working on a blood or spinal fluid test for Alzheimer's," says Neil Buckholtz, head of Alzheimer's research at the National Institute on Aging in Bethesda, Md. "Theoretically, there have to be markers--things going on in the body that could be detected and measured."

Meanwhile, researchers concentrate on learning just how the disease evolves and does its damage.

"I'm very optimistic that within the next five or 10 years we will have a much better understanding of the process," Buckholtz says. "I think there are eventually going to be some tests, but it's not clear what they will be."

Much progress has been made in the last 10 years. Before then, "senility" was popularly believed to be a natural part of growing old. Alzheimer's disease, first diagnosed in 1907, was considered to be quite rare.

Now researchers believe that except for a slowing of brain processes, aging does not necessarily degrade the brain. Dementia is abnormal, usually caused by disease.

Alzheimer's is the cause of half of all dementia and is a contributor in another one-fourth of all cases, researchers estimate. They believe there are more than 4.1 million cases of Alzheimer's in America today, and as the population ages along with the baby boomers, the total is expected to rise dramatically.

Because dementia is at times so difficult to diagnose, the risks of developing it are very rough estimates. According to Malcolm B. Dick, a psychologist who diagnoses dementia at the UCI Alzheimer's clinic, the risk between ages 65 and 74 is 3% to 10%. The risk about doubles for each additional decade of life, he says. Some estimate it reaches nearly 50% by age 85.

The more than 60 other causes of memory defects--among them depression, thyroid malfunction and vitamin B-12 deficiency--are less common, and in some cases their effects are reversible.

Los Angeles Times Articles