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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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.

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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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.

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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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.