A Milkshake for Alzheimer's?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The story of a milkshake that could aid metabolism and improve cognition for Alzheimer's patients has gotten a fair amount of press, including this piece in the Wall Street Journal.  Here are a few facts to consider:

• The product is called Axona and is marketed as a "medical food", a category that does not require FDA approval.
• In the key clinical study, patients taking Axona had slightly improved cognition after 45 days, but not after 90 days.
• The group that showed the most improvement was the group with no known genetic disposition to Alzheimer's disease.
• The "experts" have fulfilled their duties as consumer advocates and pointed out all of the reasons why the limited data is not scientifically conclusive.

While I agree that there is limited data, and that patients should be cautious when interpreting the manufacturer's claims about efficacy, I think we also need to be careful not to bury novel hypotheses before they are proven incorrect.  Remember, lack of proof that something works is not the same as proof that it does not work.  In this case, the jury is still out.

The bottom line on this is that it probably has little or no beneficial effect.  However, any resourceful person with Alzheimer's disease, who is looking for every possible means of maintaining their cognitive health, might want to check it out.  There doesn't appear to be any major health-related downside and, given how little we understand about Alzheimer's disease, it might be worth the effort for some.

Diagnosing Alzheimer's: Bio-Markers vs. Cognitive Tests

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Journalists keep surprising me.

They, of all people, should be accustomed to choosing their words carefully.  However, in today's LA Times, a journalist reviewed a study comparing bio-markers and cognitive tests for their relative merits in diagnosing Alzheimer's disease, and probably misled a lot of readers with a poor word choice in the headline (below).

LA Times: Alzheimer's tests using pen and paper still the best

If a study compares two of the many possible approaches to a problem, and one approach is deemed superior to the other, then it is "better".  But it is not necessarily the "best".

In the body of the article, the words "old-fashioned tests using pen and paper" were probably chosen with much more care.  I say this because the field of cognitive assessment has made great progress in recent years using sophisticated math and computers to score test performances, and to compare performances across large databases of carefully studied patients. This has been a great imrprovement over the pen and paper approach.  But even the newer, hi-tech assessments are not the "best" approach.

The "best" approach in the practical sense, is to use all of the available diagnostic information that can be collected in a cost-effective manner.  In the process of an evaluation, routine bio-markers can rule-in or rule-out some routine causes of cognitive dysfunction and help physicians arrive at a correct diagnosis.  As for Alzheimer's disease (AD), a bio-marker that suggests AD combined with a cogntive test (be it an old-fashioned test or a more modern test), is currently the "best" approach.

I admit that the difference between the choice of "better" and "best" is subtle, and probably completely innocent.  But by choosing "best", the author framed the problem into a misleadingly small, either-or scenario, and may have given physicians and patients another reason to delay their own educational process about how to best manage emerging cognitive problems. That is sloppy journalism and it is counter-productive to the challenge we all face from the growing threat of Alzheimer's disease.

The Power of Art Therapy

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does art therapy improve the health of people with cognitive disorders?  The literature on this topic is slim but growing, and there is lots of evidence that art therapy enriches lives. 

This video (below) was produce by the Cognitive Dynamics Foundation, an organization with the goal of improving the quality of life for those who are cognitively impaired, and their caregivers, through expressive arts therapies.  The video tells the story of Lester Potts, an Alabama sawmiller who first took to painting after being diagnosed with Alzheimer's disease in his 70's.  To the surprise and delight of his family, Lester expressed himself poignantly through his art, even though he had lost much of his verbal communication.

Admittedly, this story is not scientifically conclusive.  We know that every patient is unique and that some respond to certain therapies and others do not.  However, in an age when so much therapy is focused on biology, it is great to be reminded about the complexity of the human condition.  This is a strong dose of anecdotal evidence that sometimes, what is good for the spirit, might be what is most helpful for the body and the brain.  It is a touching testament to the possible power of art therapy.