MEMORY CARE
LATE Dementia Research Brings T
hose in memory care are well aware of a troubling problem: For some people, existing Alzheimer’s disease
interventions or clinical trials just don’t work. An international research group has
discovered one reason why: Some of these people don’t have Alzheimer’s. While it’s known that many types of
neurodegenerative diseases are referred to as “dementia,” many older people were assumed to have Alzheimer’s, because their outward symptoms were like those of Alzheimer’s. But within their brains, it was diff erent.
They didn’t show the usual buildup of beta-amyloid or tau characteristic of Alz- heimer’s. Instead, their brains showed that another type of protein had caused dam- age: TDP-43. The group named this dementia lim-
bic-predominant age-related TDP-43 en- cephalopathy, or LATE, and published the news in the April 30 issue of the journal Brain. They estimate LATE may account for 17 percent of all cases of dementia. This protein is also implicated in amy-
otrophic lateral sclerosis—ALS or Lou Gehrig’s disease, and in frontotemporal lobar degeneration. Yet LATE may occur far more often that these other diseases. LATE tends to occur in people older than
80, and it may progress more slowly than Alzheimer’s. It can also occur in conjunc- tion with Alzheimer’s—and in those cases, the progression may happen much faster. This is one of a series of breakthroughs in Alzheimer’s and dementia research involving the Sanders-Brown Center on Aging at the University of Kentucky. One of these was the discovery that changes in the brain occurred before a person showed outward symptoms.
Dr. Peter Nelson is one of the co-chair-
persons of the working group. Director of the Neuropathology Division of the Pathol- ogy Department at the University of Ken- tucky, he began exploring dementia and its causes in part because his grandmother died of Alzheimer’s. Here, he addresses some of the implications of this discovery for senior living leaders.
Knowing is key to therapies “It’s always good to know what you have,” Dr. Nelson says. The information might lead to diff erent types of interventions or treatments—even diff erent needs for ser- vices and environments among memory care residences. “The clinical syndrome is one thing, but
the diseases that underlie it can be more than one thing,” he says. “There’s a big shift in upcoming years
as we learn how to treat these different types—how to tailor the therapies. It’s go- ing to change, ultimately, how we treat these diseases.”
The biomarker gap The LATE discovery also carries the impli- cation that there could be many diff erent types of dementia—with diverse causes and results. To begin to track and diagnose these will take the development of more biomarkers, so that types of dementia could be diagnosed through a blood test or a neu- roimaging scan. Family history isn’t too helpful in diagno-
ses, either. Because LATE occurs so late in life, many of our forebears would have died before it had a chance to manifest. Complicating the picture is the scenario
of mixed disease, such as having both LATE and Alzheimer’s. Biomarkers would allow
MAY/JUNE 2019
ARGENTUM.ORG 45
Change Agent Profi le
Peter Nelson, PhD Director,
Neuropathology Division
University of Kentucky
doctors to determine how many diff erent types, and which types, a person has, so treatment could be most eff ective. For now, LATE can be diagnosed only after death. “It would be good to get insight in life to things that currently can be studied only in autopsy,” Dr. Nelson says.
The one thing to do now Dr. Nelson’s top message: Please participate or encourage participation in clinical trials. “There’s sometimes a fallacy that only
people who are cognitively impaired should take part in clinical trials,” he says. “We need people who are cognitively OK, because a lot of new drugs that might be tried for LATE and Alzheimer’s will be preventive strategies. We want to make people who are impaired better, but also study the process of preventing this in the fi rst place.” Clinical trials are a double win, he says: If
there is any disease, a volunteer could fi nd out early and begin therapies earlier. “You could get a top-notch neurological workup and do something for the betterment of the world at the same time.”
New Perspective on Memory Care By Sara Wildberger
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