Dear Doctors: I understand that there is treatment for the beginning stages of Alzheimer's disease that can stave off serious decline. There are also new tests to determine if a person is in the beginning stages, at which point it would be advantageous to take the new drugs. Am I right in this?

Dear Reader: While there have been recent advances in both the diagnosis and treatment of Alzheimer’s disease, the advances are more limited than your question suggests.

Alzheimer’s is a complex disease. Despite decades of research, we are still in the early stages of understanding it. This form of dementia unfolds through multiple pathways and includes a number of subtypes. Also, it often presents alongside other forms of dementia. This means progress in identifying and treating Alzheimer’s is slow and gradual.

Despite a shortage of effective treatments currently, an early diagnosis helps the person and their family understand ongoing changes. Catching it early can help avoid unnecessary medical interventions. New, highly sensitive tests that can detect blood-based biomarkers may transform Alzheimer’s diagnosis.

This includes blood tests known as Lumipulse or Elecsys. The U.S. Food and Drug Administration approved these last year -- with important caveats. The tests look for proteins associated with the formation of amyloid plaques in the brain. Amyloid plaques are abnormal accumulations of protein that can disrupt neural function, and they are a biological marker seen with Alzheimer’s. However, their presence alone is not enough for a diagnosis. Some older adults with no cognitive impairment have amyloid plaques in their brains. For that reason, the FDA has limited the use of these tests to adults showing signs of cognitive impairment who are over age 50 for Lumipulse or over age 55 for Elecsys.

Currently there are two categories of treatment, both producing modest effects. One is drugs to manage and improve a person’s symptoms. This includes drugs such as donepezil, which act on neurotransmitters and related signaling pathways within the brain. Memory, attention and language improve for some people. Memantine, another medication, may have a modest protective effect on the brain.

The other category is a newer class of drugs that clear the amyloid plaques from the brain. These modestly slow disease progression and cognitive decline by 25% to 35%. They do not stop Alzheimer’s, but they are the first medicines to alter the course of Alzheimer’s. These drugs may have significant side effects and require a comprehensive plan of care and follow-up, including multiple brain MRIs.

These new drugs have transformed research into new therapies. There are more clinical trials in Alzheimer’s than ever before. Studies indicate other pathways besides the amyloid protein that might be targeted for new therapies. Dr. S. Thomas Carmichael, the chair of neurology at UCLA Health, notes that “the field is filled with new hope and energy. We know that we can alter the course of the disease. Though this is modest, it is a pivot point that increases energy for other and distinct approaches that may more substantially reduce this disease.”

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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Dear Doctors: You hear a lot about inflammation these days and how it's bad for your health, but isn't it also part of how your immune system protects you and keeps you healthy? At this point, I'm not sure I understand what inflammation is or how it works. Can you explain?

Dear Reader: We agree with you that inflammation is having a bit of a moment in the media these days. Often, we hear inflammation discussed as a danger to health and well-being. But you are also correct that inflammation is a crucial part of our immune response. Throughout the day (and our lives, really), inflammation goes a long way to keep us healthy. What is often missing from these discussions, though, is the dual nature of this process. The truth is that inflammation can be either beneficial or harmful. The deciding factors are how long it lasts, and how closely it is regulated.

To understand inflammation, we should begin with the idea of homeostasis. Homeostasis is a state of being when all the crucial systems of the body remain in a normal range. This includes blood pressure, heart rate, temperature, blood sugar and fluid levels. But external conditions are always changing. Maybe you're cold, you ate some chocolate or you raced up a flight of stairs. Constant tweaking happens in your body to maintain homeostasis through it all. Biological mechanisms, including inflammation, are some of the tweaks that help restore balance.

An inflammatory response begins with biochemical signals that tell the body something is out of balance. These signals send the immune system into immediate action, tailored to the disruption. The body’s inflammatory response can include increasing blood flow to deliver oxygen, nutrients and immune cells. The response might direct white blood cells to a specific site to battle pathogens. In a physical injury, the body might send white blood cells to clear away damaged tissue. The response might also create heat, swelling or pain at the site of the injury to protect the area and promote healing.

Short-term inflammation, known as acute inflammation, is largely protective. When the immune system's response continues unchecked, problems begin to arise. This is known as chronic inflammation. Many things can trigger chronic inflammation: disease, stress, depression, lack of sleep, poor diet, exhaustion, repeated vigorous exercise or immune dysfunction. The same biochemical processes that help in acute inflammation can be destructive when the immune pathways remain activated. Chronic low-grade inflammation can increase the risk of a range of diseases, including cardiovascular disease, diabetes and certain cancers.

The good news is that you can reduce the risk of chronic inflammation through lifestyle choices. Diet plays a key role. Eat whole, fresh foods, limit added sugars and avoid ultra-processed foods. Aim for about 150 minutes of moderate physical activity each week. This will help maintain a healthy weight and make it easier to get adequate, high-quality sleep. Limiting alcohol and avoiding tobacco products is also important. So is managing chronic stress. The goal is to return the body to balance and give the immune system a night off.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I have Type 2 diabetes, and in the last year, I have had a problem with excessive itching of my feet. A nerve study showed I had good nerves to my feet, but there might be problems with the finer nerves. Is this itching a form of neuropathy? Is there anything that can help?

Dear Reader: When someone has Type 2 diabetes, it means their body is no longer able to use insulin properly. The body’s cells become resistant to this hormone needed to move glucose out of the blood and into the cells so the cells can use it as fuel. The pancreas can also gradually lose the ability to produce enough insulin to keep up with demand. Together, these changes make it difficult to keep blood sugar levels within the normal range.

Over time, persistently elevated blood sugar begins to take a toll on the body. This can include damage to the kidneys, heart, eyes, nerves and extremities. One common result of this damage is the onset of unusual sensations, particularly in the feet. Known as peripheral neuropathy, it often causes tingling, stinging or burning. While less common, the persistent itchiness that you have described is also possible. And as you have surmised, it can also be a form of neuropathy.

The nerve conduction study you underwent typically assesses larger nerve fibers. It is the smaller sensory fibers that transmit pain and itch. These may not show up clearly on routine testing. As a result, even when nerve studies appear normal, the finer nerves can play a role in the symptoms. That said, neuropathy is not the only reason people living with Type 2 diabetes may experience itchy feet. High blood sugar can interfere with the skin's self-repair mechanisms, including the ability to hold water. This can lead to chronic dry skin, which can become itchy.

When this is the case, it is important to use gentle cleansers when washing the feet. Use hypoallergenic and fragrance-free lotions to keep the skin on the feet supple and moist. Also be careful about friction caused by footwear. Choose socks with a soft, close weave that won't irritate the skin. Shoes should be supportive, without any pinch or pressure points.

People living with diabetes can also sustain damage to the nerves that control sweating, which can leave the skin of the feet very dry and prone to itching. The disease can also suppress immune function. This increases the risk of developing a fungal infection, such as athlete's foot, which can cause intense itching.

While vigilant foot care can lead to a reduction in itching, the most important thing you can do is work on improved blood sugar control. That includes using any medications prescribed by your doctor, eating a nutritionally balanced low-glycemic diet and getting regular exercise. And if you haven't talked to your doctor yet about this itch, we urge you to do so. They can prescribe topical treatments and, if needed, certain oral medications. These can help manage the itch and improve your quality of life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)