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Brain Docs Debate Memory Drugs

Thursday, March 05, 2009

It's a truism for most of us that if you live long enough, your mind starts to go. But only recently have neurologists begun to understand how memory loss works. Much of this knowledge has emerged while studying Alzheimer's Disease leading some researchers to wonder whether they should also be working on treatments for what is basically ‘normal aging’ and not just a condition that’s more clearly a ‘disease.’ WNYC’s Fred Mogul listened in to a recent debate among researchers and others about where these lines should be drawn.

REPORTER: Inside a shiny steel canister the size of a large trash can, a sedated mouse is letting us look at his brain. We can’t see him lying there, but he’s hooked up to an M.R.I. that’s hooked up to a computer. Dr. Scott Small points on the monitor to the small area of the brain called the hippocampus.

SMALL: It’s deep in the temporal lobes, a little bit off the surface of the brain. And, actually, in mice it’s located a little more superficially; in humans, it’s little deeper.

REPORTER: Hippocampus means “seahorse” in Latin – which is roughly the shape of this area of the brain.

SMALL: So, you can see, here’s the tail of the seahorse. And it sort of skirts around like this. It’s this particular part of the hippocampus that seems to be most affected by Alzheimer’s in the earliest stage of the disease.

REPORTER: Only in recent years have Dr. Small and other researchers begun teasing apart the roles played by different regions within the hippocampus

SMALL: And what we’re finding is that a neighboring area seems to be targeted first and foremost by the normal aging process.

REPORTER: Which, early on, looks pretty much the same as Alzheimer’s Disease, in its initial stages.

SMALL: So, we can begin to really dissociate the normal wear and tear in the aging process, and how it contributes to memory decline, versus the earliest stages of Alzheimer’s Disease.

REPORTER: In a published paper last year, Dr. Small – who’s a neurologist at Columbia University Medical Center -- reported that exercise seemed to help keep the normal memory part of the hippocampus in good shape. It’s not clear why, but one theory is that exercise helps keep glucose levels from creeping up. The finding has motivated Dr. Small not only to further investigate the effects of exercise on the hippocampus, but also to think about

SMALL: Developing pharmacological agents to stave off normal age-related memory decline.

REPORTER: In other words: trying to find memory-improving drugs.

SMALL: We’re now living longer, and would like to stay cognitively engaged longer. So, more and more people in their seventies and eighties feel that mild forgetfulness, even though it’s mild, is disrupting their lives. And so I think it’s a little bit quick and moralizing to tell these people that we should not take their concerns seriously.

REPORTER: Last week, Dr. Small participated in an online debate about the ethics and feasibility of developing drugs for memory loss. He told fellow panelists: for deteriorating vision, we give people a treatment called “eyeglasses,” so why not come up with a treatment for deteriorating memory? Dr. Wes Ashford has his doubts.

ASHFORD: I think this is a myth that you can somehow take a drug and do better. I think you have to be really careful and look at a great deal of data to determine that.

REPORTER: Dr. Ashford, a Senior Research Scientist in psychiatry at Stanford University,

was the strongest skeptic of what Dr. Small and others are calling “cognitive enhancement.” Dr. Ashford likened efforts to improve memory with medication to the way his long-ago college roommates crammed for tests by taking Dexedrine and Benzedrine. Dr. Ashford didn’t say it’s morally wrong to seek newer, better memory drugs, but he hinted that the quest is misguided and premature: Premature, because researchers are only just beginning to understand the chemistry and genetics of aging and memory. And misguided, because doctors should focus on pathologies that cause the body to function improperly..

ASHFORD: I think you look at the problems that cause functional impairment, that this is really where medicine belongs doing its work. We really need to see aging in terms of what it’s particular process is and given understanding that process then going on further what can happen

REPORTER: Stanford law professor Hank Greely wrote a controversial piece last year in the journal Nature. He and his co-authors supported most uses of “cognitive enhancement” drugs, such as Ritalin, to improve work and study. Greely’s few misgivings are about safety and whether people are working with their doctors and about fairness and whether all people are getting access to such drugs or feeling obliged, or even coerced, to use them. Another consideration is setting priorities.

GREELY: Will this lead to less attention being paid to Alzheimer’s Disease? I think that’s a real concern.

REPORTER: The race is well under-way for drug companies to do for normal memory loss what they’ve been doing for wrinkles and impotence. Dr. Small estimates he spends about two-thirds of his time on Alzheimer’s Disease and one-third on normal memory loss. He says treating Alzheimer’s patients – but not being able to do much for them -- is what keeps him in the lab and at his computer on weekends, looking for a cure. But at the same time, he’s open to exploring the effects of normal aging on the brain -- and to finding “pharmaceutical agents” that help preserve memory.

Related Links

Alzheimer's Research Forum
Alzheimer's Fact Sheet
Alzheimer's Stats in the U.S.

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