FALL 1995 ISSUE
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SINAI HOSPITAL
Alzheimer's Disease - Small Strides
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«~ia;~i~i a ~ iim i
continued from page 2
der, Medicare and most private in-
surance companies do not cover the
costs of nursing home care. The
cost of caring for an Alzheimer's pa-
tient in an institution can be more
than $30,000 per year. The disease
forces family members to deal with
a complicated illness which can be
a role-reversal for many adult chil-
dren in caring for their incapaci-
tated parents.
Compared to many diseases,
Alzheimer's is a daunting challenge
to physicians as well. "At present,
there is no prevention, no cure, and
very little in the way of treatment,"
says William Leuchter, MD, sec-
tion chief of Neurology at Sinai. He
cites Parkinson's Disease, a disor-
der of the central nervous system,
as a comparison. "Though Parkin-
son's Disease is not curable, we
have many treatment options for
relief of symptoms. The difference
is that in Alzheimer's the individ-
ual has symptoms that generally
cannot be remedied by medica-
tions."
Despite the bleak picture, Sinai
Hospital is tackling Alzheimer's on
the clinical front and in the labo-
ratory. "Therapy anywhere along
the line that interrupts this process
of degeneration would be useful,"
Dr. LeWitt says.
In its clinical program, Sinai is
one of a handful of hospitals in the
United States offering experimen-
tal medications to Alzheimer's pa-
tients. Since 1988, Sinai has
participated in several multi-cen-
ter drug trials for treating
Alzheimer's disease.
Dr. LeWitt is optimistic about
two new medications that are cur-
rently being tested in clinical
trials at Sinai. "We have been fol-
lowing about 300 Alzheimer's
patients regularly at the Center.
Physostigmine and metrifonate are
two medications we are currently
working with in clinical trials for
enhancing memory and other
aspects of the mind. Both seem to
be reasonably well tolerated by
patients and have shown some
efficacy."
Besides the clinical studies, Sinai
offers Alzheimer's patients and
their families a wide range of
diagnostic and support services,
based at the Clinical Neuroscience
Center's location on Maple Road.
Often, family practitioners are the
first physicians to see Alzheimer's
patients, but the diagnosis can be
challenging. Individual issues have
to be carefully screened and eval-
uated to avoid confusion with oth-
er physical conditions that can
cause dementia or cognitive disor-
ganization. Some of these condi-
tions include disorders such as
tumors, metabolic and endocrine
disturbances, vitamin B12 defi-
ciency, small strokes, and neuro-
logical disorders such as Hunt-
ington's Chorea and Parkinson's
Disease. Cardiovascular diseases
and side effects from certain med-
ications can bring about mental
confusion, especially in people over
age 65.
"Alzheimer's is a 'rule-out' diag-
nosis," says Vicki Berchou, RN,
who specializes in working with
Alzheimer's patients and their fam-
ilies at the Neuroscience Center.
"We listen carefully to each pa-
tient's story. Certain life events can
be stressful, causing depression,
anxiety, and inappropriate behav-
ior thought to be Alzheimer's dis-
ease. We look at how long this
n the research laboratory, Sinai physicians are
probing the brain's chemistry for answers that will
unlock the mysteries of Alzheimer's and aging.
Aided by grants from two national and two local
organizations, Peter LeWitt, MD, along with David
Loeffler, PhD, DVM, and Chaim Brickman, MD, have
been examining human tissue.
Regardless of the cause of Alzheimer's disease, one
source of damage to brain neurons is believed to be
toxic oxygen molecules, or free radicals. Drs. LeWitt,
Loeffler, and Brickman are investigating a naturally-
occurring anti-oxidant protein in the brain, cerulo-
plasm. They have detected increased levels of this
protein in Alzheimer's disease brain tissue. This find-
ing offers a clue for involvement of an inflammatory
process. The researchers suspect that continuous neu-
ron loss in Alzheimer's may be linked to an inflamma-
tion of the brain.
Currently, they are investigating the specificity of
this finding by comparing ceruloplasm concentrations
in specimens from aged normal individuals, patients
with Alzheim.er's disease, and patients with other neu-
rodegenerative diseases including Parkinson's Disease.
These studies may furnish important information
relating to the neurodegenerative process itself, as
well as the response of the brain to the disease process.
Ultimately this information may be useful in improving
therapy of patients with Alzheimer's disease.
It's a long research process from theory to treatment.
This is just the beginning...but this theory may some-
day lead to improved treatment for Alzheimer's. Sinai
is dedicated to being at the forefront of such scientific
discoveries.
ak
continues. Does the individual fail
to snap out of it? This is not a dis-
ease that has an abrupt onset,"
she notes.
Physicians at the Center also use
several measurement scales that
can differentiate between age-re-
lated changes and abnormality.
"Sometimes we have the task of re-
assuring people that they are set-
ting too high a standard for their
memory function," Dr. LeWitt says.
"Some behavioral disturbances
may be age-appropriate and should
not be cause for concern."
Once a diagnosis of Alzheimer's
disease has been made, the Neu-
roscience Center assists in a wide
range of services that include edu-
cation and family meetings. Sinai
will continue to look for a treatment
and a cure. In the meantime, the
experts at the Clinical Neuro-
science Center will meet their
patients' needs with the latest ther-
apies available.
HealthNews Briefs
continued from page 1
delivering patient mail, provid-
ing clerical and computer sup-
port to hospital departments,
translating Russian/ English for
patients, making daily telephone
calls from your home to elderly
and homebound individuals,
and assisting families in the
Surgical Waiting Room or at an
offsite surgery center. Are you
interested? To learn more about
the outstanding volunteer pro-
grams at Sinai Hospital, call
313-493-5300. Then press 1 to
be connected with the Director
of Volunteer Services.