What do you anticipate will be the most important clinical development in Alzheimer’s disease in 2014?

That’s the question we asked Ronald C. Petersen, MD, PhD, of the Mayo Clinic in Rochester, Minn., Allan Levey, MD, PhD, of Emory University in Atlanta, Alan J. Lerner, MD, of University Hospitals Case Medical Center in Cleveland, and George T. Grossberg, MD, of St. Louis University in St. Louis. In this video they give their insightful, but very different, answers — ranging from biomarkers for tau tangles to lifestyle modifications and costs of dementia care.

View the video here:
http://www.medpagetoday.com/HOTTOPICS2014/special-reports/SpecialReports-Videos/384

By Medpage Today

Alzheimer’s Risk Tied to Banned Pesticide

Exposure to the notorious pesticide DDT may play a role in development of Alzheimer’s disease, a small case-control study suggested.

Levels of dichlorodiphenyldichloroethylene (DDE), the main metabolite of DDT, averaged 2.64 ng/mg in serum (SE 0.35) in 86 individuals diagnosed with Alzheimer’s disease, compared with 0.69 ng/mg (SE 0.1) in 79 controls (P<0.001), according toJason R. Richardson, PhD, of Rutgers Robert Wood Johnson Medical School in Piscataway, N.J., and colleagues.

Looked at another way, those study participants in the highest tertile of serum DDE level had quadruple the risk of carrying an Alzheimer’s disease diagnosis (odds ratio 4.18, 95% CI 2.54-5.82 versus the lowest tertile), the researchers reported online in JAMA Neurology.

Mean scores on the 30-point Mini-Mental State Examination (MMSE) were lower by 1.605 points (95% CI 0.114-3.095) in the highest versus lower tertiles of serum DDE, Richardson and colleagues also found.

And, they identified a potential mechanism whereby DDT/DDE exposure may promote development of Alzheimer’s disease. In vitro experiments with human neuroblastoma cells showed that exposure to either chemical boosted secretion of amyloid precursor protein — the parent of beta-amyloid protein. Beta-amyloid plaques in the brain are a major hallmark of Alzheimer’s disease.

Although DDT was banned in the U.S. in 1972, Richardson and colleagues noted, it is still in use elsewhere in the world. Americans may continue to be exposed to the pesticide through imported foods. Moreover, it is very long-lived in the environment, and exposure to contaminated soils may be another route of continuing exposure.

The researchers cited findings from recent federal surveys that found 75% to 80% of participants had measurable levels of DDE in serum.

Other researchers not involved in the study cautioned that it was small, preliminary, and not designed to establish causality. Huntington Potter, PhD, of the University of Colorado School of Medicine in Aurora, told MedPage Today that it was essentially “a pilot study.”

But Potter, as well as authors of an accompanying editorial in JAMA Neurology, noted that it was important for suggesting a specific environmental factor that may contribute to Alzheimer’s disease risk — something that has long been hypothesized but with few specific clues for where to look.

“Richardson and colleagues have provided both a wake-up call to explore environmental influences and pointed us to a first area to assess — pesticides, which have already been implicated in other human illnesses,” wrote Steven DeKosky, MD, of the University of Virginia in Charlottesville, and Sam Gandy, MD, PhD, of the Mount Sinai Alzheimer’s Disease Research Center in New York City, in the editorial.

For example, last year a meta-analysis found that pesticide exposure was a significant risk factor for Parkinson’s disease.

For the study, Richardson and colleagues recruited two cohorts of participants, one at the University of Texas Southwestern Medical Center in Dallas and the other at Emory University in Atlanta, from 2002 to 2008. Blood samples were drawn and the investigators decided by consensus, on the basis of published diagnostic criteria, whether participants had Alzheimer’s disease or were cognitive normal.

One finding that tended to reinforce the connection between DDE levels and Alzheimer’s disease risk was that participants with high levels and the APOE4 genotype — well known to dramatically increase the risk of Alzheimer’s disease risk — showed an exaggerated decrease in MMSE scores relative to those with low DDE levels.

The mean difference in MMSE score between the first and third tertiles of serum DDE was -1.70 (95% CI minus 0.11-minus 3.29) among those with the APOE4 genotype, versus -0.53 (95% CI minus 0.43-minus 0.62) for those with APOE2/3 genotypes (P=0.04 for interaction).

A weakness in the study identified by the editorialists as well as Potter was that, when the two study cohorts were analyzed separately, the association of DDE with Alzheimer’s disease risk was not statistically significant in either. It became significant only when the data were pooled.

Consequently, Potter said, the results should be considered preliminary. He noted as well that noncausal explanations for the association can’t be ruled out.

For example, he said, individuals with Alzheimer’s disease may simply be more rapid metabolizers of DDT, such that their DDE levels are higher even though their exposure to DDT is not.

DeKosky and Gandy argued that more resources should be directed to uncovering environmental factors that promote Alzheimer’s disease, because it appears “less likely” that undiscovered genetic factors will have “new and powerful effects” on the risk.

“The time has arrived to direct resources toward the formation of collaborative teams of epidemiologists, toxicologists, geneticists, and dementia researchers,” they wrote, with collaborations among the various NIH institutes and other public and private partners.

By John Gever, Deputy Managing Editor, MedPage Today.

Record $122 million increase for Alzheimer’s disease signed into law by President Obama

At the urging of the Alzheimer’s Association and its more than 600,000 advocates, the funding bill signed into law today by President Obama contained an unprecedented $122 million increase for Alzheimer’s research, education, outreach and caregiver support. The Association applauds the Obama administration for calling for increased Alzheimer’s funding in the president’s Fiscal Year 2014 budget and Congress for providing funding to enable the continued, effective implementation of the National Plan to Address Alzheimer’s Disease. Both the administration and Congress have recognized the unfolding Alzheimer’s crisis and worked in a bipartisan fashion to strengthen Alzheimer’s care and support while accelerating research toward therapies that can slow, stop and ultimately prevent this disease.

“The Alzheimer’s Association celebrates this significant milestone with our more than 600,000 advocates who have been relentless in their efforts given the current fiscal climate. Their determination and passion are second to none,” said Harry Johns, president and CEO of the Alzheimer’s Association. “We commend President Obama for including Alzheimer’s in his budget request and Congress for providing additional resources to convert scientific opportunity into life-changing outcomes. We look forward to continuing to work together with both the Administration and Congress to build further momentum toward overcoming this devastating disease. It will be through collaboration and ongoing resource commitments that we will meet the goal of the National Alzheimer’s Plan of preventing and effectively treating Alzheimer’s by 2025.”

As the world’s leading voluntary health organization in Alzheimer’s care, support and research, the Alzheimer’s Association leads collaborative efforts in the fight against Alzheimer’s stateside and worldwide. Global Alzheimer’s Association Interactive Network (GAAIN) is an open-access, big data resource which gives researchers rapid access to data to accelerate research efforts. The International Alzheimer’s Disease Research Portfolio (IADRP), a database of global research, which is a partnership of the National Institute on Aging and the Alzheimer’s Association. In December 2013, Johns participated in the G8 Dementia Summit in London, stressing the need for collaboration in addressing this worldwide epidemic impacting at least 44 million people around the globe. The Alzheimer’s Association is also the largest nonprofit funder of Alzheimer’s research, awarding over $315 million to more than 2,200 scientists since 1982, and uses its own resources to actively contribute to public private partnerships with government and industry, such as the recently announced Accelerating Medicines Partnership — Alzheimer’s Disease program.

The new federal funding allocated for Alzheimer’s disease includes a $100 million increase for the National Institute on Aging for Alzheimer’s research, which will be added to what the National Institutes of Health (NIH) estimates will be $484 million in Alzheimer’s research funding across NIH in fiscal year 2013. A further $3.3 million has been provided to support Alzheimer’s caregivers, $4 million to train health professionals on issues related to Alzheimer’s disease, $10.5 million to expand the home and community based caregiver services and $4.2 million for outreach activities to raise awareness. Additionally, the National Institutes of Health’s BRAIN Initiative will receive $30 million to support brain research that could impact several diseases, including Alzheimer’s.

There are currently more than 5 million Americans living with Alzheimer’s disease and that number is poised to grow to as many as 16 million by 2050, according the Alzheimer’s Association 2013 Alzheimer’s Disease Facts and Figures report. In addition to the human toll of the disease, care for Alzheimer’s, the country’s most expensive condition, costs the nation $203 billion annually with projections to reach $1.2 trillion by 2050. Yet for every $27,000 Medicare and Medicaid spend on caring for individuals with Alzheimer’s, the National Institutes of Health (NIH) spends only $100 on Alzheimer’s research.

By Alzheimer’s Association

Vitamin E may aid those with mild to moderate Alzheimer’s

Vitamin E is far from an Alzheimer’s cure, but a new study finds it allowed trial participants to get less help from caregivers and therefore retain more independence longer.

Taking high doses of vitamin E appears to help people in all stages of Alzheimer’s disease, a new study suggests.

Research a decade ago showed that vitamin E was helpful in late-stage Alzheimer’s disease. Now a study published Tuesday by the Journal of the American Medical Association finds the benefits extend to people with mild to moderate forms of the disease.

“This looks very promising,” said lead researcher Mary Sano, director of the Alzheimer’s Disease Research Center at the James J. Peters VA Medical Center, and the Icahn School of Medicine at Mount Sinai, both in New York City.

Vitamin E is far from a cure, only somewhat improving functional activities such as planning and organizing, the study found. But it did allow trial participants, who were studied for an average of more than two years, to get less help from caregivers and therefore retain more independence longer.

“It’s not something where you must do this, it’s going to make all the difference,” said Rachelle Doody, director of the Alzheimer’s Disease and Memory Disorders Center at Baylor College of Medicine in Houston. But Doody, who was not involved in the current study, said she thinks it’s worthwhile for most Alzheimer’s patients, in consultation with their doctor, to take 2,000 IU of vitamin E per day.

That amount far exceeds the government’s recommended dose for healthy adults, which is 22.4 IU or 15 mg per day. There is no indication that high doses of vitamin E help healthy adults, and research shows an increased risk of death with such high doses, particularly for people with congestive heart failure.

That’s why Heather Snyder, Director of Medical & Scientific Relations at the Alzheimer’s Association, thinks that people with mild to moderate Alzheimer’s should wait for more research before jumping to add vitamin E to their pill box.

The new study looked at patients in the Veteran’s Affairs system, so they were virtually all male. It’s not yet clear, Snyder said, that the benefits of vitamin E will be true for women as well.

It’s also unclear why high doses of vitamin E would help people with Alzheimer’s, Snyder said, so the Alzheimer’s Association is funding research to uncover a possible mechanism.

Vitamin E is a so-called antioxidant, meaning it combats the damage that oxygen does to cells. It also stabilizes cell membranes. Perhaps, Doody said, at very high doses, enough vitamin E reaches the brain to protect against the brain cell death that characterizes Alzheimer’s.

Doody, who has done her own research into Alzheimer’s and vitamin E, believes the vitamin is safe and life-extending for people with the memory disease.

The new study also examined a drug called memantine, which is already used to treat advanced Alzheimer’s, but found no benefit to mild-to-moderate Alzheimer’s patients from the drug alone or in connection with high doses of vitamin E.

All of the 600 patients in the trial were also prescribed the standard-of-care drugs, called cholinesterase inhibitors, although Sano said she thinks vitamin E will also benefit patients who are not taking those drugs.

by Alzheimer’s Association

Flu Vaccine Not Linked to Alzheimer’s

Tis the season for flu vaccine! Every year we get calls from people asking if there is a link between the flu vaccine and Alzheimer’s disease. This is an idea that came about more than a decade ago and has been debunked many times over.

Fact:  Several mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer’s disease and overall better health! For example:

• –   A report in the Nov. 3, 2004, Journal of the American Medical Association  found that annual flu shots for older adults were associated with a reduced risk of death from all causes.

–   A  2001 Canadian Medical Journal report suggests older adults who were vaccinated against diphtheria or tetanus, polio, and influenza seemed to have a lower risk of developing Alzheimer’s disease than those not receiving these vaccinations.

The bottom line is that you should speak to your doctor about whether or not you should get a flu vaccine this year and don’t let fears of Alzheimer’s risk stop you!

About the  author: Elizabeth Edgerly, Ph.D., is the chief program officer for the Alzheimer’s Association, Northern California and Northern Nevada Chapter. To read more blog posts by Dr. Edgerly, click here.

This post originally appeared on www.alzheimersblog.org.

Learn More

• Late-Stage Alzheimer’s and Infections
• Risk Factors for Alzheimer’s Disease
• Key Facts About Seasonal Flu Vaccine

By The Alzheimer´s Association

Ensure a Healthy Life for Yourself

As a senior citizen, you should have every opportunity to enjoy your golden years. Many turn to their doctors for care and procedures to help ensure the healthiest lives possible. Unfortunately, at times the prescriptions given and devices we have implanted can have major side effects and manufacturing defects that can hinder our abilities.

It’s up to you to have all the knowledge possible to protect your health, both before and after medical care. It can be difficult to keep track of the FDA’s latest warnings and recalls, that’s why The American Recall Center has set out to make it easier. We are building a comprehensive resource on the Internet for consumer-related healthcare topics, broken down in straightforward terms, so you can easily access the information you need.

Music, Art and Alzheimer’s

Music and art can enrich the lives of people with Alzheimer’s disease. Both allow for self-expression and engagement, even after dementia has progressed.

Music

Although music has been with us since the dawn of time, in the last few decades studies have found that music as a therapeutic tool can increase cognitive function in Alzheimer’s patients.

Music can be powerful. Studies have shown music may reduce agitation and improve behavioral issues that are common in the middle-stages of the disease. Even in the late-stages of Alzheimer’s, a person may be able to tap a

beat or sing lyrics to a song from childhood. Music provides a way to connect, even after verbal communication has become difficult.

Use these tips when selecting music for a person with dementia:

• Identify music that’s familiar and enjoyable to the person. If possible, let the person choose the music.
• Choose a source of music that isn’t interrupted by commercials, which can cause confusion.
• Use music to create the mood you want. For example, a tranquil piece of music can help create a calm environment, while a faster paced song from someone’s childhood may boost spirit and evoke happy memories.
• Encourage movement (clapping, dancing) to add to the enjoyment.
• Avoid sensory overload; eliminate competing noises by shutting windows and doors and by turning off the television. Make sure the volume of the music is not too loud.

Caregivers Take Note – Music as Therapy

When Glen Campbell took the stage at the Grammy Awards and accepted his Lifetime Achievement Award, he did so as one of the more than 5 million Americans diagnosed with Alzheimer’s disease.  What is inspiring about the 75-year-old Campbell’s Grammy night appearance is that he has not retired from his love of making music despite his recent diagnosis.  In fact, he is starting his Farewell Tour and is cutting a new album.

Is music one of the keys to a longer, happier life – despite your health issues?

The news about Campbell got me thinking about studies and articles I have read about music therapy.  Although music has been with us since the dawn of time, in the last few decades studies have found that music as a therapeutic tool can increase cognitive function in Alzheimer’s patients, help premature infants gain weight, encourage autistic children to communicate, lead stroke patients to regain speech and mobility, control pain for dental, surgical and orthopedic patients, and manage anxiety and depression for psychiatric patients.

Dr. Oliver Sacks, a renowned neurologist and psychologist at Columbia University Medical Center best known for his 1973 book Awakenings, which became an Academy Award-nominated film starring Robin Williams and Robert De Niro, and who also wrote Musicophilia: Tales of Music and the Brain, testified at the Hearing before the Senate Special Committee on Aging entitled, “Forever Young: Music and Aging,” and issued this statement:

“The power of music is very remarkable… One sees Parkinsonian patients unable to walk, but able to dance perfectly well or patients almost unable to talk, who are able to sing perfectly well… I think that music therapy and music therapists are crucial and indispensable in institutions for elderly people and among neurologically disabled patients.”

The Magic Brain Workout Is Music

Since music is associated with one of the five senses — hearing — which is controlled by the brain it makes sense that we should exercise our brains with music listening to spur cognitive function in the same way we use physical therapy to exercise our limbs, muscles and joints to regain mobility and physical function.

When it comes to Alzheimer’s patients, studies have shown that music reduces agitation or improves behavioral issues such as violent outbursts.  In one pilot program, 45 patients with mid- to late-stage dementia had one hour of personalized music therapy, three times a week, for 10 months, and improved their scores on a cognitive-function test by 50 percent on average. One patient in the study recognized his wife for the first time in months.  Another music therapy study showed that stroke victims can learn to walk and use their hands again.

And, music therapy is not just used with older patients.  When it comes to those children diagnosed on the autism spectrum, music therapy allows these children to develop identification and appropriate expression of their emotions — music becomes the universal language.  Many people with diagnoses on the autism spectrum have innate musical talents so music therapy can give these kids a sense of accomplishment and success.

When I spoke to Holly Robinson Peete, the successful actress, talk show host and singer, about her son R.J. who was diagnosed at age 4 with autism, she said he loves music and he has even recorded a song.  In fact, Holly finds music a great way for her entire family to connect with R.J. and to enter his world.

She told me, “I think music makes him more comfortable — it is a way for R.J. to communicate without being judged.”

Music — Cure for Caregiver Complaints, Too

Music as therapy is not just for your loved one.  We know that caregivers encounter increased stress over caring for a loved one.  Since studies show that listening to music can lead to increased secretion levels of melatonin, a hormone associated with mood regulation, lower aggression, reduced depression and enhanced sleep.  Using music to cope with these common caregiver complaints can be a welcome relief to caregiver burn-out.

How to Use Music in Your Caregiving Plan

Although the 2008 documentary Young @ Heart, showcased a chorus of 80-year-olds singing Beatles, Rolling Stones and Sonic Youth cover songs, most experts agree that with an older loved one it is best to choose music that reminds them of an earlier, happier time in their lives.

1. Discover the “happy times tunes”:  Talking to your loved one about happy times in their life and understanding the music associations with that time are essential.  Whether it is big band, gospel, rock ‘n’ roll, country, opera or blues, find out what made your loved one happiest.  Most older loved ones, especially Alzheimer’s patients who retain long-term memory as opposed to short-term memory, find tunes from their youth the most joyful but be careful.  Music can also evoke sad memories.  One Holocaust survivor in a pilot program reportedly became very upset upon hearing a Wagner opera which reminded him of that era of his life.
2. Engage younger generations:  You can help create emotional intimacy when spouses and families share creative music experiences.  Whether it is downloading songs from iTunes, creating a Pandora play list or using the latest technical creation for digital music files, engage your kids in interacting with their grandparent or sibling with special needs to choose their favorite music.
3. Pick the right setting:  It may not be as simple as turning on a radio.  The radio can be distracting with constant advertising that breaks the peace of music.  Instead, try internet radio like Pandora channels, or use an iPod or CD player.  And, be careful with headphones — some may take comfort in the privacy of headphones while others will become irritated or uncomfortable.   Also, consider live music situations carefully.  For author Gail Sheehy, being able to take her husband, who was suffering from cancer, to a last jazz night out on the town was a gift she will always treasure.  But, for special needs children and some older adults — the unsettling activity of a live concert or band can be frightening.
4. Let your music play:  As a caregiver music is your therapy as well. Whether it is creating your own playlist to lift your mood when you have a “down day” or just taking pleasure in watching your loved one become engaged, music can make your heart soar.  Celia Pomerantz, author of A Mother’s Daughter’s Journey,  found that her mother, who grew up in Puerto Rico, loved a certain era of salsa music such as Tito Puente.  She created song lists of her mom’s favorite tunes while her mother was in the nursing home.  Celia became enchanted as her mother blossomed into the woman residents called “the dancing queen.”  The joy of music and watching her mother dance lifted Celia’s spirits about her mother’s Alzheimer’s diagnosis.
5. Find a professional music therapist:  The American Music Therapy Association (AMTA), a non-profit organization that represents over 5,000 music therapists, corporate members and related associations worldwide offers information about music therapy studies and a listing of credentialed music therapists that offer services in institutional, residential and private home settings.

 Music can both evoke and create memories that last forever.  I close with this heartwarming story from the AMTA website:

When a couple danced together for the first time after five years of the husband’s deterioration from probable Alzheimer’s disease, the wife said: “Thank you for helping us dance. It’s the first time in three years that my husband held me in his arms.” Tearfully, she said that she had missed him just holding her and that music therapy had made that possible.

Art

Map out a plan to approach Alzheimer’s

Go to our free online tool, Alzheimer’s Navigator and complete a series of short surveys to receive a customized action plan.

Learn more:
Alzheimer’s Navigator

Art projects can create a sense of accomplishment and purpose. They can provide the person with dementia — as well as caregivers — an opportunity for self-expression.

When planning an art activity for someone with middle- to late-stage Alzheimer’s, keep these tips in mind:

• Keep the project on an adult level. Avoid anything that might be demeaning or seem child-like.
• Build conversation into the project. Provide encouragement, discuss what the person is creating or reminiscence.
• Help the person begin the activity. If the person is painting, you may need to start the brush movement. Most other projects should only require basic instruction and assistance.
• Use safe materials. Avoid toxic substances and sharp tools.
• Allow plenty of time, keeping in mind that the person doesn’t have to finish the project in one sitting.

Read more: http://www.alz.org/care/alzheimers-dementia-music-art-therapy.asp#ixzz2Zzx4QM5F

by Alzheimer’s Association

Patients’ self-reported memory slips may be early signs of Alzheimer’s

 

Several new Alzheimer’s studies suggest adults who think they’re having memory slips or cognitive problems may be onto something.

Four studies presented at the Alzheimer’s Association’s International Conference on July 17 in Boston show that a patient’s subjective concerns about their memory or thinking skills may be early warning signs for dementia and Alzheimer’s.

It’s an emerging field in Alzheimer’s research, according to the organization. Called “SCD” for subjective cognitive decline, researchers have been looking at whether these personal opinions from patients of their own memory and organizational skill lapses could serve as one of the earliest signs of eventual dementia. If so, future studies that look at new treatments, therapies and lifestyle changes to stave off dementia would likely start when these signs first emerge, Maria Carrillo, Alzheimer’s Association vice president of medical and scientific relations, explained in a statement.

“Early detection is extremely important for the success of therapy trials, where earlier intervention may be the key to producing positive treatment and prevention results,” she said.

The studies are all considered preliminary since they were only presented at a medical conference and have yet to be published in a peer-reviewed journal. However, they suggest that self-reports of memory lapses or cognitive hiccups may provide the earliest signs of more serious cognitive decline eventually leading to dementia.

In one of the studies, researchers at Brigham and Women’s Hospital in Boston looked at the link between self-reported memory concerns and signs of physical brain changes associated with Alzheimer’s among 131 people, average age 73.5, with no history of serious neurological problems. The researchers gave them PET Scans to look for presence of beta-amyloid, a protein that builds up to form plaque in the brain that’s implicated in the development of Alzheimer’s disease.

People who reported worse memory were more likely to have higher levels of beta-amyloid than their peers who did not report memory problems. Also, people who reported cognitive problems in areas like organizing tasks and prioritizing also had higher beta-amyloid levels than those who did not.

“We suggest that individuals can be accurate judges of their own cognitive decline at the earliest stages of Alzheimer’s disease,” study author Dr. Rebecca Amariglio, a researcher at Brigham and Women’s Hospital and Massachusetts General Hospital, said in a news release.

Another study presented at the Alzheimer’s conference linked self-reported memory changes to a near-doubling of risk for dementia or mild cognitive impairment (MCI), a disorder that causes changes that are serious enough to be noticed by individuals experiencing them and other people, but not severe enough to impair daily functioning. People with MCI are at an increased risk for developing Alzheimer’s down the road, but not all will get worse.

A team led by Dr. Richard J. Kryscio, chair of biostatistics at the College of Public Health at the University of Kentucky in Lexington, reviewed medical records of 531 people, average age of 73, who were enrolled in a study in which they were given annual memory and cognitive exams each year for an average of 10 years. Before each exam, they were asked to report any changes of their memory, similar to the other studies.

During the course of the study, nearly 56 percent of participants reported changes in their memory skills. Those individuals were found to be at the greater risk of developing MCI or dementia. Their memory complaints occurred on average six years before a dementia diagnosis and nine years before an MCI diagnosis.

 

 

 

 

 

Study examines HRT impact on females’ memory

The study also showed some groups were more at risk. A family history of dementia was associated with increased risk for MCI, while smoking sped up the time of an MCI diagnosis from nine years to six years. Women taking estrogen hormone therapies also had an increased risk for a dementia diagnosis, but their diagnosis time increased from six years to 15 years.

“In terms of research, the identification of specific risk factors coupled with a memory complaint could help identify a high-risk group that might help inform the design of future prevention trials,” said Kryscio.

The next study looked at a gene associated with Alzheimer’s, APOE4. Variants and mutations in the APOE4 gene is the strongest genetic risk factor associated with Alzheimer’s. French researchers at Inserm U897 in Bordeaux, France interviewed more than 3,800 people age 70 and older from a long-running study of nurses’ health. Over a six-year period from 1995 to 2001, researchers gave the nurses four memory tests.

They found that for APOE4 carriers, having a concern about a single memory symptom predicted verbal memory declines that occurred over the course of six years. For people without APOE4, they had to have three or more memory symptoms to show decline over the next six years.

“Subjective memory symptoms seemed to be a better predictor of subsequent cognitive decline in APOE4 carriers than in non-carriers, likely because there is a larger degree of true memory decline in carriers,” said lead researcher Dr. Cecilia Samieri.

She cautioned more studies were needed to confirm the results.

The last study, conducted by German researchers at the University of Bonn, wanted to see if SCD, subjective cognitive decline, was associated with a specific kind of memory decline: episodic memory problems. Episodic memory involves recalling specific past events. That’s different from working memory, which encompasses the memories of how to perform tasks that we use to complete daily functions.

Researchers looked at more than 2,200 cognitively normal adults, average age of 80, who were enrolled in a German study in which they were given memory tests every 18 months for an average of eight years. They too were asked before each test whether or not they felt like their memory was becoming worse, to measure SCD.

More than 990 patients answered “yes,” and another group of about 370 participants said “yes” and added they had “concerns” about their memory loss. Both of these groups performed worse on the memory tests than people who reported no declines or concerns.

The group with self-reported memory declines but no concerns showed significant declines in episodic memory compared to the group without memory declines. Those who said they were concerned about their memory declines showed an even greater loss of episodic memory. The researchers found no difference among the groups in terms of working memory or their overall cognitive scores from the tests.

Delayed retirement lowers dementia

Said study author Dr. Alexander Koppora, a psychiatrist at the University of Bonn, “We show here that [subjective memory impairment] is a predictor of episodic memory decline.”

He told USA Today that about half of the study pool neared age 90 without memory concerns, which was “good news” for some.

The bottom line from all these studies? Listening to patients talk about their own worries about their memory and cognitive skills could be the earliest indication of MCI, Alzheimer’s or other forms of dementia.

“These people are sensing something, and there’s some biological signals that correlate,” Dr. Ronald C. Peterson, director of the Mayo Clinic’s Alzheimer’s Center, told The New York Times. “I think it’s real.”

Not everyone with memory slips will get dementia, though.

“Every time you forget someone’s name, you don’t need to go running to the doctor,” Dr. Reisa Sperling, director of the Alzheimer’s Center at Brigham and Women’s Hospital, told the Associated Press.

Heather Snyder, director of medical and scientific operations for the Alzheimer’s Association, added to HealthDay, “We’re not talking about those times you walk out of your house and realize you’ve forgotten your keys. We’re talking about cases where you identify a change over time — you’ve always been able to balance your checkbook with no problem, but now you’re having difficulty,” she said.

The Alzheimer’s Association has more information on signs and symptoms of different types of dementia.

by Alzheimer’s Association

Highlights From the World’s Largest Conference for Dementia Research

Jul 24, 2013

As a scientist and administrator, and as immediate past chair of the Alzheimer’s Association Medical and Scientific Advisory Council and a current member of the Association’s Board of Directors, I have seen the Alzheimer’s Association International Conference (AAIC^®) grow into the world’s largest and most prestigious conference of its kind. It brings together more than 5,000 researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer’s disease and other dementias.

AAIC is anticipated each year—because among other attributes—it is a catalyst for generating knowledge, new collaborations and partnerships, while fostering a collegial research community. Celebrating 25 years of progress while shaping the future of dementia science, AAIC 2013 in Boston  hosted experts and researchers from more than 70 countries, and featured about 2,000 scientific presentations.

This year, additional components of the conference sought to engage professional care providers and the general public. Dementia Care @ AAIC was a one-day international program featuring research that will drive best practices in  person-centered care for individuals with Alzheimer’s and other dementias. I participated in a Community Research Forum to share the science released at AAIC with the public in an intimate forum.  We covered the spectrum of Alzheimer’s disease and dementia research, including new treatment and prevention strategies, possible new risk factors, advances in early detection and diagnosis, and investigations into the causes and progression of the disease.

 

After immersing myself in the science, I found that some of the most interesting research at AAIC 2013 concerned possible risk factors for Alzheimer’s disease, dementia and cognitive decline, and also insights into early detection of the disease. At AAIC, we did hear about some very early stage trials of possible new Alzheimer’s therapies, nothing described here is close to being available for general use. That said, a number of major drug studies are ongoing and we look forward to hearing the results reported over the coming months. Here are some of the highlights:

• Most kinds of cancer associated with decreased risk of Alzheimer’s: A very large study of about 3.5 million U.S. veterans indicated that surviving many kinds of cancer is associated with a significantly decreased risk of Alzheimer’s disease. The study also suggested that chemotherapy treatment for almost all of those cancers conferred an additional decrease in Alzheimer’s risk. The challenge to researchers now is to determine whether or not this can give us new ideas to pursue for Alzheimer’s treatment.
• Diabetes drug associated with reduced risk of dementia: Research has shown us that type 2 diabetes may double the risk of dementia. However, a new study of nearly 15,000 type 2 diabetes patients age 55 and older suggests that people with diabetes who started on the drug metformin, an insulin sensitizer, had a significantly reduced risk of developing dementia compared with people who started other diabetes therapies. Again, we still need to determine in additional studies, what role—if any—this drug may have in Alzheimer’s treatment.
• Older age at retirement at is associated with a reduced risk of dementia: An analysis of health and insurance records of more than 420,000 self-employed workers in France found that retirement at older age is associated with a reduced risk of dementia, with a lower risk for each added year of working longer. The researchers suggested that professional activity may contribute to higher levels of mental stimulation and social engagement, which may be protective against dementia, though more research is needed in this area.
• Self-reported changes in memory may be earliest clinical markers of Alzheimer’s: A number of studies reported at AAIC provided evidence that subjective cognitive decline (SCD) — which is the self-reported perception of memory or cognition problems — may in fact be the first indication of future Alzheimer’s disease. This certainly does not mean that everyone who experiences memory changes is bound to get Alzheimer’s disease or another dementia. It is very important now for scientists to determine what combination of symptoms and test results is the true indicator that Alzheimer’s disease is in someone’s future, and what changes are simply a part of the aging process. At AAIC 2013, an international group of Alzheimer’s researchers announced the formation of the Subjective Cognitive Decline Initiative (SCD-I) to develop a new research agenda for SCD.
• Online tests for Alzheimer’s do not measure up: A panel of Canadian experts reviewed 16 freely accessible online tests for Alzheimer’s disease, and found that the tests scored poorly on scales of overall scientific validity, reliability and ethical factors.
• No evidence of benefit in population screening for dementia: UK researchers reviewed a series of studies that looked at population screening for dementia and compared them with a routine pattern of care in the general population, among patients in general medical practice, and among patients in community care. The researchers found no evidence of the effect of community screening on patient outcomes including cognitive, mental and emotional health, social function and planning, and no indication of its added value compared to current practice. The Alzheimer’s Association recommends that people see their doctor for a thorough evaluation at the earliest signs of memory problems or changes. For the 10 Warning Signs of Alzheimer’s, visit www.alz.org.

The importance of Alzheimer’s disease and dementia research is growing not just for people living with the disease and their families, but also for the general public who are concerned about the disease and the elected officials that represent us. The creation of the first-ever U.S. National Plan to Address Alzheimer’s Disease was a landmark event, and its ongoing refinement and implementation got a significant amount of attention from the attendees of AAIC 2013.

I am honored to serve as chair of the Advisory Council on Alzheimer’s Research, Care, and Services. The council was mandated by the National Alzheimer’s Project Act to advise the U.S. Secretary of Health and Human Services on the development of a national plan for Alzheimer’s disease. As a follow up to testimony I and others provided the Senate Aging Committee in April, a symposium was held at AAIC to discuss current progress implementing the National Alzheimer’s Plan. The session included officials from the U.S. Government, the Alzheimer’s Association and scientists in the field. Attendees from around the globe were impressed that the plan has successfully stimulated funding for Alzheimer’s disease research in the United States;  there was some consensus that the ambitious plan will likely lead to significant progress in the disease.

Two other sessions had governmental and public policy focuses.  The first was a presentation and discussion lead by the Center for Disease Control and the Alzheimer’s Association about The Healthy Brain Initiative they created for 2013.  This roadmap is an effort to advance cognitive health and outline how state and local public health agencies and their partners can promote cognitive functioning, address cognitive impairment for individuals living in the community and help meet the needs of Alzheimer’s care partners.  The second was a session convened by the Alzheimer’s Association to discuss the recent draft decision by the Center for Medicare and Medicaid Services (CMS) regarding coverage for brain amyloid imaging.  AAIC offered stakeholders in the amyloid imaging world an opportunity to gather to discuss the decision along with ways to respond to CMS during the current public comment period.  Attendees engaged in a healthy discussion, encouraging support for coverage expansion beyond the current proposal– essentially, covering one PET scan for brain amyloid in the context of an approved clinical trial.

The next AAIC is scheduled for July 12-17, 2014 in Copenhagen, Denmark. I am already looking forward to seeing the advances made by the research community one year from now.

About the blog author: Ronald Petersen, Ph.D., M.D., is one of the nation’s leading experts in Alzheimer’s disease and the physician who diagnosed President Reagan’s Alzheimer’s disease in 1994. A professor of neurology and Cora Kanow Professor in Alzheimer’s Disease Research at the Mayo Clinic College of Medicine in Rochester, MN., Dr. Petersen is currently the director of Mayo Clinic Alzheimer’s Disease Research Center and director of the Mayo Clinic Study of Aging. He is immediate past Chair of the Alzheimer’s Association Medical and Scientific Advisory Council and is currently on the Association’s Board of Directors.  He recently was honored at the Alzheimer’s Association International Conference® with the Henry Wisniewski Lifetime Achievement Award for his contributions to the field.

by Alzheimer’s Association

Why Is Our Life Expectancy Shorter Than in Other Developed Countries?

 

The gap is growing.

July 16, 2013  |  

 

 

Let’s talk life expectancy.

The stats first. They tell a clear story: Americans now live shorter lives than men and women in most of the rest of the developed world. And that gap is growing.

Back in 1990, shouts a  new study published last week in the prestigious Journal of the American Medical Association, the United States ranked just 20th on life expectancy among the world’s 34 industrial nations. The United States now ranks 27th — despite spending much more on health care than any other nation.

Americans, notes an editorial the journal ran to accompany the study, are losing ground globally “by every” health measure.

Why such poor performance? Media reports on last week’s new  State of U.S. Healthstudy hit all the usual suspects: poor diet, poor access to affordable health care, poor personal health habits, and just plain poverty.

In the Wall Street Journal, for instance, a chief wellness officer in Ohio  opined that if Americans exercised more and ate and smoked less, the United States would surely start moving up in the global health rankings.

But many epidemiologists — scientists who study health outcomes — have their doubts. They  point out that the United States ranked as one of the world’s healthiest nations in the 1950s, a time when Americans smoked heavily, ate a diet that would horrify any 21st-century nutritionist, and hardly ever exercised.

Poor Americans, then as now, had chronic problems accessing health care. But poverty, epidemiologists note, can’t explain why fully insured middle-income Americans today have significantly worse health outcomes than middle-income people in other rich nations.

The University of Washington’s Dr. Stephen Bezruchka  has been tracking these outcomes since the 1990s. The new research published in the Journal of the American Medical Association, Bezruchka told Too Much last week, should worry Americans at all income levels.

“Even if we are rich, college-educated, white-skinned, and practice all the right health behaviors,” he notes, “similar people in other rich nations will live longer.”

A dozen years ago, Bezruchka published in Newsweek the first mass-media commentary, at least in the United States, to challenge the conventional take on poor U.S. global health rankings.

To really understand America’s poor health standing globally, epidemiologists like Bezruchka posit, we need to look at “the social determinants of health,” those social and economic realities that define our daily lives.

None of these determinants matter more, these researchers contend, than the level of a society’s economic inequality, the divide between the affluent and everyone else.  Over 170 studies worldwide have so far linked income inequality to health outcomes. The more unequal a society, the studies show, the more unhealthy most everyone in it — and not the poor alone.

Just how does inequality translate into unhealthy outcomes? Growing numbers of researchers place the blame on stress. The more inequality in a society, the more stress on a daily level. Chronic stress, over time, wears down our immune systems and leaves us more vulnerable to disease.

This same stress drives people to seek relief in unhealthy habits. They may do drugs or smoke — or eat more “comfort foods” packed with sugar and fat.

Inequality has an equally potent impact on policy decisions around health.

“A substantial proportion of our adult health,” as Stephen Bezruchka explained last week, gets programmed in the early years of a child’s life. Given this reality, guaranteeing every child the best possible supports in the early years ought to be priority number one for any society committed to better health for all.

But unequal nations do precious little of this guaranteeing. The nations with the highest ranking for child well-being turn out to be the nations with the most equal distributions of income.