Less than a week after former President Ronald Reagan revealed that doctors have told him that he apparently has Alzheimer’s disease, medical researchers are reporting that a simple eyedrop test could hold the key to the first reliable diagnosis of the mystifying and debilitating illness, which attacks the brain and nervous system of older adults.
In an article in Friday’s edition of the journal Science, scientists announced that when a drug called tropicamide was put into the eyes of 51 elderly test subjects, the pupils of the 19 men and women thought to have Alzheimer’s disease grew significantly larger than those of the others.
“This is an exciting and important finding,” said Dr. Marsel Mesulam, a neurologist who is director of Alzheimer’s research at Northwestern University Medical School and co-author of the article. “We could distinguish between those who have Alzheimer’s and those who do not with 95 percent accuracy.”
At present, no sure test exists for diagnosing Alzheimer’s disease, which is believed to afflict as many as 4 million Americans. It can now be confirmed only by an autopsy.
That leaves physicians with the task of attempting to detect it through procedures and examinations, which, in effect, eliminate other possibilities but which are costly and have no guarantees of accuracy.
The Science article says that the wrong diagnosis is made in 25 to 40 percent of Alzheimer’s cases; even seasoned specialists are said to err 10 to 20 percent of the time.
Mesulam and his co-authors, faculty members at Harvard University Medical School, hope their test will lead to a definitive diagnostic tool that could eventually save millions of dollars through prevention and early treatment as new therapies become available.
The lack of a dependable diagnosis has been the major hurdle in Alzheimer’s research because doctors are often forced to wait until patients are in the later stages of the disease before deciding whether to enter them in clinical trials. And with misdiagnosis rates so high, therapy results can be incorrect and misleading.
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But in response to the promise shown by the eyedrop exam, the director of Alzheimer’s Disease Research Center at the University of Pittsburgh cautioned against undue optimism.
“The test involved fewer than 60 people,” said Dr. Steven DeKosky. “While this certainly is an exciting finding, we have to do more research to confirm these results and see if the test is reliable for Alzheimer’s disease.”
It is hard to see how anyone could be overly optimistic because at almost every level of the disorder, daunting questions prevail.
There is no treatment or prevention of Alzheimer’ disease, and although researchers have found that at least four genes are associated with it, the function of this genetic linkage is uncertain.
What is certain is the profoundly agonizing impact that the disease has on its victims and their loved ones.
Beginning with such symptoms as confusion, forgetfulness and difficulty in choosing words, the Alzheimer’s patient gradually slips ever deeper into dementia. As time passes, aggressive personality changes and perplexing behavior such as aimless wandering will often occur.
Although doctors say the disease has always plagued human beings, it was once considered a normal part of the aging process and called senility.
In 1906, it was identified by Alois Alzheimer, a German psychiatrist and pathologist, who described in a medical journal the brain abnormalities he discovered in an autopsy of a patient with a mental disorder.
It has been only in the last 20 years, however, that medicine has trained its sights on the disease.
“The reason it took so long was that people died before scientists could see large numbers of those with Alzheimer’s,” said Dr. Zaven Khachaturian, who directs some $300 million in Alzheimer’s research at the federal government’s National Institute of Aging in Bethesda, Md.
“At the beginning of this century there were 1 million people who were 65 and over; now there are almost 20 million.”
The number who suffer from the disease increases exponentially with age. “Every 10 years, the prevalence doubles,” Khachaturian said. “At age 65, between 5 and 10 percent of the population has Alzheimer’s. By age 75, the percentage doubles, and by age 85, the total is close to 40 percent.”
Khachaturian began research on the disease at the institute in 1978. “The budget then was very modest-no more than $2 million.”
The Alzheimer’s Association, headquartered in Chicago, was formed two years later by research scientists and ordinary citizens as a grass-roots, voluntary private health agency.
The association-which oversees local support groups for families, distributes legal and medical information to them, raises funds for research and is an advocate with government-has grown from 7 local chapters in 1980 to 218 today and its annual budget from $75,000 to $60 million, said association president Edward Truschke.
Khachaturian is among those upbeat about the prospects for making inroads on the disease.
“We’re making headway in diagnosing the disease, and there’s an incredible amount of work on ideas about the causes. Exciting things with respect to treatment are happening.
“In the psychosocial domain where the rubber hits the road, we are teaching coping strategies to family-care providers that will reduce their stress and won’t add to the confusion and disability of the patient.”
Juanita Tucker, 72, who lives on the South Side and cares for her 80-year-old husband, Allan, an Alzheimer’s patient for eight years, has absorbed such lessons from support groups and the grinding, day-to-day task of caring for her husband.
“One of the things you have to realize is that the loved one’s behavior is caused by the illness. The person may lash out at you, but it’s not deliberate so you should not react to it.”
Getting away from time to time is essential, Tucker said.
“And you can’t feel guilty. I get help and go to plays, and recently I took a four-day trip with friends.
“Even though it’s not easy, being a care-giver doesn’t have to be as grim and dire as you think when you first get the diagnosis, but I was saddened to hear about Mr. Reagan, and my heart goes out to his wife. No matter what your social or economic situation, the emotional aspects are overwhelming.”
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