Wednesday, January 18, 2017

Alzheimer's study

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

Kenneth S. Kosik, MD, is professor of neuroscience and codirector of the Neuroscience Research Institute

It’s easy to think that the mysteries of Alzheimer’s disease will be revealed in the high-tech hallways of US medical centers and research institutes. But new discoveries are coming from far-off places like Medellín, Colombia, which may be ground zero for finding the genetic basis of this dreaded neurodegenerative disease that strips people of memories and destroys personalities.
For more than 25 years, I have worked with Dr. Francisco Lopera of Medellín’s University of Antioquia in studying the largest known family with inherited Alzheimer’s disease. Its family tree goes back 300 hundred years. Hundreds of individuals in this family are fated to get the disease. Their symptoms usually develop between the ages of 45 and 50.
Studying this community has given us a clear picture of Alzheimer’s in this genetic microcosm. We now know the gene, called presenilin 1 (PSEN1), that is responsible for this family’s disease. Knowing the gene mutation means we can predict which family members will get Alzheimer’s. Knowing whom the disease will strike, and when, offers a powerful basis for finding a treatment and determining if it is effective. The Colombian family is now part of a large prevention trial.
While most of the family members with the PSEN1 variant develop Alzheimer’s disease before age 50, a few develop it later. We have recently discovered that these individuals carry a different genetic variant that provides some protection against the disease. This modifier gene can delay Alzheimer’s onset by as much eight to 10 years. But it doesn’t provide complete protection — we haven’t seen anyone with the PSEN1 mutation who escapes Alzheimer’s disease.
In a surprisingly improbable happenstance, another large family with a different genetic mutation that also causes Alzheimer’s at an early age lives in a nearby village. This gives us an opportunity to put our findings of a modifier gene to the test in a different genetic setting.

Obstacles remain

Despite more than 100 years of research, relatively little is known about Alzheimer’s disease. Experts still don’t have a fundamental understanding of the underlying biological and physiological changes of the disease or what drives them.
The scope of the problem is daunting. Around the world, more than 40 million people are currently suffering from Alzheimer’s; more than 5 million of them live in the United States, and that number is projected to double as baby boomers age over the next 20 years. The disease already burdens our communities and our country: 15 million Americans provide care for a loved one with the disease, while Alzheimer’s health care costs exceed $200 billion a year in the US and are projected to surpass $1 trillion as the population ages.


The drug development process for Alzheimer’s disease is riddled with challenges. One issue for clinical trials is the inclusion of individuals misdiagnosed with Alzheimer’s disease. Including individuals with vascular dementia, Lewy body dementia, or even poorly understood forms of cognitive impairment — all of which can look like Alzheimer’s — can easily throw off a trial’s results. On the other hand, including those with advanced Alzheimer’s may also skew results because they may have lost too many brain cells to measurably respond to the therapy.
Researchers also face challenges when measuring trial outcomes, since they must quantify changes in the way a person thinks (cognition). Directly measuring cognition can be hard to do, so stand-ins such as brain imaging are often used to interpret whether a therapy is effective. Unfortunately, such stand-ins don’t always correlate with changes in cognition or quality of life.

A path forward

Lopera and other colleagues are now conducting a clinical trial in Colombia to test an antibody directed against a type of protein called amyloid, which collects in the brain plaques associated with Alzheimer’s disease.
Regardless of the outcome of this trial, additional research and trials in Medellín and other parts of the world may help us better identify the underlying physiology of the disease, information the global scientific community desperately needs. Expanding the scope of our understanding can help expand the pipeline for drugs to target Alzheimer’s. There are likely many ways into this problem, but one thing is certain: The only way out of it is research.

Tuesday, January 17, 2017

Dementia drugs help head and heart

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

Heart   Alzheimer's and Dementia Weekly

Drugs that are used for treating Alzheimer’s disease in its early stages are linked to a reduced risk of heart attacks and death, according to a large study of over 7,000 people with Alzheimer’s disease in Sweden. 

The research, which is published online in the European Heart Journal [1], looked at cholinesterase inhibitors (ChEIs), such as donepezil (Aricept®), rivastigmine (Exelon®) and galantamine (Reminyl®), which are used for treating mild to moderate Alzheimer’s disease [2]. Side-effects of ChEIs include a beneficial effect on the vagus nerve, which controls the rate at which the heart beats, and some experimental studies have suggested that ChEIs could also have anti-inflammatory properties.

Professor Peter Nordström, of Umeå University, Umeå, Sweden, and colleagues followed 7073 people with Alzheimer’s disease, who were on the Swedish Dementia Registry from May 2007 to December 2010. They found that those who were on ChEIs had a 36% reduced risk of death from any cause, a 38% reduced risk of a myocardial infarction (heart attack) and a 26% reduced risk of death from cardiovascular causes such as stroke compared to people not taking ChEIs. These results included adjustments for various confounding factors such as age, sex, whether the diagnosis was for Alzheimer’s dementia or Alzheimer’s mixed dementia (where more than one type of dementia occur simultaneously), level of care, and medical history including medications for other conditions.

Prof Nordström said: 

“If you translate these reductions in risk into absolute figures, it means that for every 100,000 people with Alzheimer’s disease, there would be 180 fewer heart attacks – 295 as opposed to 475 – and 1125 fewer deaths from all causes – 2000 versus 3125 – every year among those taking ChEIs compared to those not using them.”
Patients taking the highest recommended doses of ChEIs had the lowest risk of heart attack or death: 65% and 46% lower respectively compared with those who had never used ChEIs.

The researchers also checked whether the reduction in risk applied only to the use of ChEIs or was seen in other drug treatments for dementia. Memantine is a drug indicated for use in moderate to advanced Alzheimer’s disease and works in a different way to ChEIs [3]. The researchers found it made no difference to the risk of heart attack or death from any cause.

Prof Nordström said: 

“As far as we know, this is the first time that the use of ChEIs has been linked to a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause. As this is an observational study, we cannot say that ChEI use is causing the reduction in risk, only that it is associated with a reduction. However, the strengths of the associations make them very interesting from the clinical point of view, although no clinical recommendations should be made on the basis of the results from our study. It would be of great value if a meta-analysis of previous, randomised controlled trials could be performed, as this might produce answers on which clinical recommendations could be based.”
As the study was based on a nationwide group of patients, Prof Nordström said it should be possible to extrapolate the findings to other countries.

Drugs for Early to Midstage
Brand NameGeneric Name
Aricept®donepezil
Exelon®rivastigmine
Remynil or Razadyne®galantamine
Drugs for Moderate to Severe Stage
Namenda® or Ebixa®memantine






Sunday, January 15, 2017

Dementia misdiagnosis

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dementia resource for caregivers and healthcare professionals,

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

T. Goodman


Researchers at the Hospital Clinic of Barcelona, Spain have uncovered a sad truth about early onset Alzheimer's disease - that more than half of those who develop it are misdiagnosed because they exhibit symptoms not customarily associated with Alzheimer's.
Symptoms like vision problems, inability to complete tasks, behavior, sudden mood changes, or language problems...  “People who develop early-onset Alzheimer’s disease often experience these atypical symptoms rather than memory problems, which can make getting an accurate diagnosis difficult,” study researcher Albert Llado, MD, PhD, said.
The researchers reviewed the cases of 40 persons, aged 40 to 60,  whose brains at autopsy showed they had Alzheimer's disease.  After reviewing the medical history of these persons, they learned that of those with confirmed early Alzheimer's disease, about 38 percent appeared with symptoms other than memory loss and 53 percent were initially misdiagnosed as having other disorders, such as behavioral variant frontotemporal lobar degeneration, normal pressure hydrocephalus, semantic dementia, primary progressive aphasia, corticobasal degeneration, pseudodementia with depression, and unclassifiable dementia.
Only 4 percent of those with memory problems were misdiagnosed. 
Even more surprising is that

Thursday, January 12, 2017

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


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The Dementia Caregiver's Little Book of Hope [Kindle

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Poem about dementia oh so true

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

Check it out


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even though the season has passed


Monday, January 9, 2017

Dementia anxiety and agitation

Caregivers, and healthcare professionals,here is some great information

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

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caregiver you can be


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

alz.org

Anxiety and Agitation

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A person with Alzheimer's may feel anxious or agitated. He or she may become restless, causing a need to move around or pace, or become upset in certain places or when focused on specific details.


    Possible causes of agitation

    Anxiety and agitation may be caused by a number of different medical conditions, medication interactions or by any circumstances that worsen the person's ability to think. Ultimately, the person with dementia is biologically experiencing a profound loss of their ability to negotiate new information and stimulus. It is a direct result of the disease.
    Situations that may lead to agitation include:
    • Moving to a new residence or nursing home
    • Changes in environment, such as travel, hospitalization or the presence of houseguests
    • Changes in caregiver arrangements
    • Misperceived threats
    • Fear and fatigue resulting from trying to make sense out of a confusing world
    Treating Behavioral Symptoms
    Anyone experiencing behavioral symptoms should receive a thorough medical checkup, especially when symptoms appear suddenly. Treatment depends on a careful diagnosis, determining possible causes and the types of behavior the person is experiencing. With proper treatment and intervention, symptoms of agitation can be reduced.

    Tips to help prevent agitation 

    Friday, January 6, 2017

    Dementia beyond disease

    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

    Amazon


    "Be prepared to be challenged and inspired! Dr. Power's book is transformational in regarding dementia as a shift in the way the person with dementia experiences the world, and then focusing on how to enhance the well-being of those in your care. Once you have read this book, you will indeed 'change [your] minds about those whose minds have changed -- Christine Bryden, Author and Dementia Advocate Dr. Power shows he is one of a mere handful of thinkers that are creating a new enlightened age of Alzheimer's, one that sets personhood, humanity and well-being above the perpetuation of a medicalized disease model. This work helps set the stage for a more humane standard of care that supports living well in our communities for all people. --Peter Reed, PhD, MPH, Director "Sanford Center for Aging"

    Al Power continues his provocative and pioneering work in dementia by taking us not only further beyond drugs, but beyond disease itself to wellbeing. We are led to place where people with dementia are returned to being part of humanity." --Peter Whitehouse, Professor of Neurology "Case Western Reserve University"

    "Al Power has done it again. His newest book challenges us to partner with the person with dementia to create the best possible life. Dementia Beyond Disease is a thought provoking and practical guide that will help all of us develop winning programs that are life-affirming for the person with dementia and for care partners. Highly recommended!" --David Troxel, Author "The Best Friends Approach to Alzheimer's Care"

    Read Dementia Beyond Disease and enhance the well being of someone with dementia


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