Lewy Body Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

While this blog strives to clarify the daily news about brain health, sometimes it serves best by simply "emphasizing" the news about brain health. A very well reported article about Lewy Body Dementia, published in the The New Old Age blog of the NYTimes, is worthy of such emphasis today.

Like Alzheimer's disease, Lewy Body disease is a debilitating brain disorder that impairs cognition and leads to dementia. However, because the symptoms are similar, it is often mis-diagnosed as Alzheimer's disease, and subsequently mis-treated.

A key difference between the two diseases is in their most typical initial symptoms: short term memory disruptions are most typical in Alzheimer's disease, whereas executive function (completing complex tasks) and visual/spatial abilities are most commonly the first impairments noted in Lewy Body disease.

Along with low awareness of Lewy Body disease, symptomatic similarities to Alzheimer's disease are two drivers of mis-diagnosis. Making matters worse, other common symptoms, such as rigidity and altered gait, sometimes lead to mis-diagnoses as Parkinson's disease.

Hopefully, with growing awareness and the formation of organizations like the Lewy Body Dementia Association, clinical efforts to correctly diagnose and treat this disease will continue to gain efficacy.

Deep Brain Stimulation for Parkinson's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

A great overview article on deep brain stimulation (DBS) for the treatment of symptoms caused by Parkinson's disease was posted today at WebMD.

DBS is accomplished by implanting electrodes directly into the brain and a transmitting device below the collarbone.  The transmitter stimulates regular electrical impulses from the electrodes, which effectively "turn off" parts of the brain where many Parkinson's symptoms originate.  Among those symptoms most commonly improved by DBS are tremors, slow movement, rigidity, and problems with walking and balance.

This is an FDA approved procedure but is commonly reviewed with caution because scientists cannot convincingly explain how or why it works.  However, the data collected in carefully designed trials on real patients is very clear and very positive.

There are many considerations in the decision to undergo DBS as part of a treatment regimen.  After all, it requires surgery that includes incisions through the skull and into the chest, so it is not a minor procedure.  However, compared to alternative approaches that intentionally destroy brain tissue, this might be considered a less invasive approach.

The cited WebMD article is fairly comprehensive and touches on a wider summary of advantages and disadvantages.  I encourage you to click through and read more about it.

Lewy Body Dementia Awareness

Contributed by: Dennis Fortier, President, Medical Care Corporation

As per this press release from the NYU Langone Medical Center, October is Lewy Body Dementia (LBD) Awareness Month.

Like Alzheimer's disease and Parkinson's disease, LBD is characterized by impaired thinking and behavioral disruptions.  Because of these similarities, it is often misdiagnosed and improperly treated.

Three out of 4 LBD patients are initially misdiagnosed and the majority of patients see more than 3 doctors for more than 10 visits over 18 months before a diagnosis is established.

The obvious solution to the problem of delayed diagnosis is education, for both the public and for their doctors.

Here are a few facts about LBD to start you on the process of building higher education and awareness:

• LBD core symptoms include: memory and thinking problems, movement problems, hallucinations, sleep disturbances and fluctuations in attention and concentration
• LBD patients have more prominent problems with visual-spatial skills (such as depth perception, bumping into objects, not seeing things in front of them)
• LBD patients experience a more rapid functional decline than Alzheimer’s disease patients with shorter intervals to nursing home placement and death
• LBD patients have personality changes such as loss of interest, become more passive, quiet or withdrawn, and have trouble paying attention
• The combination of cognitive, motor and behavioral symptoms place severe burden and stress on caregivers who often find themselves socially isolated
• LBD patients are more likely to suffer from depression

Can B-12 Vitamins Prevent Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Can B-12 vitamines prevent memory loss?  As with so many questions, the answer to this one is "it depends".

Remember, there are many causes of memory loss, including depression, anxiety, diabetes, medications, thyroid disorders, head injuries, strokes, Alzheimer's disease, Parkinson's disease, tumors, sleep disorders, and drug use, just to name the most common. Vitamin deficiency is also on the list of common causes, especially for older adults who become less proficient at absorbing B vitamins from the foods they eat.

According to a recent study conducted at Rush University Medical Center and published in Neurology, research subjects who had markers for vitamin B deficiency, such as brain shrinkage and high homocysteine levels, also performed worse on cognitive tests compared to subjects without vitamin B deficiency.  These findings are consistent with other studies linking vitamin B deficiency to poor cognition.

So, it would be a stretch to conclude that taking a B-12 supplement will protect a person from all causes of memory loss or cognitive decline.  However, the evidence suggesting that proper intake of B-12 is important to ongoing brain health is quite strong.  In that regard, think about including fish, meat, poultry, eggs, milk, and cheese in your diet as good sources of B vitamins.

Berries May Lower Risk of Parkinson's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Eating berries and other foods that contain the pigment flavone (known as flavonoids), has been shown to have many health benefits.  Now, according to research set for presentation at the annual meeting of the American Academy of Neurology in April, eating such foods may also lower one's risk of Parkinson's disease.

In an extensive study of more than 100,000 subjects followed for more than 20 years, researchers tracked dietary habits of the research participants and carefully monitored intake of flavonoids.  In the final analysis, male participants with the highest intake of flavonoids, had a 40% lower incidence of Parkinson's disease than those with the lowest intake of flavonoids.

Importantly, this apparent risk reducing effect did not translate to women.  However, a subclass of flavonids (anthocyanins), showed risk reducing benefits for both men and women.

This was a major study involving a huge sample and a long period of follow up.  Nonetheless, as per the scientific process, final conclusions will be withheld until additional studies duplicate the findings, and a solid explanation is put forth as to why flavonoids accrue such benefits.

In any event, this is an impressive study with an optimistic result. It is especially welcome news given that there are no known downsides to adopting a flovonoid-rich diet of fruits and berries.

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Blood Test for Diagnosing Alzheimer's: A Major Leap Forward?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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With so many of the news stories I summarize here, I include caveats about the long and arduous path that basic science must travel before a clinically beneficial advance becomes available to the public. The same caveat applies to the heavy coverage of a new, blood-based diagnostic test recently developed by the Scripps Research Institute and published in the January 7 issue of Cell.

Having said that, this scientific approach strikes me as one worthy of the frothy press it has already spawned.

The approach is exciting in its novelty. Rather than identifying the specific antigens that cause an immune response (production of antibodies) at early stages of a particular disease, and then screening the blood for the presence of those antibodies, the Scripps researchers took another path. They skipped the step at which conventional science is currently focused. That is, they did not bother with the daunting challenge of identifying which specific antigens might stimulate an immune response to fight in early stage Alzheimer's disease.

Rather, in their study, they loaded the blood with thousands of synthetic molecules designed to bind to antibodies of all sorts. By then analyzing the results from patients with Alzheimer's compared to those with Parkinson's and those deemed "healthy", they detected clear evidence that Alzheimer's patients had a much higher concentration of two particular antibodies in their blood. The conclusion, which must be validated with more data, is that these two antibodies are bio-markers for early-stage Alzheimer's disease.

This may prove to be extremely valuable in detecting early stage disease presence, but may pay other dividends as well. If these antibodies do indeed indicate a response to Alzheimer's pathology, then this study may also shed important, new light on the actual disease process which, in turn, could accelerate research on new treatments

Obviously, there is much science to conduct before the world can benefit from this research. But the prospect of leap-frogging one nagging problem in the process, the identification of specific antigens that indicate Alzheimer's, is an exciting proposition.

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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.

Physical Exercise is Great for Your Brain

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The evidence has been accumulating for years, from a variety of sources, on multiple aspects of cognition and brain health, that physical exercise is great for your brain. While the specific mechanisms driving the health benefits are not well understood, the relationship is clear.

An excellent summary of the evidence was published today the blog BrainandSpinalCord.org. Among the facts are several indications that physical exercise may be a boon to recovery and healing of injuries. Additionally there is evidence that it can be neuro-protective and play a role in certain debilitating neurologic disorders such as Parkinson's disease and Alzheimer's disease.

It can't be said enough; staying active is a good thing.

What Causes Dementia?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Because the general media commonly interchanges the terms "Alzheimer's" and "dementia", there is much confusion about the definition of each and the difference between the two. As such, I like to offer a clarifying viewpoint on a regular basis.

Alzheimer's is a disease. We don't completely understand it but the development of amyloid plaques and neurofibrillary tangles in the brain seem to play a role.

Dementia is a descriptive term for the symptoms caused by disorders that impair cognition. Specifically, if memory and at least one other realm of cognition (judgment, executive function, verbal fluency, etc.) decline to the point where they interfere with daily life, then the condition is dementia.

A key point is that there are many causes of dementia; Alzheimer's is merely one of them. Vascuclar disease, Parkinson's disease, and Normal Pressure Hydrocephalus and others are also on the list. The conditions and disorders that cause memory loss are worth learning about.

The distinction between memory loss and dementia, and the causes of each are well developed in a recent article on examiner.com by Patricia Grace. This perspective and other good views are presented regularly at the blog: AgingwithGrace.net.

New Treatment Guidelines for ALS

Contributed by: Dennis Fortier, President, Medical Care Corporation
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In the October 13 issue of Neurology, the American Academy of Neurology has published new treatment guidelines for amyotrophic lateral sclerosis (ALS), often called Lou Gehrig's disease.

The guidelines are designed to help physicians optimize the quality of life for their ALS patients. While many with ALS with succumb to the disease within 3 to 5 years, others live as long as ten years after diagnosis. For these patients in particular, much can be done to ensure overal health and comfort throughout the disease course.

A more complete summary and link to the full publication can be viewed here but the basic guidelines are as follows:

• prescribe Riluzole, the only FDA approved drug for ALS
• use an assisted-breathing device
• use a feeding (PEG) tube
• offer botulinum toxin B to treat drooling if oral medications do not help
• consider screening for behavioral/cognition problems because such problems might affect patients’ willingness to accept suggested treatments
• enroll early in a specialized multidisciplinary ALS clinic to optimize care

As with other neurological disorders such as Parkinson's and Alzheimer's disease, there is no cure for ALS. However, as we see across all of these diseases, we have increased our ability to manage symptoms, prolong survival, and maintain a high quality of life. One key to such success is ongoing dissemination of guidelines outlining the highest standards of care.

The Costs of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
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With the intensity of current discussions on Healthcare reform, I am re-posting this earlier comment (from March 23) on the costs of AD and Dementia. The figures may surprise you.

March 23, 2009 - This week has seen extensive media coverage of a report from the National Alzheimer's Association stating that the annual costs of care for an Alzheimer's patient are triple the cost of an elderly person without Alzheimer's Disease. These figures are very consistent with a bevy of other studies indicating a similar cost differential but can viewed with more clarity from another perspective.

First, it is useful to compare the demented elderly vs. the non-demented elderly as opposed to Alzheimer's patients vs. non-Alzheimer's patients. This adds clarity because the driver of the cost increase is the presence of dementia, regardless of its cause (Alzheimer's is the cause of about 65%, vascular disease 20%, Parkinsons/Lewy Body and all others 15%).

Second, since these diseases cross all socio-economic strata, some of the afflicted pay for their own institutional care while others rely on public support programs. As such, aggregating figures that include the costs of institutionalization muddies the view.

Here are the figures comparing the costs of medical services (physician appointments, hospital stays, procedures, and medications) for demented vs. non-demented people aged 65-74:

Average Annual Cost of Non-Demented: $3,851
Average Annual Cost of Demented: $15,998

The demented are more costly by a factor of 4.2. However, it is very rare for an elder, demented person to be completely free of other chronic conditions. Chronic conditions require management via thorough and consistent self-care which is often difficult when coupled with dementia. As such, it is the combination of dementia and other chronic diseases that drives costs most impressively.

Consider these figures showing prevalence of four common chronic medical problems in the aged 65-74 population:

29% Coronary Heart Disease (CHD)
28% Congestive Heart Failure (CHF)
23% Diabetes
17% Chronic Obstructive Pulmonary Disease (COPD)

Now look at the costs associated with these medical problems when combined with dementia compared to the costs associated with those problems in cognitively vital elders:

Dementia +CHD - $27,237 ($10,894 no dementia)
Dementia + CHF - $34,304 ($17,993 no dementia)
Dementia + Diabetes - $24,392 ($7,469 no dementia)
Dementia + COPD - $28,463 ($12,059 no dementia)

It is clear that dementia drives higher utilization of medical services, especially when combined with other common medical problems. Of course, figures associated with the cost of institutionalized care (and informal care giving) make the picture all the more bleak but this view is perhaps the most clear.

Alzheimer's Disease and Stem Cells

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The scientific process can be long and slow. In fact, the very nature of science is to be deliberate, comprehensive, and redundant as a means of objectively elevating hypotheses into facts.

You may have seen headlines this week about a potentially important discovery from the Garvan Institute of Medical Research in Sydney, Australia. The researcher's (Bryce Vissel and Andrea Abdipranoto) findings published in the journal Stem Cells suggest that excessive inflammation can prevent the brain from repairing itself properly. They also have hypothesized that a certain brain chemical, activin A, can suppress inflammation and allow the brain's stem cells to stimulate repair.

This is early stage research performed in mice and, as noted, the scientific process is generally long and arduous. But this is a new finding that may shed some important light on the disease process in Alzheimer's and Parkinson's. I suspect we will be hearing more about this.

The costs of Alzheimer's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

This week has seen extensive media coverage of a report from the National Alzheimer's Association stating that the annual costs of care for an Alzheimer's patient are triple the cost of an elderly person without Alzheimer's Disease. These figures are very consistent with a bevy of other studies indicating a similar cost differential but can viewed with more clarity from another perspective.

First, it is useful to compare the demented elderly vs. the non-demented elderly as opposed to Alzheimer's patients vs. non-Alzheimer's patients. This adds clarity because the driver of the cost increase is the presence of dementia, regardless of its cause (Alzheimer's is the cause of about 65%, vascular disease 20%, Parkinsons/Lewy Body and all others 15%).

Second, since these diseases cross all socio-economic strata, some of the afflicted pay for their own institutional care while others rely on public support programs. As such, aggregating figures that include the costs of institutionalization muddies the view.

Here are the figures comparing the costs of medical services (physician appointments, hospital stays, procedures, and medications) for demented vs. non-demented people aged 65-74:

Average Annual Cost of Non-Demented: $3,851
Average Annual Cost of Demented: $15,998

The demented are more costly by a factor of 4.2. However, it is very rare for an elder, demented person to be completely free of other chronic conditions. Chronic conditions require management via thorough and consistent self-care which is often difficult when coupled with dementia. As such, it is the combination of dementia and other chronic diseases that drives costs most impressively.

Consider these figures showing prevalence of four common chronic medical problems in the aged 65-74 population:

29% Coronary Heart Disease (CHD)
28% Congestive Heart Failure (CHF)
23% Diabetes
17% Chronic Obstructive Pulmonary Disease (COPD)

Now look at the costs associated with these medical problems when combined with dementia compared to the costs associated with those problems in cognitively vital elders:

Dementia +CHD - $27,237 ($10,894 no dementia)
Dementia + CHF - $34,304 ($17,993 no dementia)
Dementia + Diabetes - $24,392 ($7,469 no dementia)
Dementia + COPD - $28,463 ($12,059 no dementia)

It is clear that dementia drives higher utilization of medical services, especially when combined with other common medical problems. Of course, figures associated with the cost of institutionalized care (and informal care giving) make the picture all the more bleak but this view is perhaps the most clear.

Mild Cognitive Impairment 101

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Mild Cognitive Impairment (MCI) is now widely but inconsistently used to describe a broad range of cognitive states. While there may not yet be a universally accepted definition, there is adequate consensus that MCI describes the space on the cognitive continuum between "Normal" and "Demented". Recall from an earlier post (Dementia 101) that a person does not meet the clinical definition of dementia until their impairment is severe enough to interfere with their social or occupational function. From this definition, the need arose to describe the situation when a person is beginning to lose function but the deficits are still subtle and not yet severe enough to meet the criteria for "dementia". To address that need, researchers at the Mayo Clinic constructed the term Mild Cognitive Impairment which has been quickly, if not uniformly, adopted in the scientific community.

As with dementia, Mild Cognitive Impairment is not a diagnosis and not something that must be treated. It is merely a symptom of some underlying medical condition such as depression, Parkinson's Disease, Vitamin B-12 deficiency, early stage Alzheimer's Disease, etc.

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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.