Tuesday, September 18, 2018

Dementia and hyperthermia risk

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]

National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services


Overheating and dementia are a tricky combination. In dementia, be careful with the danger of hyperthermia (a kind of overheating) almost any summer day. Learn how to avoid the heat and get quick relief. 




Now that Li Ming is retired, she likes to work in her garden—even in hot weather. Then last summer, an unusual heat wave hit her area. The temperature was over 100°F, and the humidity was at least 90%. By the third day, her daughter Kim came over because Li Ming sounded confused on the phone. Kim found her mom passed out on the kitchen floor. Li Ming's large fan wasn't enough to fight the effect of heat and humidity. She had heat stroke, the most serious form of hyperthermia.

How to Respond

Almost every summer, there is a deadly heat wave in some part of the country. Too much heat is not safe for anyone. It is even riskier for older people and especially for those with a dementia such as Alzheimer's. It is important to get relief from the heat quickly. If not, one may begin feeling confused or faint. The heart could become stressed and maybe stop beating.

If you suspect someone is suffering from a heat-related illness:

  1. Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge the person to lie down.
  2. If you suspect heat stroke, call 911.
  3. Apply a cold, wet cloth to the wrists, neck, armpits and/or groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
  4. Help the individual to bathe or sponge off with cool water.
  5. If the person can swallow safely, offer fluids such as water or fruit and vegetable juices, but avoid alcohol and caffeine.

Warning Signs

  • Fainting
  • Change in behavior—confusion, being grouchy, acting strangely, or staggering
  • Dry flushed skin and a strong rapid pulse or a slow weak pulse
  • Body temperature over 104°F
  • Not sweating even if it is hot, acting agitated

How Can I Lower My Risk?

Things you can do to lower your risk of heat-related illness:
  • Drink plenty of liquids—water, fruit, or vegetable juices. Aim for eight glasses every day. Heat tends to make you lose fluids, so it is very important to remember to keep drinking liquids when it's hot. Try to stay away from drinks containing alcohol or caffeine. If your doctor has told you to limit your liquids, ask what you should do when it is very hot.
  • If you live in a home or apartment without fans or air conditioning, try to keep your house as cool as possible.
  • Limit your use of the oven. Cover windows with shades, blinds, or curtains during the hottest part of the day. Open your windows at night.
  • If your house is hot, try to spend at least 2 hours during mid-day some place that has air conditioning—for example, go to the shopping mall, movies, library, senior center, or a friend's house.
  • If you need help getting to a cool place, ask a friend or relative. Some Area Agencies on Aging, religious groups, or senior centers provide this service. If necessary, take a taxi or call for senior transportation. Don't stand outside in the heat waiting for a bus.
  • If you have an air conditioner but can't afford the electric bills, there may be some local resources that can help. The Low Income Home Energy Assistance Program is one possible resource.
  • Dress for the weather. Some people find natural fabrics such as cotton to be cooler than synthetic fibers. Light-colored clothes feel cooler. Don't try to exercise or do a lot of activities when it's hot.
  • Avoid crowded places when it's hot outside. Plan trips during non-rush hour times.

Listen To Weather Reports

If the temperature or humidity is going up or an air pollution alert is in effect, you are at an increased risk for a heat-related illness. Play it safe by checking the weather report before going outside.

What Should I Remember?

Headache, confusion, dizziness, or nausea could be a sign of a heat-related illness. Go to the doctor or an emergency room to find out if you need treatment.

Older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F to put them at risk for a heat-related illness.

To keep heat-related illnesses from becoming a dangerous heat stroke, remember to:

  1. Get out of the sun and into a cool place—air-conditioning is best.
  2. Drink fluids, but avoid alcohol and caffeine. Water, fruit, or vegetable juices are good choices.
  3. Shower, bathe, or at least sponge off with cool water.
  4. Lie down and rest in a cool place.
  5. Visit your doctor or an emergency room if you don't cool down quickly.

A Senior Watch

During hot weather, think about making daily visits to older relatives and neighbors. Remind them to drink lots of water or juice. If there is a heat wave, offer to help them go some place cool, such as air-conditioned malls, libraries, or senior centers.

Additional Resources:

The Low Income Home Energy Assistance Program (LIHEAP) within the Administration for Children and Families in the U.S. Department of Health and Human Services helps eligible households pay for home cooling and heating costs. People interested in applying for assistance should contact their local or state LIHEAP agency or go to http://www.acf.hhs.gov/programs/ocs/liheap.

For a free copy of the NIA’s AgePage on hyperthermia in English or in Spanish, contact the NIA Information Center at 1-800-222-2225 or go to:


SOURCE:
National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services

Sunday, September 16, 2018

Prevent Alzheimer's with Memantine

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition]



NAMENDA® / EBIXA® (generic MEMANTINE) is FDA-approved for Alzheimer's. Learn about new research on how it may help in preventing or slowing dementia. 




The molecular processes that lead to Alzheimer's begin years before symptoms appear. Researchers have now found that an FDA-approved drug, memantine, currently used only for alleviating the symptoms of moderate-to-severe Alzheimer’s disease, might be used to prevent or slow the progression of the disease if used before those symptoms appear. The research also offers, based on extensive experimentation, a hypothesis as to why this might work. 

The findings are published currently online in the journal Alzheimer’s & Dementia.

Prevent it from starting in the first place

“Based on what we’ve learned so far, it is my opinion that we will never be able to cure Alzheimer’s disease by treating patients once they become symptomatic,” said George Bloom, a UVA professor and chair of the Department of Biology, who oversaw the study in his lab. “The best hope for conquering this disease is to first recognize patients who are at risk, and begin treating them prophylactically with new drugs and perhaps lifestyle adjustments that would reduce the rate at which the silent phase of the disease progresses. 

“Ideally, we would prevent it from starting in the first place.” 


Brain Neurons Attempt to Divide

As Alzheimer’s disease begins, there is a lengthy period of time, perhaps a decade or longer, when brain neurons affected by the disease attempt to divide, possibly as a way to compensate for the death of neurons. This is unusual in that most neurons develop prenatally and then never divide again. But in Alzheimer’s the cells make the attempt, and then die. 


George Bloom’s lab specializes in understanding the biochemical changes that lead to Alzheimer’s disease. (Photo by Dan Addison, University Communications)
“It’s been estimated that as much as 90 percent of neuron death that occurs in the Alzheimer’s brain follows this cell cycle reentry process, which is an abnormal attempt to divide,” Bloom said. “By the end of the course of the disease, the patient will have lost about 30 percent of the neurons in the frontal lobes of the brain.”

Memantine blocks cell cycle reentry

Erin Kodis, a former Ph.D. student in Bloom’s lab and now a scientific editor at AlphaBioCom, hypothesized that excess calcium entering neurons through calcium channels on their surface drive those neurons back into the cell cycle. This occurs before a chain of events that ultimately produce the plaques found in the Alzheimer’s brain. Several experiments by Kodis ultimately proved her theory correct. 

The building blocks of the plaques are a protein called amyloid beta oligomers. Kodis found that when neurons are exposed to toxic amyloid oligomers, the channel, called the NMDA receptor, opens, thus allowing the calcium flow that drives neurons back into the cell cycle. 

Memantine blocks cell cycle reentry by closing the NMDA receptor, Kodis found.

Giving Memantine Long Before Symptoms

“The experiments suggest that memantine might have potent disease-modifying properties if it could be administered to patients long before they have become symptomatic and diagnosed with Alzheimer’s disease,” Bloom said. “Perhaps this could prevent the disease or slow its progression long enough that the average age of symptom onset could be significantly later, if it happens at all.”

Side Effects are Modest

Side effects of the drug appear to be infrequent and modest. 

Bloom said potential patients would need to be screened for Alzheimer’s biomarkers years before symptoms appear. Selected patients then would need to be treated with memantine, possibly for life, in hopes of stopping the disease from ever developing, or further developing.

Not to Raise False Hopes

“I don’t want to raise false hopes,” Bloom said, but “if this idea of using memantine as a prophylactic pans out, it will be because we now understand that calcium is one of the agents that gets the disease started, and we may be able to stop or slow the process if done very early.” 

Bloom currently is working with colleagues at the UVA School of Medicine to design a clinical trial to investigate the feasibility of using memantine as an early intervention. 

Saturday, September 15, 2018

Alzheimer's screening tool may be the eyes

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition]


UW Medicine, University of Washington

Alzheimer’s is difficult to diagnose, but researchers now have a promising new screening tool, using the window to the brain: the eye. 




A study of 3,877 randomly selected patients1 found a significant link between three degenerative eye diseases – age-related macular degeneration, diabetic retinopathy and glaucoma – and Alzheimer’s disease. 


The results offer physicians a new way to detect those at higher risk of this disorder, which causes memory loss and other symptoms of cognitive decline. 

The researchers, from the University of Washington School of Medicine, the Kaiser Permanente Washington Health Institute and the UW School of Nursing, reported their findings in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Checking on Dementia

“We don’t mean people with these eye conditions will get Alzheimer’s disease,” said lead researcher Dr. Cecilia Lee, assistant professor of ophthalmology at the UW School of Medicine. “The main message from this study is that ophthalmologists should be more aware of the risks of developing dementia for people with these eye conditions, and primary care doctors seeing patients with these eye conditions might be more careful on checking on possible dementia or memory loss.” 

The participants in the study were age 65 and older and did not have Alzheimer’s disease at the time of enrollment. They were part of the Adult Changes in Thought database started in 1994 by Dr. Eric Larson, who is at Kaiser Permanente Washington Health Research Institute. 

Over the five-year study, 792 cases of Alzheimer’s disease were diagnosed by a committee of dementia experts. Patients with age-related macular degeneration, diabetic retinopathy, or glaucoma were at 40 % to 50% greater risk of developing Alzheimer’s disease compared to similar people without these eye conditions. Cataract diagnosis was not an Alzheimer’s disease risk factor.

Learn from the Brain by Looking at the Eye

“What we found was not subtle,” said Dr. Paul Crane, professor of medicine, Division of General Internal Medicine, at the UW School of Medicine. “This study solidifies that there are mechanistic things we can learn from the brain by looking at the eye.” 

More than 46 million older adults are affected by dementia worldwide and 131.5 million cases are expected by 2050, the researchers said. Alzheimer’ disease is the most common dementia,and discovering risk factors may lead to early detection and preventive measures, they said in their paper. 

Lee said anything happening in the eye may relate to what’s happening in the brain, an extension of the central nervous system. The possible connections need more study. She said a better understanding of neurodegeneration in the eye and the brain could bring more success in diagnosing Alzheimer’s early and developing better treatments.

New Area of Opportunity

The researchers said several factors suggest the effects they uncovered were specific to ophthalmic conditions and not merely age-related phenomenon. 

Larson said for years Alzheimer’s researchers were focused on amyloid buildup in brain tissue, but that hasn’t brought much benefit to patients. 

“This paper is pointing to a new area of opportunity,” he said. 


SUPPORT:
  • Funding for this research came from the National Institutes of Health, National Institute of Aging, National Eye Institute, an Unrestricted grant from Research to Prevent Blindness, and royalties from UpToDate.
REFERENCE: SOURCE:

Wednesday, September 12, 2018

Mend memory in 25 ways

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition]



MEND is UCLA's 25-step personalized program to reverse memory loss. In the university's study, nine of 10 participants displayed significant memory improvements. Learn how. Includes a chart summing-up the 25 steps. 




MEND is a novel, personalized and comprehensive program to reverse memory loss. In a recent MEND study, nine of 10 participants displayed subjective or objective improvement in their memories, beginning within three to six months after the program's start. Of the six patients who had to discontinue working or were struggling with their jobs at the time they joined the study, all were able to return to work or continue working with improved performance


Improvements have been sustained, and as of this writing, the longest patient follow-up is two and one-half years from initial treatment. These first ten included patients with memory loss associated with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI; when a patient reports cognitive problems). One patient, diagnosed with late stage Alzheimer's, did not improve.

MEND: 25-Step Memory Program

GoalApproachNotes
Optimize diet: minimize simple carbohydrates, minimize inflammation.Patients given choice of several low glycemic, low inflammatory, low grain diets.Minimize inflammation, minimize insulin resistance.
Enhance autophagy, ketogenesisFast 12 hr each night, including 3 hr prior to bedtime.Reduce insulin levels, reduce Aβ.
Reduce stressPersonalized—yoga or meditation or music, etc.Reduction of cortisol, CRF, stress axis.
Optimize sleep8 hr sleep per night; melatonin 0.5mg po qhs; Trp 500mg po 3x/wk if awakening. Exclude sleep apnea.
Exercise30-60' per day, 4-6 days/wk
Brain stimulationPosit or related
Homocysteine <7 font="">Me-B12, MTHF, P5P; TMG if necessary
Serum B12 >500Me-B12
CRP <1 .0="" a="">1.5Anti-inflammatory diet; curcumin; DHA/EPA; optimize hygieneCritical role of inflammation in AD
Fasting insulin <7 font="" hgba1c="">Diet as aboveType II diabetes-AD relationship
Hormone balanceOptimize fT3, fT4, E2, T, progesterone, pregnenolone, cortisol
GI healthRepair if needed; prebiotics and probioticsAvoid inflammation, autoimmunity
Reduction of AβCurcumin, Ashwagandha
Cognitive enhancementBacopa monniera, MgT
25OH-D3 = 50-100ng/mlVitamins D3, K2
Increase NGFH. erinaceus or ALCAR
Provide synaptic structural componentsCiticoline, DHA
Optimize antioxidantsMixed tocopherols and tocotrienols, Se, blueberries, NAC, ascorbate, α-lipoic acid
Optimize Zn:fCu ratioDepends on values obtained
Ensure nocturnal oxygenationExclude or treat sleep apnea
Optimize mitochondrial functionCoQ or ubiquinol, α-lipoic acid, PQQ, NAC, ALCAR, Se, Zn, resveratrol, ascorbate, thiamine
Increase focusPantothenic acidAcetylcholine synthesis requirement
Increase SirT1 functionResveratrol
Exclude heavy metal toxicityEvaluate Hg, Pb, Cd; chelate if indicatedCNS effects of heavy metals
MCT effectsCoconut oil or Axona
KEY:
Hg, mercury; Pb, lead; Cd, cadmium; MCT, medium chain triglycerides; PQQ, polyquinoline quinone; NAC, N-acetyl cysteine; CoQ, coenzyme Q; ALCAR, acetyl-L-carnitine; DHA, docosahexaenoic acid; MgT, magnesium threonate; fT3, free triiodothyronine; fT4, free thyroxine; E2, estradiol; T, testosterone; Me-B12, methylcobalamin; MTHF, methyltetrahydrofolate; P5P, pyridoxal-5-phosphate; TMG, trimethylglycine; Trp, tryptophan

Encouraging Findings

The study, which comes jointly from the UCLA Mary S. Easton Center for Alzheimer's Disease Research and the Buck Institute for Research on Aging, is the first to suggest that memory loss in patients may be reversed, and improvement sustained, using a complex therapeutic program that involves comprehensive changes in diet, brain stimulation, exercise, optimization of sleep, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry.
The findings, published in the current online edition of the journal Aging, "are very encouraging. However, at the current time the results are anecdotal, and therefore a more extensive, controlled clinical trial is warranted," said Dale Bredesen, the Augustus Rose Professor of Neurology and Director of the Easton Center at UCLA, a professor at the Buck Institute, and the author of the paper.
In the case of Alzheimer's disease, Bredesen notes, there is not one drug that has been developed that stops or even slows the disease's progression, and drugs have only had modest effects on symptoms. "In the past decade alone, hundreds of clinical trials have been conducted for Alzheimer's at an aggregate cost of over a billion dollars, without success," he said.

Combination Therapy

Other chronic illnesses such as cardiovascular disease, cancer, and HIV, have been improved through the use of combination therapies, he noted. Yet in the case of Alzheimer's and other memory disorders, comprehensive combination therapies have not been explored. Yet over the past few decades, genetic and biochemical research has revealed an extensive network of molecular interactions involved in AD pathogenesis. "That suggested that a broader-based therapeutics approach, rather than a single drug that aims at a single target, may be feasible and potentially more effective for the treatment of cognitive decline due to Alzheimer's," said Bredesen.
While extensive preclinical studies from numerous laboratories have identified single pathogenetic targets for potential intervention, in human studies, such single target therapeutic approaches have not borne out. But, said Bredesen, it's possible addressing multiple targets within the network underlying Alzheimer's may be successful even when each target is affected in a relatively modest way. "In other words," he said, "the effects of the various targets may be additive, or even synergistic."
Given this, Bredesen thought that rather than a single targeted agent, the solution might be a systems type approach, the kind that is in line with the approach taken with other chronic illnesses -- a multiple-component system.
"The existing Alzheimer's drugs affect a single target, but Alzheimer's disease is more complex. Imagine having a roof with 36 holes in it, and your drug patched one hole very well -- the drug may have worked, a single "hole" may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much."
“The shift to applying a broad combination therapy to Alzheimer’s is a crucial turning point towards effectively treating Alzheimer’s disease,” says Dr. Marwan N. Sabbagh, Research Professor of Neurology at the University of Arizona College of Medicine in Phoenix

Personalized Approach

Bredesen's approach is personalized to the patient, based on extensive testing to determine what is affecting the plasticity signaling network of the brain. As one example, in the case of the patient with a demanding job who was forgetting her way home, her therapeutic program consisted of some, but not all of the components involved with Bredesen's therapeutic program, and included:
  • (1) eliminating all simple carbohydrates, leading to a weight loss of 20 pounds;
  • (2) eliminating gluten and processed food from her diet, with increased vegetables, fruits, and non-farmed fish;
  • (3) to reduce stress, she began yoga;
  • (4) as a second measure to reduce the stress of her job, she began to meditate for 20 minutes twice per day;
  • (5) she took melatonin each night;
  • (6) she increased her sleep from 4-5 hours per night to 7-8 hours per night;
  • (7) she took methylcobalamin each day;
  • (8) she took vitamin D3 each day;
  • (9) fish oil each day;
  • (10) CoQ10 each day;
  • (11) she optimized her oral hygiene using an electric flosser and electric toothbrush;
  • (12) following discussion with her primary care provider, she reinstated hormone replacement therapy that had been discontinued;
  • (13) she fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime;
  • (14) she exercised for a minimum of 30 minutes, 4-6 days per week.

Pluses & Minuses

The results for nine of the 10 patients reported in the paper suggest that memory loss may be reversed, and improvement sustained with this therapeutic program, said Bredesen. "This is the first successful demonstration," he noted, but he cautioned that the results are anecdotal, and therefore a more extensive, controlled clinical trial is needed. "The current, anecdotal results require a larger trial, not only to confirm or refute the results reported here, but also to address key questions raised, such as the degree of improvement that can be achieved routinely, how late in the course of cognitive decline reversal can be effected, whether such an approach may be effective in patients with familial Alzheimer's disease, and last, how long improvement can be sustained," he said.
The downside to this program is its complexity. It is not easy to follow, with the burden falling on the patients and caregivers, and none of the patients were able to stick to the entire protocol.
On the other hand, the fact that there was such great memory improvement in so many patients shows that this is not an all-or-nothing program. Even doing some of the program's steps was enough to improve memory.
Even better, said Bredesen, are the program's side effects: "It is noteworthy that the major side effect of this therapeutic system is improved health and an optimal body mass index, a stark contrast to the side effects of many drugs."

Big Trial, Rapid Results

Muses Labs will soon launch a two-year observational study to conduct a large-scale trial of the MEND program. The trial will include 200+ participants with Alzheimer's disease, at selected medical facilities across the country.
Says Muses Labs’ CEO Vik Chandra, “Muses Labs intends to utilize the Internet and recent technology innovations to make personalized combination therapy practical and accessible to every individual with Alzheimer’s disease around the world.”
As the therapy does not rely upon new drugs, but rather an innovative combination of existing pharma and broader-based therapeutics, wider availability is only a couple of years away.

Saturday, September 8, 2018

Less dementia with high blood pressure treatment

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition]



n a new study, treating blood pressure more aggressively lowered odds of developing mild cognitive impairment, a gateway to dementia. CBS News chief medical correspondent Dr. Jon LaPook explains. 




CHICAGO — The first randomized clinical trial to demonstrate that intensive blood pressure treatment reduces new cases of mild cognitive impairment (MCI), and the combined risk of MCI plus all-cause dementia, was the highlight of new research results reported at the Alzheimer’s Association International Conference (AAIC) 2018 in Chicago. 

MCI is often nicknamed "PRE-DEMENTIA". If the risk for MCI is lowered, it implies that the risk for dementia is lowered. 


Reducing Risk

The preliminary results of the SPRINT MIND trial, presented at AAIC 2018, provide the strongest evidence to date about reducing risk of MCI and dementia through the treatment of high blood pressure, which is one of the leading causes of cardiovascular disease worldwide. 

“The exciting data from innovative research studies reported at AAIC 2018 give us many reasons to be hopeful,” said Maria C. Carrillo, PhD, Alzheimer's Association Chief Science Officer. “For example, the reduction in new cases of MCI seen in the SPRINT MIND study adds credibility to the vision of future Alzheimer’s therapy that combines drugs and modifiable risk factor interventions — as we do now in cardiovascular disease.”

Better Dementia Prevention Strategies

“We welcome innovative clinical trial designs and therapeutic targets, and new methods of delivering therapies and attacking the disease, as we heard presented at AAIC,” Carrillo said. “A new therapy has not been approved in a long time. We need bold steps — from basic science all the way through clinical trials — to provide better treatments and prevention strategies for the millions of people living with Alzheimer’s and other dementias, and the millions more at risk.”

New SPRINT MIND Trial

At AAIC 2018, researchers reported preliminary results related to risk of dementia and cognitive decline from the Systolic Blood Pressure Intervention Trial (SPRINT). SPRINT is a randomized clinical trial that compares two strategies for managing high blood pressure (hypertension) in older adults: an intensive strategy with a systolic blood pressure goal of less than 120 mm Hg versus a standard care strategy targeting a systolic blood pressure goal of less than 140 mm Hg. 

SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT MIND) examined whether treating for the lower blood pressure target reduces the risk of developing dementia and/or MCI. Study participants were 9,361 hypertensive older adults with increased cardiovascular risk but without diagnosed diabetes, dementia or stroke. Participant mean age was 67.9 years (35.6 percent women) and 8,626 completed at least one follow-up cognitive assessment.

Significantly Lower Rate

In SPRINT MIND, the researchers found a statistically significant 19 percent lower rate of new cases of MCI in the intensive blood pressure treatment group. The combined outcome of MCI plus probable all-cause dementia was 15 percent lower in the intensive versus standard treatment group. 

“This study shows more conclusively than ever before that there are things you can do — especially regarding cardiovascular disease risk factors — to reduce your risk of MCI and dementia,” said Carrillo. 


MORE INFORMATION:
  • Check out the NIH's Mind Your Risks® health campaign to increase awareness of the link between vascular disease and brain health.
  • AAIC is the premier annual forum for presentation and discussion of the latest Alzheimer's and dementia research. Bringing the world closer to breakthroughs in dementia science, AAIC 2018 convened more than 5,100 leading experts and researchers from around the world and featured more than 2,500 scientific presentations.
SOURCES:

Thursday, September 6, 2018

Diagnose dementia better with F-18 scans

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Eli Lilly and Company



At $3,000 per scan, are F18 Scans worth it? They let doctors see plaque in the brain, the main suspect behind Alzheimer's. They show doctors if, where and how much plaque there is. They can sharpen an Alzheimer's diagnosis or rule it out completely. Learn how F18 Scans improve care and diagnosis. 




INDIANAPOLIS -- Eli Lilly released important data showing that F18 beta-amyloid imaging was associated with better diagnosis and management of patients with dementia. 

There are over 100 tpyes of dementia. Some are curable, some demand different treatments than others. The differences in treatment can be critical. 

The most common type of dementia is Alzheimer's disease. It is so common that it is common for doctors to diagnose a patient with Alzheimer's when they really have a different type of dementia. This can lead to ineffective or even dangerous treatments. Furthermore, even when a person has Alzheimer's, it is challenging to treat it. Doctors usually base the medications they prescribe, as well as recommended treatments, on a somewhat subjective judgement call referred to as a "clinical diagnosis". 

With new F18 scanning technologies, doctors can actually "see" how much Alzheimer's plaque is in a person's brain, if any. They now have an objective tool to help them dramatically sharpen their diagnosis. 

To see an invterview of a patient who benefitted from an F18 Scan after he was diagnosed with dementia, watch the video,
"F18 Alzheimer's Scan Delivers Better Prescriptions & Fewer Tests". 

In this latest study from Ely Lilly, change in management  was observed in both patients who met and did not meet the Appropriate Use Criteria (AUC), which were developed by the Society of Nuclear Medicine and Molecular Imaging and the Alzheimer's Association to provide guidance on which patients are most appropriate for imaging and how best to use the results. These data were presented at the Alzheimer's Association International Conference (AAIC) by Andrew Siderowf, M.D., MSCE, medical director, Avid Radiopharmaceuticals, a subsidiary of Lilly.

"This study included patients in which there was diagnostic uncertainty by the treating physician and found that changes in diagnosis and management of Alzheimer's disease did not vary between patients depending on whether they met the Appropriate Use Criteria or not. In addition, analysis of beta-amyloid scans conducted post-diagnosis indicated that many patients being treated with medications may have potentially been misdiagnosed and inappropriately treated," said Dr. Siderowf. "While we support the development of the Appropriate Use Criteria, one of the clearest insights resulting from these data is that we need to continue to fine tune our understanding of the appropriate use of these tools and their utility for patients facing a diagnosis of Alzheimer's disease."

The objective of the study was to evaluate which patients are most likely to receive different care if they had an amyloid PET scan as part of their diagnostic work-up. In particular, the study evaluated if patients who met the working definition of the AUC would be more affected than those who did not. The AUC guidelines propose that patients who are being evaluated for dementia with atypical presentations, younger patients, and patients with unexplained mild cognitive impairment, are most appropriate for amyloid PET imaging. For the patient to be included in the study, Alzheimer's disease had to be under consideration and the treating physician had to have uncertainty regarding the diagnosis. 
To see an invterview of a patient who actually used an F18 Scan after he was diagnosed with dementia, watch the video,
"F18 Alzheimer's Scan Delivers Better Prescriptions & Fewer Tests".


Results showed that 59 percent of subjects met the working definition of AUC. Forty-seven percent of the AUC-like cases were amyloid positive compared to 62 percent of non-AUC cases. Diagnosis changed after PET scan for 58 percent of AUC cases versus 45 percent of non-AUC cases (p=0.10). The proportion of patients with change in management plan was high for both AUC (88 percent) and non-AUC (77 percent) cases. In particular, the use of Alzheimer's disease medications including cholinesterase inhibitors, or memantine, declined after a negative florbetapir F 18 scan by 20 percent (from 26/54 to 15/54 cases; p=0.002) in AUC cases and by 33 percent (from 17/27 to 8/27 cases; p=0.004) in non-AUC cases. Diagnoses for non-AUC cases in which Alzheimer's disease medications were withdrawn after a negative scan included prodromal Alzheimer's disease/mild cognitive impairment due to Alzheimer's disease (n=8), or mild cognitive impairment of uncertain etiology (n=1). This study found that patients with an uncertain diagnosis, but who are not otherwise explicitly captured by AUC, may be reasonable candidates for amyloid imaging.

"Alzheimer's disease is one of many possible causes of cognitive impairment, which can make diagnosis challenging. In fact, it is estimated that up to one in five patients clinically diagnosed with probable Alzheimer's disease during life do not exhibit Alzheimer's disease pathology upon autopsy[1],[2]," said Dr. Siderowf. "These results reinforce how knowledge of the presence or absence of amyloid pathology can substantially affect both diagnosis and management in these patients being evaluated for Alzheimer's disease or other possible causes of cognitive decline."

MORE INFORMATION:

Study Methods The impact of amyloid PET on actual patient care was examined in a previous study.[3]

In the prior study, performed at 19 clinical sites, treating physicians provided a provisional diagnosis and management plan prior to receiving results of amyloid PET imaging with florbetapir F 18. Participants' medical records for the three months immediately after imaging were abstracted to capture their actual diagnosis and management. For the current study, participants were classified as meeting an operational definition of AUC-like or not, based on pre-scan diagnosis and demographic features.

About Florbetapir F 18 Injection[6] Florbetapir F 18 is indicated for Positron Emission Tomography (PET) imaging of the brain to estimate beta-amyloid neuritic plaque density in adult patients with cognitive impairment who are being evaluated for Alzheimer's Disease (AD) and other causes of cognitive decline. A negative florbetapir F 18 scan indicates sparse to no neuritic plaques and is inconsistent with a neuropathological diagnosis of AD at the time of image acquisition; a negative scan result reduces the likelihood that a patient's cognitive impairment is due to AD. A positive florbetapir F 18 scan indicates moderate to frequent amyloid neuritic plaques; neuropathological examination has shown this amount of amyloid neuritic plaque is present in patients with AD, but may also be present in patients with other types of neurologic conditions as well as older people with normal cognition. Florbetapir F 18 is an adjunct to other diagnostic evaluations.

Limitations of Use:
  • A positive florbetapir F 18 scan does not establish a diagnosis of AD or other cognitive disorder
  • Safety and effectiveness of florbetapir F 18 have not been established for:
    • Predicting development of dementia or other neurologic condition
    • Monitoring responses to therapies
WARNINGS AND PRECAUTIONS

Risk for Image Misinterpretation and Other Errors
  • Errors may occur in the florbetapir F 18 estimation of brain neuritic plaque density during image interpretation
  • Image interpretation should be performed independently of the patient's clinical information. The use of clinical information in the interpretation of florbetapir F 18 images has not been evaluated and may lead to errors. Other errors may be due to extensive brain atrophy that limits the ability to distinguish gray and white matter on the florbetapir F 18 scan as well as motion artifacts that distort the image
  • Florbetapir F 18 scan results are indicative of the brain neuritic amyloid plaque content only at the time of image acquisition and a negative scan result does not preclude the development of brain amyloid in the future
Radiation Risk
  • Florbetapir F 18, similar to other radiopharmaceuticals, contributes to a patient's overall long‐term cumulative radiation exposure. Long-term cumulative radiation exposure is associated with an increased risk of cancer. Ensure safe handling to protect patients and health care workers from unintentional radiation exposure
MOST COMMON ADVERSE REACTIONS
  • The most common adverse reactions reported in clinical trials were headache (1.8%), musculoskeletal pain (0.7%), blood pressure increased (0.7%), nausea (0.7%), fatigue (0.5%), and injection site reaction (0.5%)
For more information about florbetapir F 18, please see the Prescribing Information athttp://pi.lilly.com/us/amyviduspi.pdf.

About Eli Lilly and Company Lilly is a global healthcare leader that unites caring with discovery to make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at www.lilly.com and http://newsroom.lilly.com/social-channels.

Amyvid™ is a trademark of Eli Lilly and Company.

[1] Petrovitch H, White LR, Ross GW, et al. Accuracy of clinical criteria for AD in the Honolulu-Asia Aging Study, a population-based study. Neurology. 2001;57(2):226–234.
[2] Lim A, Tsuang D, Kukull W, et al. Clinico-neuropathological correlation of Alzheimer's disease in a community-based case series. J Am Geriatr Soc. 1999;47(5):564–569.
[3] Grundman M, Pontecorvo MJ, Salloway SP, et al. Potential impact of amyloid imaging on diagnosis and intended management in patients with progressive cognitive decline. Alzheimer Dis Assoc Disord. 2013 Jan;27(1):4-15.
[4] Alzheimer's Association. 2014 Alzheimer's Disease Facts and Figures.http://www.alz.org/downloads/facts_figures_2014.pdf. Accessed on June 4, 2014.
[5] Alzheimer's Disease International. Policy Brief for Heads of Government: The Global Impact of Dementia 2013 - 2050. http://www.alz.co.uk/research/GlobalImpactDementia2013.pdf. Published December 2013. Accessed onJune 4, 2014.
[6] Amyvid [package insert]. Indianapolis, IN: Lilly USA, LLC; 2012.

SOURCE:
Eli Lilly and Company

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