Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________
In a recent posting supporting the value of awareness in our collective fight against Alzheimer's disease, I wrote that memory loss is not a normal part of aging. Based on comments left by readers, it became clear to me that, among some portion of the population, that is a difficult fact to accept. In fact, by most readers' accounts, the evidence seems stacked in the other direction with a high percentage of elders complaining of eroding ability to store and retrieve information.
Given this response, I think it is important to reconcile the two perspectives. There are two important points to consider.
First, what many label as "memory loss" is actually something else; commonly "slow recall" or "distraction". Each of these is described in full in this earlier post. It is clear that the term memory loss is interpreted quite widely and many consider all sorts of cognitive deficits to be memory problems when often they are something else. At the end of the day, there are probably far fewer actual "memory complaints" than many of the readers perceive.
Second, because medical conditions that impair memory are prevalent in old age, memory loss is indeed common. People with depression, thyroid disease, vitamin deficiencies, multiple medications, metabolic disorders, vascular disease and early stage Alzheimer's may all complain of memory loss. My earlier posting took the position that having one of these conditions is not normal.
In hindsight, it would have been more clear for me to write that memory loss is not a normal part of healthy aging.
Monday, November 9, 2009
Friday, November 6, 2009
Alzheimer's Awareness: Why Bother?
Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________
As you may have read elsewhere, November is National Alzheimer’s Awareness Month. But surely, the public is already well aware of this horrible disease. After all, Alzheimer’s has directly affected approximately 1 in every 2 families and the others must have certainly noted its prominent coverage in the news. We don’t really need more awareness, right?
Wrong.
Some of the information below may surprise you. That is to say, it is information about which you are not presently aware. However, by merely learning the seven facts below you will be helping to reduce the Alzheimer’s problem. That’s right…making you aware of this information and encouraging you to share it with your social networks will facilitate a more informed and more effective approach to combating the threat we face from this disease.
First, here are a few facts and figures that you may already know. Alzheimer’s currently affects more than 5 million Americans and that number is likely to triple by 2050. It is the sixth leading cause of death in the USA and is climbing steadily in the rankings. Also, Alzheimer’s is the leading cause of dementia and accounts for about 65% of all dementia worldwide. These are all sobering facts but perhaps not new to your understanding.
7 Facts You Need To Know
Now, here are some points you may not know but should. It is the following information that I hope will stimulate discussion and promote a better understanding of the disease. With more discourse, we can begin to erode the lingering stigma that currently prevents some people with early symptoms from seeking timely medical attention.
1) We generally detect Alzheimer’s at the end-stage of the disease. On average, Alzheimer’s follows a 14-year course from the onset of the first symptoms until death. There is some variability across patients but 14 years is pretty typical. The more surprising news is that, on average, we diagnose Alzheimer’s in years 8-10 of that disease course. This means that for most patients, symptoms go undiagnosed and untreated for at least seven years, during which time the lesions spread through the brain and cause irreparable damage. Please be aware that we diagnose Alzheimer’s disease far too late to optimize the effects of currently available treatments.
2) Memory loss is not a part of normal aging. The point about end-stage detection raises an obvious question about “why” we diagnose this disease so late. There are many contributing factors but most of them can be reduced through awareness and education. Some patients resist medical attention in the early stages because they fear a stigmatizing label or because they are misinformed to believe that Alzheimer’s cannot be treated. Many people, including a startling number of physicians, incorrectly believe that memory loss is a normal part of aging. Improving the timeliness of diagnoses for Alzheimer’s is, in many ways, a problem that can be addressed through awareness and education. Please be aware that memory loss is not a part of normal aging and, regardless of the cause of the memory loss, timely medical intervention is best.
3) Current Alzheimer’s drugs are probably more effective than you think. Our widespread practice of late detection has many negative consequences. For example, one of the reasons that current treatments are often deemed ineffective is because they are routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy. Yes, we need better treatments, but a great start would be to intervene earlier with the treatments we already have. Please be aware that currently approved treatments may be more effective than some headlines indicate.
4) Alzheimer’s disease can be treated. Another treatment related concept about which everyone should be aware is this. Preventing or slowing further brain damage is preferable to letting the damage spread without constraint. Yet, many physicians, patients, and caregivers conclude that any treatment short of a cure is not worthwhile. While today it is true that we have no cure for Alzheimer’s, that does not mean there is no treatment. With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life. Please be aware that “we have no cure” does not mean “there is no treatment”.
5) The Alzheimer’s drug pipeline is full. Here’s another fact of which you should be aware. Through an intense research effort over the past twenty years, scientists have gained a lot of insight about Alzheimer’s disease mechanisms and about other factors that increase the risk for the disease. Much has been learned and some very promising drugs, based on sound theoretical approaches, are in FDA clinical trials right now. While much of the disease remains shrouded in mystery and we may still be a long way from better treatments, it is possible that an effective agent is already in the pipeline. Please be aware that, although we don’t know when, better treatments for Alzheimer’s are certainly on the way.
6) Taking good care of your heart will help your brain stay healthy. Know this; the health of your brain is very closely tied to the health of your body, particularly your heart. Researchers have shown conclusively that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. The mechanisms that keep oxygen rich blood flowing through your body play a key role in maintaining a healthy brain. Everyone should be aware about the close association between vascular health and cognitive health. Please be aware that maintaining good vascular health will help you age with cognitive vitality.
7) Managing risk factors may delay or prevent cognitive problems later in life. There are well-identified risk factors for Alzheimer’s disease that are within our power to manage. These include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. With greater awareness of these facts, we can imagine a world where diabetics take more care to control their blood sugar, where helmets are more prevalent in recreational activities that are likely to cause head trauma, where people smoke less and eat more fruits and vegetables, and where everyone makes a better effort to exercise and to stay socially engaged on a regular basis. While these facts may not be well known, they are all well proven. Galvanizing an effort to publicize them is one purpose of National Alzheimer’s Awareness Month. Please be aware that many risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.
So why bother with Alzheimer’s awareness? Because it is a terrible disease poised to ravage our aging society and the lack of education and awareness has lead to a stigma that prevents a more proactive approach to early intervention. The result is that we diagnose it too late, which hampers the efficacy of available treatments. A more educated public could manage risk factors to minimize the likelihood of Alzheimer’s, could monitor personal cognitive health with greater vigilance, and could seek medical attention at the earliest sign of decline. Physicians could then diagnose problems earlier and prescribe appropriate treatment including diet, exercise, and drugs to slow disease progression as much as possible. In the end, we could have fewer cases, more effective treatment, slower progression, higher quality of life, and lower healthcare costs. The social, emotional, and fiscal benefits of awareness and education in this area are too large to quantify.
By reading this article, you have increased your understanding of the problem and raised your awareness about what can be done. That is a great step in the right direction but you can do one thing more. You can help to spread this message.
In the spirit of National Alzheimer’s Awareness Month, please share this article with your friends to promote more widespread awareness. Post it to your Facebook page, mark it in Delicious, Tweet it, Digg it, or email it. It doesn’t matter how you do your part, it only matters that you get it done.
Follow me on Twitter.
________________________________________________
As you may have read elsewhere, November is National Alzheimer’s Awareness Month. But surely, the public is already well aware of this horrible disease. After all, Alzheimer’s has directly affected approximately 1 in every 2 families and the others must have certainly noted its prominent coverage in the news. We don’t really need more awareness, right?
Wrong.
Some of the information below may surprise you. That is to say, it is information about which you are not presently aware. However, by merely learning the seven facts below you will be helping to reduce the Alzheimer’s problem. That’s right…making you aware of this information and encouraging you to share it with your social networks will facilitate a more informed and more effective approach to combating the threat we face from this disease.
First, here are a few facts and figures that you may already know. Alzheimer’s currently affects more than 5 million Americans and that number is likely to triple by 2050. It is the sixth leading cause of death in the USA and is climbing steadily in the rankings. Also, Alzheimer’s is the leading cause of dementia and accounts for about 65% of all dementia worldwide. These are all sobering facts but perhaps not new to your understanding.
7 Facts You Need To Know
Now, here are some points you may not know but should. It is the following information that I hope will stimulate discussion and promote a better understanding of the disease. With more discourse, we can begin to erode the lingering stigma that currently prevents some people with early symptoms from seeking timely medical attention.
1) We generally detect Alzheimer’s at the end-stage of the disease. On average, Alzheimer’s follows a 14-year course from the onset of the first symptoms until death. There is some variability across patients but 14 years is pretty typical. The more surprising news is that, on average, we diagnose Alzheimer’s in years 8-10 of that disease course. This means that for most patients, symptoms go undiagnosed and untreated for at least seven years, during which time the lesions spread through the brain and cause irreparable damage. Please be aware that we diagnose Alzheimer’s disease far too late to optimize the effects of currently available treatments.
2) Memory loss is not a part of normal aging. The point about end-stage detection raises an obvious question about “why” we diagnose this disease so late. There are many contributing factors but most of them can be reduced through awareness and education. Some patients resist medical attention in the early stages because they fear a stigmatizing label or because they are misinformed to believe that Alzheimer’s cannot be treated. Many people, including a startling number of physicians, incorrectly believe that memory loss is a normal part of aging. Improving the timeliness of diagnoses for Alzheimer’s is, in many ways, a problem that can be addressed through awareness and education. Please be aware that memory loss is not a part of normal aging and, regardless of the cause of the memory loss, timely medical intervention is best.
3) Current Alzheimer’s drugs are probably more effective than you think. Our widespread practice of late detection has many negative consequences. For example, one of the reasons that current treatments are often deemed ineffective is because they are routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy. Yes, we need better treatments, but a great start would be to intervene earlier with the treatments we already have. Please be aware that currently approved treatments may be more effective than some headlines indicate.
4) Alzheimer’s disease can be treated. Another treatment related concept about which everyone should be aware is this. Preventing or slowing further brain damage is preferable to letting the damage spread without constraint. Yet, many physicians, patients, and caregivers conclude that any treatment short of a cure is not worthwhile. While today it is true that we have no cure for Alzheimer’s, that does not mean there is no treatment. With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life. Please be aware that “we have no cure” does not mean “there is no treatment”.
5) The Alzheimer’s drug pipeline is full. Here’s another fact of which you should be aware. Through an intense research effort over the past twenty years, scientists have gained a lot of insight about Alzheimer’s disease mechanisms and about other factors that increase the risk for the disease. Much has been learned and some very promising drugs, based on sound theoretical approaches, are in FDA clinical trials right now. While much of the disease remains shrouded in mystery and we may still be a long way from better treatments, it is possible that an effective agent is already in the pipeline. Please be aware that, although we don’t know when, better treatments for Alzheimer’s are certainly on the way.
6) Taking good care of your heart will help your brain stay healthy. Know this; the health of your brain is very closely tied to the health of your body, particularly your heart. Researchers have shown conclusively that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. The mechanisms that keep oxygen rich blood flowing through your body play a key role in maintaining a healthy brain. Everyone should be aware about the close association between vascular health and cognitive health. Please be aware that maintaining good vascular health will help you age with cognitive vitality.
7) Managing risk factors may delay or prevent cognitive problems later in life. There are well-identified risk factors for Alzheimer’s disease that are within our power to manage. These include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. With greater awareness of these facts, we can imagine a world where diabetics take more care to control their blood sugar, where helmets are more prevalent in recreational activities that are likely to cause head trauma, where people smoke less and eat more fruits and vegetables, and where everyone makes a better effort to exercise and to stay socially engaged on a regular basis. While these facts may not be well known, they are all well proven. Galvanizing an effort to publicize them is one purpose of National Alzheimer’s Awareness Month. Please be aware that many risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.
So why bother with Alzheimer’s awareness? Because it is a terrible disease poised to ravage our aging society and the lack of education and awareness has lead to a stigma that prevents a more proactive approach to early intervention. The result is that we diagnose it too late, which hampers the efficacy of available treatments. A more educated public could manage risk factors to minimize the likelihood of Alzheimer’s, could monitor personal cognitive health with greater vigilance, and could seek medical attention at the earliest sign of decline. Physicians could then diagnose problems earlier and prescribe appropriate treatment including diet, exercise, and drugs to slow disease progression as much as possible. In the end, we could have fewer cases, more effective treatment, slower progression, higher quality of life, and lower healthcare costs. The social, emotional, and fiscal benefits of awareness and education in this area are too large to quantify.
By reading this article, you have increased your understanding of the problem and raised your awareness about what can be done. That is a great step in the right direction but you can do one thing more. You can help to spread this message.
In the spirit of National Alzheimer’s Awareness Month, please share this article with your friends to promote more widespread awareness. Post it to your Facebook page, mark it in Delicious, Tweet it, Digg it, or email it. It doesn’t matter how you do your part, it only matters that you get it done.
Follow me on Twitter.
Thursday, November 5, 2009
Vision Problems and Variant AD
Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego. ______________________________________
In a minority of Alzheimer's patients the disease shows up first as problems with vision rather than memory or other cognitive functions. But diagnosis can be difficult because standard eye exams are often inconclusive for these patients.
Neuro-ophthalmologists Pierre-Francois Kaeser, MD, and Francois-Xavier Borruat, MD, Jules Gonin Eye Hospital, Switzerland, examined and followed 10 patients with unexplained vision loss who were ultimately diagnosed with the visual variant of Alzheimer's disease (VVAD). Their study -- presented at the 2009 Joint Meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology (PAAO) -- describes clinical clues that may improve ophthalmologists' ability to detect VVAD and refer patients for further tests. When patients receive neurological assessment, treatment and family counseling early in the disease, outcomes may be better for all concerned.
VVAD patients differ from typical Alzheimer's patients in a number of ways. At the time they report visual problems, many are younger than those for whom memory loss is the tell-tale sign. In Dr. Kaeser's study the median patient age was 65, and only 3 of 10 reported memory loss. In comprehensive neuro-ophthalmic exams even though most patients' visual acuity was adequate, all but one had difficulty with reading, 8 of 10 with writing, and 6 of 10 with basic calculations. The visual field was altered in 8 of 10 patients.
All had trouble identifying colored numbers despite being able to name colors correctly, and, importantly, 8 of 10 patients had difficulty recognizing and interpreting components of a complex image (simultagnosia). This is an early indicator of the brain damage that prevents later-stage Alzheimer's patients from recognizing people they know and navigating familiar surroundings. MRI and PET scans revealed neurological changes consistent with VVAD in all study patients. Though VVAD patients' first symptoms are visual, Alzheimer's memory and personality impairments eventually occur in most.
Interestingly, in the neurology field VVAD is referred to as Posterior Cortical Atrophy (PCA), because the posterior, or back of the brain, shrinks. When pathologists examine the brain tissue from these patients, they see amyloid plaques in the occipital lobe, which is in the posterior part of the brain, and resposible for vision.
New Dimebon Trials Launched
Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________
As we have chronicled in past posts, there are multiple agents for treating Alzheimer's disease in the FDA pipeline. One of the most advanced, and by many measures, most promising, is Dimebon.
The co-developers of this agent (Pfizer and Medivation) have announced two additional trials that are now enrolling subjects. While it is not completely understood, Dimebon appears to have a novel mechanism compared to the currently approved drugs Aricept, Razadyne, and Exelon, all of which are cholinesterase inhibitors and Namenda, which is a glutamate blocker. The mechanism is theorized to be one of improving mitochondrial function to promote ongoing cell health. The new trials will explore poly-therapy with Aricept and with Namenda.
To learn more details and to inquire about enrolling in the studies, please follow these links to the CONTACT study (or email contactstudy@medivation.com) and to the CONSTELLATION study (or call 1-877-377-4476).
________________________________________________
As we have chronicled in past posts, there are multiple agents for treating Alzheimer's disease in the FDA pipeline. One of the most advanced, and by many measures, most promising, is Dimebon.
The co-developers of this agent (Pfizer and Medivation) have announced two additional trials that are now enrolling subjects. While it is not completely understood, Dimebon appears to have a novel mechanism compared to the currently approved drugs Aricept, Razadyne, and Exelon, all of which are cholinesterase inhibitors and Namenda, which is a glutamate blocker. The mechanism is theorized to be one of improving mitochondrial function to promote ongoing cell health. The new trials will explore poly-therapy with Aricept and with Namenda.
To learn more details and to inquire about enrolling in the studies, please follow these links to the CONTACT study (or email contactstudy@medivation.com) and to the CONSTELLATION study (or call 1-877-377-4476).
Wednesday, November 4, 2009
Inflammation and AD
Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego. ______________________________________
Microglia are the housekeepers of the brain, digesting foreign bodies and protecting neurons from damage. In culture, these cells are well known for ingesting amyloid-β, and in Alzheimer disease they surround amyloid deposits.
This leads to the hypothesis that the microglia may surround the plaques, but are essentially protecting the rest of the brain and not involved in modifying, depositing, or removing the plaques. The study also raises the possibility that cell-mediated inflammation does not promote more amyloid or more Aβ, which has been a hypothesis for a long time.
Microglia are the housekeepers of the brain, digesting foreign bodies and protecting neurons from damage. In culture, these cells are well known for ingesting amyloid-β, and in Alzheimer disease they surround amyloid deposits.
But in a study published in the October 18 Nature Neuroscience online, researchers in Germany have almost completely removed microglia from the brains of transgenic mice, and to their surprise they found absolutely no change in plaque size or number.
Subscribe to:
Posts (Atom)
Posts
