FALL 1995 ISSUE ■ SINAI HOSPITAL Alzheimer's Disease - Small Strides ► «~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.