COMMENTARY

Balancing the Buzz

Priscilla Scherer, RN

Disclosures

August 14, 2002

Introduction

This is the first of a series of "From the Editor" columns for the Medscape Neurology & Neurosurgery site. These columns will be my way of highlighting old and new features on the site and discussing the issues in the news and on Medscape that may be of particular interest to you. With coverage from the international Alzheimer's conference about to post, I want to use this first column to take a look at conference news and buzz and at how we attempt to balance the buzz.

After 15 or so years of covering various medical conferences, I am still struck by the disconnect between what happens at meetings and what does (and does not) make the news at home. Much important research was presented at the Alzheimer's meeting, yet relatively little made it into our newspapers. It being medicine, I'm not sure whether that's bad or good, but I'm leaning towards good.

At the World Alzheimer's Congress 2 years ago, an enormous flurry of excitement whirled around a vaccine that not only slowed progression but actually seemed to reverse the course of disease, at least in monkeys, and this vaccine was in preliminary testing in humans. A-beta42 was suddenly sexy, even though it had been in development for a number of years; indeed, reports of the vaccine even made the nightly news and people started lining up to participate in the clinical trials. After years of trying to be optimistic about drugs that, at best, delayed the inevitable, who wouldn't be excited about this apparent leap forward? Two years later, we have learned that in humans, this particular version of the compound is associated with serious brain inflammation, and trials using that compound have been stopped. Don't get me wrong. This was an important story but by no means the only story at that meeting.

The eighth and most recent international Alzheimer's conference took place about 3 weeks ago, in Stockholm, Sweden. With the number of those afflicted expected to triple by 2050 and thousands of important research presentations on diagnosis, treatment, risk factors, and prevention, the meeting passed with remarkably little notice in the popular press. The biggest buzz at the meeting itself revolved around techniques that "light up" amyloid plaques in positron emission tomography scans of the brain.

As a medical editor, part of my job is to look at the buzz and separate the hype from the reality before deciding how and how much to cover the new information. I'm fortunate to have a number of "friends-of-Medscape" and editorial advisors to help measure and parse such reports.

I polled several Alzheimer's specialists about the buzz and asked their opinions about what they considered to be the most important research presented at the conference. Their answers were interesting and surprising -- primarily because even despite the fact that each works in a different setting (academic, clinical, bench science, and radiologic), they did all agree that the neuroimaging data ("...to see amyloid in the living brain...") is exciting, not the least because scientists from centers in Europe, Japan, and the United States are all working on it, on their own and collaboratively. But likewise important were numerous studies involving the search for more Alzheimer's susceptibility genes, other reliable biomarkers of disease potential, and the effects of vascular dementia and other risk factors on the development of Alzheimer's disease.

While noting that the uses of various biomarkers for Alzheimer's are years away from being implemented, John Morris, Professor of Neurology at Washington University in St. Louis, Missouri, is excited by the possibility that Alzheimer's lesions could be imaged even before the appearance of dementia. Morris was one of the first neuroscientists to take a close look at patients with mild cognitive impairment and continues to track the factors that predict whether these patients will or will not progress to dementia. "Should effective disease-modifying therapies also be developed, the ability to detect preclinical stages would allow the initiation of therapy in individuals at very high risk for Alzheimer's but before the occurrence of dementia," Morris said.

Philip Scheltens, Professor of Neurology at Vrije Universiteit, Amsterdam, The Netherlands, and a leader in using imaging techniques to differentiate patients with dementia, agrees but points out that such presymptomatic diagnosis is a long way off, primarily because the ligands used for the scanning still bind nonspecifically.

To illustrate, Keith Edwards, Director of the Alzheimer's Diagnostic and Treatment Center in Bennington, Vermont, added this caveat. "It is clear from the Nuns' study that many (about 20%) normal adults over age 80 with no dementia have many amyloid plaques on autopsy." In his opinion, "The tau imaging is more promising than amyloid, as tau (the tangles) is better correlated with disease." Edwards also noted the importance of studies showing the influence of vascular risk factors on the expression of Alzheimer's disease -- factors that are currently treatable and even preventable, if seemingly pedestrian.

If you haven't seen it yet, please take a look at the news from the 8th International Congress on Alzheimer's Disease and Related Disorders. Within the next couple of weeks, we will post in-depth coverage of the meeting by 3 other authorities active in the field -- Gunhild Waldemar, from Copenhagen University Hospital, Copenhagen, Denmark; Norman Relkin, of the Weill-Cornell Medical College, New York, NY; and Robert Green, of Boston University School of Medicine, Boston, Massachusetts. (Included in these reviews is a report of newer versions of and alternatives to the previously mentioned anti-amyloid immunization approach, and important studies that are helping to differentiate the various non-Alzheimer's dementias.) These thoughtful discussions of the key presentations will provide even more balance and perspective to the buzz from the meeting.

Did you attend the Alzheimer's conference? What do you think about the difference between popular hype and reality with regard to science? I welcome your comments, suggestions, and criticisms. What would you like to see on the Medscape Neurology & Neurosurgery site? Please email your ideas to me at neuroeditor@webmd.net. (If your concern is technical, however, please contact our customer support staff at medscapecustomersupport@webmd.net).

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