World Alzheimer’s Day

On a blustery October morning, three years ago, Allen Wilson walked into the kitchen of the beachside Surfers Paradise apartment he shared with his partner, Miriam Taylor*[1]. With fondness he watched as she stood at the sink, slicing pears for their breakfast.He waited for her enthusiastic, “Happy Birthday”. Despite his age, he couldn’t help but feel some vestigial childlike anticipation for the card, the gift and the cake.

But there was only silence.

Not one to make a fuss, Allen, who had just turned 75, sat down to their usual breakfast of Weet-Bix and chopped fruit. The day consisted of a swim in the ocean, a walk on the beach and running errands in the afternoon. At no stage did Miriam, who had previously made a big fuss about his birthdays, acknowledge that the day was special.

A simple slip of the mind? Perhaps. But as they prepared for bed Allen couldn’t shake the sense of foreboding that something more sinister was at play. Lately he had been picking up subtle changes in his partner’s behaviour.

Over the following months there were more memory lapses. He persuaded Miriam, who was 65 at the time to visit their GP, Dr Mark Jeffery, a Gold Coast-based clinician. A CT scan of Miriam’s head showed some classical features – hippocampal atrophy, dilation of the Sylvian fissures and shrinkage of the temporal lobes – that were consistent with Alzheimer’s disease. A subsequent visit to a geriatrician confirmed the dreaded diagnosis.

Alzheimer’s disease – first described by German physician Alois Alzheimer in 1906 – is a neurodegenerative brain disorder of unknown aetiology that results in memory impairment, increased difficulty in performing day-to-day tasks, and behavioural and psychological changes. As the disease progresses sufferers tend to become increasingly confused, disengaged and irritable.

Dementia, of which Alzheimer’s disease comprises about 70 per cent of cases[1], is the second leading underlying cause of death in Australia[2]. It is estimated to affect more than 420,000 Australians, with 250 people diagnosed with it every day[3]. The average life expectancy after symptoms begin is eight years^[4], with sufferers usually succumbing to complications of advanced debilitation, such as infection and malnutrition.

Multiple treatments, including antioxidant therapy, dietary supplementation, hormone replacement, and cognitive rehabilitation have been tried, but none have been proven to delay the eventual progression of the disease.

 Many specialists recommend an initial trial of cholinesterase inhibitor medication for newly diagnosed patients. The drug reduces breakdown of the neurotransmitter acetylcholine thereby partly compensating for the loss of cholinergic neurons in the brain.

This class of medication has shown a small but measurable improvement in cognition, neuropsychiatric symptoms and activities of daily living in up to 50 per cent of patients with mild to moderate Alzheimer’s dementia[5]. They do not, however, appear to affect the progression of disability and they can be associated with significant side-effects.   

When Miriam learned about these possible side-effects, she refused to take the medications. Instead, with Allen’s support, she went to a holistic wellness centre and undertook sessions of hyperbaric oxygen therapy. She also took supplements to help remove heavy metal contaminants from her system and had all her amalgam tooth fillings removed.

Despite these measures there was no noticeable improvement in her dementia and Dr Jeffery recommended she try another alternative treatment: red-light therapy.

It has been known for some time that controlled exposure to red and near-infrared light can improve wound healing and reduce inflammation through a process known as photobiomodulation – the term for light’s ability to modulate key biological processes at a cellular or genetic level[6]. Some studies have shown it may also decrease and possibly even reverse the level of damage in animal models for Alzheimer’s disease[7]. 

To date, almost all studies on the effects of near-infrared light for Alzheimer’s disease have been performed on animals. The only human trial that has been reported in a peer-reviewed journal is a small study where five volunteers with Alzheimer’s-consistent dementia received daily light therapy to their head. All reported an improvement in their symptoms[8].

Feeling she had nothing to lose, Miriam purchased a mobile infrared light device produced and marketed by Vielight, a company based in Canada. This device delivers 810 nm wavelength infrared light via something that looks like a futuristic cross between a light bicycle helmet and a cumbersome set of headphones.

Miriam has used this device for 20 minutes per day, six days a week, for the past 18 months. “She is doing well. Her short-term memory loss is stable,” said Allen, who believes it is making a difference.

Vielight founder Lew Lim, who has a background in engineering and medical neuroscience, says it’s encouraging that some Alzheimer’s sufferers have observed positive effects, though he accepts more research is needed. “We are mobilising a gold-standard clinical trial involving a few hundred participants assessed in North American medical research institutions,” he said.

But waiting is not an option for some. Retired cabinetmaker David Ryder, 69, who has been using red-light therapy for his own Parkinson’s disease, encouraged his wife, Faye* [9], 65, to give it a try after she was diagnosed in 2016 as having Alzheimer’s type dementia.

After two months of using red-light therapy Ryder says he noticed improvements in his wife’s condition. In addition to red-light therapy Faye has implemented dietary changes and vitamin supplementation, and Ryder believes this combination has maintained the improvements in his wife’s dementia.     

Dr Daniel Johnstone, 36, medical scientist and lecturer at the University of Sydney’s medical research centre the Bosch Institute, has been involved in a number of animal experiments on the use of photobiomodulation for Alzheimer’s disease and believes red and near-infrared light therapy can also provide benefit in humans. 

“If you can get the correct wavelength and intensity of light to vulnerable cells then you can afford them some level of protection against degeneration, whatever the underlying cause,” he said.

His supervisor at the Bosch Institute, executive director Professor Jonathan Stone, says there is growing evidence that photobiomodulation can potentially help in the cognitive aspects of Alzheimer’s disease.

“When sufficient silent microbleeds occur, the individual begins to experience some noticeable loss of function,” said Prof Stone. “But we can delay this breakdown by things that help our heart and blood vessels, such as controlling our blood pressure and diabetes, and keeping our cholesterol down, as well as life-style measures including exercise, controlling our weight, eating a vegetable-rich diet, and interventions like red-light therapy.”

Dr Ann Liebert, director of photomolecular research at the Australasian Research Institute and senior lecturer at the University of Sydney’s department of medicine, noticed that patients in her physiotherapy practice who had been treated with laser before major surgery generally recovered more rapidly.

As a result, Dr Liebert began to administer laser to some of her patients with cognitive decline. She says four out of five of her patients who have Alzheimer’s disease have experienced benefits. This experience has prompted Dr Liebert, in collaboration with geriatrician Dr Gregory Bennett, to apply for ethics approval to begin a clinical trial investigating the benefits of light therapy.

Dr Bennett has been administering laser to some of his dementia patients since 2015 and has also noticed some positive results. He advises, however, that randomised, blinded, controlled trials are needed. 

Tips for delaying age-related dementia

1. Keep blood pressure under control
2. Keep cholesterol down to prevent atherosclerosis
3. Eat a vegetable-rich diet
4. Maintain a healthy body weight
5. Exercise daily
6. If you have diabetes, keep it under control
7. Use such alternative treatments like red-light therapy as an adjunction to your doctor’s treatment, not instead of it
8.  

Top tips to fight Alzheimer’s provided by Professor Jonathan Stone of the Bosch Institute.

For details about World Alzheimer’s Day go to: https://www.alz.org/about/awareness-initiatives/world-alzheimers-day

Feature image: Max Burr from Tasmania, who has Parkinson’s, wearing his home-made light device which he believes has helped his condition.

[1] https://www.dementia.org.au/about-dementia/types-of-dementia/alzheimers-disease

[2] https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death

[3] https://www.dementia.org.au/statistics

[4] https://www.alz.org/au/dementia-alzheimers-australia.asp

[5] https://www.ncbi.nlm.nih.gov/pubmed/12611743

[6] https://www.ncbi.nlm.nih.gov/pubmed/27943458

[7] https://www.ncbi.nlm.nih.gov/pubmed/24387311

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568598/

[9] names have been changed to protect confidentiality