P&S Journal: Fall 1997, Vol.17, No.3
Three More Alzheimer's Studies
Illustrative of their role as leaders in the investigation of neurological disease, P&S researchers authored or coauthored three of nine papers related to Alzheimer's disease in a March theme issue of the Journal of the American Medical Association.
The researchers represented the Gertrude H. Sergievsky Center, which studies the epidemiology of brain disease. "The concentration of talent and collaborative environment at Columbia and the Sergievsky Center at present make it possible to contribute to the body of knowledge about Alzheimer's disease," says Dr. Richard Mayeux, the Gertrude H. Sergievsky Professor of Neurology, Psychiatry and Public Health (Epidemiology) and director of the Sergievsky Center.
As a result of one of the studies, funded by the National Institute on Aging, physicians may now for the first time be able to set a time frame for when an Alzheimer's patient will succumb to the disease. Dr. Yaakov Stern, associate professor of neuropsychology, and colleagues developed mathematical formulas to estimate the length of time before a patient either requires nursing home care (or its equivalent) or dies.
For example, a 76-year-old woman who began showing signs of the disease at age 73, who had the illness for three years, had a cognitive function score of 45 out of 57, and who had no signs of extrapyramidal damage or psychosis, can be told that 25 percent of similar patients require nursing home care within 29 months and 50 percent in 49 months.
"Patients with Alzheimer's disease and their families typically may inquire when to expect important disease end points such as nursing home admission or death," says Dr. Stern. "But until now, it has not been possible to provide an accurate, empirically based answer."
Dr. Mayeux was principal investigator on a Columbia study that implies that individuals who develop dementia with stroke and those who develop Alzheimer's disease may share a genetic susceptibility. The study, funded in part by the NIH, found a connection between APOE genotype, a known genetic risk factor for Alzheimer's disease, and dementia in patients with stroke.
The authors concluded that although the occurrence of stroke seems unrelated to APOE genotype, the outcome after stroke may be worse for individuals with an APOE 4 allele.
Drs. Mayeux and Benjamin Tycko, associate professor of pathology, also were co-authors on a study with Rush University investigators that concluded that APOE 4 allele continues to account for some degree of genetic risk for Alzheimer's disease in the very old, but other genetic and environmental factors may also be important.
"The major public health implication of these results is that vigorous efforts to identify other risk factors for Alzheimer's disease, especially factors that are potentially modifiable, should continue," the authors wrote. The study was funded by the National Institute on Aging.