Blogger Holiday

Contributed by: Dennis Fortier, President, Medical Care Corporation

For the past week, the key contributors to the blog have been on holiday but full coverage of the daily brain news will resume soon on August 1st. Any major news items will be covered between now and then but, in the absence of a major story, the blog will be inactive.

When we return, there will be much news to report and distill. Last week I attended the ICAD conference in Vienna, Austria along with thousands of scientists researching all aspects of this disease. Much news has been generated by the presentations during the week-long conference and several clear themes emerged with regard to the future direction of ongoing research.

While the Brain Today blog has not yet reported on much of this news, rest assured that we have taken careful notes and will update you readers comprehensively over the coming weeks.

Alcohol and Dementia

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Drinking one or two alcoholic beverages a day -- but no more than that -- appears to protect older adults from developing dementia, researchers reported here at the International Conference on Alzheimer's Disease.

Researchers identified 3,069 participants in the Ginkgo Evaluation of Memory Study who were age 75 or older. They had undergone a complete assessment of cognition at the start of the study and were evaluated for their cognitive status at six-month intervals, and then were followed for around six years. During the study, 388 cases of dementia occurred among the participants originally classified as normal and 188 cases were diagnosed among patients who had mild cognitive impairment at baseline.

At baseline, 1,286 individuals were teetotalers, 55.7% of whom were women. Of those who drank alcohol, 39.1% were women. More abstainers -- 20.2% -- were classified as having mild cognitive impairment at baseline than consumers (12.3%).

After five years in the study, the 2,587 normal individuals who were self-reported moderate drinkers had a 37% reduced risk of developing dementia when compared with the abstainers (P=0.017) -- the group of patients most at risk of developing dementia.

However, when the researchers scrutinized development of dementia among the 482 patients with mild cognitive impairment at baseline, they found a near doubling of the risk of developing dementia -- a hazard ratio of 1.92 (P<0.05).

This study does not give license to drink beyond one or two alcoholic beverages a day since excessive alcohol consumption is associated with alcoholic dementia and other medical problems. Always, talk to your doctor before starting any major lifestyle modification, including regular consumption of alcohol.

Dimebon and the Amyloid Hypothesis

Contributed by: Dennis Fortier, President, Medical Care Corporation

Among the many interesting studies presented this week at the ICAD conference in Vienna, Austria , one that has generated lots of discussion looked at Dimebon's potential impact on the amyloid load in the brain.

As you may recall from an earlier post, many experts believe that an accumulation of beta-amyloid is the primary cause of Alzheimer's disease. This theory is currently driving the majority of drug development work.

Dimebon, an antihistamine, appears to improve cognition through a loosely understood improvement of mitochondrial function. However, through ongoing research to better understand how Dimebon works, scientists have recently looked at its impact on the amyloid load. To most everyone's surprise, mouse brain cells in a dish produced much higher amounts of the amyloid proteins when combined with Dimebon. This finding sits in stark contrast to the expected reduction in amyloid that the prevalent hypothesis suggests.

These results raise new questions about the mechanism of Dimebon and suggest that the amyloid hypothesis, if valid, may well be more complicated than initially believed. In any case, this study contributes new information to the process of understanding Alzheimer's pathology and provides the scientific community with a new set of potentially fruitful questions to explore.

Doctors Emphasize the Importance of Early Alzheimer's Detection

Contributed by: Dennis Fortier, President, Medical Care Corporation

I am with my colleagues this week at the International Conference on Alzheimer's Disease in Vienna, Austria. This is the premiere forum for research in this field and papers from around the world will be presented and discussed by some of the world's leading experts. You should have noticed a heavier than usual dose Alzheimer's related news stories during the past two days and you can expect that trend to continue through the week.

Today I would like to highlight an important study being discussed on the factors that can inhibit a timely diagnosis of AD. The leading factor, according to this research, is "therapeutic nihilism" or, the belief that there are no benefits to treatment.

While we have known that this attitude, while unfounded, is common among the aging masses, this study has shown that it is also prevalent among primary care physicians. Once again, we see that education is an immediately viable approach to improving our effectiveness against this disease.

Alzheimer's Drug Development by Eli Lilly

Contributed by: Dennis Fortier, President, Medical Care Corporation

There seems to be a bit of confusion about the various drug trials currently underway by Eli Lilly. Here is a brief summary of their activity:

The IDENTITY trials are enrolling patients aged 55+ in over 30 countries including the USA. The compound in these studies is a gamma-secretase inhibitor that is hypothesized to reduce the accumulation of amyloid plaques in the brain.

The more recently announced EXPEDITION trials are enrolling patients aged 55+ in 16 countries including the USA. These studies are measuring the potential effects of an anti-amyloid monoclonal antibody (Solanezumab) delivered via intravenous infusion.

More details about each trial including how to inquire about enrolling can be found in this announcement from Eli Lilly.

Lack of Education About Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

The Alzheimer's Society in the UK recently published the results of their survey exploring the degree to which the average person understands this disease.

While there was no surprise that the average citizen is not aware of recent scientific advances, certain findings were somewhat alarming. In that regard, the fact that a third of respondents thought Alzheimer's disease was an inevitable part of normal aging was particularly illuminating.

Additionally, about a quarter of all respondents were not aware that risk factors can be managed to reduce the likelihood of dementia. Given this low level of understanding, one can easily see why there is not a greater proactive approach by aging patients to engage their physicians in discussions about memory loss.

In the near term, the greatest health care advance we can facilitate in the Alzheimer's field will be driven by education. If we had a well-informed public visiting enlightened physicians where cognitive health was regularly and objectively monitored, we would identify memory disorders much earlier and intervene with greater clinical success.

Caffeine and Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation

Today there were many headlines about caffeine and Alzheimer's disease. Many of those headlines suggested that coffee might actually cure Alzheimer's disease. That conclusion is more than a bit premature and will be difficult to reconcile with the vast number of heavy coffee drinkers progressing through advanced stages of the disease as I write this.

This news originated from the Alzheimer's Disease Research Center (ADRC) in Tampa, Florida with a study published online in the Journal of Alzheimer's Disease. In that study, mice with a condition similar to Alzheimer's disease were given caffeinated water in a dose equivalent to about 5 cups of coffee per day for humans. These mice then showed a reduction in the beta-amyloid plaques in their brains and improved performance on a series of thinking and learning tests.

While some correlation between caffeine and improved cognition has been shown in other studies as well, this particular study does not warrant headlines suggesting a cure for Alzheimer's disease (a comment that I am sure the scientists conducting the study would support).

Today's ambitious headlines are merely an example of health care editors turning a small scientific conclusion into a tantalizing story in the press.

Aricept to be Available in New Formulations?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Eisai, Inc., makers of the most widely prescribed Alzheimer's medication (Aricept), released a status update today on two studies they have sponsored. The indications are that they expect to bring two new formulations of Aricept to the market in the future.

First, they have concluded a successful review of phase III data on a sustained release capsule that could improve clinical outcomes by mediating the dose of the drug in the bloodstream. The company announced an intention to file and NDA (New Drug Application) with the FDA by end of summer 2009.

Eisai also announced that they are studying a transdermal patch formulation at locations in Japan and the USA. Their expectation is that an NDA for this formulation might be filed within the next 12 months.

The FDA pipeline for new Alzheimer's treatments is quite full but it is encouraging to see that those drugs already approved are also being optimized through ongoing research and development.