words by barbara hurley / photograph by john emerson
tephen Scheinthal, DO, is admittedly “passionate” about aging and aging research. “It’s my life,” he explains, adding that it all began when he embarked on memory research as an undergraduate at Brandeis University under the tutelage of a distinguished scientist who steered him into academic medicine.
A native New Jerseyan, he came back to his home state and to UMDNJ’s School of Osteopathic Medicine for his medical degree and never left. He found his professional home and the perfect place to indulge his passion: the school’s New Jersey Institute for Successful Aging, where he is associate director.
For Scheinthal, “successful aging” is the ability to maintain independent living and a reasonable quality of life. Preserving independence in an older population, he maintains, should be the focus. “Too often families are very disturbed if their elder doesn’t know what day of the week it is,” he says. “What difference does it make if it’s Tuesday or Wednesday, if that person can still function independently? The emphasis should be on what they can do.”
And, of course, a serious obstacle to what an elder can do is dementia, memory disorders that impair the ability to perform the activities of daily living — eating, dressing and basic hygiene. Consequently, Scheinthal has taken an active interest in clinical trials for his patients over the past 11 years in the hopes of improving the lives of people with dementia. He has served as principal investigator on several studies and has been involved in clinical trials that resulted in the drug donepizil as well as galantimine. “Seeing these products move from an idea to a viable treatment option was extremely rewarding,” he notes.
Alzheimer’s disease, he says, is the most common dementia and the one most often the target of clinical trials. Yet, it’s hard to recruit patients from among a population that often doesn’t qualify for studies due to other medications they may be on or other medical conditions.
Safety is a giant concern for Scheinthal. He is emphatic: “I tell my patients that nowhere will they find an institution more committed to safety for clinical trial participants than UMDNJ.” He is always looking for a good match for his patients, where benefits outweigh risks, and ultimately more treatment options emerge, especially for those with Alzheimer’s disease. Clinical trials can be a big time commitment; potential participants may be scared and skeptical. But Scheinthal has seen change as a result, and has seen people benefit from trial results. “Make a difference is our motto,” he says, “both now in people’s lives and in the future.”
He is always open to new trials and is optimistic about where they might lead. A new trial has recently started. His colleague, Anita Chopra, MD, director of the Institute, explains.
“Five Alzheimer’s disease medications are currently available,” she reports, “But all these drugs treat the symptoms of the disease. Now we’re looking at the underlying problem occurring in the brain and how to modify the disease itself.” She further notes that current treatment options may address issues like memory problems and mental confusion, but they do not cure, halt or even slow the disease process. She is pleased with the new direction of research into Alzheimer’s and excited about the new clinical trial.
The trial is evaluating the safety and effectiveness of an investigational drug, Bapineuzumab, to help control the progression of mild to moderate Alzheimer’s disease. The drug is a humanized monoclonal antibody designed to clear toxic beta amyloid from the brain. The beta amyloid protein is a key component of the plaques that are implicated in the pathology of the disease. “This is a very exciting development,” she says. “There’s a growing body of evidence about the pivotal role of the beta-amyloid peptide — Abeta — in the development of Alzheimer’s. Now alternative classes of drugs that target the formation of the beta amyloid plaque are being actively pursued in the hope that they could positively modify the course of the disease.”
She agrees with Scheinthal about the difficulty of recruiting patients for clinical trials. “Ageism is another factor,” she adds. “Despite the fact that some clinical trials are testing medications that target conditions more common among the elderly, they exclude a subset of older patients based on age alone.” And she notes that dementia patients pose special challenges, like transportation, for the caregiver. But the reasons for participation, beside the anticipation of a personal benefit, usually include a desire to help science move forward and to aid others with the same condition. “The elderly are the fastest growing segment of our population and a group that uses a disproportionate amount of healthcare resources,” she says. “Their lack of adequate representation in clinical trials is particularly troublesome. How are we to really assess the impact these drugs have on improving clinical care or quality of life for an older adult?”
Chopra has worked on clinical trials since 1993; the overwhelming majority has been related to dementia. Her interest in geriatrics grew from a close relationship with her grandparents while she was growing up in India and a growing awareness as she progressed through her medical training in the U.S. of a lack of education about older people. “I met medical professionals who looked at dementia as a normal part of aging,” she remembers, “And I saw older people with inappropriate care or too much medication.” She now sees successful aging — the avoidance of disease and disability, maintenance of physical and mental function and engagement with life — as an attainable goal.