Written By Joseph Neighbor
Alzheimer's Disease is perhaps the most famous, least understood medical crisis facing our generation. Though only five million Americans suffer with it, the cost of care exceeds $230 billion a year, making Alzheimer's the single most expensive disease to treat. And that burden will grow exponentially in the near future. By 2050, the number afflicted will triple. The cost of care will triple, too.
Of the top 10 cause of death in the U.S., Alzheimer's Disease stands alone as the only one for which we have no cure, nor method of prevention. We don't even have a way to slow it down. Existing medications treat only symptoms, and there hasn't been a new drug approved by the FDA in a decade. The degeneration of neurons in the brain remains a mysterious process. We're running out of time to figure it out.
The Federal government recognizes this. After all, it's in their interest to find a solution: Medicaid and Medicare picks up roughly 70% of the total cost of care. The long-term solvency of those programs depends on a cure. Accordingly, in 2010, Congress unanimously passed, and the President signed into law, the National Alzheimer's Project Act, which aims to have a treatment for Alzheimer's by 2025. The NIH has doubled the amount of funds earmarked for research into the disease over the last two years, bringing the sum to nearly a billion dollars a year—an unprecedented increase.
There are reasons for optimism. Seldom has so much money and effort been directed toward solving a specific medical problem. No doubt this will lead to a better understanding of the disease, which will hopefully lead to more effective therapies. But it will also, presumably, lead to a more general understanding of the basic workings of memory and cognition. This begs the question: If researchers develop a drug to improve how the brain functions, could it be useful for healthy people? Might we unintentionally find a way to hotwire the mind? Could Alzheimer's research pave the way for the general cognition-enhancing pill so often depicted in science fiction?
After all, it's not unknown in the history of medicine for researchers to set out to solve one problem and accidently solve another. Viagra was originally intended to treat coronary disease. Modafinil—often cited as a magic cognitive-booster, a la Limitless—was designed for narcoleptics. That's why current laws reserve a good deal of leeway for physicians to prescribe medications for off-label uses. Basically, once a drug is FDA approved for one purpose, doctors can then use it for other things if they think it would be helpful, barring any studies demonstrating that particular off-label use is exceedingly dangerous.
So, legally, prescribing drugs off-label is fair game. This makes it possible, theoretically, for medication designed to treat memory and cognition in Alzheimer's patients to be prescribed to ordinary people who want a better, more efficient mind.
In fact, some researchers are testing what would happen if we did just that. A study at UC-Berkeley measured the effect of donepezil, the most common drug for treating Alzheimer's symptoms, on healthy people doing various visual learning tests. Donepezil works by fighting the enzyme in the brain that naturally breaks down acetylcholine, a neurotransmitter. Essentially, the thinking is that more acetylcholine in the cerebral cortex leads to better cognition.
Though the sample size of the study was limited, and the tests focused on very specific forms of cognition, the results were promising. According to Dr. Michael Silver, the primary investigator of the study, there's evidence that donepezil enhances visual perception, spatial attention, and some forms of perceptual learning.
In 2014, researchers at Boston Children's Hospital conducted a donepezil study on kids with amblyopia, a defect of the eye that impairs its ability to focus and take in visual information. In order for a child's brain to develop properly, it needs that visual information. The study found that donepezil chemically re-wired the brain to allow it to process visual stimuli better, as well as increase its neuroplasticity, so patients can learn faster.
That doesn't mean donepezil is a miracle cognitive booster. "If you could just increase your acetylcholine signaling and get better at perception, attention and learning, how come evolution hasn't figured that out yet? Why don't we just have more acetylcholine, all the time?" said Dr. Silver. "The big caveat is maybe you're worse at other things that aren't being measured."
Tinkering with the delicate chemical balance arrived at by tens of thousands of years of evolution is a dicey enterprise. It's something that should be pursued with caution. But donepezil is just one drug that happens to exist right now. Now that Alzheimer's is recognized as an exigent health crisis on the order of cancer and HIV, and research funding is setting new records both here and abroad, it's possible that a breakthrough era in medicine might be at hand. If we understand the brain well enough to slow or stop the process of neurodegeneration, maybe we can find a way to make the brain operate just plain better for the rest of us.
There will be protests. After all, the point is to develop a drug to treat a disease, not hotwire a healthy brain. From DIY bodyhackers and genetic manipulators to doping students and athletes, attempts at human augmentation are always confronted with thorny ethical questions such as what is cheating, who should have access to these enhancements, and, crucially, whether anyone should have them at all. Often, the discussion comes down to the precise difference between "therapy" and "enhancement."
Alzheimer's muddies those distinctions. Amyloid plaques and Tau tangles—the pathological hallmarks of the disease—can be observed 20 years before actual symptoms appear. Surely, a person showing those hallmarks should be entitled to medicine that could halt the disease's progression, regardless of whether it's actually impairing his or her life yet. If these therapies, used as a preventive measure, also happen to have ancillary benefits for cognition, memory or learning that allow such a person to excel at school or work, would we deem that an unfair advantage? Besides, if the drug is safe and boosts brainpower, why shouldn't we all take it?
A firm understanding of the inner workings of the brain continues to elude us. The implications of arriving at that understanding are unimaginable. Perhaps Alzheimer's Disease could provide the urgency, the direction and the money to propel us not only to its cure, but also to a better brain for humankind.
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