Food for Thought: “Forget Alzheimer’s”? – A Book Review

“Forget Alzheimer’s” is the title and the message of a book by German journalist Cornelia Stolze who is claiming to tell the “truth about a disease which isn’t one” (Cornelia Stolze, Vergiss Alzheimer. Die Wahrheit über eine Krankheit, die keine ist, Köln/Cologne 2011: Kiepenheuer & Witsch).

The book is strongly criticizing the handling of dementia, in particular Alzheimer’s disease (AD) in today’s medicine, pointing out the lack of adequate diagnostics and therapies and contrasting this sad reality with the often exaggerated promises of imminent breakthroughs by experts.

Stolze starts by explaining that to date, it is extremely difficult to diagnose Alzheimer’s disease. Most claims about new methods to confirm a diagnosis or, even better, to predict the onset have turned out to be false. She also points out that about 50 diseases and at least 150 medications may cause dementia symptoms. She concludes that most physicians are overextended to differentiate and often too early and too easily put the patient down as having Alzheimer’s, thereby impeding a causal treatment and condemning the patient to unnecessary mental derangement.

Examples are cognitive impairments associated with dehydration and depression, but also a variety of drugs, in particular, if patients take cocktails of drugs prescribed by different specialists who neglected potential interactions and side effects. Complications during surgery or anesthesia, too, can cause dementia symptoms. Stolze summarizes that about 75% of all dementia diagnoses are false.

She also points out that most medications on the market for the treatment of AD are ineffective, do not provide causal therapy and may at best slow down disease progression for a limited period of time.

These chapters are a strength of the book and can be read as a roll call to relatives, patient advocacy groups and the health care system in general to raise awareness about the various forms of dementia and to demand better diagnosis and better drugs.

Stolze then tells the 1970s story of how Alzheimer’s disease was put on the agenda of the then newly founded US National Institute on Aging (NIA). Back then, little was known about Alzheimer’s disease, but using a fancy name describing a threatening disease was way more efficient in raising awareness and money from governments and private sponsors than by talking in general terms about senility or dementia.

Subsequently, Stolze’s story gets astray as she tries to convince the reader that AD has been and still is a mere invention by the medical industry, and that every scientific description of the disease – whether in terms of pathology, biochemistry or cellular and molecular biology – is full of errors, inconsistencies and contradictions.

The author makes no efforts to go into the details to substantiate this claim. As an example, Stolze writes that plaques – long viewed as the hallmarks of AD – can be found in the brains of mentally wide awake elderly as well. She ignores that this fact has puzzled researchers since long and that there is an explanation to it already: plaques in the brain of healthy people do have a different molecular composition than those in people with AD, in which they predominantly consist of a certain, very toxic variant of the A beta peptide. The details have been elucidated by researchers from the German biotech company Probiodrug, with the first publications appearing in the late 1990s. The hypothesis meanwhile has been confirmed independently by various research groups around the world and a first drug addressing the underlying mechanism already has reached clinical stage.

Moreover, Stolze completely ignores that there are inherited forms of AD such as Familial Alzheimer’s disease (FAD) or Early Onset Familial Alzheimer’s disease (EOFAD), uncommon forms of Alzheimer’s disease which usually strike quite early in life. They are inherited in an autosomal dominant fashion and the genes involved have been characterized years ago. Moreover, studies in these inherited forms have revealed further details of the pathophysiological mechanisms involved in AD in general.

Further parts of the book deal with selected German Alzheimer specialists and their connections to industry and politics, raising questions about conflict of interest disclosures. This is an ongoing debate in medicine in general, and Stolze seems to share the widely held beliefs in Germany that a researcher or medical doctor, who files for a patent, already has crossed the line to unethical behavior.

Most regrettable about the book is that it shakes the confidence in medicine of patients, relatives and people involved in the care of dementia patients without providing any valuable guidance what to do and whom to trust if a loved one is showing signs of confusion, disorientation or loss of memory.