Opinion | Alzheimer’s : From care to cure!

“We need a healthcare infrastructure that views cognitive health as a vital sign, just as important as blood pressure or heart rate. By the time a patient forgets the name of his or her child, the molecular war has been raging for decades. We must learn to intervene while the embers are still flickering, rather than waiting for the entire house to be engulfed in flames”.

Whenever I hear of an elderly person losing memory, my mind leans toward Alzheimer’s disease or FTD—not because I am a clinician, but because my mother lives with Alzheimer’s. It is a progressive neurodegenerative disease with no cure, and all I can read is the harmful buildup of misfolded proteins, like beta-amyloid and tau, in the brain. These misfolded proteins ultimately trigger the cognitive decline and behavioral changes in affected individuals.

The earliest and most predominant sign of cognitive decline is often recent memory loss, a symptom that families, by and large, dismiss as a normal part of ageing rather than recognizing it as a possible sign of dementia. As a result, they often do not approach the appropriate medical professional at an early stage. When dementia progresses and the affected individual begins to exhibit behavioral changes, the family finally becomes aware of the seriousness of the condition—but by then, valuable time has already been lost.

It would be unfair to blame families or label them as careless, as awareness about dementia remains only nominal in our society. Unlike conditions such as polio, diabetes, or hypertension—where public sensitization campaigns have been widespread—dementia continues to be poorly understood. Most people are unaware of its early signs and the importance of seeking timely medical intervention. Tragically, these families often face social backlash and are criticized for neglecting their elders, despite having acted out of ignorance rather than indifference.

It is therefore imperative to raise public awareness about the early symptoms of dementia. Timely recognition and appropriate medical intervention can, at the very least; slow the progression of the disease—and in certain cases, like thyroid-related dementia or depression-related dementia (Pseudo dementia), the cognitive decline can actually be reversed.

While current treatments focus on managing symptoms, I wish there could be a way to neutralize the misfolded proteins directly, rendering them biologically inert. The functional silencing of these misfolded proteins could open doors to precision approaches. I could imagine a PET-scan guided technique that targets these toxic proteins directly, without harming the healthy tissues. In a way, such therapy could function similarly to dialysis in end-stage renal disease (ESRD), which removes harmful or toxic substances from the blood. The frequency and intensity of these interventions could, in principle, be adjusted based on the accumulation of misfolded proteins, just as dialysis schedules depend on a patient’s condition.

To achieve this, we must look beyond the brain as an isolated organ and treat the proteinopathy as a systemic challenge. If we can develop “molecular filters” or synthetic antibodies that act as chaperones, we might prevent these proteins from aggregating into the plaques and tangles that suffocate neurons. There is also the possibility of introducing misfolded proteins into experimental animals, allowing their immune systems to generate specific antibodies. Studying these antibodies could help guide the development of drugs or vaccines that neutralize the harmful proteins in humans. While antibody and vaccine strategies are being explored in research, combining them with functional silencing and precision interventions presents a holistic, visionary approach.

This shift toward bio-technological intervention represents a bridge between biology and engineering. Imagine a future where a “brain clearance” session is as routine as a blood transfusion, where the biological “clutter” of tau and amyloid is scrubbed away before it can trigger the irreversible death of neurons. This would move us away from the current era of “reactive medicine”—where we only act once the damage is visible—and into an era of “proactive preservation.”

However, scientific innovation cannot succeed in a vacuum of social silence. The “care to cure” pipeline requires a society that does not hide its elderly in shame. We need a healthcare infrastructure that views cognitive health as a vital sign, just as important as blood pressure or heart rate. By the time a patient forgets the name of his or her child, the molecular war has been raging for decades. We must learn to intervene while the embers are still flickering, rather than waiting for the entire house to be engulfed in flames.

Ultimately, there is a dire need to shift focus from symptomatic care to root-level intervention. Researchers could explore drugs and vaccines that specifically target misfolded proteins, potentially halting their toxic activity at the source. Such approaches might one day transform the way we address neurodegenerative diseases, offering hope not just for patients but also for sons like me who watch helplessly as a mother’s memory and personality fade. We owe it to the next generation to ensure that “fading away” is no longer an inevitable part of growing old, but a biological hurdle we have finally learned to clear.

mushtaqmallakralgund@gmail.com