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Journalism of Courage
For the last four years, researchers at the All-India Institute of Medical Sciences (AIIMS), have been working with patients from Delhi-NCR at their memory clinic and geriatric departments to develop a blood screening test that could diagnose what caused their memory to fade. Now, they have seen positive results in 90 patients, all between 50 and 75, which give hope to their families of an early diagnosis of the condition, better therapy to stall it and an improved quality of life.
Researchers tested their patients — 35 with serious memory lapse, 25 with mild cognitive impairment, and 30 healthy people — on six markers in the blood and how they compared with each other. And these have helped them map an early onset of Alzheimer’s Disease, a condition where clusters of amyloid beta (Aß) and tau proteins in the brain disrupt memory and processing functions of cells. The ratio of these proteins in the blood can help you determine if you have Alzheimer’s.
Considering an estimated 8.8 million Indians older than 60 have some form of dementia, a predictive blood test can help sift those with Alzheimer’s and help in better disease management.
WHY IS THE BLOOD MARKER TEST SIGNIFICANT?
Buoyed by these findings, which have been published in BioMed Central, a UK medical journal, the researchers have now applied for a grant from the Department of Biotechnology (DBT) for further research on this project. The study was supported by the Indian Council of Medical Research (ICMR) and the Department of Health Research (DHR). “The research could change therapy protocols if found to be successful in larger trials with a bigger sample size. The biggest gap in understanding Alzheimer’s is the lack of blood screening for biomarkers. We have good cerebrospinal fluid (CSF) biomarkers and imaging tests like PET and MRI as of now. But these can detect the disease only when symptoms have already shown up,” says Dr Vishnu VY, additional professor, Department of Neurology.The AIIMS blood test can detect these biomarkers at least 10 to 15 years before the disease becomes full-blown, enabling doctors to slow down its progress. “This can be done by treatments that can manage symptoms and a lifestyle correction in mid-adult life, involving diet, exercise and managing existing co-morbidities, if any. The idea is to preserve the patient’s level of function longer,” says Dr Vishnu.
Dr Saroj Kumar, assistant professor, Department of Biophysics, who worked with a team of researchers from Neurology and Geriatric departments, says, “There is no cure for Alzheimer’s and once detected, one can only provide symptomatic relief. But it develops over 15-20 years. So if we are able to detect signs 10 years before, we can slow down degeneration,” he says.
WHY EARLY LIFESTYLE CORRECTION MATTERS?
According to Dr (Prof) M. V. Padma Srivastava, Chairperson, Neurology, Paras Health, Gurugram, early diagnosis can be a game-changer. “For instance, treatments like cholinesterase inhibitors and memantine are more effective when administered early, as they can help maintain cognitive functions for a longer period. A nutrient-rich diet, particularly, one similar to the Mediterranean or MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) works because it emphasises the consumption of leafy greens, berries, nuts, olive oil, fish and whole grains while reducing intake of red meat, saturated fats, and sugars. These dietary patterns are linked to lower levels of amyloid plaques and neurofibrillary tangles in the brain. Physical exercises enhance blood flow to the brain, reduce inflammation, and promote neuroplasticity, which can help maintain cognitive abilities. A study by the Journal of Alzheimer’s Disease found that moderate to high physical activity was associated with a 40 per cent reduced risk of cognitive decline,” she adds.
WHY BLOOD BIOMARKERS ARE THE BEST FOR EARLY STAGE DETECTION?
Biomarkers are measurable biological changes that indicate if a disease is present or a person is at risk of developing a disease. While beta-amyloid and tau deposits are good biomarkers of Alzheimer’s, four more are linked to neurons and inflammation. “Excess amyloid beta proteins form senile plaques, which interrupt memory, thinking and planning abilities. Excess tau protein forms neurofibrillary tangles (NFTs) in the brain, which impact neurons. Our study found increased levels of amyloid beta and tau proteins in the blood plasma of Alzheimer’s and mild cognitive impairment patients,” explains Dr Kumar.
His team also found elevated levels of pro-inflammatory cytokines in Alzheimer’s and mild cognitive impaired patients, which are important for cell activation and immunity. Other markers like Synaptophysin (Syp) and Glial Fibrillary Acidic Protein (GFAP), which help neurons and cells message and coordinate with each other, can track cell degradation. “Syp was low in Alzheimer’s and mild cognitive impairment patients. GFAP had increased levels in plasma of Alzheimer’s and mild cognitive impairment patients.” In fact, GFAP can predict future conversion of mild cognitive impairment to dementia.
WHAT NEXT?
Dr Vishnu says the research is at a preliminary stage but his lab is now working on targetted drug delivery to affected cells.
