Expertscape is pleased to speak with Professor George Perry about Alzheimer Disease and what we can expect from the latest research.

Professor Perry is the Semmes Foundation Distinguished University Chair in Neurobiology and the former Dean of the College of Sciences at the University of Texas at San Antonio. You can follow him on Twitter and on Wikipedia.

Professor Perry is an Expertscape World Expert in Alzheimer disease.

Expertscape: What do you consider to be the most significant advancement in Alzheimer research, and what has that impact been?

Professor George Perry: The most transformative advancement in Alzheimer disease (AD) is an apparent failure: the fall of the 30-year domination of the amyloid hypothesis. In its place, we’re seeing the success of lifestyle modification supporting AD as a multifactorial chronic condition that requires, like heart disease, multiple points of intervention to improve public health. Adoption of this more holistic view can transform how we benefit patients as we advance our understanding of complex mechanisms.

Expertscape: What do you think will be the next big discovery in the study and treatment of AD and what will that mean for those afflicted?

Prof. Perry: Understanding the transformation of health to AD. The dominant proposal is that AD begins decades prior to clinical symptoms; this view suggests that AD is part of the continuum with normal aging. Our own data suggests AD is a clear break from normal aging; a pleotropic change in everything that renders neurons resistant to death but functionless. Understanding this transformative process requires a systems-based approach.

Expertscape: How did you get involved in Alzheimer research?

Prof. Perry: I trained as a marine biologist and later as a cell biologist. Entry to AD was by employment to study it at Case Western Reserve University in the early 1980s. I adapted many insights in studying oxidative stress on marine organisms and applied them to understanding the brain. My training as a marine biologist plays an important window as to how I view AD as adaptational.

Expertscape: Do you have any specific advice for those now entering healthcare, and particularly those interested in this area of research and care?

Prof. Perry: Now is the most exciting time in history to be entering health research. With the genome, proteome and other ‘omics’ at the forefront, we now have the knowledge to begin to understand the elegant complexity of life.

Expertscape: What would you suggest are the most important questions to be asking a physician about Alzheimer disease?

Prof. Perry: Prior to onset, ask what you can do to reduce your risk. We know that exercise, stress reduction, diet, and a reason for living all substantially reduce risk. Following onset of dementia, having a clear diagnosis is important to determine if there are treatable conditions that are contributing. Depression and several other issues can lead to cognitive loss, and are treatable. Also, the type of care outlined can have an impact on the family as well as the patient, and particularly with regard to the management of behavioral issues.

Expertscape: Our readers may wonder: “There are Alzheimer specialists near me. Are there particular considerations that warrant traveling a distance to see a world expert?”

Prof. Perry: It is critical to see a physician with the expertise to provide a thorough differential diagnosis, and not just give you a simple psychological test and afterwards prescribe Aricept. In addition to Expertscape, NIH-funded Alzheimer Centers, Alzheimer Association and the Alzheimer Foundation of American can provide a referral.

Expertscape: What are you working on now, and what to you hope to discover?

Prof. Perry: Instead of causing AD, amyloid beta actually lowers oxidative stress. We think the mechanism involves copper binding and iron stabilization resulting from the turnover of mitochondria. We are working on the details of this mechanism by advanced microscopy and mass spectrometry. Further, we are studying how neurons avoid death during AD.

Expertscape: Let’s talk about the University of Texas San Antonio. What would you like to mention?

Prof. Perry: UTSA and the San Antonio community are investing in brain health by hiring leading faculty to impact the greatest health challenges facing society: diseases of the brain.

Expertscape: Are there particular advancements that encourage you?

Prof. Perry: The modern era of AD research began 40 years ago and revealed much about AD and the brain, and the list of accomplishments over that span is both long and encouraging. In contrast, reductionist linear theories such as the amyloid cascade and tau have diverted attention and the majority of resources from the complexity of AD as a chronic homeostatic disease. Mark Smith and I have argued against this simplistic thinking for over 20 years.

Expertscape: Are there particular organizations that you would like to mention?

Prof. Perry: The Alzheimer’s Association and the National Institute on Aging have played a leading role in supporting and advocating for research. The Alzheimer’s Foundation of America has support for families and the Alzheimer’s Research and Prevention Foundation is effectively leading study and advocacy of lifestyle modification to reduce AD. These particular organizations have each made invaluable contributions.

Expertscape: What makes your work in Alzheimer research so rewarding?

Prof. Perry: That I have been able to channel my lifelong interest in biology to understand a complex disease is most rewarding. Disease is simply biology examined from a different ‘abnormal’ viewpoint, and it is thoughtful studies that help us to illuminate both the normal and abnormal to benefit society.

Expertscape: What do you see for the future of Alzheimer research and treatment?

Prof. Perry: I hope that the failure of linear logic, such as the amyloid cascade, leads scientists and clinicians to a reappraisal of the path forward instead of towards more obscure and untestable ideas that can seem reasonable (for example the need to treat earlier), but could delay progress for further decades.

Expertscape: Thank you, Prof. Perry, for this stimulating conversation.

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