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US expert sees need for new treatment models for Alzheimer’s diseaseMyongji Hospital, Mayo Clinic hold joint conference to mark cooperative ties
  • By Lee Han-soo
  • Published 2019.06.11 17:53
  • Updated 2019.06.18 10:12
  • comments 0

Alternative treatments can help dementia patients psychologically, if not physiologically, while East Asians appear to be less prone to the disease than Europeans, a U.S. expert said.

Richard Caselli, neurology professor at Mayo Clinic, made these and other points during an interview with Korea Biomedical Review on the sidelines of a joint international medical symposium with Myongji Hospital.

Myongji Hospital and Mayo Clinic held the symposium to commemorate the one year mark for the Korean hospital joining the Mayo Clinic Care Network (MCCN) at the Conrad Hotel in Seoul, on Tuesday.

The MCCN, which started in 2011, is a collection of independent medical institutions that have been selected by the Mayo Clinic after undergoing a rigorous validation process to allow the exclusive use of Mayo's knowledge, expertise, and resources.

The MCCN consists of more than 40 member organizations in the U.S., China, Mexico, Philippines, Saudi Arabia, Singapore, and the United Arab Emirates. While remaining independent, the members share a common goal to improve the delivery of healthcare.

This year, the symposium tackled a variety of topics that affect the modern medical era with sessions presented by four Mayo Clinic professors and eight local medical professors.

One of the topics thoroughly discussed during the symposium was dementia.

The illness has recently become a global problem with the surge of the aging populations. Governments from various countries have started to notice the issue and have begun to make considerable investments in dementia management.

The U.S. spent $42.8 billion on dementia R&D in 2017 alone, under the National Plan to Address Alzheimer's Disease and Related Dementia. The U.K. government plans to invest 730 million pounds ($1.02 billion) from 2015 to 2020 under the Prime Minister's Challenge on Dementia 2020. Japan spent 7.1 billion yen in dementia R&D in 2014. The country also supports long-term research, early diagnosis, raising awareness, and enhancing connectedness among dementia patients.

In Korea, the government promised to spend 1 trillion won ($920 million) budget for dementia last year after President Moon Jae-in emphasized putting more responsibility on the state in taking care of dementia patients.

Korea Biomedical Review met with Dr. Richard Caselli to discuss the disease in detail and talk about treatments that are being developed for Alzheimer's and global problems that nations face regarding taking care and treating patients.

Dr. Richard Caselli, Mayo Clinic medical director for service and neurology professor, shares his thoughts on dementia, in an interview with Korea Biomedical Review on the sidelines of the Myongji International Medical Symposium at the Conrad Hotel in Seoul, on Tuesday.

Question: There is much talk about Alzheimer's being a natural event and that it will be impossible to cure the disease completely. What is your opinion on the subject?

Answer: I think it all comes down to the age in which the disease happens. If a 55-year-old develops Alzheimer's disease, it is clearly not normal and can be considered as a disease. However, if the disease develops in a 95-year old patient, we have to ask ourselves if the disease is just an inevitable part of aging even if the condition is bad and dysfunctional.

Death is a normal part of aging as well but do we consider death normal? Dementia asks the same questions if it comes at a certain age that we can all agree to be old.

Since the disease becomes more common the older a person gets, I believe it's more of a philosophical question where we have to decide to look at a demented 95-year-old as just a senior or as a patient with a disease that needs to be cured.

I'm not sure I can answer that question as it varies on a person's philosophy.

Q: Various pharmaceutical companies have been trying to develop a dementia treatment by targeting amyloid plaques and tau pathology. However, no companies have succeeded yet in developing a treatment that works. Do you believe that there is a possibility of developing a cure by targeting these two causes?

A: All of the efforts so far were primarily aimed at targeting amyloid. However, despite pharmaceutical companies successfully getting amyloid out of the brain, they have been failing to develop a drug. This suggests that that amyloid is not what's causing the problem.

Amyloid can be a marker for the disease, and I believe that this theory is legitimate, but the problem can be that amyloid might not be toxic to the brain, which raises the possibility for another explanation.

There are currently a variety of different theories on what the other explanation can be. One possibility is the loss of function on some other critical component of the amyloid system.

The amyloid precursor protein (APP) is a long molecule, and it gets broken down into different pieces. Some of them are extracellular and are involved in modulating how excitable a synapse is and other fragments that contain DNA, which influences genes by turning them on or off. These pieces are examples of things that amyloid might be involved positively.

So many pharmaceutical companies have been working on the idea that A-beta peptides, specifically, is toxic to the brain.

However, even though they managed to eliminate the A-beta peptides, it did not solve the problem.

There are still other possible strategies; one of the strategies is to upregulate alpha secretase, another pathway that doesn't lead a beta-peptide, which would create more of the beneficial fragments such as the soluble APP-alpha.

Another possibility would be by preventing the spread of tau pathology. When Alzheimer's disease first begins, it starts in a minimal part of the brain in an area called the medial temporal lobe. However, eventually, the disease spreads throughout the brain.

One way that makes such spread possible is the abnormal tau will spread from one brain cell to another in a prion-like way.

Therefore, if we can stop this and keep the initial damage to a secluded area, patients will have some memory loss but will be still functional and not develop dementia.

Q: Although there are no clinical proofs that alternative treatment work in treating Alzheimer's disease, various people still use them as a method of treating the disease. What is your opinion on alternative treatment in treating Alzheimer's?

A: One of the things that the East and West have in common is the hearsay cures.

The short answer is I don't think there is any proof of such alternative treatments working on the disease, so I am highly skeptical about any claims of their effectiveness.

However, although the remedies can prove that it has had no biological difference, I believe such old-remedies are fine in a psycho-social standpoint. This is because so much of the care for dementia patients is about managing their behaviors.

For example, if a patient feels loved and taken care of, they will behave themselves, but if they think antagonized, they will start acting out and since they are demented the patients are not going to act out in a sane way.

Such acting out is actually the biggest problem in treating dementia.

So if we put those alternative remedies in cultural content, I think they have a role to play even if they are not biologically effective.

Q: There have continuously been unproven health supplements that claim effectiveness in preventing dementia for profit. What is your opinion on the subject?

A: There should be more done to regulate such supplements. In the U.S., there are no regulations regarding health supplements, which have led to the industry to grow into a multibillion-dollar industry. If the authorities do regulate them, I think they will all go away.

Q: Are there specific areas or ethnicities that are more prone to dementia than others?

A: Yes. The high-risk areas tend to parallel with the frequency of the Apolipoprotein E 4 (APOE4) gene.

Northern Europe is a very high-risk area, while southern Europe has a much lower risk. Asia is also a low-risk area. I don't know the specific number for Korea, but the APOE4 prevalence in China is somewhere around 9 to 10 percent, which is half of the prevalence in the U.S. or Europe.

Also, the Apolipoprotein E 2 (APOE2) gene, which is a protective gene against dementia, is higher in China than it is in the U.S. or Europe.


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