Archives for March 2015

Behavioral Challenges: Coping With… Paranoia/Suspiciousness

(Alzheimer’s Foundation of America) Individuals with dementia may become paranoid as a result of false beliefs, or delusions, which are a symptom of the disease. Examples of paranoia are accusations that someone is poisoning their food or stealing their money, or statements such as, “My spouse is an imposter.”

Possible problems:

  • Discuss paranoid behaviors with the individual’s doctor. Medications may need to be adjusted.
  • Explain to other family members and caregivers that suspicious accusations are a part of the illness.
  • Respond to the feeling behind the accusation. If the accusation involves hurting someone who has passed away, you might suggest, “You really miss your mother; tell me about her.”
  • Try non-verbal reassurances like a gentle touch or hug.
  • If the individual suspects money is “missing,” allow them to keep small amounts of money in a pocket or pocketbook for easy inspection.
  • Assist the person in looking for a missing object. Try to learn where their favorite hiding places are for storing objects that are frequently “lost.”
  • Avoid arguing.

Behavioral Challenges: Potential Causes of Behavioral Symptoms

While the underlying cause of the behavioral symptoms of Alzheimer’s disease and related dementias is the illness itself—changes in the brain due to the death of brain cells, there are multiple other factors that may trigger the various behaviors and emotions that can unfold during the progression of the disease. Understanding the cause and effect can help family and professional caregivers better manage situations that may arise.

Reaction to Loss:

We all rely on input from our environment to guide us in activities and relationships. An individual with dementia has lost both the benefit of such input and the ability to inform us of their internal world. This absence causes fear, insecurity and frustration, which may present in the form of aggression and agitated behavior. Some Suggestions:

  • Provide reassurance.
  • Speak in a calm voice.
  • Promote a sense of security and comfort.

Inability to Meet Basic Needs:

As a result of cognitive impairment and psychiatric symptoms, a person’s basic needs might not be met. The resulting hunger, dehydration, elimination problems and fatigue can produce behavioral changes. Individuals with dementia may stay hungry because of, for example, their inability to feed themselves, depression or loss of muscle coordination. They may show their discomfort through agitated and aggressive behavior. Likewise, they may forget how to pour water into a cup or never ask for a drink due to their inability to communicate. Dehydration can lead to urinary tract infection, constipation and fever—putting individuals at a high risk fordelirium and consequently more behavioral problems. Similarly, individuals may forget where or what the bathroom is, and eventually may not recognize the internal cues for urination or a bowel movement. Elimination problems may prompt agitation, aggression, wandering, pacing, and incontinence. Compounding this, they may develop urinary tract infections or constipation which, left untreated, could result in delirium.

Lastly, people with dementia may get tired easily because of wandering, pacing and disruption of the sleep-wake cycle. Fatigue often leads to irritability and aggression. Some Suggestions:

  • Offer verbal and physical assistance during meals.
  • Serve foods that the individual likes.
  • Provide adequate snacks and supplements.
  • Prevent distraction during meals by rearranging the environment
  • Serve pre-cut or finger food if using utensils becomes difficult.
  • Consult with a healthcare professional about swallowing problems.
  • Schedule fluid intake to ensure six to eight glasses of liquid per day.
  • Avoid coffee, tea beverages with caffeine that act as diuretics.
  • Establish a routine for using the toilet, such as assisting them to the bathroom every two hours.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Put up signs (with illustrations) to indicate the bathroom door.
  • Use easy-to-remove clothing, such as those with elastic waistbands.
  • Try soothing music or a massage to induce sleep.
  • Reduce environmental stimuli.
  • Encourage short periods of napping to prevent exhaustion.

Co-Existing Medical Problems:

Pain and discomfort from a medical problem (i.e., dental pain, urinary tract infection) or medication side effects can go unnoticed because of the individual’s inability to report it due to poor memory and/or loss of verbal skills. In addition, caregivers may have difficulty gauging the individual’s pain because the person does not respond to questions. As a result, these individuals may not receive necessary medication or treatment. Those who are in pain and discomfort tend to exhibit verbal and physical aggression, restlessness, wandering and pacing.Some Suggestions:

  • Become familiar with the person’s medical history.
  • Assess their non-verbal behavior to help identify the cause of distress.
  • Watch for signs of urinary tract infection and other medical conditions.
  • Monitor medications for side effects.

Co-Existing Psychiatric Disorders:

Individuals with a previous diagnosis of psychiatric disorders, such as schizophrenia,depression or mania, and those with mental retardation are likely to exhibit more behavioral problems when they develop dementia than other individuals without psychiatric illnesses. Those with hallucinations or delusions and who are depressed or manic tend to exhibit more aggressive and agitated behavior. Some Suggestions:

  • Consult with your physician about available medications, such as anti-depressants, anti-psychotics and other mood stabilizers, to control severe symptoms, if appropriate. Also discuss non-drug interventions, like behavioral modifications and environmental changes.
  • Provide reassurance.
  • Distract and redirect with other activities.

Environmental Factors:

Excessive noise, poor or glaring lighting and cold temperature in the home or a long-term care facility, and overcrowding in a group setting can increase agitation, screaming and aggressive behavior. Any change in the environment or routines, such as bathing and eating, can cause frustration and agitation. As well, boredom that results from lack of activities, and conflicts among residents in a group setting can manifest in behavioral changes. Some Suggestions:

  • Reduce excess stimuli, such as the TV or radio.
  • Elevate the room temperature.
  • Ensure adequate lighting.
  • Carefully and gradually introduce changes in routine or the environment.
  • Provide activities that are simple and creative.
  • In a group setting, staff should anticipate the characteristics of each resident and adjust the environment accordingly.

Sensory Impairment:

Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel more frightened and frustrated. For example, those with poor eyesight may not eat their food or they may be at risk for falls. Some Suggestions:

  • Assess vision and hearing.
  • Ensure that individuals who wear glasses or hearing aids have them in place.
  • Evaluate problems such as cataracts, glaucoma or other eye diseases, and correct them with surgery, if feasible, or by creative environmental changes. 

Factors Related to the Caregiver:

A caregiver’s attitude and knowledge of dementia affect the care of individuals with the disease. Individuals usually respond to a caregiver’s mood and cues accordingly. Some Suggestions:

  • Become educated about the disease.
  • Stick to routines.
  • Learn effective communication techniques and how to cope with specific behavioral challenges.
  • Use a calm tone of voice combined with gentle touch to convey reassurance.
  • Validate the person’s feelings.
  • Speak slowly and simply.
  • Distract and redirect to positive activities.
  • Be patient and kind.
  • Remember that behavior problems result from the disease. Do not take things that the person says and does personally; it is the disease speaking.
  • Recall fond memories from the past, including ways in which your loved one cared for and supported you in the past.  This will increase your ability to be patient and understanding in difficult situations.
  • Reach out to friends and family for support, educate them about Alzheimer’s disease, and consider sharing with them the specific symptoms that your loved one is experiencing.  This way, they will be better able to both support you and interact positively with your loved one.
  • Acknowledge your own feelings, possibly sadness, anger or frustration, and consider joining a caregiver support group or attending individual counseling.
  • Remember to practice good self-care—physically and mentally.  Try to eat nutritious meals, get a good night’s sleep, exercise regularly, and make time for your own interests and friendships.  The better you take care of yourself, the better you can care for your loved one.

 

Behavioral Challenges: Strategies to Head Off or Deal With Behavior Problems

  • Pay attention to what the individual with dementia is saying—both verbally and non-verbally. Caregivers also should be aware of their communication techniques, including providing one-step instructions and speaking in a reassuring tone.
  • Think ahead and plan for situations that could result in problem behaviors.
  • Understand that trying to argue with someone who has dementia only results in frustration for both them and the caregiver.
  • Distract and divert attention whenever possible.
  • Hold to the same routine.
  • Keep things simple to avoid frustration.
  • Promote a sense of security and comfort.
  • Use positive reinforcements, such as smiles, a gentle touch, personal attention and praise.
  • Allow the individual to have some sense of control. Being able to “save face” is important to someone who is very confused.
  • Maintain a calm manner even when the individual becomes aggressive or agitated. This can defuse a tense situation and help reduce a person’s fears.
  • Assess the situation to protect yourself. Should an individual’s aggression become violent, be mindful of your own safety first.
  • Caregivers should practice ways to reduce stress when they become angry or frustrated, since anger and frustration could aggravate a behavior problem.
  • Remember that behavior problems result from the disease. Do not take things that the person says and does personally; it is the disease speaking.
  • Be creative and use common sense.
  • Try to keep a sense of humor even in the most difficult situations.
Citation

http://www.alzfdn.org/EducationandCare/paranoia.html

©2015 Alzheimer’s Foundation of America. All rights reserved.

 

Diabetes and the Risk of Alzheimer’s Disease

PLoS One. 2014 Jan 29;9(1):e87095. doi: 10.1371/journal.pone.0087095. eCollection 2014.

Diabetes mellitus and the risk of Alzheimer’s disease: a nationwide population-based study.

Huang CC1, Chung CM2, Leu HB3, Lin LY4, Chiu CC5, Hsu CY5, Chiang CH6, Huang PH7, Chen TJ8, Lin SJ9, Chen JW1, Chan WL10.

Abstract

Objectives

Possible association between diabetes mellitus (DM) and Alzheimer’s disease (AD) has been controversial. This study used a nationwide population-based dataset to investigate the relationship between DM and subsequent AD incidence.

Methods

Data were collected from Taiwan’s National Health Insurance Research Database, which released a cohort dataset of 1,000,000 randomly sampled people and confirmed it to be representative of the Taiwanese population. We identified 71,433 patients newly diagnosed with diabetes (age 58.74 ± 14.02 years) since January 1997. Using propensity score, we matched them with 71,311 non-diabetic subjects by time of enrollment, age, gender, hypertension, hyperlipidemia, and previous stroke history. All the patients were followed up to December 31, 2007. The endpoint of the study was occurrence of AD.

Results

Over a maximum 11 years of follow-up, diabetic patients experienced a higher incidence of AD than non-diabetic subjects (0.48% vs. 0.37%, p<0.001). After Cox proportional hazard regression model analysis, DM (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.50-2.07, p<0.001), age (HR, 1.11; 95% CI, 1.10-1.12, p<0.001), female gender (HR, 1.24; 95% CI, 1.06-1.46, p=0.008), hypertension (HR, 1.30; 95% CI, 1.07-1.59, p=0.01), previous stroke history (HR, 1.79; 95% CI, 1.28-2.50, p<0.001), and urbanization status (metropolis, HR, 1.32; 95% CI, 1.07-1.63, p=0.009) were independently associated with the increased risk of AD. Neither monotherapy nor combination therapy with oral antidiabetic medications were associated with the risk of AD after adjusting for underlying risk factors and the duration of DM since diagnosis. However, combination therapy with insulin was found to be associated with greater risk of AD (HR, 2.17; 95% CI, 1.04-4.52, p=0.039).

Conclusion

Newly diagnosed DM was associated with increased risk of AD. Use of hypoglycemic agents did not ameliorate the risk.

Citation

http://www.ncbi.nlm.nih.gov/pubmed/24489845

 

Managing Caregiver Grief, Guilt, and Exhaustion

(American Association of Retired Persons) Ever since I’ve been a caregiver, I’ve been waiting for The Call. If you’re caring for a loved one, you know what I mean — the telephone rings, and you learn that your parent has taken a turn for the worse and you must rush to his side. In the past 12 years I’ve taken care of my father, then my mother and now my 93-year-old mother-in-law. The Call keeps coming, and I’ve been on edge the whole time, waiting.

Last August my husband and I were reluctant to take our annual family vacation. Would something happen? But we went, knowing that time with our adult children, who live all around the country, was also important.

We had just entered the rental house when the phone rang. My mother-in-law had been admitted to a hospital many hours away. My brother-in-law gave us bedside reports, and she was released the next day.

Collage of Sally Abrahms' family photographs and handwriting - The Emotions of CaregivingThere is no formula for becoming a caregiver. Each experience is unpredictable, ever changing and unique. — Courtesy Sally Abrahms

On the last day of vacation, the phone rang again. My mother had had a massive stroke. I traveled for six hours to her and stayed in the hospital with her for six days until she died.

Caregiving brings about a swirl of feelings: sadness, frustration, anger, anxiety, guilt, resentment, confusion, isolation, loss, fear, grief, impatience and stress. I have been overwhelmed, drained by sibling tension and torn between my own family, work, personal time and parental needs.

I’ve also experienced devotion, tenderness, intimacy, gratitude, patience and purpose in my role. In fact, a recent study from the Sloan Center on Aging & Work at Boston College found that older Americans who feel they are making a difference in caregiving and are highly engaged in what they’re doing feel happier and more content. I understand that, as well.

But from my on-the-job training, professional reporting and research, including writing a weekly blog for AARP on the topic, I believe most caregivers confront three distinct and difficult experiences. With help from experts, I’ve also learned ways to manage them.

Grief

Caregivers frequently grieve the loss of the person they once knew, even though their loved one is still alive. Until her first stroke, in 2008, my mother, a former university English teacher, read a book a day, without glasses, and was in three book clubs. Post-stroke, she could no longer see well enough to read and couldn’t process Books on Tape. Instead of dashing to a play, a lecture or a party, she stayed home, unable to walk unaided or get up from a chair by herself. She was a different person.

“When someone dies, it is an overwhelming and horrible experience, but it is the end of something,” says Suzanne Mintz, cofounder of the National Family Caregivers Association and author of A Family Caregiver Speaks Up: It Doesn’t Have to Be This Hard.

“But with a caregiver, the grief is perpetual; it goes on and on and on.”

Mintz has watched her husband, diagnosed with multiple sclerosis in 1974, lose his independence.

“You grieve because you’ve lost the life you had, and you know it won’t be coming back. Both of you have the diagnosis — the person with the condition and the family caregiver,” says Mintz.

One way to combat grief is to forge a way to relate to the “new” person. Chuck Niggley’s wife was diagnosed with Parkinson’s disease 27 years ago.

“Do I ever think about what if my wife weren’t ill? Sure,” says the Beaverton, Ore., 73-year-old.

“But I don’t spend time dwelling on it. I’ve given up going to a three-hour movie or a baseball game with her, but we’ve substituted things we can do together, like attending our grandchildren’s events and going to music programs.”

The arts, in fact, give caregivers and their charges a powerful way to connect. Interactive creative programs — such as songwriting, storytelling, dancing, playing instruments and painting — provide ways for caregivers and care recipients to relinquish their usual roles and enjoy a fun and stimulating sensory experience together.

New York’s Museum of Modern Art opens its doors to those with dementia and their caregivers each month. An art educator leads a discussion about master artists — van Gogh, Picasso, Degas — while the group views their works. This exercise taps into little-used senses and memories and ignites lively conversation, often making it impossible to tell who’s taking care of whom.

My mother had always loved poetry, so I would bring Robert Louis Stevenson’s A Child’s Garden of Verses, a collection of the same poems she had once read to me and I had read to my children, when I visited. She’d smile as we finished the lines together, and I felt close to the mother I remembered while relating to the person she had become.

Guilt

During caregiving guilt is constant. Guilt for not spending enough time with your loved one. Guilt for not tending to your own family. Guilt for having negative feelings. And guilt for resenting your new role. On my hundreds of trips back and forth to visit my mother, I remember thinking that — shame on me — I wish this would be over so I could get my life back.

What caregivers must remember is that this is a situation over which you have limited control and shouldn’t feel guilty about, says Alexis Abramson, a gerontologist and author of The Caregiver’s Survival Handbook. “However, you are in control of how you react to it,” she says. And that is empowering.

Abramson advises reaching out to caregiving organizations that offer education and support, investigating elder-care benefits at work and resources in the community (respite programs, adult-day-care centers, transportation services), and scheduling time for yourself.

Without a network of support, caregivers often become isolated, which can lead to depression and their own serious health issues, and further exacerbate problems — one being guilt.

One way for caregivers to handle guilt is “to accept that having negative feelings about caregiving is normal,” says Barry J. Jacobs, a psychologist and author of The Emotional Survival Guide for Caregivers.“You love the person you’re caring for, but you hate the caregiving. That’s normal.”

Exhaustion

Caregiving often leaves the caregiver feeling depleted, both physically and mentally. For years, every other Saturday or Sunday my husband and I would pull a “doubleheader”: driving two hours to see my mother, then driving another hour to be with his mother, and finally getting back home by 8 that night, when I would fall into bed and not move. It was physically draining, sure, but the mental toll also wiped me out for the next day and left me dreading the time we’d have to return.

“That’s when the caregiving plan needs to be changed,” says Jacobs. “Caregivers need to be smart and strategic about setting limits on the tasks they take on, and recruit others to pitch in.”

Yes, taking the pressure off yourself is key. Hire outside help. Involve other family members and friends. A sibling or in-law who lives far away may be able to pay Mom’s bills online, deal with insurance companies or take time off to stay with her so you can take a breather.

“When family members do pitch in, then everyone feels like a team in caring for a loved one,” says Jacobs.

“Caregivers feel better supported and more resilient; family relationships become stronger and more enduring, even after their loved one has died.”

Talking out emotions with a friend, an elder mediator, a therapist or a peer group can also lighten the mental load.

“Many of the caregivers I see who do well go to support groups,” says Lisa Campbell, a clinical psychologist who specializes in 50-plus issues at the Willow Wellness Center in Park Ridge, Ill. “It’s normal to feel overwhelmed,” she says. “Families are complicated.”

This is why, in part, there is no pat formula for navigating your own maze when you become a caregiver. Each experience is unpredictable, ever changing and unique. Your plan will require constant revision. You’ll need to reach out to others for ideas, advice and help, and that includes finding ways to take care of the caregiver — you.

Citation

by: Sally Abrahms, from: AARP Bulletin, November 7, 2012

Sally Abrahms blogs about caregiving at  blog.aarp.org/author/aarpsally.

The contents of all material available on www.aarp.org are copyrighted by AARP. Copyright is not claimed as to any part of an original work prepared by a U.S. or state government officer or employee as part of that person’s official duties.

 

Nutritional Status According to Stages of Alzheimer’s Disease

Aging Clin Exp Res. 2014 Dec 25. [Epub ahead of print]

Nutritional status according to the stages of Alzheimer’s disease.

Marino LV1, Ramos LF, Chiarello PG.

Abstract

Objective

To assess the nutritional status of Alzheimer’s disease (AD) patients with no other associated dementia, according to disease stage.

Design

Cross-sectional observational study.

Setting

Neurobehavioral Diseases Outpatient Clinic, Clinical Hospital, Ribeirao Preto Medical School (University of São Paulo).

Participants

The sample consisted of 36 individuals of both genders with AD diagnosis, and no other associated type of dementia, in various stages of the disease, according to the Clinical Dementia Rating (CDR 0.5-3).

Measurements

Nutritional status was evaluated using the Mini Nutritional Assessment (MNA) and anthropometric measurements such as weight, body mass index (BMI) and arm, waist, abdomen and hip circumferences. In addition, body composition was assessed by bioelectrical impedance analysis (BIA).

Results

The mean age of the group was 74.2 ± 10.1 years, 72.2 % of them were women. The MNA showed that most of these individuals were at risk for malnutrition (55.5 %) and many of them (43.7 %) were underweight according to BMI. Data from BIA analysis revealed that 41.7 % of these individuals had a quantity of body fat classified as malnutrition and 11.1 % had a phase angle (PA) below recommended values for age group.

There was a negative and significant correlation of lean mass and PA with age, and of global MNA evaluation with CDR, as well as a positive correlation of MNA total score with fat mass and BMI.

Worse classifications of nutritional status obtained by MNA scores were also observed in the more severe stages of the disease, according to the CDR.

Conclusion

Patients with AD are mostly elderly with changes in body composition that are typical of aging, with signs of peripheral malnutrition and preservation of abdominal fat. However, greater impairment of general nutritional status was observed in the more advanced stages of AD, creating a situation of greater vulnerability for these patients.

Citation
http://www.ncbi.nlm.nih.gov/pubmed/25539973

 

Healthy Eating, Exercise, and Brain-Training Program Results in Slower Mental Decline for Older People

(The Lancet via ScienceDaily) A comprehensive program providing older people at risk of dementia with healthy eating guidance, exercise, brain training, and management of metabolic and vascular risk factors appears to slow down cognitive decline, according to the first ever randomised controlled trial of its kind, published in The Lancet.

In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study, researchers led by Professor Miia Kivipelto from the Karolinska Institutet in Stockholm, Sweden, National Institute for Health and Welfare in Helsinki, and University of Eastern Finland, assessed the effects on brain function of a comprehensive intervention aimed at addressing some of the most important risk factors for age-related dementia, such as high body-mass index and heart health.

1260 people from across Finland, aged 60-77 years, were included in the study, with half randomly allocated to the intervention group, and half allocated to a control group, who received regular health advice only. All of the study participants were deemed to be at risk of dementia, based on standardised test scores.

The intensive intervention consisted of regular meetings over two years with physicians, nurses, and other health professionals, with participants given comprehensive advice on maintaining a healthy diet, exercise programs including both muscle and cardiovascular training, brain training exercises, and management of metabolic and vascular risk factors through regular blood tests, and other means.

After two years, study participants’ mental function was scored using a standard test, the Neuropsychological Test Battery (NTB), where a higher score corresponds to better mental functioning. Overall test scores in the intervention group were 25% higher than in the control group.

For some parts of the test, the difference between groups was even more striking — for executive functioning (the brain’s ability to organise and regulate thought processes) scores were 83% higher in the intervention group, and processing speed was 150% higher.

Based on a pre-specified analysis, the intervention appeared to have no effect on patients’ memory. However, based on post-hoc analyses, there was a difference in memory scores between the intervention and control groups.

According to Professor Kivipelto,

“Much previous research has shown that there are links between cognitive decline in older people and factors such as diet, heart health, and fitness. However, our study is the first large randomised controlled trial to show that an intensive program aimed at addressing these risk factors might be able to prevent cognitive decline in elderly people who are at risk of dementia.”

The study participants will now be followed for at least seven years to determine whether the diminished cognitive decline seen in this trial is followed by reduced levels of dementia and Alzheimer’s diagnoses. The researchers will also be investigating possible mechanisms whereby the intervention might affect brain function.

Citation

Story Source:

The above story is based on materials provided by The Lancet. Note: Materials may be edited for content and length.

Journal Reference:

Tiia Ngandu, Jenni Lehtisalo, Alina Solomon, Esko Levälahti, Satu Ahtiluoto, Riitta Antikainen, Lars Bäckman, Tuomo Hänninen, Antti Jula, Tiina Laatikainen, Jaana Lindström, Francesca Mangialasche, Teemu Paajanen, Satu Pajala, Markku Peltonen, Rainer Rauramaa, Anna Stigsdotter-Neely, Timo Strandberg, Jaakko Tuomilehto, Hilkka Soininen, Miia Kivipelto. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 2015; DOI: 10.1016/S0140-6736(15)60461-5

The Lancet. (2015, March 11). Healthy eating, exercise, and brain-training program results in slower mental decline for older people. ScienceDaily. Retrieved March 15, 2015 from www.sciencedaily.com/releases/2015/03/150311210415.htm

 

Alzheimer’s Breakthrough Uses Ultrasound Technology

(Queensland Brain Institute) Queensland scientists have found that non-invasive ultrasound technology can be used to treat Alzheimer’s disease and restore memory. University of Queensland researchers discovered that the innovative drug-free approach breaks apart the neurotoxic amyloid plaques that result in memory loss and cognitive decline.

Welcoming the findings today at UQ’s Queensland Brain Institute, Queensland Premier Annastacia Palaszczuk said they could have a wide impact for the community.

“The Government’s $9 million investment into this technology was to drive discoveries into clinics, and today’s announcement indicates that together with the Queensland Brain Institute, it was a worthwhile investment,” Ms Palaszczuk said.

“I want my Government to encourage more of this type of innovative research.

“Our Advance Queensland initiative aims to increase research and discoveries like this and to put this state’s research at the forefront internationally by supporting local researchers and helping to keep them in Queensland.

“These exciting findings will hopefully be of benefit to all Australians in the future.”

QBI Founding Director Professor Perry Bartlett said the discovery – a result of ‘game-changing’ work performed at the Queensland Brain Institute’s Clem Jones Centre for Ageing Dementia Research – was made possible through the support of the State and Federal Governments and philanthropic support led by the Clem Jones Foundation.

“The farsighted investment of government and philanthropic partners has allowed us to build the research excellence and capacity required to make major discoveries such as this,” Professor Perry Bartlett said.

“I believe the work opens up an entirely novel avenue for future therapeutic treatment.”

Clem Jones Centre for Ageing Dementia Research director Professor Jürgen Götz said the new treatment method could revolutionise Alzheimer’s treatment by restoring memory.

“We’re extremely excited by this innovation of treating Alzheimer’s without using drug therapeutics,” Professor Götz said.

“The ultrasound waves oscillate tremendously quickly, activating microglial cells that digest and remove the amyloid plaques that destroy brain synapses.

“The word ‘breakthrough’ is often mis-used, but in this case I think this really does fundamentally change our understanding of how to treat this disease, and I foresee a great future for this approach.”

Alzheimer’s affects more than two-thirds of dementia patients, and approximately a quarter of a million Australians.

The total number of dementia cases in Australia is expected to rise to 900,000 by 2050.

“With an ageing population placing an increasing burden on the health system, an important factor is cost, and other potential drug treatments using antibodies will be expensive,” Professor Götz said.

“In contrast, this method uses relatively inexpensive ultrasound and microbubble technology which is non-invasive and appears highly effective.

The approach is able to temporarily open the blood-brain barrier, activating mechanisms that clear toxic protein clumps and restoring memory functions.

“With our approach the blood-brain barrier’s opening is only temporary for a few hours, so it quickly restores its protective role,” Professor Götz said.

Research has been conducted using mice with an Alzheimer’s model, with the next step being to scale the research in higher animal models ahead of human clinical trials, which are at least two years away.

“This treatment restored memory function to the same level of normal healthy mice,” Professor Götz said.

“We’re also working on seeing whether this method clears toxic protein aggregates in neurodegenerative diseases other than Alzheimer’s and whether this also restores executive functions, including decision-making and motor control.”

Findings of the research, “Scanning ultrasound efficiently removes amyloid-β and restores memory in an Alzheimer’s model”, are published in the journal Science Translational Medicine.

Citation

Journal Reference:

G. Leinenga, J. Gotz. Scanning ultrasound removes amyloid-  and restores memory in an Alzheimer’s disease mouse model. Science Translational Medicine, 2015; 7 (278): 278ra33 DOI: 10.1126/scitranslmed.aaa2512

http://qbi.uq.edu.au/content/alzheimer%E2%80%99s-breakthrough-uses-ultrasound-technology

© 2015 The University of Queensland

 

Boosting a Natural Protection Against Alzheimer’s Disease

(UC San Diego) Combining investigational therapy with gene variant may reduce dangers from debilitating brain plaques.

Researchers at the University of California, San Diego School of Medicine have identified a gene variant that may be used to predict people most likely to respond to an investigational therapy under development for Alzheimer’s disease (AD). The study, published March 12 in Cell Stem Cell, is based on experiments with cultured neurons derived from adult stem cells.

“Our results suggest that certain gene variants allow us to reduce the amount of beta amyloid produced by neurons,” said senior author Lawrence Goldstein, PhD, director of UC San Diego Sanford Stem Cell Clinical Center and UC San Diego Stem Cell Program.

“This is potentially significant for slowing the progression of Alzheimer’s disease.” AD is the most common cause of dementia in the United States, afflicting one in nine people age 65 and older.

The genetic risk factor investigated are variants of the SORL1 gene. The gene codes for a protein that affects the processing and subsequent accumulation of beta amyloid peptides, small bits of sticky protein that build up in the spaces between neurons. These plaques are linked to neuronal death and related dementia.

Previous studies have shown that certain variants of the SORL1 gene confer some protection from AD, while other variants are associated with about a 30 percent higher likelihood of developing the disease. Approximately one-third of the U.S. adult population is believed to carry the non-protective gene variants.

The study’s primary finding is that variants in the SORL1 gene may also be associated with how neurons respond to a natural compound in the brain that normally acts to protect nerve cell health. The protective compound, called BDNF, short for brain-derived neurotrophic factor, is currently being investigated as a potential therapy for a number of neurological diseases, including AD, because of its role in promoting neuronal survival.

For the study, UC San Diego researchers took skin cells from 13 people, seven of whom had AD and six of whom were healthy control subjects, and reprogrammed the skin cells into stem cells. These stem cells were coaxed to differentiate into neurons, and the neurons were cultured and then treated with BDNF.

The experiments revealed that neurons that carried disease-protective SORL1 variants responded to the therapy by reducing their baseline rate of beta amyloid peptide production by, on average, 20 percent. In contrast, the neurons carrying the risk variants of the gene, showed no change in baseline beta amyloid production.

“BDNF is found in everyone’s brain,” said first author Jessica Young, PhD, a postdoctoral fellow in the Goldstein laboratory. “What we found is that if you add more BDNF to neurons that carry a genetic risk factor for the disease, the neurons don’t respond. Those with the protective genetic profile do.”

“The value of this kind of stem cell study is that it lets us probe the uniquely human aspects of disease and identify how a person’s DNA might determine their drug response, in this case to a potential treatment for Alzheimer’s,” Young said.

“Future clinical trials on BDNF should consider stratifying patients based on their SORL1 risk factor and likelihood of benefiting from the therapy.”

Co-authors include Jonathan Boulanger-Weill, Daniel A. Williams, Grace Woodruff, Floyd Buen, Arra C. Revilla, Cheryl Herrera, Mason A. Israel, Shauna H. Yuan, and Steven D. Edland, all at UC San Diego.

Funding for the study was provided, in part, by the California Institute of Regenerative Medicine, A.P. Gianinni Foundation for Medical Research, BrightFocus Foundation and the National Institutes of Health (grant 2P50AG005131-31).

Citation

By Christina Johnson and Scott LaFee

https://health.ucsd.edu/news/releases/Pages/2015-03-12-boosting-natural-alzheimers-protection.aspx

Copyright © 2015 Regents of the University of California. All rights reserved.

 

Discovery of Alzheimer’s Disease Treatment by 2025 Will Save U.S. $220 Billion Within First Five Years

(Alzheimer’s Association) The United States could save $220 billion within the first five years of a treatment for Alzheimer’s disease being introduced, according to a new report from the Alzheimer’s Association.

The Alzheimer’s Association report, Changing the Trajectory of Alzheimer’s Disease: How a Treatment by 2025 Saves Lives and Dollars, takes an in-depth look at the potential lives saved and positive economic impact if a hypothetical treatment that effectively delays the onset of Alzheimer’s disease is discovered and made available to Americans by 2025. The report shows that meeting the 2025 goal of the national Alzheimer’s plan would reduce the number of individuals affected by the disease by 2.5 million within the first five years of a treatment being available.

“Alzheimer’s disease is a triple threat, with soaring prevalence, lack of treatment and enormous costs, that no one can afford,” said Harry Johns, president and CEO of the Alzheimer’s Association. “If we’re going to change the current trajectory of the disease, thus saving lives and money, we need consistent and meaningful investments in research from the federal government.”

The report reinforces the value of reaching the 2025 goal set by the National Plan to Address Alzheimer’s Disease mandate by the National Alzheimer’s Project Act (NAPA). If the federal government were to invest $2 billion per year as recommended by the scientific community, then it would recoup its investment within the first three years after a treatment became available.

“Promising research is ready for the pipeline, and leading scientists believe the national goal is attainable if we accelerate federal funding,” said Johns. “With millions of lives and trillions of dollars at stake, we need real progress in the fight against Alzheimer’s.”

The impact of introducing a hypothetical treatment in 2025
A treatment introduced in 2025 that delays the onset of Alzheimer’s would cut the number of people in 2050 who have the disease by 42 percent — from 13.5 million to 7.8 million.

While delaying onset, finding a cure and saving lives are the most important goals, bringing some financial relief to the health care system and those affected by the disease is also a top priority. Under the Alzheimer’s Accountability Act, Congress has required the National Institutes of Health (NIH) to submit a professional judgment budget to Congress every fiscal year until 2025 to help guide them in allocating funding for Alzheimer’s research.

The Alzheimer’s Association’s report shows the positive impact of adequate funding and the potential consequences of under-funding:

  • In 2015, the costs to all payers for the care of people living with Alzheimer’s disease and other dementias will total an estimated $226 billion, with Medicare and Medicaid paying 68 percent of the costs. Without a treatment costs are projected to increase to more than $1.1 trillion in 2050.
  • Reaching the 2025 goal would save payers $220 billion over five years and $367 billion in the year 2050 alone. Savings to Medicare and Medicaid would account for nearly 60 percent of the savings.
  • People living with Alzheimer’s and other dementias and their families would save $54 billion over the first five years in their out-of-pocket costs if the 2025 goal is met.

The Alzheimer’s Association is working closely with the federal government to ensure the plan and goals outlined under NAPA are being executed and met. A full text of the Alzheimer’s Association Changing the Trajectory of Alzheimer’s Disease: How a Treatment by 2025 Saves Lives and Dollars can be viewed at alz.org/trajectory.

Alzheimer’s Association
The Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer’s care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. For more information, visit alz.org.

Citation

http://www.alz.org/news_and_events_discovery_of_Alzheimers_disease_treatment.asp

Copyright © 2015  Alzheimer’s Association®. All rights reserved.