Researchers grapple for Alzheimer's cure as it threatens to overwhelm health care system By ANITA CREAMER THE SACRAMENTO BEE asps were audible as the images flashed before a gathering of scientists at a recent UC Davis Alzheimer's Disease Center patholo- gy conference. On the screen before them were photos of a brain severely wasted with age, with what looked like silver rivers of atrophy cutting deeply through the tissue. Even for the experts, it can be shocking to see the damage that Alzheimer's disease inflicts on the aging brain. What can stop the devastation of Alzheimer's? Without better answers from researchers, the degenerative brain disease already the nation's sixth leading cause of death will be diagnosed in as many as 16 mil- lion aging baby boomers by 2050. Unchecked, it could rob millions of their memories and lives, their past and future, even as it threatens to overwhelm the health care system. Against the setting of this looming public health crisis, scientists devote themselves to diagnosis and research along the third-floor hallways of the Lawrence J. Ellison Ambulatory Care Center on the leafy UC Davis Medical Center campus. They are unlikely warriors on the front lines: the neurologists and neuropsychologists, the project scientists and brain-imaging whiz kids and dedicated clinic staff who are fascinated by the science of the aging brain but frustrated by how little public recognition there seems to be that a crisis is at hand. Led by neurologist Charles DeCarli, the disease center's researchers test patients for Alzheimer's and other dementias. They counsel patients and their families the caregivers - on how to cope with the disease. Searching for breakthroughs, they run clinical trials of medications that might help slow the progress of Alzheimer's disease. And they perform research on the aging brain using cutting-edge imaging technology, as well as extensive neuropsychological testing of a core of volunteers. But progress is slow: Prevention and cure are probably many years away. Miracles are in short supply; so is funding. And for every answer, it seems, there's another question. "Do I find it discouraging that we're no closer to an answer?" asked DeCarli, 58, who has been the center's director for the past decade. "No, no, no. Sure, I'd like us to get an answer, but who's going to do the work? "We can lick this thing. It's just finding the path." The process of searching for answers begins in the Alzheimer's Disease Center's quiet third-floor clinic, a place of hope and fear. Here, patients and research participants are tested and diagnosed. The staff members offer visitors a cup of coffee and candy from a plentifully stocked bowl. Newcomers, fearful of the news that could await them, are often too nervous to accept. "They're scared when they first come through that door," said pa- tient-care coordinator Rebekha Alfaro. Referred by concerned primary-care physicians or family members, about five patients visit the clinic each Wednesday for testing or follow-up diagnosis. They huddle with their family members in the conference room, and they listen to the words they don't want to hear. Sometimes, 'A -w MCT PHOTO Charles DeCarli, left, director of the Alzheimer's Disease Center in Sacramento, Calif., shows a research participant's brain scan to Dr. John Olichney, right, during the neuropathology conference, Thursday, April 3, 2014. it's DeCarli who breaks the news; sometimes, it's the center's associate director, Sarah Farias. It's never an easy conversation. Treatment remains limited. DeCarli prescribes only Aricept and Nemenda to people with Alzheimer's. Those medications can help slow memory loss in patients in the early stages of the disease but not always, and not with other forms of dementia. To give people diagnosed with mild cognitive impairment, or MCI, some sense of hope, the Alzheimer's center recent launched Brain Fitness 101, a series of classes led by an earnest post-doctoral fellow, Tim Davis, to promote lifestyle changes that can keep aging brains healthy. One of the center's new grants, pending funding, will study the aging brain and vascular illness: As people routinely survive stroke and heart at- tack, how is brain health affected? Are these people more likely to develop Alzheimer's, too? For now, the basic equation for dementia researchers is that heart health equals brain health, because of the brain's rich blood supply network. A good diet won't prevent Alzheimer's, but researchers suspect it can help older adults forestall the development of memory loss by a few years. It won't be long enough to find a cure. Don Reynolds referred himself to the clinic for testing four years ago, concerned about his memory. Now, at 81, the retired social worker comes to his monthly counseling ap- pointments with the center's clinical social worker, Esther Lara, armed with a file folder of information and a big spiral notebook filled with questions and observations on his illness. He is remarkably analytical and self- aware despite his diagnosis, which worsened over the past year from MCI into possible Alzheimer's disease. He'll describe entering a room at home and not remembering why he is there - but unlike simple forgetfulness, the reason never comes back to him. "I'm the person who likes to be equipped for things," said Reynolds, who lives with his wife, Ruth, 79, in Carmichael. "How do I prepare for that and do some understanding of what's coming? When I have the qual- ity of half a brain, how do I function? How do I make day-to-day decisions?" He isn't happy to have a dementia diagnosis, but he accepts it. But the unknown and unknowable hang over his life. Research is the heart of the Alzheimer's Disease Center opera- tion: Through longitudinal studies - following more than 500 research participants over a period of years - the center's scientists work to determine the differences between the normal aging of the healthy brain and, on the other hand, the aging of brains that have deteriorated because of dementia. As part of a federal research grant on how brains age, research volun- teers visit the center every year for extensive neuropsychological testing and physical exams. Some of the volunteers have been participating for 15 years; as they've grown older, some have remained healthy. But others have experienced grad- ual declines in reasoning, judgment and memory. By 85, almost half of people will develop dementia, studies show. The greatest risk factor for Alzheimer's is age. Past testing has shown research participant Joseph Giel to be in good cognitive shape. For Giel, a 90-year-old retired McClellan manager who lives in Loomis, coming to the center is his way to give back. A widower and stroke survivor, he has participated in the center's cognitive functioning research since 2011. His daughter, Kathleen, drives him to the annual appointment, which typically takes all morning. He takes all the same standard diag- nostic tools that are used to evaluate patients for memory loss. The basic mini-mental status exam measures recall, logic and prob- lem-solving ability. Widely available on the Internet, the mini-mental generally includes questions about the date and place, ALZHEIMER'S 119 Don't let a sports injury keep you sidelined... See "The Shoulder Guy" - Performed over 400 Arthroscopic Shoulder Surgeries in 2013 alone! 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