Diagnostic Tests for Alzheimer’s Disease

(BrightFocus Foundation)  With the adoption of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5), the definition of the condition formerly called dementia has been significantly transformed and updated. That makes this an excellent time to review the approach to diagnostic assessment of dementia and identification of Alzheimer’s disease (AD). Previously, a diagnosis of probable AD required the presence of a decline in memory and at least one of several other cognitive domains, not attributable to another medical or psychiatric disorder, resulting in an impairment of social and/or occupational functioning.

mri-300-X-200DSM 5 updates this approach in light of our greater understanding of neurocognitive disorders. Now, the presence of decline in one or more cognitive functions warrants the diagnosis of Major Neurocognitive Disorder (MND) if this impairment interferes with independence and is not better explained by another medical or psychiatric disorder. AD is the most common MND, but clinicians can use information from the history, current mental status examination, and neuropsychological or medical testing to refine the diagnosis further and specify whether AD or another type of MND is suspected.

Careful assessment of a person’s history, current complaints, and mental status examination remains the cornerstone of diagnostic assessment, but clinical assessment runs a risk of missing early and subtle indicators of MND, misclassifying AD as a different cognitive disorder, or mistaking another cognitive disorder for AD. Fortunately, a variety of additional tests are available to increase the accuracy of diagnosis, which are discussed below. Some less reliable or less widespread tests will not be covered in this discussion.

Medical History and Mental Status Examination

Clinical assessment of a patient’s history and performing a mental status examination are necessary steps in the evaluation of cognitive disorders. In identifying the presence of AD, the presence of a typical slow and insidious progression of symptoms is sought. Other factors capable of producing cognitive impairment are identified, including medical disorders, substances or medications that can cause cognitive impairment, or psychiatric conditions associated with cognitive changes. The characteristic clinical syndrome of AD includes a prominent disturbance of what is known as episodic memory (long-term memory that involves the recollection of situations, specific events, and experiences).

Memory of recent events is particularly impaired, and evidence that reminders are of limited benefit is consistent with the memory storage problem typically found in AD. Language and visuospatial problems may also be reported or identified. In less common variants of AD, the disturbance of language or visual functions may be more prominent than memory difficulties in the disease’s early stage.

Neuropsychological Screening Tests

Brief Neuropsychological Assessment Tools such as the Mini Mental State Exam (MMSE) and the Montreal Cognitive Assessment (MoCA) are available to screen for cognitive difficulties, although large scale routine screening of asymptomatic people is not recommended. In a busy primary care practice setting or in other appropriate contexts, these examination aids can justify further diagnostic testing in an individual who reports or shows cognitive changes. Longer and more comprehensive neuropsychological test batteries can estimate the severity of decline and characterize specific cognitive strengths and weaknesses. Administration of these test batteries requires training and certification. Evidence from neuropsychological testing, whether brief or more extensive, is interpreted in the context of a person’s overall medical and psychosocial circumstances.

Blood Tests

Currently available blood tests do not definitively identify the presence or absence of AD, but they are nonetheless useful. Blood tests can examine for other causes of cognitive impairment that can mimic AD’s clinical presentation. Infections such as HIV, metabolic disturbances such as hypothyroidism or hyponatremia (low blood sodium), autoimmune disorders such as giant cell arteritis, nutritional deficiencies such as pernicious anemia, and toxic conditions such as heavy metal poisoning are among the many conditions that can impair cognition and might be revealed by appropriately chosen blood tests.

Cerebrospinal Fluid (CSF) Tests

A lumbar puncture is required for withdrawal of cerebrospinal fluid. When clinicians are searching for infectious causes of cognitive impairment such as herpes encephalitis, examination of cerebrospinal fluid may be necessary in order to reach a definitive diagnosis. It is possible to quantify the relationship between cerebrospinal fluid beta amyloid and tau, proteins associated with Alzheimer’s disease. An abnormal result for this test, in the context of clinically measured cognitive impairment, is considered a “biomarker” associated with AD. CSF tests, however, are used infrequently in many settings due to the potential discomfort, possible complications, and limited availability of trained clinicians available to perform this procedure.

Brain Imaging

Brain imaging (neuroimaging) studies are recognized as an important component of the evaluation of any individual with a prominent change in cognitive functioning. Neuroimaging techniques fall into two major categories:

Computed Tomography and Magnetic Resonance Imaging

Structural imaging such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) yields a picture of the brain that allows identification of such features as volume loss or abnormal structural features such as white matter disease, masses, or vascular abnormalities, which are considered indications of neuronal degeneration. Newer techniques such as diffusion tensor imaging reveal subtle structural changes that may precede more easily identifiable volume loss in the brain. Functional imaging such as fMRI can be used to identify abnormal patterns of brain activation or metabolic activity.

Positron Emission Tomography

Positron Emission Tomography (PET) scanning uses radioactively labeled tracers to investigate the brain’s inner workings. Pictures of the brain distribution of radioactively labeled glucose is injected intravenously. Glucose is used for energy by the brain, and can help to identify areas of abnormal metabolic activity. Most insurances will cover the cost of using this FDG-PET to differentiate between suspected AD and frontotemporal dementias.

A newer class of PET tracers identifies the presence of accumulated beta amyloid. Abnormal results for this scan are associated with a high probability of clinical AD, but the expense of this test (which is not routinely covered by insurance) has impeded its widespread use. Amyloid PET scans provide a biomarker of amyloid accumulation.

EEG

Electroencephalography (EEG) is occasionally ordered during the course of the evaluation of an individual with new cognitive changes. EEG changes associated with a very specific cause of dementia, such as the typical pattern seen in Creutzfeldt-Jakob disease, are uncommon. EEG can identify the presence of a treatable seizure disorder or suggest the presence of a delirium that may be at least partly reversible.

Summary

In many cases, the diagnosis of AD is made with considerable accuracy on the basis of history and mental status examination. AD, however, is only one of many disorders capable of interfering with cognitive function. We still await the availability of a clinical test for AD that is very accurate, widely available, and covered by insurance, but the diagnostic tests described here are very useful for supporting a clinical diagnosis and seeking treatable alternate explanations for cognitive changes.

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Two-Year Clinical Trial of Multifaceted Lifestyle-Based Intervention Provides Cognitive Benefits for Older Adults at Risk of Dementia

(AAIC) Positive results presented at the Alzheimer’s Association International Conference® 2014 (AAIC® 2014) in Copenhagen include data from a two-year clinical trial in Finland of a multi-component lifestyle intervention, known as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER Study).

The study with 1,260 older adults at risk for cognitive impairment and Alzheimer’s showed that physical activity, nutritional guidance, cognitive training, social activities and management of heart health risk factors improved cognitive performance, both overall and in separate measures of executive function, such as planning abilities, and the relationship between cognitive functions and physical movement.

“AAIC is the premiere Alzheimer’s and dementia research conference, and this year’s topics are exciting both in their scope and findings,” said Keith Fargo, Ph.D., Alzheimer’s Association director of Scientific Programs & Outreach. “Regarding the FINGER Study, researchers have previously observed a number of modifiable factors associated with increased risk of late-life cognitive impairment and Alzheimer’s, but short-term studies focusing on single, isolated risk factors have had modest results, at best. Longer, larger, better controlled trials looking at modifying multiple risk factors – like the FINGER Study – have been needed. This new data is very encouraging, and we look forward to further studies to confirm and extend these findings.”

With the support of the Alzheimer’s Association and the Alzheimer’s community, the United States created its first National Plan to Address Alzheimer’s Disease in 2012. The plan includes the critical goal, which was adopted by the G8 at the Dementia Summit in 2013, of preventing and effectively treating Alzheimer’s by 2025. It is only through strong implementation and adequate funding of the Plan, including an additional $200 million in fiscal year 2015 for Alzheimer’s research, that we’ll meet that goal. For more information and to get involved, visit www.alz.org

Lifestyle Changes Improve Memory and Thinking in At-Risk Older Adults in Two-Year Clinical Trial

At AAIC 2014, Miia Kivipelto, M.D., Ph.D., Professor at the Karolinska Institutet, Sweden and the National Institute for Health and Welfare, Helsinki, Finland, and colleagues reported on the results of the FINGER Study, a two-year randomized controlled trial of 1,260 participants age 60 to 77 with modifiable risk factors for cognitive impairment and Alzheimer’s. Randomized controlled clinical trials are considered the “gold standard” for demonstrating treatment efficacy and safety.

Participants were divided into two groups; one received an intervention that included nutritional guidance, physical exercise, cognitive training, social activities, and management of heart health risk factors, while the control group received regular health advice. After two years, the intervention group performed significantly better on a comprehensive cognitive examination. In addition to performing better overall, the intervention group did significantly better on specific tests of memory, executive function (complex aspects of thought such as planning, judgment, and problem-solving), and speed of cognitive processing.

“This is the first randomized control trial showing that it is possible to prevent cognitive decline using a multi-domain intervention among older at-risk individuals. These results highlight the value of addressing multiple risk factors in improving performance in several cognitive domains,” said Kivipelto. “Participants told us their experience was very positive, and dropout rate only 11 percent after two years.”

The researchers say an extended, 7-year follow up study is planned, and will include measures of dementia/Alzheimer’s incidence and biomarkers including brain imaging with MRI and PET

About AAIC

The Alzheimer’s Association International Conference (AAIC) is the world’s largest gathering of leading researchers from around the world focused on Alzheimer’s and other dementias. As a part of the Alzheimer’s Association’s research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community. Scientists leading the advancement of research gather to report and discuss the most current data on the cause, diagnosis, treatment and prevention of Alzheimer’s disease and related disorders.

About the Alzheimer’s Association

The Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer 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. Visit www.alz.org or call 800.272.3900.

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Genentech Alzheimer’s Drug Crenezumab Misses Goals in Studies

(AP) An experimental drug from the biotech company Genentech failed to slow mental decline in mid-stage studies on more than 500 people with mild to moderate Alzheimer’s disease, but showed some promise in the least-impaired participants who received a higher dose.

Pneumonia and deaths were more common among those receiving the drug, but researchers downplayed that. Study leader Dr. Jeffrey Cummings of the Cleveland Clinic said none of the deaths seemed due to the drug and pneumonia occurred at a rate to be expected in older people.

“We’re very encouraged” by the hint of benefit for patients with milder dementia and will talk with regulators about next steps for the drug, crenezumab (cruh-NEZ-oo-mab), said a Genentech scientist, Dr. Carole Ho. The results fit with other evidence suggesting that treating earlier in the course of the disease is better, she said.

Results were revealed Wednesday at the Alzheimer’s Association International Conference in Copenhagen.

They are the latest mixed bag on treatments aimed at clearing away the sticky amyloid plaques clogging Alzheimer’s patients’ brains. About 35 million people worldwide have Alzheimer’s, the most common form of dementia. There is no cure and current treatments only temporarily ease symptoms.

Last year, an Eli Lilly & Co. medicine, solanezumab, that also sought to clear away amyloid missed main goals in two studies but combined results suggested it might help people with milder disease. It’s in further study now. Before that, bapineuzumab, a similar drug being developed by Pfizer Inc. and Johnson & Johnson, showed promise in mid-stage testing but flopped in larger, more definitive trials.

The Genentech drug has been closely watched because it targets amyloid more broadly than the other drugs do, and the California-based company has a long track record of success with many biological medicines against cancer.

Mid-stage studies aim to give some idea of safety and whether the drug is effective enough to advance to larger, more definitive studies aimed at winning market approval.

In one study, 431 patients ages 50 to 80 with mild to moderate Alzheimer’s were given crenezumab or dummy drug as shots every two weeks, or as a higher dose in infusions every four weeks for 17 months. No significant difference was seen among the groups on two widely used measures of thinking and functioning skills.

However, the 70 most mildly impaired participants who received the higher dose declined 35 percent less on the cognitive measure than the 33 mildly impaired people given dummy infusions. The difference was about 3.5 points on the roughly 70-point scale — “equivalent to six or nine months” of delay in decline, Cummings said.

This result isn’t definitive, though, and can only be considered a signal worth exploring in future research because it didn’t involve the whole group tested. And even in this mildly impaired group, the drug did not improve the second measure, ability to function in daily life.

In the second study, 73 people who showed amyloid plaques on brain imaging also were given crenezumab or dummy shots or infusions. The main outcome — levels of amyloid seen on brain imaging after treatment — will be presented at a medical conference in November. Results on cognitive function seem to mirror those in the larger study, Cummings said.

Five people given crenezumab died — one from sudden death, two from respiratory failure, one from pneumonia and one from worsening Alzheimer’s.

“We believe that the safety profile is acceptable,” because deaths do not seem related to the drug, Genentech’s Ho said. “It is not a show stopper.”

Genentech and its corporate parent, Switzerland-based Roche Holding AG, paid for the study and Cummings is a paid adviser to Genentech.

In a statement Wednesday, the Alzheimer’s Association noted that crenezumab was being tested in another study aimed at preventing the disease, and said the new results give hope it will be more successful in that setting.

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Can An Eye Test Predict Alzheimer’s? Scientists Unveil New Vision Scans

(Forbes) A simple eye test could soon reveal whether you have Alzheimer’s Disease – or even if the disease looms in your future. In fact, according to trial results released this week, the vision test detected signs of Alzheimer’s 15 to 20 years before the appearance of clinical signs.

This potentially game-changing news comes out of the Alzheimer’s Association International Conference, currently ongoing in Copenhagen, Denmark, where two presentations highlighted the potential of new vision screening technologies that use retinal imaging to measure amyloid plaque formation in the back of the eye.

The technology is based on an astoundingly simple idea: The brain-clogging amyloid plaques considered an indicator of Alzheimer’s can also be seen in the back of the eye, which is considered a mirror for brain health.

“If this test works, then one day screening for Alzheimer’s disease may be as simple as getting your eyes checked” said Yogi Kanagasingam, one of the researchers conducting clinical trials.

670px-pet_alzheimerPET scan of a human brain with Alzheimer’s disease (Photo credit: Wikipedia)

The first test, from Neurovision Imaging of Sacramento, California, utilizes retinal image fluorescence photography to scan the supranucleus region of the retina for a fluorescent signature characteristic of beta amyloid plaques. In preparation for the scan, participants take curcumin, the ingredient in turmeric that gives the spice its fluorescent yellow color, to “light up” the amyloid plaques with a specific fluorescent signature.

Preliminary data released on 40 trial subjects showed that levels of amyloid in the retina correlated closely with amyloid levels in the brain as revealed by PET (positron emission tomography) scans, the current detection method of choice.
The retinal imaging was also able to tell subjects with Alzheimer’s from those without the disease with 100 percent sensitivity and 80.6 percent specificity. Neurovision is working with Australia’s Edith Cowan University McCusker Alzheimer’s Research Foundation to test their retinal imaging scan.

NeuroVision isn’t alone in the retinal imaging field; a second data presentation, this time from Massachusetts-based Cognoptix, also showed promising results from another pioneering technology. Cognoptix’s SAPPHIRE II technology utilizes a fluorescent ligand eye scanning (FLES) process in which a topical ointment applied to the lens of the eye binds to beta-amyloid. The plaques are then detected with a laser scanner.

The Cognoptix clinical trial data, published in February in the Journal of Alzheimer’s Disease and Other Dementias, involved 40 participants and predicted Alzheimer’s with 85 percent sensitivity. It differentiated participants with Alzheimer’s from those without the disease with 95% accuracy.

A retinal imaging test for Alzheimer’s, if it proved accurate, could drastically change the way Alzheimer’s is diagnosed. “Presently the tests that are used in clinical trials are PET scan of the brain and CSF via lumbar puncture to measure levels of amyloid and tau,” says CEO NeuroVision CEO Steven Verdooner. ”Our retinal imaging test is expected to be meaningfully less expensive than a PET scan, is noninvasive, and potentially more sensitive.”

Early detection of Alzheimer’s disease is a key goal of current research because the treatments currently available to slow the progression of the disease are much more effective if started early.

What’s more, because a retinal imaging test is relatively simple to take and without major longterm health effects, it could be re-administered regularly to monitor the progress of the disease. “We believe the ability to measure progression is very powerful and are engaging in partnerships for therapeutic trials to prove that out,” says Verdooner.

Right now, because PET scans are radioactive, doctors don’t like to repeat them multiple times and usually wait at least 18 months before administering a second PET scan. According to Verdooner, Neurovision’s test can be repeated after an interval as short as three months.

While a vision test for Alzheimer’s isn’t going to be commercially available anytime soon, the wait isn’t going to be as long as you might think, either. The current trial winds up in the fall, at which point Neurovision will begin working with academic institutions to continue validating the retinal imaging procedure.

NeuroVision’s test could be available as soon as the second half of 2015, Verdooner says. “Once commercialized, we expect it to be available in doctors’ offices and can be administered by request from the patient or a referring doctor.”

The retinal imaging test will be administered as part of a package, along with blood-based biomarkers and cognitive screening, Verdooner says. “The paradigm we’re aiming at is a battery of tests that is cost-effective, fast, and non-invasive.”

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5 Groundbreaking Trials Are Testing Ways to Prevent Alzheimer’s

(Time) Researchers are testing some promising drug candidates to halt Alzheimer’s dementia – even before symptoms start.

At the Alzheimer’s Association International Conference in Copenhagen, scientists described five trials that taking the unprecedented step of testing drugs that may prevent the onset of the neurodegenerative disease in people not yet experiencing cognitive decline.

The participants in the trial are all at high risk of developing Alzheimer’s either because they carry two copies of the ApoE4 gene, which is associated with a strong chance of developing the disease, or a genetic mutation that triggers the condition much earlier in life, during the 40s.

Most will be testing drugs that target amyloid, the protein that builds up in abnormal amounts in the brains of Alzheimer’s patients and triggers other damaging changes that affect memory and cognitive functions. While other scientists reported some encouraging data on the effectiveness of diet, exercise, social support and controlling heart-related risk factors—see our piece about thelifestyle changes that prevented the disease—most experts believe that the best way to prevent Alzheimer’s may involve a combination of such lifestyle approaches with an effective drug.

Here’s the latest information on the five trials.

1.  Dominantly Inherited Alzheimer Network Trial (DIAN TU)

Who is enrolled: People with a genetic mutation for Alzheimer’s disease or those who don’t know their genetic status but have a parent or sibling with Alzheimer’s-related mutations

When they should enroll: when they are cognitively normal or have mild cognitive impairment

Drugs tested: Two experimental drugs, gantenerumab and solanezumab, both of which are antibodies designed to bind to amyloid and prevent it from forming brain-damaging plaques

2.  Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Study (A4)

Who is enrolled: People aged 65 to 85 years with normal thinking and memory

When they should enroll: Any time they become age eligible

Drugs tested: Solanezumab, an experimental anti-amyloid compound

3. TOMMORROW

Who is enrolled: Healthy seniors

When they should enroll: When they are cognitively normal or have mild cognitive impairment

Drugs tested: The trial will first pilot a screening test for two genes to see if it can accurately predict risk of mild cognitive impairment. The next phase of the trial will test an experimental compound designed to delay symptoms of mild cognitive impairment and Alzheimer’s disease in people without symptoms.

4. Alzheimer’s Prevention Initiative Autosomal Dominant Alzheimer’s Disease Treatment Trial

Who is enrolled: 300 people from a family in Columbia affected by a genetic predisposition to developing Alzheimer’s disease early in life

When they should enroll: Before symptoms begin

Drug tested: Anti-amyloid antibody crenezumab

5. Alzheimer’s Prevention Initiative APOE4 Treatment Trial

Who is enrolled: people with two copies of APOE4, who are at high risk of developing Alzheimer’s disease

When they should enroll: Before cognitive symptoms of Alzheimer’s begin

Drugs tested: An immunotherapy that prompts the body’s immune system to produce antibodies against amyloid protein, and a beta-secretase inhibitor that blocks the production of certain forms of amyloid.

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Alzheimer’s is a Fatal, Progressive Disease Impacting at Least 44 Million People Worldwide – Yet It is Widely Misunderstood

(Alzheimer’s Association) According to an Alzheimer’s Association 12-country survey, 59 percent of people surveyed believe incorrectly that Alzheimer’s disease is a typical part of aging and 40 percent of people believe that Alzheimer’s is not fatal. During the inaugural Alzheimer’s & Brain Awareness Month this June, the Alzheimer’s Association initiated a global conversation about the Alzheimer’s crisis and asking people around the world to use their brains to fight the disease.

The survey, conducted in Australia, Brazil, Canada, China, Denmark, Germany, Japan, India, Mexico, Nigeria, Saudi Arabia and the United Kingdom, also found that 37 percent of people surveyed incorrectly believe that you have to have a family history to be at risk for Alzheimer’s disease. The Alzheimer’s Association 2014 Alzheimer’s Disease Facts and Figures report released in March found that nearly a quarter (24 percent) of Americans hold the same mistaken belief, despite advancing age being the greatest risk factor for Alzheimer’s.

“Alzheimer’s is a devastating disease that slowly robs people of their independence and eventually their lives,” said Harry Johns, president and CEO of the Alzheimer’s Association.

“Sadly, Alzheimer’s disease knows no bounds. Anyone with a brain is at risk for Alzheimer’s disease, so everyone with a brain should join the fight against it.”

Despite lack of understanding of the severity of Alzheimer’s, it is still one of the most feared diseases. When asked what disease or condition they were most afraid of getting, a quarter of people selected Alzheimer’s (23 percent), second only to cancer (42 percent). When asked what disease or condition they were most afraid of a loved one getting, a third of people in Japan (34 percent), Canada (32 percent) and the UK (33 percent) selected Alzheimer’s. When considering health priorities, 96 percent of people surveyed said that being self-sufficient and not depending on others — an inevitability as Alzheimer’s disease progresses — is important.

Being able to pay for long-term care (88 percent) and caring for elderly parents at home (86 percent) were also important. These feelings are nearly universal with 98 percent of Americans saying that be self-sufficient and not depending on others is important (98 percent), as is the ability to care for elderly parents at home (91 percent) and being able to pay for long-term care (89 percent), according to the Alzheimer’s Association Facts and Figures report.

Government Responsibility

Unless something is done to change its course, worldwide prevalence of Alzheimer’s disease and other dementias will soar to 76 million by 2030 and threaten economies around the globe. A large majority of people surveyed — 71 percent — say that the government is responsible for helping find a cure or way to prevent Alzheimer’s.

“Despite an obvious and large knowledge gap, people around the world still recognize the threat the Alzheimer’s crisis presents and hold their government accountable for finding a cure and prevention,” said Johns. “In the U.S. and among the G7, federal governments have committed to preventing and effectively treating Alzheimer’s disease by 2025. We must hold our leaders responsible for investing in the research needed to realize that goal.”

Country and Age Breakdown

  • The mistaken belief that Alzheimer’s is a typical part of aging was highest in India (84 percent), Saudi Arabia (81 percent) and China (80 percent).
  • The UK and Mexico had the highest recognition that Alzheimer’s is not a typical part of aging (62 percent), but 37 percent and 38 percent, respectively, were still misinformed.
  • More than half of people surveyed in Germany (56 percent) and Mexico (55 percent) and Brazil (53 percent) do not realize that Alzheimer’s is fatal.
  • While 40 percent were misinformed, more people ages 18-34 (60 percent), 35-44 (61 percent), and 45-44 (58 percent) agreed that Alzheimer’s is a fatal disease than people ages 60+ (53 percent).

Get Involved

During Alzheimer’s & Brain Awareness Month, people around the world came together on a special day to raise awareness and funds for the fight against Alzheimer’s disease. On June 21, teams participated in The Longest Day®, a sunrise-to-sunset event to honor the strength, passion and endurance of those living with Alzheimer’s and their caregivers.

Other ways to join the fight against Alzheimer’s disease include:

  • Share the facts — Post and tweet about Alzheimer’s disease and brain risk throughout the month. If you have a brain, you are at risk for Alzheimer’s disease.
  • Be social — Turn Facebook purple using an END ALZ graphic as your profile picture.
  • Go purple — Wear purple all month but especially on Saturday, June 21, the longest day of the year, to support those facing the devastation of Alzheimer’s disease every day.
  • Use your brain to learn about Alzheimer’s disease — Take the Brain Tour at alz.org (available in 15 languages).

For more information on Alzheimer’s disease and the inaugural Alzheimer’s & Brain Awareness Month, visit alz.org/abam.

Survey Methodology

The Alzheimer’s & Brain Awareness Month International Survey was conducted by Abt SRBI. A total of 6,307 adults age 18+ were surveyed in local languages May 22-June 4, 2014, in three modes:

  1. Surveys were conducted online by sampling online panels in Australia (n=500), Brazil (n=501), Canada (n=500), Denmark (n=533), Germany (n=501), Japan (n=500), Mexico (n=502), Saudi Arabia (n=500), and the United Kingdom (n=500). Online panels were sampled in multiple replicates in proportion to the age and gender demographics of the panels, and quota ranges were used to limit skews by age and gender. For these online samples, a credibility interview of plus or minus approximately 5.1 percent is assumed for each country.
  2. Surveys were conducted by telephone by Random-Digit-Dialing (RDD) sampling of landline and mobile phone households in China (n=500) and India (n=500) by in-country market research agencies under the direction of Abt SRBI. The survey questions were fielded on an omnibus survey in each country. The final samples are probability-based samples but are demographically skewed. The sample in China is disproportionately urban and over-represents younger adults. The sample in India is almost entirely urban and under represents older adults. The margin of sampling error for each country is plus or minus approximately 4.4 percentage points at the 95 percent confidence interval.
  3. The survey in Nigeria (n=500) was conducted face-to-face in respondents’ households by cluster sampling urban populations and randomly selecting households and individuals within households. The survey questions were fielded on an omnibus survey. The resulting interviews comprise a probability-based, representative sample of the urban population of Nigeria. The margin of sampling error is plus or minus approximately 4.4 percentage points at the 95 percent confidence interval.

Alzheimer’s Association

The Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer 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 www.alz.org.

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The Scary Facts People Don’t Know About Alzheimer’s Disease

(Newsweek) Imagine losing your memories—forgetting your friends, unable to recognize your spouse, no longer recalling the names of your own children. Imagine, too, that you lose interest in reading, hiking, cooking or whatever other pastimes and passions define your life. Now imagine that you can no longer eat, walk or dress yourself. You must rely on people around you for the most basic human tasks, like taking medications and brushing your teeth, but you don’t fully understand what’s going on, because you can’t remember what’s happened or why.

This is life with Alzheimer’s disease.

Alzheimer’s is the sixth leading cause of death in the United States, and it’s arguably one of the most terrifying illnesses out there. It’s fatal. It claws its way into your family’s finances. And not a single treatment exists to slow, stop, prevent or reverse the disease, which is why the number of Americans with Alzheimer’s is set to skyrocket from an estimated 5.2 million today to as many as 16 million in 2050, costing the country $1.2 trillion in long-term care, hospice care and health care, according to the Alzheimer’s Association.

Last year, an estimated 15.5 million caregivers provided 17.7 billions hours of unpaid care to those with Alzheimer’s and other dementias. That’s around $220 billion in unpaid work or lost wages—and, disturbingly, more than 400 times the NIH’s annual funding for the disease.

Worldwide, those numbers are even scarier.

Last year, there were 44.4 million people across the globe with Alzheimer’s and other dementias, according to Alzheimer’s Disease International (ADI). That number could hit 135.5 million by 2050, and much of that growth will be found in developing countries. In 2010, the annual cost of caring for people with Alzheimer’s and dementia reached $604 billion; as ADI puts is, “If dementia care were a company, it would be the world’s largest by annual revenue exceeding Wal-Mart ($414 billion) and Exxon Mobil ($311 billion).”

Even scarier is the fact that many basic facts about the disease are not well known by the general population. A new survey from the Alzheimer’s Association finds that Alzheimer’s disease is grossly misunderstood and underestimated, despite being the second-most-feared disease, behind cancer.

Nearly 60 percent of people worldwide wrongly believe that Alzheimer’s is part of the natural process of aging, according to the Alzheimer’s & Brain Awareness Month International Survey, which was conducted among 6,307 adults over the age of 18, in 12 countries, including Australia, Brazil, Canada, India, Nigeria and the United Kingdom. That incorrect belief was highest in India (84 percent), Saudi Arabia (81 percent) and China (80 percent).

Just as concerning, 40 percent of people think Alzheimer’s is not fatal (it is) and another 37 percent believe you must have a family history with the disease to be at risk (you don’t; the greatest risk factor is advanced age). Around half of respondents in Germany, Mexico and Brazil do not understand the fact that Alzheimer’s is, indeed, fatal.

When respondents were asked what illness or condition they feared a loved one getting, around one-third of people in Japan, Canada and the U.K. said Alzheimer’s.

When it comes to finding a cure or prevention for the disease, 71 percent hold the government responsible. And yet among the 193 countries in the WHO, just 13 have national dementia plans, according to ADI. Here in the U.S., Alzheimer’s is deeply underfunded. In 2013, the National Institute of Health gave $5.3 billion to cancer research, nearly $3 billion to HIV/AIDS and $1.2 billion to heart disease. Alzheimer’s research received slightly more than $500 million.

Anyone with a brain is at risk for developing Alzheimer’s and so everyone should care about the disease. The Alzheimer’s Association is capitalizing on that fact—as well as the survey findings—by sponsoring the Longest Day, a worldwide event taking place this Saturday to raise awareness and funding for Alzheimer’s disease.

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Exercise and Brain Health: Delaying Cognitive Decline

(BrightFocus Foundation) It is widely accepted now that “what is good for the heart is good for the brain.” Physical activity, good nutrition, adequate sleep, stress reduction, and control of risk factors such as high cholesterol and elevated blood pressure protect not only cardiac health but also support optimal brain health. For physical activity in particular, the evidence strongly supports a connection between regular exercise and improved cognitive aging, greater delay in the onset of Alzheimer’s disease, and better functioning in individuals already affected by cognitive impairment.

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Why Exercise is Beneficial

There are many reasons why physical activity might benefit brain health. Exercise helps regulate blood pressure and it lowers the levels of blood fats. This can favorably affect the risk for arteriosclerotic vascular disease that affects both heart and brain. Exercise helps maintain healthy responsiveness of cells to insulin, a regulator of metabolism. When insulin sensitivity is protected, the development of diabetes may be less likely.

Exercise also decreases inflammatory responses throughout the body. We know from recent research that inflammation can increase heart disease and also set the stage for accelerated aging, depression, and major neurocognitive disorders (the newer term that includes what we have called dementia in the past).

Many Forms of Exercise are Important

Many of us think of exercise mostly in terms of aerobic activity such as running, cycling, or swimming. In older adults especially, there are other forms of physical activity that are just as important!

Resistance training uses weights, elastic bands, or even the body’s own mass to build muscle strength. Bone health, too, is protected by challenging our muscles with resistance. Flexibility training or stretching keeps the joints supple and maintains our ability to bend safely. Tying our shoes, picking things up off the ground, or turning to see what is behind our cars when we back up require considerable flexibility.

Balance training, finally, reduces risk for one of the major sources of disability and death in older adults: fall-related injuries. Simple, brief exercises can improve gait and stance stability enough to make a real difference in safety, and this is no small benefit when we consider that falls in older adults are made more likely and more dangerous by slower reaction time, more fragile bones, and visual impairment among other age-associated changes.

Among the many randomized, controlled trials that have tested the benefits of exercise for cognitive health, positive findings have been frequent. One comprehensive study of studies, or meta-analysis, included 24 high quality trials of aerobic exercise, or aerobic exercise combined with strength training, in mixed-age adults.

Many of these adults were older, some in their 80s, and age in any case seemed unimportant in predicting the observed improvements. Exercise helped the participants of these studies achieve measurable improvements in attention, processing speed, executive function, and aspects of memory.

Delaying Cognitive Decline

Even after cognitive loss has begun, physical activity may be able to delay further loss. One of the controlled comparisons of physical exercise to placebo in older adults with memory complaints showed that after even 24 weeks of moderate exercise there was significant improvement in measures of cognitive impairment. It was striking, too, that the gains lasted another year and a half after the exercise program had ended.

Along with the expected improvement in physical fitness and function, physical activity has even been shown to improve behaviors and cognitive function in people already affected by dementia. A recent meta-analysis demonstrated that the size of the cognitive benefit was on a par with the size of other benefits.

Talk with Your Doctor

In light of the strong support for benefits of physical exercise as a preventive or palliative intervention for cognitive decline, it’s remarkable that health care professionals often fail to advise their patients, especially older patients, how very important activity can be. It was estimated in 2003-2005 that only about 15% or fewer of men and women age 65 and older received exercise counseling from their primary care physicians.

Since that time, of course, the benefits of exercise have been publicized much more, and perhaps a more current study would show improvement. The amount of exercise recommended for healthy adults over age 65 is relatively modest: aerobic exercise at an appropriate moderate level five days each week for 30 minutes each day, or at a vigorous level for 20 minutes on three days per week, along with resistance training (two to three times per week), flexibility training, and balance exercises as appropriate.

Summary

The fight against cognitive aging and cognitive decline is advancing on many fronts. Perhaps we will understand more in the near future about early identification of people at risk. We may find more effective symptom-reducing medications and even medicines that prevent or moderate the disease’s course. But even before such advances, physical activity provides a readily available tool for helping to protect our brains, functioning, and even safety. Let’s keep active!

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