'Boston Legal' lawyer makes his case for Alzheimer's drug

"Boston Legal" "Juiced" episode, ABC, Dec. 1

The premise

Denny Crane (William Shatner) is undergoing a PET scan. The colors and images show that his brain activity is diminished in certain areas. While he is on the scanner, his doctors also test his ability to count backward from 100 by 7s and find that this ability has deteriorated.

They conclude from the scan and tests that his Alzheimer's disease has progressed to Stage 3 or 4, signifying mild to moderate memory decline. New memories are most difficult, older memories less so. Crane has also become socially withdrawn.

He learns of an experimental drug (known as Dimebon) studied to treat Alzheimer's disease in Russia and tries to get it on humane grounds, even though it isn't approved by the Food and Drug Administration.

There are ongoing Stage 3 FDA trials, but Crane is told that "Pfizer bought the rights" and it won't be available for public use for at least three years, when the clinical trials are likely to be completed.

His battle to receive this drug goes all the way to the U.S. Supreme Court.

Crane is frequently disoriented during this period and experiences delusions that he is back in the past with his young daughter. His doctor tells him he may live for years in this condition.

The medical questions

Can the rate of progression of Alzheimer's disease be detected by a PET scan of the brain? Is mild to moderate disease characterized by difficulty performing cognitive tasks, frequent disorientation, delusions and short-term memory loss? Does an Alzheimer's patient relive old experiences? Are promising Russian drugs undergoing FDA trials? Would someone be able to obtain an experimental drug without FDA approval? Can a patient live for years like this?

The reality

"Alzheimer's disease causes characteristic metabolic patterns of deficits which can be detected by PET scans," says Dr. P. Murali Doraiswamy, chief of biological psychiatry at Duke University.

Initially, he says, the deficits are restricted to some concentrated areas in the parietal and temporal lobes, but as the dementia progresses, the deficits spread.

But Doraiswamy and William H. Thies, chief medical and scientific officer of the Alzheimer's Assn., emphasize that PET scans are not definitive.

"No imaging technique is generally regarded as diagnostic for Alzheimer's disease," Thies says.