Combining a Brain Scan with a Spinal Fluid Test


Contributed by: Dennis Fortier, President, Medical Care Corporation
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According to a study published in the latest issue of Archives of Neurology, researchers at University College London's Institute of Neurology have collected evidence of a correlation between two interesting brain pathologies. The research looked at low levels of beta-amyloid in the spinal fluid and, based on an MRI brain scan twelve months later, the rate of brain atrophy (or shrinkage).

The interest in this study stems from prior research showing that a low level of amyloid in the cerebral spinal fluid (CSF) is a common (but not certain) precursor to Alzheimer's disease. Furthermore, typical Alzheimer's pathology includes the death of brain cells leading to brain shrinkage. Therefore, noting that these two indicators seem to move in unfavorable directions, even before symptoms are present, might lead to methods for earlier detection and intervention.

In general, the expert research community supports the notion of combining indicators to detect early trends that should be carefully monitored. While this study is certainly noteworthy, coverage in the media, that has portrayed these findings as a method for detecting early stage Alzheimer's disease, is probably over-stated at this early point.
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Does Early Diagnosis of Alzheimer's Really Create an Ethical Dilemma?


Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does early diagnosis of Alzheimer's really create an ethical dilemma?

For all of the press devoted to scrutinizing the pros and cons of delivering an Alzheimer's diagnosis to a patient with only mild symptoms, including a front page article in today's NY Times, it is easy to overlook the question posed above. In fact, anyone could be forgiven if they assumed, based on the constant characterization in the press, that a dilemma is at hand.

The Dilemma That Isn't

Posing this question may generate provocative headlines and robust debate but, if we step back and consider the larger context, there really is no dilemma. We do not need any ethicists to ponder and rule on this question because it doesn't require a single, universal answer.

Some people seek clinical information and get comfort from having it available, even when the information consists of bad news like an Alzheimer's diagnosis. Others prefer ignorance when new information will cause them to worry needlessly about a situation they cannot change.

Patients Choose
Rather than debating which approach is better and pronouncing the presence of a dilemma, all we need to do is let individuals choose their preference. Those who want to know should be told; those who do not want to know, needn't have the information thrust upon them. When someone has a sign or symptom of a medical problem and then seeks a physician's opinion about the underlying problem, they are pretty much declaring that they want a diagnosis. In the real world, the "want-to-know vs. don't-want-to-know" decision is made by either consulting a physician or not.

This situation is not as black and white as described here, but it certainly is far less gray than characterized by the press. In general, people seeking medical attention for a cognitive complaint want help and physicians have an obligation to diagnose the problem and treat it as effectively as possible.

Sometimes this will involve giving patients news they would rather not hear, but the symptoms and the angst that comes with those symptoms, are already a reality in the patient's lives. A definitive diagnosis reduces uncertainty and helps the treatment process move optimally forward.

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Could Alzheimer's be Caused by Inflammation?


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As with all unsolved scientific problems, hypotheses are constantly developed, modified, and tested with each new study shaping the ongoing debate in some way. In terms of the question "What Causes Alzheimer's?", the hypothesis that inflammation is the culprit has long been discussed and, to some degree, tested in the lab.

The LA Times ran an interesting article this week highlighting the inflammation hypothesis and describing its merits. It's a good overview of a theory that is not considered central by leading thinkers today, but may well have merit.

One quote in the article suggests that this is a "very new" way of thinking about the problem, but that is not really true. Inflammation has been fairly well scrutinized for its role in the Alzheimer's disease process. The current scientific emphasis elsewhere (primarily on the amyloid hypothesis), merely suggests that inflammation is not the most compelling avenue according to most of the experts in the field.

However, most would agree that inflammation may play some role in the complex cascade of pathology associated with this disease.
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Congress Passes Nat'l Alzheimer's Prevention Act


Contributed by: Dennis Fortier, President, Medical Care Corporation
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The passing of the National Alzheimer's Prevention Act is good news; another solid step in the right direction.

One of the common theories about why a solution to the Alzheimer's problem has been elusive, is that we have no national strategy coordinating a game plan. In lieu of such a coordinated approach, we have arguably ignored pockets of potential scientific importance, squandered funding by over-studying fruitless theories, and failed to learn about and share effective community programs from around the country.

There is no doubt that it is a difficult puzzle to solve and that the cost of solving it more slowly than necessary is enormous. Perhaps even incalculable.

It makes sense that an efficient approach would include an effort to ensure that scientific resources are focused on carefully selected initiatives with minimal overlap, that social programs are carefully vetted for efficacy and then pragmatically supported in the public sector, and that available research funding is directed in a comprehensively thoughtful manner.

All of these principles are captured in the spirit of the National Alzheimer's Prevention Act. Specifically, it requires that the Department of Health and Human Services will appoint an inter-agency council to recommend a national plan of action.

You can also help by urging the President to support this effort. Click here to do your part.

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Understanding Cholesterol and Alzheimer's Risk


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As we have often noted, cardiovascular risk factors including high blood pressure, obesity, and high overall cholesterol can increase the likelihood of getting Alzheimer's disease (AD). A study published earlier this week in the Archives of Neurology may have shed more particular light on the relationship between cholesterol and AD.

According to researchers at Columbia University, high levels of HDL cholesterol (the "good" form), are 60% less likely to develop AD. They followed 1,130 seniors with no history of memory loss or dementia and measured their cholesterol levels every 18 months for four years. Their findings supported the theory that high levels of HDL cholesterol are correlated with lower incidence of AD.

While this has excellent face validity in that high HDL levels have been correlated with better cardiovascular heatlh in other studies, there is no compelling biological explanation of how or why elevated HDL's would reduce risk for AD. Also, earlier studies on HDL's and AD, conducted by the National Institute on Aging, showed the opposite result. That is, high HDL cholesterol was correlated with a higher risk of AD.

The relationship between cholesterol and AD risk is an area of ongoing study with many questions yet unanswered. However, based on the well documented vascular benefits of controlled cholesterol, it is wise to keep overall cholesterol and HDL cholesterol within the established ranges of good health.

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Memory Assessment During Routine Medical Exams


Contributed by: Dennis Fortier, President, Medical Care Corporation
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As we have noted in this space before, the Health Care Reform Act will mandate "detection of cognitive impairment" during routine Medicare Exams beginning in 2011. However, the approach by which physicians will comply with this new requirement remains an open question.

How should cognitive impairment be detected in a primary care setting?

The merit of any particular solution must be judged on several factors. For example, with all other factors held equal, a brief test would be superior to a short test as would a non-invasive test be superior to an invasive one. Cost matters as well; surely a less expensive test is preferable to a costly one. Similarly, a test that is highly sensitive to even subtle declines in cognition would be a better solution than one that only detects more severe symptoms.

While I have described attributes for comparing "tests", it may be that a test need not be part of the ideal solution. Perhaps physicians need only be proactive in soliciting memory concerns (or other cognitive complaints) from their patients.

Under such a scenario, those who express a concern could advance to a more sophisticated evaluation and the others would be questioned again at their next annual wellness exam. That's not a perfect solution for detecting problems in patients who are not already concerned, but many experts in this space would argue that such an approach would be a major leap forward. In fact, it might be the only approach that blends enough pragmatism and cost-efficacy to actually work in a busy primary care setting.

I recently listened to a webimar about a brief instrument called the "AD8", an informant-based questionnaire that could be useful in helping physicians identify patients who need a more thorough evaluation of their cognition. Various participants from the audience, many with ties to competing instruments, raised concerns about the whether or not it was a viable solution. An expert panel then discussed various pros and cons of the AD8 during the ensuing dialogue. The point of this post is not to evaluate the AD8 but to highlight the value of a new focus on cognitive health.

From my perspective, the facts that (1) Health Care reform is mandating more attention to cognitive health and (2) national discussions are unfolding to explore competing approaches, are both extremely positive developments. Memory concerns must be identified and addressed as early as possible to ensure timely intervention against progressive illnesses. This is our best bet to avoid future insolvency of our public health care system.

Efforts to initiate discussions about brain health between patients and their physicians are exactly what we need. We are on the right track.
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Crossing the Blood/Brain Barrier

Contributed by: Dennis Fortier, President, Medical Care Corporation
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This is a topic of towering importance in the field of treating brain disorders.

As we have discussed here previously, the brain is protected from foreign substances in the blood stream by a sophisticated barrier that is difficult to cross. This protective barrier is key to maintaining brain health but poses a challenge for scientists developing treatments that target the brain because, in very many instances, the treatment cannot cross from the blood stream to the brain where it can interact directly with the intended pathological target.

As researchers continue to develop hypotheses and investigate novel approaches for crossing the blood/brain barrier, the general media reports on these efforts with regularity. While there is no definitive breakthrough as yet, I think it is an important topic to follow.

Today I am highlighting a summary of thinking from researchers at Rensselaer Polytechnic Institute. I encourage you to click through this link and read the summary.
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More Evidence that Walking is Good for the Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation
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For the second time in as many months, a major study has shown that a regular walk leads to better brain health.

We recently posted this analysis of data from the Cardiovascular Health Study - Cognition Study showing that regular walking over a period of years preserved brain volume. Now, further analysis of the same data set was presented at the Radiological Society of North America showing that cognition was preserved among walkers at a significantly better level than among a sedentary group.

The data are compelling; a regular daily walk is good for you.
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Promising Alzheimer's Drugs on the Horizon

Contributed by: Dennis Fortier, President, Medical Care Corporation
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While we often emphasize the importance of non-pharmacologic therapies for treating Alzheimer's disease, more effective drugs could have an enormous, positive impact on our ability to combat its looming threat. A such, here is a brief summary of three of the most promising treatments in the FDA pipeline.

All three of these agents operate on the amyloid hypothesis which holds that, an accumulation of beta-amyloid, a naturally occurring protein in the brain, is the cause of Alzheimer's disease. While two recent trials on agents developed to reduce the production of beta-amyloid have failed, these three are intended to remove beta-amyloid from the brain.

Two similar drugs are Solanezumab and Bapineuzumab. Both are anti-bodies that attach to amyloid and then carry it away when they are flushed out of the body by the immune system. Solanezumab most likely operates outside of the brain which may lead to better tolerance than Bapineuzumab, which had more evidence of efficacy in its earlier stage studies. Each trial is well underway and the first published data should be forthcoming in late 2011 or early 2012.

Gammagard is Baxter's intraveneous immunoglobulin or IVIG, which also relies on removing amyloid through immune system mechanisms. IVIG is already on the market but with no approved claims for treating Alzheimer's disease.

There are certainly other approaches in the pipeline, some of which may bring better results in a shorter time frame than the three highlighted here. But these seem to have the strongest theoretical underpinnings and have bred the most optimism in the scientific community.
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Treating Alzheimer's Disease Without Drugs

Contributed by: Dennis Fortier, President, Medical Care Corporation
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One of the common themes in this blog is that "current treatment for Alzheimer's disease is better than many headlines indicate".

We write this because the argument against treatment efficacy is almost always framed through the narrow lens of drug-based interventions when, in reality, drugs are only one part of the most effective approach. A robust approach includes management of risk factors like smoking and excessive drinking, controlling co-morbid conditions such as diabetes and hypertension, proper diet, physical exercise, and both social and intellectual engagement.

We also point out that many reports of poor treatment efficacy are based on studies of Alzheimer's patients in whom the disease is too far progressed, and the brain too ravaged, for treatment to have a fair chance at working.

There is an additional area of treatment that has shown impressive efficacy and should be emphasized as well; it is psychosocial interventions. These include care-giver education, structured communication techniques, home safety, family counseling, and problem resolution. The results have been clear; caregivers who know what to expect and how best to deal with problems as they emerge, are less stressed, less depressed, and more effective in giving care. The result is healthier patients who maintain higher quality of life and a prolonged ability to avoid institutionalized care.

The Huffington Post has a great summary today of this approach and I encourage all readers to click through and to share this with their interested peers.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Physical Exercise and Genetic Risk of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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It has been well established that certain genes confer a higher risk for, but not a certain correlation with, Alzheimer's disease. It has also been well established that physical activity confers many health benefits including better flow of oxygen-rich blood to the brain and higher cognitive function.

Now, a study from the University of Wisconsin, Milwaukee, has looked at the benefits of physical exercise on those subjects with a specific, genetic, predisposition to Alzheimer's. As we would have hoped, the benefits of the physical activity seem to translate to this "at-risk" group as well.

The full publication on this study has not yet been released but the methodology was straight forward. Reearch subjects were separated into a "physically active" group and a "sedentary" group and brain activity was measured with functional MRI. According to the pre-publication press, there was no difference in brain activity in the hippocampul region (where short-term memory is processed) between those with a genetic risk for Alzheimer's and those without it.

This suggests that, even for those with a genetic predisposition to the disease, physical activity might be beneficial in delaying the onset or slowing the progression of Alzheimer's, just as it is for the rest of the population with a more favorable genetic profile.
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Better View of the Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The enormous complexity of the brain makes understanding how it works, and how diseases affect its function, a daunting challenge. This challenge has been exacerbated by the microscopic scale of neurons and synapses, which makes it nearly impossible to gather information visually.

Now, researchers at Stanford University have developed a method for staining thin slices of brain tissue, capturing a series of high resolution images, and then stitching the images together to create a visual model of brain structure. Their paper on the method is published this week in Nature and the photo below shows the level of synaptic detail that their approach renders.

This is pretty exciting as it could greatly improve our ability to inspect brain tissue and to understand brain function; both of which could play a role in accelerating our understanding of the field.
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Misplaced Moral Argument about Predicting Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation
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When following the press in the brain health space, it is very common to find well-written opinion letters and perspective pieces about the moral dilemma of predicting Alzheimer's disease in healthy adults. Common headlines vary around the "would you want to know" or "would you take the test" theme. The crux of the argument is that, with no cure, we should not bother predicting the disease and revealing such a tragic fate.

In a nutshell, these are the usual defenses:
  • Predictions allow vigilant monitoring and timely intervention when symptoms appear which leads to better treatment.
  • Predictions allow for financial, legal, and spiritual preparation for end of life.
  • Predictions identify important research subjects who can greatly improve scientific efforts to develop new treatments by volunteering for trials.
There are other arguments but those are the most common and most compelling justifications.

The purpose of this post is neither to condemn nor condone the notion of predicting Alzheimer's disease but to point out how often the moral debate is misplaced. For predictive approaches, like genetic tests, I say let the debate rage. However, for identifying approaches, those that indicate with certainty if a person has Alzheimer's pathology that has not yet progressed to a stage producing obvious symptoms, then the whole notion of "prediction" is misplaced.

But the moral debaters do not respect this important difference between predicting the disease and identifying the disease. People who have it, have it. And when they present to a physician and complain of cognitive difficulties, they are asking their physician to figure out the cause of the problem and treat it as best as possible. No moral dilemma; these people want to know.

Remember, everyone has the right to not visit their doctor and not investigate emerging cognitive problems. Those who want to actively manage their health should be allowed and those who wish to remain ignorant have rights as well.

Soon, we will have the ability to identify Alzheimer's pathology with a PET scan which will enable earlier and more accurate diagnoses. In the not too distant future, we will likely have a spinal fluid test (followed by a blood test) that will accurately diagnose Alzheimer's disease at even early stages through more cost effective means. These are great steps forward and there is no moral or ethical downside to gaining these important clinical abilities.

Predicting Alzheimer's disease is a topic worthy of moral debate; identifying the disease is a categorically constructive step in the right direction.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Non-Clinical Benefits of Early Detection of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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In this short video from PBS, the National Alzheimer's Association's Medical Director, William Thies summarizes the non-clinical benefits of getting an early diagnosis of Alzheimer's disease.

He doesn't touch on the emerging evidence that treatment, even with currently approved medications, may also have greater benefits at an earlier stage of disease progression when the brain is still quite healthy. The extent of such treatment benefits is generally moderate but, for some patients, it can be quite meaningful.

William Thies, Ph.D., Chief Medical and Scientific Officer, Alzheimer’s Association

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Alzheimer's Researchers Need Volunteer Subjects

Contributed by: Dennis Fortier, President, Medical Care Corporation
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We all agree; rapid scientific advance in the field of Alzheimer's disease will be the only way to avoid a joint crisis of declining senior health and an underfunded public health system in the coming years.

One barrier to such rapid advance is completely within our control. It requires no brilliant insight or penetrating scientific discovery; it merely requires volunteers.

Enrolling research subjects into the many ongoing trials, and the many new trials expected to open in the coming years, is a timely process. In fact, the enrollment stage of a study can take years. This is a terrible waste of time in the race to save the generation that is now entering the high-risk years for Alzheimer's disease. We need to do better.

The National Alzheimer's Association has launched the Trial Match program to help interested volunteers find a study that might be right for them. I encourage you to share this with anyone you think might benefit from the information.

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What Next for PET Imaging and Alzheimer's Diagnosis?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Last week we noted here that Mayo Clinic had named certain bio-markers, specifically those agents that bind to amyloid plaques in the brain and become visible with a PET scan, as the most important medical innovation of the coming year.

Such bio-markers may help diagnose Alzheimer's disease with more certainty than current methods. However, many experts correctly point out that, down the road, cheaper and more practical tests based on blood or cerebral spinal fluid samples, might offer equal benefits in a more pragmatic approach. In fact, changing protein levels in the blood and spinal fluid are likely, according to current theories, to show changes prior to plaque formation in the brain and therefore, might offer even earlier diagnosis than PET scans.

Interestingly, Eli Lilly announced yesterday that they are acquiring Avid Radio Pharmaceuticals, the maker of the PET tracer agent that is likely to be the first to gain FDA approval in early 2011. Given an acquisition price of up to $800 million (depending on achievement of certain milestones), for a company with no sales, it is safe to say that big pharma is sold on the value of diagnosing Alzheimer's disease with PET imaging.

The benefits of using bio-markers and PET imaging to diagnose AD, to detect changes in the brain during research, and to evaluate the effect of drugs in clinical trial, are all positive steps in our collective battle to reign in this terrible disease. But I am looking forward to even bigger steps and better solutions that seem to be following closely behind this exciting advance.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Diagnosing Alzheimer's with PET Imaging

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Mayo Clinic has concluded its 2010 Medical Innovation Summit and released it's annual list of top Medical Innovations.

Coming in at number 1 on their Top 10 list is: New molecular imaging biomarker for early detection, prevention and treatment of Alzheimer's disease. Specifically, they are referring to AV-45, a radioactive agent developed by Avid Radiopharmaceuticals.

This science has been under development for quite some time and is expected to receive FDA approval in early 2011. The concept is to inject a tracer agent into the blood stream that will make it's way to the brain, bind with amyloid plaques, and light up in a PET scan. This will make the presence of amyloid in the brain more visible.

Since amyloid is a key pathological indicator (if not the cause) of Alzheimer's disease, gaining an understanding of amyloid load in the brain is useful in several regards. It can indicate the presence of AD pathology at an early stage, even before major cognitive deficits have emerged and could allow for earlier detection and timely intervention against this progressive disease process. It could be useful in measuring treatment effects which could accelerate clinical trials and bring better drugs to market more rapidly. And finally, it could potentially be used in identifying preventative agents that block or reverse the build-up of amyloid in the brain.

Similar technologies are also under development from GE and Bayer and will likely make important contributions in the global battle to thwart Alzheimer's disease in the coming decade.
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Alzheimer's and Fish Oil

Contributed by: Dennis Fortier, President, Medical Care Corporation
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If you stay attuned to news about Alzheimer's disease, you have likely seen the coverage of a study published this week in the Journal of the American Medical Association concluding that fish oil (or the omega-3 fat commonly known as DHA), has no benefit for Alzheimer's patients.

This was a well done study on more than 400 patients and the results were clear. However, as is often the case, readers of the press are advised to interpret specific scientific findings within their specific context, while being careful not to casually generalize the conclusions.

In this case, please keep in mind that the "no benefit" conclusion was drawn with regards to Alzheimer's patients. As we know, the current definition of Alzheimer's disease (although it is evolving) requires "dementia", which means that the subjects in this study had advanced pathology and significant brain damage with extensively impaired cognition. Given that degraded state of the brain, it's really not a surprise that fish oil supplements showed no improvement in cognition.

More importantly, this conclusion should not be generalized as meaning that previously well-established benefits of fish oil have been repudiated. The benefits shown in numerous epidemiological studies have shown that diets rich in omega-3 fatty acids reduce the risk of Alzheimer's disease.

In other words, once you have brain damage due to Alzheimer's disease, it is probably too late for fish oil to benefit your cognition. But earlier, while your brain is still healthy, omega-3 fats probably do have important benefits and likely reduce the risk of Alzheimer's down the road.
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5 Reasons Why Alzheimer's Awareness Matters More Than You Think

Contributed by: Dennis Fortier, President, Medical Care Corporation
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More so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat.

Summarized here are five reasons why greater awareness about Alzheimer’s disease, and a deeper public understanding of risks and prevention strategies, will play a key role in the nation’s ability to triumph against the prospect of a devastating AD epidemic.

1. Low Awareness drives higher medical costs

In this important but often overlooked regard, higher awareness and a better understanding of symptoms will benefit the vast majority of people who do not have Alzheimer’s disease (AD).

While AD is a worrisome topic, we have reached a point where the general level of education and awareness about the disease is high enough to induce worry, but not high enough to eliminate “unnecessary” worry. As a result, we are seeing a rise in expensive medical evaluations and increased costs of care driven by patients who are perfectly healthy.

In general, the public knows two things about AD. They know it is a debilitating disease with no cure, and they know that memory loss is a common symptom. That’s enough information to create a lot of angst in an aging population but a little more information would bring some needed relief.

For example, not every memory lapse is like every other, and many, if not most, are completely benign with no underlying medical cause. Furthermore, even those memory lapses that are related to a medical condition are often caused by some easily treatable problem.

INCREASE YOUR AWARENESS:
Here are a few things to know and to share with your social networks.

Memory loss can be caused by many common and treatable ailments including, but not limited to:
  • thyroid disorders
  • depression
  • vitamin deficiencies
  • medications (both prescription and over the counter)
  • anxiety
  • poorly controlled diabetes
Every instance of forgetfulness is not akin to a diagnosis of AD and not all memory lapses are equal:
  • Failing to store information for later recall when we are stressed or distracted is most likely a sign of overload than of a serious medical condition.
  • Taking longer to recall names as we age is a natural part of slower information processing in an older brain.
  • Forgetting where you parked at the mall is probably more like the rule than the exception.
Repeating a question or a story within a short time and not remembering the first instance is the kind of memory loss that should prompt a discussion with your physician.

2. Awareness facilitates timely medical intervention and better treatment outcomes


As discussed above, understanding the difference between worrisome signs and those that are less concerning can help the public make better decisions about if and when to speak with a physician. But there are other facets of increased awareness that will also facilitate earlier, proactive behavior that results in earlier medical intervention and better treatment results.

Specifically, knowing that treatment is more effective than is commonly reported in the press will drive more people to their physicians at early stage of symptoms before irreparable brain damage has occurred.

INCREASE YOUR AWARENESS: Here is an important perspective to keep in mind when you read about ongoing studies of treatment efficacy:

Many studies on drug efficacy have shown minimal treatment effect for the primary class of Alzheimer’s drugs (cholinesterase inhibitors) approved for sale in the USA. However, it should be understood that while the AVERAGE treatment effect is fairly moderate, some patients respond better than others. The average is comprised of a range of outcomes from better to worse and it is important to remember that no one knows in advance which patients will benefit more and which will benefit less.

More importantly, studies focused on isolating the effect of pharmaceutical therapy obscure the effect of a more robust treatment regimen that includes physical exercise, a healthy diet, proper control of hypertension and diabetes, avoidance of other medications that impair cognition and function, ongoing intellectual stimulation, and structured social engagement. Such a full regimen has demonstrated superior treatment effects than drug therapy alone in a meaningful number of patients. There is growing evidence that this is especially true when treatment begins early in the disease process.


While you should not be overly optimistic about currently approved treatments, you should not be overly discouraged by reports that drugs alone are not effective. In the real world, doctors prescribe drugs as one part of a more comprehensive treatment plan and, in some instances, AD progression can be meaningfully delayed.


3. Awareness erodes stigma and further enables timely medical intervention

Another major barrier to early intervention, aside from the nihilistic perceptions about treatment efficacy discussed above, is stigma. In fact, research shows that many people feel a sense of shame or embarrassment associated with a diagnosis of AD. This promotes denial and serves as an obstacle to early diagnosis and treatment.

However, research also shows that most stigmatizing topics can be brought into the open and can shed their embarrassing nature through education and discussion. Awareness campaigns generate discussion, which breeds familiarity and reduces stigma. In this regard, awareness is a direct path to openness, dialogue, information exchange, proactive management of symptoms, and professional medical intervention at the earliest possible stages.

INCREASE YOUR AWARENESS:
Consider these facts and then be sure your mind and your heart are both open to the plight of those facing Alzheimer’s disease.
  • More than 1 out of every 2 Americans now knows someone with Alzheimer’s disease.
  • The risk of getting Alzheimer’s disease is low until about age 65 then doubles every five years.
  • At age 85, the risk of AD is nearly 50%.

4. Awareness and management of risk factors can lower incidence of Alzheimer's disease

While it is true that AD remains poorly understood and difficult to treat, an enormous amount of research and new learning has been achieved in the last decade. We now recognize several risk factors that increase the likelihood of getting the disease and a few others that reduce the risk. The best news is that many of the risk factors are completely within our control and lend themselves to active management.

Gaining a clear understanding of how to reduce risks for AD can sometimes require careful discernment between sound science and commercial hype. In this regard, awareness and education are critical components of an effective strategy for maintaining cognitive health through risk factor management.

INCREASE YOUR AWARENESS:
Here is a brief summary of well-established risk factors that should be discussed with your physician to establish a risk management strategy:

Cardiovascular conditions increase the likelihood of Alzheimer’s disease and should be actively managed to mitigate the risk:
  • Obesity
  • High Cholesterol
  • Hypertension (High-blood pressure)
Diabetes, especially when poorly controlled, increases the risk for Alzheimer’s disease. If you are diabetic, work with your physician to keep it under optimal control.

Substance abuse and heavy smoking are correlated with higher risk for Alzheimer’s disease providing one more important reason to seek any help you need in breaking a reliance on tobacco, drugs and alcohol.

There are also some manageable factors that reduce your risk for Alzheimer’s disease including proper diet, physical activity, and ongoing social and intellectual engagement. Gaining these benefits is as easy as being aware and making good life style decisions.

5. Awareness accelerates scientific progress
One of the challenges preventing faster progress in understanding Alzheimer’s disease is the availability of subjects who volunteer for research studies. In this highly active field, there are studies seeking healthy adults who do not have Alzheimer’s, others that seek adults with various levels of memory loss, and still other studies enrolling subjects who have been diagnosed with the disease.

Participating in a study is a commitment to pursue a regular regimen of therapy and a closely monitored protocol of care. However, it is also a commitment by the investigating physician to provide a defined level of care, which is in many cases, a higher level of care than you might get from your usual physician.

Often times, a study provides an opportunity to be treated with experimental drugs that are otherwise unavailable. Because drug development is a low-probability endeavor, early stage agents are more likely to be ineffective than they are to have a significant health benefit. However, depending on a person’s current prognosis, the opportunity to try an experimental treatment might be appealing.

In any event, each study contributes to our overall knowledge and moves us one step closer to the solution we all seek. Volunteers who participate in these studies keep the wheels of scientific progress moving.

INCREASE YOUR AWARNEESS: Learn about ongoing trials and stay abreast of new studies as they are launched. After all, one out of every two of us knows someone who might be interested.

Resources for learning about FDA trials:
  • Alzheimer’s Association Trial Match
  • NIH Alzheimer’s Education and Referral Center (ADEAR)
It is easy to overlook “awareness” as an important part of the solution to the Alzheimer’s problem. This is especially true given the clear need for better treatment. However, a little reflection on the benefits of awareness, weighed against the relative ease with which we can spread information today, shows the massive benefits of greater awareness.

Awareness matters. Please do your part to increase awareness by sharing this article with your online social networks.

Presidential Proclamation on National Alzheimer's Awarness Month

Contributed by: Dennis Fortier, President, Medical Care Corporation
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You will likely see an increase in Alzheimer's coverage in the press this month as National Alzheimer's Awareness Month has begun.

Tomorrow, I will post my take on why I think Awareness is extremely important and, in fact, under-rated as an effective strategy toward real progress in the fight against this disease. In the meantime, I think this presidential proclamation from the White House makes a pretty compelling case about the need to pay attention to Alzheimer's disease.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Can we Thwart Alzheimer's in a Decade?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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In a well written opinion piece in the New York Times, former Supreme Court Justice Sandra Day O'Connor joined with Stanley Prusiner and Ken Dychtwald to summarize the magnitude of the Alzheimer's problem and the fiscal path toward solving it.

A few interesting facts that are well publicized individually but placed effectively together in the NYTimes piece:
  • 10,000 Americans will turn 65 every day for the next 19 years
  • for every penny that the NIH spends on Alzheimer's research, American society spends $3.50 caring for patients with the disease
  • the NIH spends about $3 billion on Aids research compared to only $469 million on Alzheimer's
There is a bill before congress requesting $2B in annual research funds for Alzheimer's and a dedicated official overseeing a national strategy to fight the disease. Given that the expert community generally agrees on which scientific problems must be tackled and solved in order to develop effective treatments for AD, this seems like a good cause to me.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Federal Funding for Alzheimer's Research

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The National Institutes of Health has announced that they will fund a second phase of the Alzheimer's Disease Neuroimaging Initiative (ADNI). This initiative is a major partnership involving both public and private funding sources, more than 50 research locations, and a target of nearly 1500 research subjects.

The first phase was funded in 2004 and is now following approximately 800 subjects in various states of cognitive health (200 normal controls, 400 with mild cognitive impairment, and 200 with mild Alzheimer's disease). The intention is to thoroughly evaluate cognitive health, track various bio-markers, and study the progression from normal health to Alzheimer's in those subjects who get he disease. Researchers are also closely studying those subjects who do not get the disease as they may offer important clues about preventative strategies.

The second phase of this initiative, ADNI2, has a $40 million commitment from the NIH to be distributed over the next 5 years. This sum will be augmented with an anticipated $25 million in additional funds provided by various private sector sources.

One of the unique aspects of ADNI is the public availability of the research data being collected. To date, more than 1700 researchers have accessed the database and analyzed findings. This massive sharing of resources has been touted as an important catalyst in scientific progress for the field in recent years.

One of the challenges for the ADNI team is to recruit healthy volunteers who wish to participate as research subjects. The potential benefits to volunteers, in terms of state of the art monitoring and care for any emerging problems, are fantastic. For interested readers, more information is available from the NIA Alzheimer's Disease Education and Referral (ADEAR) Center at 1-800-438-4380 or www.nia.nih.gov/Alzheimers.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Smoking Increases Risk of Alzheimer's Disease and Vacular Dementia


Contributed by: Dennis Fortier, President, Medical Care Corporation
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Many of smoking's detrimental effects on long-term health have been well know for decades. Research has clearly shown that smoking can lead to lung cancer, emphysema, and heart disease. Now, based on research published this week in the Archives of Internal Medicine, we know that smoking can also dramatically increase risk for Alzheimer's disease and for vascular dementia.

In a study of more than 21 thousand subjects who were followed for an average of 23 years, Kaiser Permanente tracked smoking habits and incidence of dementia. The findings were clear:

Compared with non-smokers, those who smoked more than two packs of cigarettes a day in midlife had a "dramatic increase" in the incidence of dementia -- more than a 157 percent increased risk of developing Alzheimer's disease and a 172 percent increased risk of developing vascular dementia, Whitmer's team found.
- Lead Researcher, Rachel A. Whitmer

It should be noted that these heightened risks were demonstrated in middle-aged subjects (50-60 years old) who smoked more than 2 packs per day. Because data were not available across the full age spectrum, we cannot say with certainty if the same risks apply (or do not apply) to older or younger subjects. Those who smoke less than two packs per day did not have the same heightened risks.

While we have long known about the many risks that smoking poses to our physical health, the evidence that it could also impair our cognitive health has been historically, less substantial. This well designed study on a large sample population and a long follow-up period draws a highly valid and important conclusion.

It's another good reason to quit. More importantly, it's another good reason not to start.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Early Detection of Alzheimer's is Best

Contributed by: Dennis Fortier, President, Medical Care Corporation
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This article from Voice of America bears an important headline: Early Diagnosis of Alzheimer's Better for Patients and Caregivers. That's a message we promote vigorously in this blog.

The article itself is not based on any particular new findings or recently published research. It is merely a summary of aggregated conclusions and an important reminder that we often intervene late. When we do so, we lose an opportunity to treat AD at an early stage when minimal brain damage has occurred. This then leads to therapeutic nihilism and the ongoing, but incorrect belief, that attempting to treat Alzheimer's disease is futile.

I highlight this today as a reminder about the importance of early detection.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Alzheimer's Risks, Signs, and Prevention

Contributed by: Dennis Fortier, President, Medical Care Corporation
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On most days, I use this space to wrap perspective around "news" about brain health that is open to misinterpretation. Today, my job is easier.

This summary, written by Dr. Glenn D. Braunstein and published by The Huffington Post, is excellent. It articulates the facts about Alzheimer's risks, signs, and prevention in an informed and unbiased way. Please click through and read it.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Can Vitamin B Reduce Risk for AD?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A short time ago, we reviewed the promising evidence that Vitamin B levels are negatively correlated with brain atrophy. That is, higher levels of Vitamin B were correlated to less brain shrinkage. This spawned hope that these vitamins might be somehow preventative of diseases that result in brain atrophy.

Today, there is more news about B Vitamins and brain health.

The Karolinska Institute in Stockholm, has published in Neurology, a study showing that elevated levels of homocysteine, an amino acid related to Vitamin B12, seemed to increase risk for developing Alzheimer's disease. However, high levels of the biologically active portion of Vitamin B12 (holoTC) was correlated with reduced risk. The results make sweeping conclusions difficult to draw.

At this point, the strongest conclusions that should be drawn from these studies of Vitamin B are that, (1) Vitamin B seems to pay some important role in brain biology, an (2) no one really knows for sure what that role is.

I have already seen several headlines suggesting that Vitamin B prevents Alzheimer's. That might someday prove to be the case, but it is far too early and too many questions remain for anyone to defend such a position.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

More Than 1 of Every 2 Americans Knows Someone with Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A recent poll by Abt SRBT, a social policy research and consulting firm, showed that 55% of Americans know either a friend or family member with Alzheimer's disease. This is consistent with other reports showing that 1 out of every 2 families has been directly touched by this progressive neurological disorder.

While this is an alarming figure, the high prevalence of exposure is driving rapid increases in awareness and education which are, in turn, reducing the stigma historically associated with dementia. This is a painful but important process that will help us prepare to face this disease head on, to increase vigilance toward early signs of memory loss, and to actively voice concerns to our physicians when subtle symptoms emerge.

While it is a shame that Alzheimer's disease is now touching such a high percentage of American lives, its rising impact is driving visible increases in awareness, understanding, and new research in the field.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Is Retirement Bad for Your Memory?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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We've all heard the "use it or lose it" mantra. It was originally intended as a descriptor for maintaining physical fitness and, in recent ears, has crossed over to the realm of mental fitness.

Research from the University of Michigan shows a correlation between memory capacity in older adults and the age at which they retired. Specifically, it showed that adults from countries where retirement happens at earlier ages, did not perform as well on memory tests as adults from countries where work is more prolonged.

That seems like a fairly indirect path to a conclusion that may have been tighter had the researchers merely collected "age of retirement" from each subject, rather than using the average retirement age of the country from which each subject hailed. However, there is something to be said for the latter approach. Perhaps cultural norms extend across similarly aged people and keep them similarly engaged in intellectual activities, with employment being only one of those activities.

Regardless of the design of this particular study, there is ample research suggesting that keeping your brain engaged seems to preserve mental function. I recently commented on it with this post that links to an excellent summary of the evidence.

Retirement sounds inviting, but disengaging from all intellectual rigor is probably not be a beneficial path to pursue.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

A Daily Walk is Surprisingly Good for Your Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation
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We often cite research that correlates physical fitness with brain health. Surveys have shown, however, that many read the phrase "physical fitness" and conjure images of gym memberships and grueling workouts. Such a perspective may be a deterrent for those who assume that minimally intense workouts yield no benefits.

This post aims to dispel the notion that only an intense physical exercise is helpful.

Research published online yesterday in Neurology shows that a brief regular walk may meaningfully reduce the likelihood Alzheimer's disease. Specifically, the research showed a significant correlation between walking regularly and maintaining the volume of gray matter in the brain throughout later adulthood. More importntnly, walking regularly was negatively correlated with incidence of cognitive impairment.

This evidence is very consistent with other studies that have shown a daily walk of a mile or so can be part of a fantastic regimen for long-term health. In this regard, the Alzheimer's Association's tradition of holding "memory walks" to raise awareness about the disease is especially apropos.

Walk forth and be well.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Can You Prevent Alzheimer's Disease?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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While we have no sure fire approach to preventing Alzheimer's disease today, each of us can meaningfully lower our own risk of suffering from Alzheimer's down the road.

Some important risk factors, like age and genetics, are beyond our control. Others, such as our physical fitness, our diet, our cardio-vascular health, our management of other medical conditions, and the degree to which we stay intellectually and socially engaged, are all directly affected by our life style choices.

A great summary of preventative advice was published this week as an opinion piece at CNN. While such articles are commonly propagated online by merchants selling unvalidated supplements or brain-exercise programs, this one stays within a message that is well supported by scientific evidence.

Other good online sources of Alzheimer's prevention information are the non-commercial websites PreventAD.com and OCVitalAging.org.
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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Revised Definition of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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With a publication slated for the November issue of Lancet Neurology, the International Working Group for New Research for the Diagnosis of AD has updated their position paper from 2007. In the new publication, they suggest that AD should be defined as impaired episodic memory plus one bio-marker (either MRI, PET, or spinal fluid) indicating known disease pathology.

Importantly, the presence of dementia would no longer be required as part of the new definition of Alzheimer's disease. This will allow physicians to diagnose the disease and intervene with therapy at an earlier stage of symptoms.

As we have discussed here often, the current practice of late diagnosis, which is driven in many ways by the old definition requiring dementia, is a major obstacle to effective treatment.

This recommendation is in line with similar proposals from US expert panels and bodes well for future advances in this field.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.