Hopeful Developments in Alzheimer’s Detection

Recently approved treatments for Alzheimer’s are providing a glimmer of hope for patients and their families, especially when the disease is identified early.

A study from Duke researchers, published on Wednesday, suggests an unexpected area that could assist in early detection: the nose.

Dr. Brad Goldstein, a physician at Duke Health and a professor at the Duke School of Medicine, is heading new initiatives to explore whether a nasal swab might be effective in detecting early signs of Alzheimer’s.

“I see various patients with nasal and sinus issues,” Goldstein explained. “My lab focuses on smell loss or olfactory dysfunction, and there’s a strong link between anosmia and neurodegenerative disorders like Alzheimer’s and Parkinson’s,” he added.

In collaboration with the Alzheimer’s Disease Research Center, established in 2021 with Duke and UNC, Goldstein has been investigating this connection.

“A few years ago, we wrote to the NIH, suggesting we explore the nose as a window into the nervous system to understand both smell loss and Alzheimer’s disease better,” Goldstein noted.

The concept is to regard the nose as “a window to the brain.”

“We revisited the idea of sampling the area at the back of the nose, where neural tissue and immune cells reside,” Goldstein shared. “Using a small endoscope and light, we collect a sample with a tiny brush.”

First, researchers numb the nose with a spray, then employ a small olfactory brush to gather tissue from the back of the nose.

Alzheimer’s develops gradually, characterized by the accumulation of abnormal proteins in the brain over years, culminating in memory loss and cognitive decline.

Early detection has proven challenging, as many conventional tests only reveal these proteins after significant damage has already occurred, and obtaining brain tissue from living patients is invasive.

The nasal swab procedure under investigation could present a more straightforward and less invasive option.

“Currently, most standard methods are somewhat invasive,” Goldstein explained. “For instance, a lumbar puncture is used to collect spinal fluid, which carries its own risks.”

While tests like amyloid PET scans are less invasive, their high costs limit their availability as standard procedures. Blood tests in use today typically identify markers that manifest only later in the disease’s progression.

“We’re examining neural and immune tissue specifically. We’re not focusing on substances that leak into the bloodstream,” the researcher clarified.

Alzheimer’s ranks as the sixth-leading cause of death in the United States. The financial burden of caring for Alzheimer’s patients is projected to exceed $380 billion in 2025, according to the Alzheimer’s Association.

Goldstein emphasized that while findings are preliminary and further research is necessary, “the potential impact on slowing disease progression for patients and families could be immense.”

Mary Umstead, a 60-year-old resident of Durham, was drawn to Goldstein’s study. Unfortunately, she knows firsthand the toll the disease can take.

Umstead lost her sister, Mariah, to Alzheimer’s at the age of 62.

“She was truly wonderful,” Umstead reminisced. “Warm, kind, genuine, and also sharp and funny.”

Her sister’s early symptoms were often dismissed as just ‘aging,’ but Umstead later recognized that Mariah was struggling long before her diagnosis.

“It began slowly, as it does for many of us with age—forgetting names or mixing them up,” Umstead remembered.

As Mariah’s condition progressed, she became more irritable, a typical symptom of neurodegenerative conditions.

“She ended up putting in 80-hour weeks, trying to manage tasks she had once handled easily,” Umstead said. “We always had to keep a close eye on her to ensure she was safe. Watching her lose her capabilities was heartbreaking.”

Umstead expressed her eagerness to participate in the study, feeling it was a way to assist other families facing the same challenges.

“If I could offer hours or days to anyone dealing with a loved one in this situation, I would,” she said.

She continued, “Now there are medications that, while they won’t cure the disease, can slow its progression. If you catch it sooner, perhaps you can save more of who that person is—their humor, their character, the aspects of them you cherish.”

Umstead fondly remembers Mariah as the big sister who could connect with everyone, even the smallest beings.

“Once, she found a hummingbird caught in a spider’s web and rescued it. It rested in her hand briefly before flying away. And she felt sorry for the spider, so she found a fly to give it,” Umstead recounted.

When sharing advice with other caregivers, Umstead emphasized, “It’s not a sprint; it’s a marathon.”

“Seek support and don’t hesitate to accept help when offered,” she advised.

As she cuddled with her sister’s beloved cat, Stormy, Umstead encouraged everyone to treasure the little moments.

“They say, ‘Stop and smell the roses,’ but really, stop and lick the ice cream! Reach out to a friend or tackle something on your bucket list. Don’t wait,” she urged. “We defer things, thinking time is on our side, but that’s never a guarantee.”