No one--to repeat, no one--understands how it happens. Every day, the minds of millions of high-functioning people slowly slip into another reality, one in which life events, loved ones' faces, children’s names and all the other memories that constitute a person’s identity have disappeared. Deep inside their brains, the slide begins decades before the symptoms of dementia manifest. By the time the car keys begin to go missing, it’s already far too late.
Currently, there are about 36 million people in the world suffering from dementia. By 2050, the population at risk for the disease is expected to hit two billion, causing what experts say will be an unprecedented health care crisis that could cost $1 trillion a year in the U.S. alone.
"The scope of the looming medical-care disaster is beyond comparison with anything that has been faced during the entire history of humanity,” said Dr. Barry Greenberg, the director of strategy for the Toronto Dementia Research Alliance, in a recent talk in Canada.
Researchers have spent decades and tens of billions of dollars in searching for a treatment to Alzheimer’s, to no avail. Even before the looming health care crisis became clear, a drug that could slow or halt the chronic, terminal evaporation of a person’s memory has long been considered the Holy Grail of neuroscience research. The reasons are both economic and philosophic. Since the protracted disease is often as painful for relatives as it is for the patient, drugs are in high demand, with pharmaceutical companies projecting a $14 billion a year market by 2020. But the real reason that a treatment is so highly desired may be because the disease’s challenges the fundamental modern conception of humanity. If Descartes’ proposition, “I think, therefore I am” is accepted as what it means--at least in the Western world--to be human, then what about the projected two billion people who will soon become living, breathing entities without the capacity to remember their own thoughts?
Today, many Alzheimer’s experts are blunt about the lack of any available treatments.
"There really is nothing," Dr. Evelyn C. Granieri told Technology Review in its recent feature on the state of Alzheimer's research. "You don't get better, ever."
This medical reality hasn’t stopped the pharmaceutical industry from turning a profit by selling drugs that are, at best, only minimally effective. Since 1996, Japanese company Eisai and U.S. drug marketer Pfizer have raked in more than $2 billion on the drug Aricept, even though studies have shown the medicine to barely slow the disease. In 2012, the Federal Drug Administration caused a scandal when it approved a higher dosage of the drug--called Aricept 23 mg--so that Pfizer and Eisai could extend their copyright despite evidence that the higher dosage was no more effective and was more likely to cause gastrointestinal problems for patients.
Meanwhile, scientists and federal agencies are rushing to find a real treatment that could stave off the economic and social disaster of having a world population of two billion patients who require daily care. Last February, the National Institute of Health approved additional Alzheimer’s research funding.
“We can’t wait to act,” Kathleen Sebelius, the U.S. health and human services secretary, said upon the announcement.
A new round of clinical trials focused on preventing the onset of the disease--rather than treating it once it has already begun--are beginning this winter. Scientists hope that these trials will demonstrate that the disease’s progression can be interrupted, that the chronic deterioration of patients’ memories can be stopped if the disease is attacked early enough.
This goal faces many challenges. There are numerous genetic mutations of Alzheimer’s, which requires scientists to match clinical trials with the appropriate patients. The disease often lies dormant for decades in a patient’s cerebral spinal fluids before it begins to affect one’s cognitive functioning, prompting scientists to ask just how early the intervention must occur. And all the while, the clock is ticking--not just for individual patients, but also for the entire health care system, prompting some scientists to call for a suspension of the private, profit-based research model in favor of a global, public-private program.
"The medical-care system is going to be bankrupt by 2050 if we don't figure out a way to delay or treat Alzheimer's disease," Greenberg told Technology Review.
"The competitive marketplace," he says, "was not conceived to overcome problems of this magnitude."
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