A New Attack on Alzheimer’s

The Obama administration has announced a bold research program to test whether a drug can prevent the onset of Alzheimer’s disease well before any symptoms appear. It is a long shot, but the payoff could be huge.

The prevailing, but not universally accepted, hypothesis is that amyloid plaques in the brain play a major role in causing Alzheimer’s. Crenezumab attacks the formation of such plaques, apparently by binding to amyloid proteins and clearing them from the brain. If the drug fails to work, the trial will probably demolish the amyloid hypothesis and set researchers scrambling to find other targets to attack.

Currently, there is no cure for Alzheimer’s, which steadily robs patients of their memory, followed by full-blown dementia. There is also no diagnostic test to identify who has it, and no treatment to slow patients’ deterioration for more than a few months. 

 

While work continues on those fronts, the new clinical trial will test whether the drug, Crenezumab, made by Genentech, can prevent the disease in a group of people whose genetic heritage guarantees that they will develop it. If the drug successfully prevents the loss of mental capacities as measured by a sensitive new cognitive test there is hope — but no guarantee — that it could do the same for members of the general public. As Pam Belluck described in The Times last week, the trial will focus on members of an extended family in Colombia who carry a rare genetic mutation that causes them to develop Alzheimer’s early in life. They typically experience cognitive impairment at about age 45 and dementia by 51. The trial will also include a smaller number of individuals in the United States with the same genetic mutation. 

Instead of recruiting thousands of volunteers and following them for an extended period as in a customary prevention trial, the researchers in Colombia will give the drug to only 100 people with the early-onset genetic mutation. They will give placebos to another 100 people with the mutation and to 100 family members who do not carry the deadly gene. 

The study will cost more than $100 million and is being financed mostly by Genentech, buttressed by $16 million from the National Institutes of Health and $15 million raised by the Banner Alzheimer’s Institute in Phoenix, which is leading the study. 

A prevention trial of a different drug that was also intended to slow formation of amyloid plaques actually made patients’ symptoms worse, possibly because it interfered with various other proteins needed by the brain. Researchers believe that Crenezumab will be safer and more effective, but again there are no guarantees. The risk is justified given that without the treatment the recipients will inevitably get Alzheimer’s in the prime of their lives. The truly big payoff will come if the drug succeeds in this group and lays the groundwork for preventing or slowing the progress of Alzheimer’s that appears late in life. The researchers will be gathering data on a variety of biomarkers — glucose activity in the brain, shrinkage of the brain, certain proteins in cerebral spinal fluid, for example — to see which if any are related to preventing amyloid plaques and the loss of mental abilities. 

If the drug prevents the deterioration of particular biomarkers and ultimately sustains mental capacity, then the same markers might be useful in identifying and treating older people likely to develop the disease. And federal regulators might be willing to approve other prevention drugs based on their short-term effects on biomarkers, speeding the conduct of clinical trials. 

More than five million Americans currently have Alzheimer’s. Without an effective preventive, the number will rise steadily as the population ages. 

Published: May 20, 2012  by NY Times, Editorial

2011 Alzheimer's Association Advocacy Forum

With newly elected leaders in Congress, it is more important than ever that our messages about the Alzheimer epidemic get heard. We need passionate Alzheimer advocates to come to Washington, D.C., to lend their VOICE to the cause.

Join us in our nation's capital May 15-17, 2011, for the Alzheimer's Association Advocacy Forum – become educated about the issues, learn new skills, network with fellow advocates and take our message directly to members of Congress to fight for our legislative agenda.

"I am going back this year! I met amazing, motivated people and had a life changing time. It is such an awe-inspirring time to be in an already beautiful place. To be able to make a difference, speak up... fight... I highly recommend this forum!"

—Advocate Suzette Armijo

2010 proved to be an outstanding year for Alzheimer advocacy. We saw:
•  The historic passage and signing of the National Alzheimer's Project Act (NAPA).
•  The inclusion of younger-onset Alzheimer's disease in the Social Security Administration's compassionate allowance program.

•  The first-ever inclusion of Alzheimer's disease and other dementias in the government's Healthy People 2020 report.

•  Detection of cognitive impairment included as a mandatory part of the new Medicare annual wellness visits
•  More than 112,000 petition signatures collected through the Alzheimer's Breakthrough Ride urging Congress to make Alzheimer's disease a national priority.

Each of these major victories, together with all important wins that have happened around the country on a state and local level, would not have been possible without the commitment and action of you, the Alzheimer advocate.

But even as we celebrate our successes, we still have much work ahead to ensure we build on this momentum to lead our country toward overcoming the Alzheimer crisis. The Alzheimer's Association Advocacy Forum is the premier experience to learn how we can continue to successfully advocate for these issues.

This year's Forum will be held May 15-17, 2011, in Washington, D.C. We have a program that is designed to help you hone your advocacy skills — not just for your visits on Capitol Hill, but also as you return home. You will learn about our legislative priorities, our critical messages and how to deliver these messages to key decision makers. You will learn about how to engage your local legislators and how to use a wide variety of resources in your communities to encourage more people to join with us as Alzheimer advocates.

I look forward to seeing you in May as we celebrate our recent victories and redouble our efforts to secure the Association's mission of a world without Alzheimer's.

Karen Kauffman
Advocacy Forum Chair

Alzheimer's: Planning for the holidays

Holidays can be bittersweet for families affected by Alzheimer's. Consider simple tips to make the holidays enjoyable for everyone.

Alzheimer's disease affects both family and community life. Holiday observances are no exception. Holiday memories from before your loved one developed Alzheimer's may darken an otherwise joyful season — and worries about how your loved one's condition may disrupt your family's plans can overshadow the simple pleasure of being together. Rather than dwell on how much things have changed or worry about what might go wrong, focus on making the holidays as enjoyable as possible.
Keep it simple at home

If you're caring for a loved one who has Alzheimer's at home:
■Make preparations together. If you bake, your loved one may be able to participate by measuring flour, stirring batter or rolling dough. You may find it meaningful to open holiday cards or wrap gifts together. Remember to concentrate on the process, rather than the result.

■Tone down your decorations. Blinking lights and large decorative displays can cause disorientation. Avoid lighted candles and other safety hazards, as well as decorations that could be mistaken for edible treats — such as artificial fruits.

■Host quiet, slow-paced gatherings. Music, conversation and meal preparation all add to the noise and stimulation of an event. Yet for a person who has Alzheimer's, a calm, quiet environment usually is best. Keep daily routines in place as much as possible and, as needed, provide your loved one a place to rest during family get-togethers.

Be practical away from home

If your loved one lives in a nursing home or other facility:
■Celebrate in the most familiar setting. For many people who have Alzheimer's, a change of environment — even a visit home — causes anxiety. Instead of creating that disruption, consider holding a small family celebration at the facility. You might also participate in holiday activities planned for the residents.

■Minimize visitor traffic. Arrange for a few family members to drop in on different days. Even if your loved one isn't sure who's who, two or three familiar faces are likely to be welcome, while nine or 10 may be overwhelming.

■Schedule visits at your loved one's best time of day. People who have Alzheimer's tire easily, especially as the disease progresses. Your loved one may appreciate morning and lunchtime visitors more than those in the afternoon or evening.
 
Holidays can be bittersweet for families affected by Alzheimer's. Consider simple tips to make the holidays enjoyable for everyone.

By Mayo Clinic

HOME TREATMENTS / REMEDIES for Multi Infarct Vascular Dementia

About six months ago I gave up on the anti-oxidant approach as a treatment for her multi infarct dementia and begun treatment of the vascular dementia from a different angle.

However, the value of vitamin E and vitamin C as a preventative of vascular disease, including vascular dementia, is supported by research - but with the vascular dementia, you need to catch it in the early stages.

With her doctor's approval, we included into mum's dementia treatment protocol, 10mg of vinpocetine three times daily to maintain a lower blood pressure in the brain. Thereby reducing the risk of further vascular accidents, thereby slowing or stopping the vascular dementia - in theory. The drug also has several other advantages, including some equivalence to Vitamin E in antioxidant effect, known to improve eye sight a bit, hearing a bit, concentration a bit, can help with ringing in the ears... in short, vinpocetine seems good for treating vascular dementia. We also included fish oil into her multi-infarct vascular dementia treatment; begun using high dose fish oil three times a day to help maintain/improve neuron function (it also helps to relieve pain etc).

[ If mum's vascular dementia had been of the bleeder type, I would have tried out the vinpocetine under medical supervision, but the fish oil can aggravate bleeding conditions, so the fish oil would not have been included. I would have also checked with her doctor about the suitability of using certain herbal hemorrhoid tablet preparations designed to cure hemorrhoids and relieve pain, as the problem with having hemorrhoids is that the veins are weakened and the hemorrhoid preparations sometimes are made to strengthen the walls of blood vessels. ]

After making the adjustments to mum's multi-infarct vascular dementia treatment regime, clotting type, we begun seeing many improvements. She can now follow a person with her eyes and head, like our grand daughter, Hannah, on a Scooter. Mum is now able to sit upright in a wheel chair unsupported, is much more awake and is much more alert to things around her. Even the wheelchair taxi driver, who knows nothing about the vascular dementia treatment being used, has commented about how much better she seems to be doing with each trip. The vascular dementia, in essence, appeared to have been slowed dramatically, perhaps even stopped, allowing the brain time to reogranise it's neural pathways. We were looking at increasing her fish oil intake in the hope it will help alleviate the vascular dementia even further, but according to the American Heart Association, more than three grams of fish oil a day can cause excessive bleeding, so that idea went out the window. Even so, with multi-infarct vascular dementia in the very advanced stage, there is still room for hope when nearly everyone else has given up.

Well, mum came to visit on Christmas day, 2004 - 4 years after entering the dementia unit - courtesy of a wheel chair bus we arrranged. She had improved much more again. She tried to use her fingers to unwrap a present, she tried talking - for the most part unintelligible - and she tried to stand. She was very much alert and awake the whole 90 minutes. These improvements are just mind grabbing and I recall becoming teary thinking maybe we had finally stopped the onslaught of the vascular dementia.

Well, about five or six more months has now gone by, mum is still responsive to us, looks at me when I talk and smiles when I tell she is looking good. Her body, though, may be getting a bit stiffer, but that might be arthritis and cold weather, or, regrettably, the dementia.

http://www.alzheimersdementia.cdadc.com/vasculardementia.html

Definition, Types and Symptoms of Multi Infarct Vascular Dementia

Multi-infarct vascular dementia is a viscious, unrelentless enemy.

As some of you may be aware, my mother suffers from advanced vascular dementia which is of the multiple infarct dementia type (thousands of mini strokes/transient ischemic attacks or TIA's as they are sometimes called).

Mum's vascular dementia was of the clot type - that is, a clot forms and clogs a blood vessel, thereby preventing cells from getting oxygen and nutrients, hence cells die. The other type of vascular dementia is of the bleeding type - a blood vessel raptures, causing a loss of blood flow to some cells, which then die.

It's important to make this distinction between these two types of vascular dementia, as in the clot type vascular dementia, one want's to thin the blood, as with half an aspirin daily, to help prevent the clots forming or doing damage. With the bleeding type vascular dementia, we want to strengthen blood vessel walls and minimise bleeding when a rapture occurs, so that more blood remains flowing in the blood vessels.

If one was to thin the blood for a bleeder type vascular dementia, it would likely cause the vascular dementia to accelerate much faster, whereas, if the same were done for a clot type vascular dementia, the vascular dementia would likely be expected to be slowed down.

The symptoms of multi-infarct vascular dementia can vary greatly from one sufferer to the next. For example, my mum was able to recall who we, her children were, well into it's advanced stages. My Aunty Myrtle, on the other hand, went more and more back into the memories of her childhood and soon lost the ability to recall who her children were and sometimes confused them with other people from her early past.

The rate of onslaught of, or deterioration from the multi-infarct vascular dementia can vary greatly from between people as well. Mum's vascular dementia slowly reaked it's destruction over many year, while Myrtle, who came down with it much later than mum, has died following the multi-infarct's much more rapid onslaught on her. Some dementia sufferers only last a few months when placed into a dementia facility - even though their dementia may not be as far advanced as others, they just seem to lose the will to live and die soon after, no matter how homely and nice and friendly the facility may be. I think it's perhaps more the separation from loved ones and carers, the change in the physical environment, that causes some dementia sufferers to just give up and die. Lets face it though, for many of those with vascular dementia or Alzheimer's Disease, there will normally come a time when the needs of the dementia sufferer exceed the abilities and or endurance of their carer to look after them.

Any way, after about 5 or 6 years, the multi-infarct vascular dementia has caused mum to become bed ridden, unable to chew, nor talk (except perhaps for yea), nor walk.

Source: www.alzheimersdementia.cdadc.com/vasculardementia.html

Psoriasis Linked to Vascular Disease

Patients with psoriasis are at increased risk for atherosclerosis and accompanying vascular diseases, researchers found.
Among predominantly male patients at a Veterans Affairs medical center, the skin disease was associated with a greater likelihood of ischemic heart disease, cerebrovascular disease, and peripheral arterial disease, as well as death, according to Robert Kirsner, M.D., Ph.D., of the University of Miami, and colleagues.

"This result is not surprising, given the systemic nature of atherosclerosis," the researchers wrote in the June issue of Archives of Dermatology.

They said the findings have "tremendous and far-reaching clinical implications, as all of these vascular conditions represent a major financial cost to the healthcare system, as well as a major cause of disability and death."

Because psoriasis has recently been shown to be a systemic inflammatory condition, researchers are interested in looking at its connection to cardiovascular risk factors and myocardial infarction, Dr. Kirsner and colleagues said.

To explore the issue, they identified 3,236 patients with psoriasis and 2,500 control patients without the condition who were treated at the Miami VA Medical Center.

The patients with psoriasis were slightly older (67.9 versus 65.1) and more likely to male (95.5% versus 88.2%, P<0.01 for both).

As expected, they were also more likely to be smokers and to have diabetes, hypertension, and dyslipidemia (P<0.01 for all).

After adjusting for these differences, patients with psoriasis were more likely to be diagnosed with the following conditions:

•Atherosclerosis (OR 2.18, 95% CI 1.59 to 3.01)

•Ischemic heart disease (OR 1.78, 95% CI 1.51 to 2.11)

•Cerebrovascular disease (OR 1.70, 95% CI 1.33 to 2.17)

•Peripheral arterial disease (OR 1.98, 95% CI 1.32 to 2.82)

Psoriasis was also independently predictive of death (OR 1.86, 95% CI 1.56 to 2.21).

Future studies are needed to determine whether aggressive treatment of psoriasis or traditional cardiovascular risk factors will improve the total atherosclerotic burden associated with the skin condition, the researchers said.

"In the meantime, we recommend that healthcare providers who are caring for patients with psoriasis be vigilant with respect to traditional risk factor screening," they said.

In addition, they continued, "it would be prudent for dermatologists to be familiar with suggested screening for cardiovascular risk factors and recommendations for aspirin use. If not, it is imperative that they work in collaboration with a primary care provider or another internal medicine specialist, who also needs to be aware of our findings."

They acknowledged some limitations of the study, including the possibility of inaccurate coding of diagnoses and the inability to assess temporal relationships between psoriasis and vascular disease because of the cross-sectional design.

By Todd Neale, Staff Writer, MedPage Today
Primary source: Archives of Dermatology

Missed and Delayed Diagnosis of Dementia in Primary Care: Prevalence and Contributing Factors

Dementia is a growing public health problem for which early detection may be beneficial. Currently, the diagnosis of dementia in primary care is dependent mostly on clinical suspicion on the basis of patient symptoms or caregivers' concerns and is prone to be missed or delayed. We conducted a systematic review of the literature to ascertain the prevalence and contributing factors for missed and delayed dementia diagnoses in primary care. Prevalence of missed and delayed diagnosis was estimated by abstracting quantitative data from studies of diagnostic sensitivity among primary care providers. Possible predictors and contributory factors were determined from the text of quantitative and qualitative studies of patient, caregiver, provider, and system-related barriers. Overall estimates of diagnostic sensitivity varied among studies and seemed to be in part a function of dementia severity, degree of patient impairment, dementia subtype, and frequency of patient-provider contact. Major contributory factors included problems with attitudes and patient-provider communication, educational deficits, and system resource constraints. The true prevalence of missed and delayed diagnoses of dementia is unknown but seems to be high. Until the case for dementia screening becomes more compelling, efforts to promote timely detection should focus on removing barriers to diagnosis.

By Bradford, Andrea MA; Kunik, Mark E. MD; Schulz, Paul MD; Williams, Susan P. MD; Singh, Hardeep MD, MPH

Dementia and How it is Diagnosed

Many of us may from time to time, forget our neighbor’s name or the items to purchase at the grocery store, and we wonder if this is part of normal aging. Your doctor is the best person to speak with regarding these concerns. There are many conditions that are treatable that may be contributing to periodic memory lapses.

Often when we think of dementia we think of Alzheimer’s disease. While Alzheimer’s disease is considered to be the underlying cause of between 60 and 80% of all dementia cases, there are also other conditions that might cause dementia. It is important to know about the other types and causes of dementia because treatment can vary between diseases and early detection can be beneficial in slowing the progression of incurable dementia's.

According to Dr. Harvey Gilbert, MD of the Gilbert Guide, some of the most common types of dementia and their causes are:

1. Vascular Dementia
This type of dementia is the second most common. It is caused by poor blood flow to the brain, depriving brain cells of the nutrients and oxygen they need to function normally. Vascular dementia can be caused by any number of conditions which narrow the blood vessels, including stroke, diabetes and hypertension.

2. Mixed Dementia
Sometimes dementia is caused by more than one medical condition. Most commonly, mixed dementia is caused by both Alzheimer's and vascular disease.

3. Dementia with Lewy Bodies (DLB)
Sometimes called Lewy Body Disease, this type of dementia is characterized by abnormal protein deposits called Lewy bodies that develop in nerve cells in the brain stem. This disrupts the brain’s ability to function normally and impairs cognition and behavior. It can also cause tremors and is often linked with Parkinson’s Disease and dementia. It is not reversible and there is no known cure.

4. Parkinson’s Disease Dementia (PDD)
Parkinson's disease is a chronic, progressive neurological condition, and in its later stages can affect cognitive functioning. Not all people with Parkinson’s disease will develop dementia, however. This type of dementia is also a lewy body dementia. Symptoms include tremors, muscle stiffness and speech problems. Reasoning, memory, speech, and judgment are also usually affected.

5. Frontotemporal Dementia
Pick's disease is the most common and recognized form of frontotemporal dementia. It is a rare disorder which causes damage to brain cells in the frontal and temporal lobes. This affects the individual’s personality significantly, usually resulting in a decline in social skills, along with emotional apathy. Unlike other dementia's, Pick’s disease usually results in behavior and personality changes occurring before memory loss and speech problems.

6. Creutzfeldt-Jacob Dementia (CJD)
A degenerative neurological disorder, CJD is also known as “mad cow disease”. The incidence is very low, occurring in only about one in one million people. There is no cure. Caused by viruses, CJD progresses rapidly, usually over a period of several months. Symptoms include memory loss, speech impairment, confusion, muscle stiffness and twitching, and a general lack of coordination, which makes the individual susceptible to falls. Sometimes blurred vision and hallucinations also occur with this form of dementia.

7. Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus involves an accumulation of cerebrospinal fluid in the brain's cavities. When this fluid does not drain as it should, the associated build-up results in added pressure on the brain, interfering with the brain’s ability to function normally. Individuals with dementia caused by normal pressure hydrocephalus often experience problems with ambulation, balance and bladder control, as well as cognitive impairments involving speech, problem-solving abilities and memory.

8. Huntington’s Disease
Huntington's disease is an inherited progressive dementia that affects the individual’s cognition, behavior and movement. Symptoms include memory problems, impaired judgment, mood swings, depression and speech problems (especially slurred speech). Delusions and hallucinations may also occur. Individuals with Huntington’s disease may also experience difficulty walking, and uncontrollable jerking movements of the face and body

9. Wernicke-Korsakoff SyndromeWernicke-Korsakoff syndrome is caused by a vitamin B1 (Thiamine)deficiency and often occurs in alcoholics, although it can also result from malnutrition, cancers, abnormally high thyroid hormone levels, long-term dialysis and long-term diuretic therapy (used to treat congestive heart failure). The symptoms include confusion, permanent gaps in memory, and impaired short-term memory. Hallucinations may also occur. If treated early by supplement, this dementia can be reversed.

10. Mild Cognitive Impairment (MCI)
Dementia can be due to illness, medications and a host of other treatable causes. With mild cognitive impairment, an individual will experience memory loss, and sometimes impaired judgment and speech, but they are usually aware of this decline. These problems usually don’t interfere with the normal activities of daily living. Individuals with mild cognitive impairment may also experience behavioral changes that involve depression, anxiety, aggression and emotional apathy. This is often due to the awareness of and frustration related to his or her condition.

With an understanding of the types of dementia, questions begin to arise about how these diseases are diagnosed. What can a patient expect when trying to determine whether he or she has some form of dementia? What can a caregiver expect?

When you initially meet with your doctor, it is important to be honest with them about the symptoms the patient is experiencing, their duration, frequency and rate of progression. The doctor will then review your current health status, family history and medication history. This includes evaluating the patient for depression, substance abuse and nutrition, and other conditions that can cause memory loss, including anemia, vitamin deficiency, diabetes, kidney or liver disease, thyroid disease, infections, cardiovascular and pulmonary problems. The patient also undergoes a physical exam and blood tests. Diagnosing specific diseases causing dementia can be difficult and it may be necessary to ask for a referral to a doctor with expertise in this area. Additional tests that may be used in conjunction with the aforementioned approaches include the Mini Mental State Evaluation (MMSE), the Mini Cog Screen, and Medical Imaging (CT, MRI and PET scans).

The MMSE is an evaluation of the patient’s cognitive status. The patient is required to identify the time, date and place where the test is taking place, be able to count backwards, identify objects previously known to him or her, be able to repeat common phrases, perform basic skills involving math, language use and comprehension, and demonstrate basic motor skills.
The Mini Cog Screen takes only a few minutes to administer, and is used as an initial screening for dementia. The patient is required to identifying three objects in the office, then draw the face of a clock in its entirety from memory, and finally, recall the three items identified earlier.
Finally, medical imaging helps doctors see images of the patient’s brain to determine whether there are any growths, abnormalities or general shrinkage which occurs in Alzheimer’s disease. These medical imaging tests can help improve the accuracy of a dementia diagnosis to 90%.

Once a diagnosis has been made, doctors can help patients to look at various treatment options and can often provide information for caregivers and families about support groups and organizations that can provide them with information about their specific diagnosis. It is recommended that patients and their families try to learn as much as they can about the disease and how it is expected to progress. Organizations like Alzheimer’s Association or the Parkinson's Society can provide valuable information about the disease, its progression and tips on how to slow the progression of the disease and deal with symptoms. These organizations also provide support groups to both the patient and their caregivers to help deal with the blow of a dementia diagnosis. As mentioned earlier, early detection is often key in being able to reverse or slow the progression of many of these diseases. Having a basic understanding of the many dementia's that may occur and how they are diagnosed will be beneficial to physicians and families alike.

If you find that you simply do not know where to begin or how to handle this change in status and what it means for your future, a Geriatric Care Manager can assist you in making plans for the future.

For information on Care Managers in your area go to http://www.caremanager.org/ or for a care manager in Maricopa County click here.

By ElderCaring.ca