Artistic rendition of a brain with a mosaic-textured surface breaking apart in the front
Image: Eoneren/E+/Getty Images Plus

Work described in this story was made possible in part by federal funding supported by taxpayers. At Harvard Medical School, the future of efforts like this — done in service to humanity — now hangs in the balance due to the government’s decision to terminate large numbers of federally funded grants and contracts across Harvard University.

First come the misplaced keys. Then the unpaid bills, the conversations that dissolve mid-sentence, the names that refuse to surface. Families, with a mixture of dread and resignation, bring the question to the doctor: Could this be Alzheimer’s?

By the time symptoms begin creating problems, the disease has been unfolding in the brain for years. Microscopic amyloid-beta plaques have accumulated between neurons, and later threads of neurofibrillary tau proteins have tangled themselves into tight knots inside brain cells. The two abnormalities — first described in 1906 by the German physician Alois Alzheimer — have become the twin hallmarks of the disease.

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For decades, researchers have chased the question: If amyloid is a key component, could clearing it out stop or even reverse Alzheimer’s?

The results are somewhat unclear. In trials, FDA-approved drugs that target amyloid plaques slow cognitive decline by about 30 percent but do not halt or reverse the disease. Many people have the plaques but never display symptoms.

But researchers at Harvard Medical School and elsewhere are using new technologies — artificial intelligence that may be able to identify new genetic determinants of the disease, blood tests for proteins in the brain, and real-time brain monitoring that reveals how individual neurons die — to find new ways to understand and possibly help treat Alzheimer’s.

In addition, new research at HMS is taking a closer look at the possible role of lithium deficiency in the onset and progression of the disease.

It’s an urgent pursuit. As more people live longer, the number of Americans living with Alzheimer’s disease is expected to rise from about 7.2 million in 2025 to about 18.8 million in 2050.

Although numbers vary depending on methodologies, economic analyses have placed the total annual cost of care for patients with Alzheimer’s and other dementias at about $1.5 trillion in 2050, compared to about $226 billion in 2015.