Have drugs to prevent Alzheimer’s disease, requires “future” patients who are unaware of it. And it is complicated.

Dmitroza/epictura

Published the 29.12.2017 at 15h21

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Keywords :

disease alzheimerRecherche volontairesNouveaux drugs

The best-known example is that of aspirin. This medicine for more than a century has exercised a fascination from the doctors, before one becomes aware of the real danger of its indiscriminate use. But in the fifties, following the discovery of the preventive effect of myocardial infarction, using its ability to dilute the blood and the hypothesis that it might also prevent the polyps, so the bowel cancer, has raised the question of the use widely among the people healthy, for a large-scale prevention. In front of the lifted shield – already in the name of ethics – the American doctors have had a reaction to brave through to a huge study to find out. The results were published at the end of 20 years. Unfortunately the negative.

But the desire of those who care for them, those who provide it, remains intact. And the disease, which frightens most French people, is for the first rank. Before the “epidemic” of Alzheimer’s disease, due to the decline in life expectancy and especially the lack of a truly effective treatment, the question arises as to treat those who ” may ” be at risk of Alzheimer’s.

Who is at risk for Alzheimer’s ?

This is where the issue becomes thorny.
The research may be keen to better understand this scourge, there are few certainties. The genetic trail is serious. We know, for example, that there is a hereditary form is very rare – 2% of cases – but there is no simple test to find out whether the threat is real and even serious.
Yet those who are trying to develop treatments deplore the fact that the tests relate only to patients at a stage where no further improvement can be highlighted. Clearly, the development of a drug goes through a first step in people healthy, only to highlight potential side effects independent of the disease, and then after a patients diagnosed, those in which we know that it is probably already too late.
This is why researchers from The Pitie Salpetriere in Paris, one of the best centre in the world of research against this disease, is launching a call for a trial which is expected to begin in early 2018. The originality of this announcement is that these doctors are looking for people in good health to prove the efficiency of early of these new treatments.

In good health but at risk of disease

It is necessary to imagine the fingering of these doctors, led by professor Bruno Dubois, one of the neurologists French who is most familiar with this disease, to recruit people to whom we must announce that the probability of suffering from this disease is important. Yet, it is today technically possible. The modern medicine knows how to identify the threat and we can be surprised by the reluctance of institutions but also of public opinion in the face of an inevitable phenomenon. Because the issue may seem simple. Either the person will not develop an Alzheimer’s and the risks are only those of the drug – well controlled – she develops the disease, but later, or never, if this new treatment is effective. On the simple logical reasoning, we could estimate that the trial will take place and soon… In practice this is not so easy to find people who are at risk of developing the disease in 10 to 15 years, because it is this period that is most interesting to prove the effectiveness of the treatments.
According to professor Philippe Amouyel of Lille, another great specialist of this disease, American researchers have undertaken studies on 5000 members of a family who has the hereditary form to find those who are at maximum risk. But it is a very isolated case. The issue what are the 98% of other forms, and the techniques of selection are not simple :a lumbar puncture, which is not a review particularly pleasant or scan particular (and expensive) that allows to put in evidence of plaques in the brain. Professor Dubois says his research ” volunteers with three criteria : have at least 60 years old, live in the Île-de-France and, without being ill, have a complaint of memory problems “
Rest after the real problem of living in full form with such a sword of Damocles hanging over his brain.

The example of Huntington’s Chorea

The medicine knows this dilemma well with Huntington’s disease.
Even if there is no disease friendly, with Huntington’s disease, it touches the bottom of the horror of a medical diagnosis. Abnormal movements and mental deterioration ?
Suffer from Huntington disease, it is suffering from a rare disease, inherited as it was formerly known as the “dance of st. vitus” because of uncontrolled movements that causes the degeneration of the brain. Movements weird, but also deterioration in intellectual progressive. First, irritability, or depression, then little by little, a total disappearance of relations with the outside world. Even if the specialists did not like the comparison, it is difficult not to think of Alzheimer’s disease. Of course the reasons are different, but the result is often the same. Except that in the case of Huntington’s chorea, are often young adult – 30, 40 years – that are affected. With, this is where the disease is particularly horrible, a transmission family, which makes this incurable disease a lottery unbearable. Because we found out where was the fault on the chromosomes. Which, in the absence of offer a treatment, makes screening possible. So imagine the terrible choice in a family where there is a case of this disease. Either ignore what tomorrow will bring, or know that we will be inexorably reached… or to be reassured.

The solution in this debate, more personal than ethics, is to provide clearly the items of the choice. You can rely on the intelligence of the man to make the right decision, condition, repeat-the benefit of full information.