Charlotte Teunissen: ‘We want to detect Alzheimer’s earlier’

What exactly is Alzheimer’s?

“Alzheimer’s is a disease of the nervous system. It is the most common form of dementia, in which forgetfulness plays an important role. Among other things, the short-term memory for facts is affected. The spatial memory also often no longer does what it did: people with Alzheimer’s can For example, they often do not find their house or bathroom anymore. What songs they used to love or the work they had, they often remember at the beginning. But what they ate that morning…? As the disease progresses, often behavioral changes such as anxiety and fear. The bad thing is: it’s getting worse and there’s nothing you can do about it. Not yet.”

What do we need to know to be able to do something about it?

“For that, we first need to have a picture of what exactly is happening in the brain. It seems that certain proteins in the brain start to clump together in Alzheimer’s disease. All kinds of processes derail because of this clotting, after which the nerve cells eventually die.”

How can someone know if this is the case with him or her?

“We have been measuring this for several years, when Alzheimer’s is suspected, by taking some cerebrospinal fluid via an epidural. In that cerebrospinal fluid we see an altered level of the protein ‘amyloid’ and of the protein ‘tau’ in people with Alzheimer’s. we have now developed at the VUmc is a test with which you can also see the changes in one of those proteins in the blood.”

So just like you measure blood values ​​to see if you have diabetes, will you soon measure blood values ​​at the doctor to see if you have Alzheimer’s?

“After which you can still be referred to the specialist, yes, for more extensive research. The test is still in the research phase, but we want to go there in the future. The good thing is that you could be there early in this way .”

And the sooner you get there…

Ideally, the more you can do. The protein changes in the brain start years before people with memory complaints end up at the doctor. Due to the harmful effect of the altered proteins, brain cells die. That process is irreversible: you never get those cells more back. The sooner you solve the protein problem, the better.”

What could be the solution?

“Large-scale drug studies have been underway for some time now. One drug intervenes in the formation of amyloid clumps. Others tackle the formation of tau clumps.”

The research into Biogen’s drug aducanumab, which addresses this issue, has been halted because it did not work well. It’s not the first drug to fail. What now?

“First of all, we must not lose heart, because Alzheimer’s is a terrible disease. So we now have to work even harder to solve it. In any case, we can learn a lot from the failed studies. , is of course the question on everyone’s mind. When exactly do these clumps, or plaques, appear? Perhaps the plaques are an end-stage of the disease. That may mean that we have to intervene in the disease process earlier. To make it even more complicated: the clumping of amyloid is only part of the disease process.We may need to combine several drugs to stop the disease.could there be an effect if we combine anti-tau therapy, anti-inflammatory therapy and anti-amyloid formation to apply?”

There are scientists who say that the amyloid theory is too simple for a complex disease like Alzheimer’s. And that’s why the drugs don’t work. What do you think about this?

“Of course, amyloid accumulation alone does not explain the disease. All kinds of other processes are involved, such as inflammatory reactions in the brain. But there is convincing evidence for a role of amyloid in Alzheimer’s, although we do not yet know exactly what role it plays. has and what the cause of this disease is. As researchers we look more broadly than just at amyloid. The only problem is that the brain is a complex organ, in which we can only do very limited research. You simply cannot reach a piece of tissue living patients.”

Suppose you can take that test at any time: do you really want to know that you will get Alzheimer’s in a few years’ time?

“We will certainly not use the test in this way, as long as there is no medicine. If you have nothing to do against it, it is not smart to test very large groups of people. If the result is positive, it causes a lot of stress “In addition, the results say nothing about when the symptoms come. It may just as well be that your memory functions fine for years to come, even if there are already protein changes going on.”

But wouldn’t such a rash motivate people to live healthier?

“That is a good question for the future. Because research shows that relaxation, exercise, eating less fat and more vegetables can keep the brain healthy for longer. We are already seeing in the Western world that the number of people with Alzheimer’s is increasing less strongly than you do. would expect based on the aging population, possibly because they have started to live healthier.”

You know up close what this disease is like.

“One of my best friends has Alzheimer’s – she’s only 48. It has given me a completely different view of my work. At first the disease mainly consisted of blood values ​​and brain fluid for me. Now I see every day how disruptive Alzheimer’s is. My girlfriend is now a mother to her teenagers in a different way. It’s hard when your mother forgets that you were out with your friends this afternoon. When she can’t cook for you anymore, when she enjoyed it so much.”

Does it motivate you extra in your work?

“Certainly! I just hope that those studies progress enough, so that she can also benefit from the treatment. But I also do it for the people after us. And for their carers. It is also very tough for them; you run your own life and also have to take care of the other continuously. It is not for nothing that one in five informal carers suffers from burnout complaints. But luckily my friend, her family and I can also laugh about it now and then. If that is no longer possible, life is going to be very hard.”

Charlotte Teunissen (47) is head of the Neurochemical Laboratory at the Alzheimer Center and professor of neurochemistry at the Amsterdam University Medical Center – the first woman to hold this chair in Europe. Teunissen is responsible for various biobanks at Amsterdam UMC, which play an important role in neurological research. Her research focuses on looking for substances in cerebrospinal fluid and blood that can detect diseases. In addition to her research into Alzheimer’s disease, Teunissen also conducts research into other brain disorders.

This article originally appeared in the July/August 2019 issue of Plus Magazine. Not yet a Plus Magazine subscriber? Becoming a subscriber is done in no time!