The Alzheimer’s crunch

Alzheimer’s disease continues to confound researchers and physicians. While promising treatments for the progressive disorder have been developed over the last 10 years – based on research advances – nearly all of them have failed in human trials.

With the aging of baby boomers and the projection that 14 million Americans will have Alzheimer’s by 2060, it’s urgent that important discoveries be translated into cures or effective new therapies to slow the disease’s progression.

To accelerate its own efforts, the UCI Institute for Memory Impairments and Neurological Disorders recently recruited highly acclaimed UCLA Alzheimer’s researcher Dr. David Sultzer to oversee its clinical research operations. As a geriatric psychiatrist, he has dedicated his career to understanding how the brain changes throughout the disease’s evolution – and understanding the behavioral manifestations of those changes.

He and UCI MIND director Joshua Grill had, at one point, both been on UCLA’s faculty. “We were familiar with each other’s work and had good relations,” Sultzer says. “When he was looking to expand UCI’s clinical trial research, he asked me to come to UCI.”

Particularly interested in the intersections between clinical research and the biological and behavioral effects of Alzheimer’s, Sultzer says: “The theme here is translation – working to optimize the translation of mechanisms to treatment. We want to take the whole of each person, down to the molecular cell level, and merge that with current advancements in treatment.”

A clinical professor of psychiatry & human behavior at UCI, Sultzer plans to incorporate his understanding of the human struggles with these behavioral changes into the fabric of clinical trials, as he did in UCLA’s Clinical Antipsychotic Trials of Intervention Effectiveness – Alzheimer’s Disease study, which examined the usefulness of antipsychotic medications in mitigating the delusions, hallucinations, aggression and agitation that often accompany the disorder.

“The challenges of clinical trials are recruitment, retention and reliability,” says Sultzer, adding that pre-symptomatic participants are key so that researchers can try to intervene before the irreversible stages. “It’s natural, if you aren’t yet showing symptoms, to want to postpone enrollment until you are, but with Alzheimer’s we have to be more proactive.”

As a physician, Sultzer is primarily focused on the clinical aspects of the disease. But, he says, UCI MIND brings together faculty from biological sciences, information and computer sciences, engineering, nursing science, education, social sciences and medicine in an effort to more holistically address Alzheimer’s.

This interdisciplinary approach helps establish firmer foundations in various aspects of Alzheimer’s beyond treatments for tau and beta-amyloid proteins, hallmarks of the disease. It leads, for example, to clinical trials on inflammation and other less-studied symptoms that may contribute significantly to memory loss and other behavioral changes associated with Alzheimer’s.

“In my prior involvements, these pieces were there but not as close by. A lot of the things being done at UCI MIND come from the productive environment and careful thought into the structure of studies and trials, so the institute is really set up to accommodate patients and families in as many ways as possible,” Sultzer says.

In addition, UCI MIND has launched programs such as the Consent-to-Contact Registry to make recruitment and retention easier on participants and relatives.

“We will continue to work toward novel solutions for Alzheimer’s disease and related dementias, but the only way we’re going to succeed is if more community members join us,” says director Grill. “UCI MIND can and will be the place in Orange County for these important translational studies, and David is an ideal person to lead these efforts.”