Perspective on Funding for AD Research

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Amidst all the news stories about the science of Alzheimer's disease, there are also stories about it's economic toll on our health care system and stories about the allocation of research dollars aimed explaining the disease and developing treatments. This week, the NIH released a statement about the American Recovery and Reinvestment Act and how some of its funds are directed at the Alzheimer's problem.

Overall, it is an encouraging piece of news citing the fact that more than 100 Alzheimer's related grants, aimed at identifying risk factors, improving diagnostics, isolating bio-markers, conducting trials, and developing new therapeutic agents, were funded through the act. Specific details were provided for the Alzheimer's Disease Neuroimaging Initiative (ADNI) which will receive $24 million in funds, and the Alzheimer’ Disease Genetics Consortium (ADGC) which will receive about $5.4 million in funds. Certainly these are large grants and represent opportunities to advance the science.

However, this news should be considered against the larger funding context that is also discussed frequently in the news. The big picture is painted clearly by Harry Johns, CEO of the National Alzheimer's Association, through his daily comments to constituents across the country.

A summary in The Detroit News on Monday makes his point. The NIH awarded $6B to cancer research last year. They awarded a further $4 billion for cardiovascular disease and $3 billion for HIV/AIDS. In comparison, the NIH funds for Alzheimer research was $428 million.

With this perspective, it is clear that the potentially devastating impact of Alzheimer's disease on the boomer generation is not reflected in the funding support of the federal government.

Is Memory Screening a Good Idea?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Is Memory Screening a Good Idea?

Yesterday was National Memory Screening Day and, as usual, there were many editorials in print and online discussing the pros and cons of memory screening. As is often the case, the answer to the question that headlines this article varies greatly depending on whom you ask. When discussed in the press, I rarely see a balanced view of pros and cons but rather a biased presentation of the "facts" aimed at supporting the author's opinion. Here's a summary of what I consider to be the most important considerations.

First, the term "screening" is open to interpretation and is generally used inconsistently from author to author depending on their respective attitudes toward screening.

For those who tend to be against memory screening, they usually adopt the traditional definition of screening which suggests that programs are perpetrated on large populations of symptom free subjects, perhaps even against the will of the subjects. I would agree that a comprehensive, population-based approach is probably not a good idea for many pragmatic reasons related to educating and further evaluating the multitudes of people whose screening results would warrant further attention.

Those who support memory screening tend to adopt a definition consistent with "case finding". This essentially means performing a memory assessment on those with concerns about their memory or evidence that it is declining. With this definition, I would support the general argument that, for people who have a memory concern, some type of evaluation (a screening if you will) should be available to them. This makes sense and would greatly improve our ability to intervene against problems in their earliest stages.

It strikes me that if we could all adopt a common understanding of what is meant by "memory screening", most of the controversy and debate would likely vanish. Having said that, there are three other prominent themes in the argument against memory screening that are not related to the definition of “screening”. Here are my comments on those themes.

Type I Errors – False Positives

This pertains to the possibility of inflicting unnecessary angst in healthy people who could be improperly assessed and mistakenly told that their memory is impaired. Those against memory screening speculate that this could lead to undue anxiety, depression, and even suicide. While that may be plausible, there is really no supporting evidence and it is probably off base. The few studies that have been conducted on attitudes toward screening have shown that people seeking memory assessment are often anxious from the outset and learning the result of an assessment, be it positive or negative, tends to reduce their anxiety.

Type II Errors – False Negatives

This pertains to the possibility that unsophisticated screening instruments or untrained screeners could miss signs of impairment and mistakenly tell symptomatic subjects that they are healthy. This of course might reduce the likelihood of that person seeing a physician and getting good care. That’s a reasonable argument and is likely to be true because we know that patients may seek second opinions when they get “bad medical news” but they are far less likely to do so after receiving “good medical news”. I think it is reasonable to insist that a beneficial memory assessment program would require both the use of a well-validated assessment instrument and well trained administrators.

The Importance of Medical Expertise

This argument suggests that, regardless of mistakes in either direction, people learning that they have a memory problem may fear Alzheimer’s disease as the underlying cause and these people should be counseled and educated immediately to assuage their anxiety. If the structure of a screening program is “high volume” and “public” in nature, then it may be conducted in an environment lacking the medical expertise that some patients will require. I would agree that there may be some real costs associated with screening programs that are not conducted within a framework capable of providing proper follow-up attention to subjects who learn of memory impairments. These costs must be considered in the evaluation of any program's merit.

A Commonly Neglected Perspective

In general, the discussions I see in the media tend to consistently neglect one important aspect of the anxiety consideration. A high percentage of the people that seek to participate in self-selecting memory assessment programs (that is, programs for which one may voluntarily seek to have their memory assessed), are already somewhat anxious about a perceived decline in their memory. We know that such anxiety is often unfounded and that many worries are merely a slowing of name recall or diminished concentration associated with normal aging. As such, voluntary memory screening programs may reassure and relieve anxiety in a high number of normally aging individuals who have been needlessly worrying about their cognitive health. This is a real benefit that should be weighed against other costs when evaluating the value of a given program.

To summarize, we may not be ready for widespread memory screening but we are certainly ready for programs that provide accurate assessment and expert follow-up for those individuals who perceive a decline in their memory. Doing so is one of the best approaches available for promoting early intervention and effective treatment for many aging people with medical conditions that impair cognitive function.

What Causes Dementia?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Because the general media commonly interchanges the terms "Alzheimer's" and "dementia", there is much confusion about the definition of each and the difference between the two. As such, I like to offer a clarifying viewpoint on a regular basis.

Alzheimer's is a disease. We don't completely understand it but the development of amyloid plaques and neurofibrillary tangles in the brain seem to play a role.

Dementia is a descriptive term for the symptoms caused by disorders that impair cognition. Specifically, if memory and at least one other realm of cognition (judgment, executive function, verbal fluency, etc.) decline to the point where they interfere with daily life, then the condition is dementia.

A key point is that there are many causes of dementia; Alzheimer's is merely one of them. Vascuclar disease, Parkinson's disease, and Normal Pressure Hydrocephalus and others are also on the list. The conditions and disorders that cause memory loss are worth learning about.

The distinction between memory loss and dementia, and the causes of each are well developed in a recent article on examiner.com by Patricia Grace. This perspective and other good views are presented regularly at the blog: AgingwithGrace.net.

Stigma and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Here's the definition of "stigma": a mark of disgrace associated with a particular circumstance, quality, or person.

It's really a shame that so often, stigma is a pure social construction based on poor understanding of a circumstance. Having an illness, for example, should never be stigmatizing and in a more informed world, it never would be.

Readers of this blog know how strongly I feel about the importance of awareness and education as parts of a solution to the growing dementia problem, specifically as it pertains to dementia caused by Alzheimer's disease. The greater the understanding and the more prevalent the discourse, the more we can reduce the stigma that holds many back from seeking help while they are still quite healthy and more likely to respond to treatment.

I recently read a great entry at one of the blogs I follow, ElderCareTalk, written by Laura Bramly. She tells an inspiring story about the strength of elders who rise above the stigma and help the rest of us see them for all that they are. I encourage you all to read it.

The Brain Healthy Lifestyle

The “Brain Healthy” Lifestyle Contributed by: Dr. Bernard Croisile, MD (Neurology), Ph.D, Chief Science Officer, HAPPYneuron
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We are all eager to learn how best to keep our brains healthy as we age and much research is underway in that regard. While evidence is still building in many areas, it is clear that certain aspects of a “brain healthy” life style have no downside and should be considered as potential, immediate additions to our regular routines.

Among the approaches with meaningful evidence of benefit are the following six:

1. Physical Exercise
2. Balanced Diet
3. Socialization
4. Stress Reduction
5. Adequate Sleep
6. Cognitive Stimulation

While the most well researched avenues to brain health are balanced diet and physical exercise, there is mounting support that these other four areas should be seriously considered in anyone’s strategy to age with cognitive vitality. Among the public, there is particularly strong interest in learning more about the benefits of cognitive stimulation.

To stay sharp and defer brain decline, the scientific evidence shows that the odds of success are significantly increased by living a “brain healthy” lifestyle and that wide and varied cognitive stimulation is a critical element of such a lifestyle. To achieve that, one must engage regularly in brain activity that spans the use of all the major brain functions of language, memory, attention, visual-spatial and logic and reasoning activities. This can be difficult to achieve consistently over time. One way to activate all these brain functions on a consistent and regular basis is to play specially designed brain games and to participate in evidence based brain-training programs.

These games are designed to be engaging and by most accounts they are generally fun and entertaining. You have nothing to lose and a lot to gain, most notably, staying sharp!