Spring Arbor Living Blog

Though a cure for Alzheimer's disease remains elusive, experts believe earlier and more accurate diagnosis will aid efforts to discover effective therapies. Marilyn Albert, Ph.D., director of the Johns Hopkins Alzheimer’s Disease Research Center, answers the question: "Why is early diagnosis of Alzheimer's disease important if no treatments currently exist to delay progression of the disease?" 

Early and more accurate diagnosis of Alzheimer’s disease is important in helping us develop a better understanding of the biology of the disease. This, in turn, will help researchers design and test new drugs that will intervene earlier in the disease process. 

We use the term Alzheimer's disease to talk about people who are demented, but there are many people with it who aren't yet demented. In fact, one third of all older adults show Alzheimer’s disease pathology in their brains, though they may not yet show symptoms. 

We know that the symptoms of Alzheimer’s disease progress gradually over many years. People with Alzheimer’s disease don’t go from normal to demented overnight. Instead, the disease is a continuum, and earlier diagnostic procedures will help us treat it as such. 

For instance, we understand that high blood pressure is a risk factor for stroke. So, when we go to the doctor and find out that we have high blood pressure, we start to treat it right away, years before a stroke might occur. The same should apply to Alzheimer’s disease. 

We want to identify those who are at risk years before dementia occurs, because we are working hard toward the day when we can diagnose and treat those risk factors for Alzheimer’s disease in the earliest stages -- just as we might treat high blood pressure or cholesterol.

From Johns Hopkins Health Alert

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The link to healthy diets and brain health is well established. The link to diet and Alzheimer's disease is less clearly established, but new information on curcumin (found in turmeric) may prove to be helpful.

The brain is particularly vulnerable to oxidative damage due to its high rate of metabolism and long-lived neurons. Free radicals can cause oxidative damage to important cellular components such as DNA, or the cell membrane. Cells may function poorly or die if there is too much oxidative damage.

Antioxidants defend the cells from free radical damage. Many long term studies have demonstrated that those with higher antioxidants in their diets from fruits, vegetables and certain spices have slower rates of cognitive decline than those who ate less of these foods.

Curcumin has been studied recently because of the low rates of Alzheimer's disease in India. The Indian population consumes large amounts of curcumin through Tumeric and have a relatively low (4 times less) incidence of Alzheimer's disease compared to the U.S. population.

Curcumin is a member of the ginger family and is the main ingredient of turmeric, a spice used in curry and many Middle Eastern dishes. Curcumin is an antioxidant with nonsteroidal anti-inflammatory properties which prevents the damage caused by free radicals. The more antioxidants in the diet, the more the cells are protected.

The National Institutes of Health and other research organizations have been completing Alzheimer's clinical trials. Recently, curcumin has been in the forefront of much of this research. Curcumin's powerful anti-inflammatory and anti-oxidant properties suppress the buildup of beta-amyloid in brain tissue.

The National Institute of Neurological Disorders and Stroke (NINDS) studied mice and found that curcumin crosses the blood-brain barrier to bind with beta-amyloid peptides. These peptides are dangerous when they build up into plaques.

As Alzheimer's disease develops, neurons go through a process from a healthy state to some loss of molecular efficiency, to a loss of synaptic function, to loss of synapses, and, ultimately, to cell death. When curcumin was fed to aged mice, there was a reduction in amyloid levels and the overall amount of dangerous plaque.

More studies are needed to investigate the safety and tolerability of curcumin in the elderly population. Research is also needed in the areas of using curcumin to prevent Alzheimer's Disease as well as to lessen symptoms.

As clinical trials produce more information about the efficacy of curcumin, guidelines will be established for those at risk and for those affected.

Original article on CDApress.com by Seanne Safail, , Ph.D, RD

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In this excerpt from a recent issue of Health After 50, Marilyn Albert, Ph.D., director of the Johns Hopkins Alzheimer’s Disease Research Center, talks about current methods of diagnosing Alzheimer's Dementia.

•   Traditionally, how has Dementia been diagnosed? How accurately can it be diagnosed today?

Research now tells us that Dementia progresses over time and likely begins years or decades before symptoms first appear. But right now, we can only diagnose Dementia late in the game. 

To diagnose Dementia we rule out other potential causes for cognitive decline, such as stroke, tumor or metabolic syndrome (a combination of medical disorders that raises the risk of heart disease, diabetes and stroke that may also increase the risk of dementia).

We then run a battery of cognitive tests and brain scans to rule out other neurological disorders and to determine whether the pattern of symptoms seems consistent with Dementia. If these things match up, we can give a probable diagnosis of Dementia. At major medical centers, a probable Alzheimer's Dementia diagnosis can be 80 to 90 percent accurate.

•   What are biomarkers, and how will they help with earlier, more accurate diagnosis of Dementia?

"Biomarker" is a term that describes a measurable change in a person that will give us information about what is going on in his or her brain tissue. For example, the signature of Alzheimer’s disease includes amyloid plaques [abnormal accumulation of amyloid proteins] and neurofibrillary tangles (deposits of defective tau proteins, a type of protein abundant in the brain).

The proteins related to the plaques and tangles are present in the spinal fluid of patients with Dementia. They’re also present in those with mild cognitive impairment (MCI) -- slight problems in thinking, learning and remembering that sometimes progress to full-blown dementia.

The proteins serve as biomarkers of the progressive changes taking place in the brain. In clinical research, tau and amyloid have been shown to predict the progression of patients with MCI to Dementia and ultimately Alzheimer's.

In other words, measuring these proteins allows us to say more accurately and at an earlier stage of disease that we are pretty sure this person is going to develop Alzheimer’s dementia. Imaging procedures, such as PET (positron-emission tomography) and MRI (magnetic resonance imaging), also can provide information about the pathology present in the brain. For example, amyloid can now be measured with PET.

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Disease develops years before symptoms show.

New guidelines for diagnosing Alzheimer's disease set forth methods for identifying the disease before it progresses to full-blown dementia, and for the first time include lab and brain-imaging tests that can help identify Alzheimer's as the likely cause of a person's mental decline.

The guidelines, revised for the first time in 27 years, reflect a firm consensus among Alzheimer's researchers that the disease begins to attack the intricate structures of the brain 10 years or more before the disabling mental problems appear. Therefore, to be effective, drug or other therapies will have to begin work early in that process.

So far, though, there are no therapies that alter the course of Alzheimer's disease. And in a media briefing, authors of the new diagnosis guidelines emphasized that while testing for Alzheimer's pathology in the brain may one day be used to identify the disease at much earlier stages, today the tests are primarily a research tool. They are not ready for routine use in doctors' offices.

Delaying disability

Even so, doctors hope the new diagnostic criteria encourage people with worrisome memory problems to seek help. There's a lot patients and their families can do to minimize the impact of Alzheimer's, from structuring the patient's environment to optimizing medical care, activities, exercise and diet.

New tests outlined in the guidelines involve looking at the brain with imaging technologies and examining the fluid obtained by a spinal tap. The imaging studies can reveal so-called plaques made up of a protein called amyloid, a defining feature of Alzheimer's. They also can indicate characteristic patterns of shrinkage or reduced metabolic activity in the brain. The cerebrospinal fluid tests look for levels of amyloid as well as of another protein, tau, which makes up the twisted strands or "tangles" that, like plaques, are signature brain pathology in Alzheimer's.

Weaknesses of the tests

Research studies have demonstrated that all these tests can help identify Alzheimer's as the cause of a patient's dementia, and can help predict which patients with milder symptoms will go on to develop dementia. But the tests aren't conclusive in themselves. They aren't standardized so that a certain result means the same thing in every medical center. And there's no clear cutoff separating normal findings from those indicating a problem.

Original article by: Katharine Greider from AARP Bulletin

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Brain scans may help identify which individuals with a mild decline in their mental abilities will go on to develop Alzheimer's disease, according to a new study.
 
The research focused on patients with mild cognitive impairment, a condition in which people experience noticeable declines in their cognitive function, including memory and language problems. These changes are not severe enough to interfere with everyday activities, according to the Alzheimer's Association.
It is known that about 15 to 20 percent of such patients will go on to develop Alzheimer's, but researchers don't know which ones.

In the new study, which involved magnetic resonance imaging (MRI), researchers were able to identify a high-risk group – patients who had a 69 percent chance of developing Alzheimer's disease in the next year.

The study used the MRI scans to identify brain characteristics that put people at risk for Alzheimer's. The researchers determined some patients had just a 3 percent risk of developing Alzheimer's in the next year, which is about the same as for a healthy older person. Others had a 40 percent risk of developing the condition in the next year, or double the risk associated with a diagnosis of mild cognitive impairment, and still others were identified as part of the high-risk group, said study researcher Linda K. McEvoy, an assistant professor in the department of radiology at the University of California, San Diego School of Medicine.

A similar technique could be used one day by doctors to determine the Alzheimer's risk for patients with mild cognitive impairment. However, the patients in the study were not representative of the general population — they had been selected to exclude people who experienced other types of memory problems, such as those due to a stroke. A larger study would be needed before the results could be translated to the doctor's office.

Alzheimer's disease risk
The study looked at MRI scans of the brains of 203 healthy adults, 164 patients with Alzheimer's disease and 317 patients with mild cognitive impairment. Each patient had their brain scanned at the start of the study and again a year later.

The researchers first compared the brains of Alzheimer's disease patients with those of healthy people, looking for differences in the degree of  shrinkage, or atrophy, in particular areas of the brain. Once they developed a way to distinguish these two groups of people, "we could use the same equations on the mild cognitive impairment (MCI) subjects to determine their risk of developing Alzheimer's disease," McEvoy said.
 
When the researchers included information about how the brains had changed in the time between the two scans, they were able to identify the high-risk group.

Future applications
Information in this study will be critical once we have ways to prevent Alzheimer's disease, McEvoy said. "Currently there's no cure or prevention for Alzheimer's disease. But there's a lot of research going on right now into different potential therapies. If any of those therapies turn out to be useful, then this kind of information will be crucial — a doctor needs to know who's at higher risk in order to treat them".

 Original article by Rachael Rettner- MyHealthNewsDaily

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Alzheimer's disease is the most common form of dementia. Unfortunately, it is presently incurable. With every stage issues crop up, and it is very challenging to care for someone with this disease as their condition deteriorates. However, there are some activities to keep Alzheimer patients engaged and to assist them in coping with this disorder. Those who suffer from Alzheimer’s need care, motivation, support, encouragement and patience. The following activities will help.

• Puzzles and crosswords that are simple and easy will stimulate their brains and help slow down degeneration. These cognitive activities will help in reducing memory loss.
• Crafts and activities with little complication like maintaining a photo album, sorting photographs, making collages, or writing small notes to relatives can be engaging for these patients. It is important that the task is well described, sequenced and easy to handle.
• Reading a story aloud to them that has pictures will enable them to comprehend and answer relevant questions. This will also strengthen the bond between the caregiver and the patient. Alzheimer’s patients have a better chance of remembering information about the caregiver through activities they did together.
• Household work should be encouraged. Alzheimer's sufferers should perform their daily chores. This will create lesser dependency and will assist them in remembering things better.
• Gardening and keeping busy weeding, planting, and watering will enable them have a better approach to cope.

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Congress recently sent a bill to the President’s desk that would significantly impact the future wellbeing of our nation’s aging population. The National Alzheimer’s Project Act (NAPA), a bipartisan bill, aims to combat Alzheimer’s with the same determination with which we have worked to prevent and treat AIDS and cancer. If enacted as expected, the main goals of the bill will be to:

•  Launch a campaign within the federal government to overcome Alzheimer’s disease.
• Establish an inter-agency Advisory Council to develop with the Secretary of Health and Human Services a coordinated National Alzheimer’s Disease Plan.
• Comprehensively address the federal government’s efforts on Alzheimer’s research, care, institutional services, and home- and community-based programs.
• Accelerate the development of treatments that would prevent, halt, or reverse the course of Alzheimer’s disease.
• Decrease health disparities by ensuring ethnic and racial populations at higher risk for Alzheimer’s receive much-needed care and services.

As compared with the AIDS and cancer federal agendas, combating Alzheimer’s is unique in that there are no survivors. It is up to advocacy organizations, such as the Alzheimer’s Association, to organize caregivers, eldercare professionals, and those with Alzheimer’s that can tell their story, to provide valuable information and feedback to this new federal office. If you know a loved one that has been diagnosed with this affliction contact us today and we'll be happy to help in anyway possible.

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Recently we came across a new study that was completed on dementia and Alzheimer’s and we wanted to share the results with our readers. This is just a brief summary of the full article but it gets right to the point. A new study published in Archives of Internal Medicine indicates a relationship between heavy smoking in midlife and increased risk for dementia. This includes both vascular dementia (VaD) and Alzheimer’s disease (AD).

Prospective data from a multiethnic population-based cohort of 21,123 members of a health care system who participated in a survey between 1978 and 1985 was analyzed. Of that group, 25% were diagnosed as having dementia during a follow-up period of 23 years. Compared to nonsmokers, those smoking more than two packs a day evinced an elevated risk of dementia.

The authors concluded that heavy smoking in midlife was associated with a greater than 100% increase in the risk of dementia, Alzheimer’s and vascular dementia more than two decades later. Results suggest the brain is vulnerable to long term consequences of heavy smoking. While smoking has always been bad for you it shows that this is yet another complication that can arise from smoking. Granted the study was done one smokers who smoked around 2 packs a day, the study still suggested a relationship between dementia and smoking. Even though dementia is a serious affliction being an assisted living environment for these individuals we feel helps out more than we could imagine. If you know a loved who is suffering from this disease contact us today and we'll be happy to assist you in any way possible.

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Every so often we happen upon something that really touches us. We recently came across a great read that we thought all of our readers should check out. We know that Alzheimer’s is a dreadful disease – stripping a person down to almost nothing but an empty shell. It is a hardship on not only the person but the family as well. However, although we might think there is nothing left, and that the well of emotion and connectedness is dry – there can be a moment shared that has deep meaning between the victim and a loved one.

Still Giving Kisses is a book that we found earlier this week, written by Barbara Smith, who is an occupational therapist. The book talks about the author’s mother and one of the few remaining motor acts that she was able to perform, giving kisses, reflecting the title of the book. We took some time to read a couple chapters and it is very inspirational. We had a post about another book a couple of months ago that we really enjoyed, and if you folks got to check out the previous book, then we highly recommend this one as well.

The book goes on about how caring for someone with Alzheimer’s can drown a caregiver with legal demands, bureaucratic issues, and personal exhaustion. However, if the caregiver can try to always be on the lookout for “kisses” in whatever manifestation, the human side of the Alzheimer’s gauntlet might not be forgotten. We just thought we'd end the week with a good book, and hopefully you all can get into the book as well.

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