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Before the Sky Falls

News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences

Can we prepare for the coming surge in Alzheimer's disease? Lyketsos thinks so, if we fix every aspect of the disease.

Dr. Lyketsos
Dr. Constantine Lyketsos

It’s a border both fascinating and frustrating, the place where physical workings of the brain translate into human behavior. And it’s where neuropsychiatrist Constantine Lyketsos has made his research and clinical home for the last two decades. Lyketsos heads the Johns Hopkins Memory Center and with Peter Rabins co-directs its geriatric psychiatry and neuropsychiatry division. Lyketsos didn’t start the Center, but he’s shaped it into what’s likely this country’s primo site for dementia diagnosis and care, especially for Alzheimer ’s disease.

Research-wise, he has worked to show that dementia is more than losing thinking ability and memory; it goes hand in hand with depression, delusions and agitation. More recently, Lyketsos has suggested that prompt, aggressive therapy for depression and other non-memory symptoms may slow the fall into full-blown dementia. He’s presently testing that idea while fostering a deeper look into the biology. The latter’s especially crucial, given the huge number of baby boomers who will soon stretch psychiatry’s resources.

Q. Is the sky really falling with respect to Alzheimer’s disease (AD) and baby boomers? Are we doing anything?

A. It’s not falling yet but it’s going to. The dementia rate should start to rise in five years as the first boomers reach their 60s. In 10 years, it’ll near 13.5 million. Keep in mind our services are already stretched, the health care workforce is getting smaller and Medicare is generally reducing reimbursement. So Hopkins has a major priority: We plan to set up new sites between Washington and Baltimore—doubling our capacity for patient care in the next three years. We’ll also "grow" training programs for caregivers while developing very sensitive computerized memory tests to let us catch patients earlier in their illness and help us easily monitor them once it progresses. Of course, we want a cure.

Q. It all sounds terribly grim.

A. It is and it isn’t. Go study people living independently and you get a surprise. The majority of 90- to 100-year-olds are in their own homes! They’re doing OK. You just hear more about those with problems.

Q. Not to be an institutional pawn, but what’s so special about what we offer patients?

A. We’ve worked years to develop a model of treatment for dementia, a systematic approach that doesn’t let people slip through the cracks. We offer appropriate therapy, of course, including the recently approved Memantine, which works on a new principle of damping down the excitotoxicity that follows atypically stimulated neurons in the brain. But since nothing yet stops the progression, we also treat symptoms. The most troubling AD symptoms are psychiatric—depression, delusions—and because we’re psychiatrists, we address them well here. There’s also an unusual emphasis on patient support: We give driving assessments, assess in-home safety, make sure life has daily structure, see that basic food and activity needs are met. We help the caregivers. And we have a two-week program that lays a foundation for successful stays at institutions, when that comes. Soup to nuts.

Q. And research is ongoing as well?

A. Yes. We believe, for example, that depression and dementia are somehow related, and we are studying that. Specifically, we’re looking at cardiovascular disease as a possible link between the two. There’s also our Biomarkers Initiative—research based on the idea that AD is really several diseases, that different people slip into it by different paths. So we’re doing large epidemiological studies of people at risk. Using blood tests, imaging and cognitive testing, we’ll follow them for some time and hope some sort of marker appears that lets us make predictions.

Q. Anything else?

A. One of my postdocs believes she’s found a molecule in blood serum that reflects brain degeneration. And even more basic, two colleagues are exploring how an overactive immune system might influence buildup of the amyloid that’s AD’s hallmark.

For more information, please visit The Memory and Alzheimer's Treatment Center

Find other Hopkins Newsletter articles from past issues.