What is happening with Alzheimer's disease?

BMJ 1998; 316 doi: (Published 07 February 1998) Cite this as: BMJ 1998;316:0

All readers of the BMJ are likely to be interested in what will happen with the management of Alzheimer's disease. A fifth of us may well develop it. Colin Masters and Konrad Beyreuther consider the disease in one of our continuing series entitled “Science, Medicine, and the Future” (p 446). The idea behind these articles is to describe what is happening now with the science of the disease and to speculate on what that may mean for clinicians in the future.

“An avalanche of knowledge” has confirmed that the generation of Aß amyloid from the amyloid precursor protein is the central pathway in the disease. How the Aß amyloid exerts its toxicity is unclear, but about half the genes that cause Alzheimer's disease have now been identified. The important environmental factors remain undiscovered. Low education, head trauma, smoking, concomitant vascular disease, diabetes, and the menopause all have effects—but they are modest and inconsequential. Might some subtle factor in the Western diet or lifestyle prove to be a major factor?

Masters and Beyreuther speculate that by 2008 we might see screening for the genes linked with the disease and possible presymptomatic treatment. There might also be drugs that will act on the amyloidogenic pathway and modify the course of the disease. Currently three drugs are on the market for treating Alzheimer's disease, four await approval, and 16 undergoing early clinical evaluation. Most act on the cholinergic system and are likely to have only a small effect, but drugs that target the amyloidogenic pathway are emerging.

Despite the high prevalence, immense cost, and exciting science of Alzheimer's disease many more column inches have probably been devoted by the media to the issue of whether silicone breast implants may cause connective tissue disease (p 403). No good epidemiological evidence has ever suggested that they do, and we publish today a Swedish study comparing connective tissue disease in 7442 women with implants and 3353 women who underwent breast reduction (p 417). There was no difference between the groups. Yet on the basis of weak anecdotal evidence American manufacturers have paid out over $4 billion to women with breast implants and the British government has set up an inquiry into the subject. A legal sideline is the probably baseless argument that women with silicone implants may damage their babies through breastfeeding (p 477).

Finally, a Paris newspaper attracted the attention of the BMJ 100 years ago by proposing to “keep a doctor” in the way a London tailor kept a poet (p 448). The journal was snooty, and a century later we are still suspicious of doctors who peddle their wares in the newspapers (p 484).

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