Alzheimer's / Dementia

The clock-drawing test has been around for many years and is sometimes used independently to quickly screen people for signs and symptoms of Alzheimer's and other dementia. It's also been integrated as a part of other screening tests such as the Mini-Cog. Some family members have even used it in their homes to unofficially screen a loved one if memory problems or behavior changes have become a concern.

Here's a couple of things I've found recent research on, as they relate to the clock-drawing test.

• The MMSE is often used as a standard test to screen for dementia, but did you know that the clock-drawing test can identify a significant deficit in executive functioning that the MMSE might miss?

• There are more than 15 different scoring methods. If you've administered the clock-drawing test before, which one do you use? Recent research suggests a simple scoring method is just as accurate as a complex one.

Read more here about the how the clock-drawing test is conducted, further research about different scoring methods, and why it's useful as a screening tool for dementia.

A drug approved for treatment of skin cancer has been shown to rapidly reverse signs and symptoms of Alzheimer's disease in mice.

Researchers at Case Western Reserve University School of Medicine demonstrated that bexarotene (brand name Targretin) decreased the presence of amyloid beta, the protein that becomes out of control and forms plaque in the brain as Alzheimer's progresses. Bexarotene is approximately 10 years old and is an FDA approved drug for cutaneous T-cell lymphoma.

Levels of amyloid beta protein present in the brain responded quickly to the drug, decreasing notably within 24 hours, and by 75% after two weeks.

Even more importantly, the mice displayed a reversal of the cognitive problems they had exhibited, such as memory problems and impaired social behavior.

The spatial memory of mice was tested by observing their navigation through a maze. Their ability to construct a nest, which requires cognition but also social interaction, improved dramatically. Researchers also noted that the mice's memory for smells improved with the treatment. (As humans, our ability to detect or distinguish between odors often deteriorates as Alzheimer's progresses.) All areas showed notable improvement after just nine days of treatment with bexarotene.

Finally, the study demonstrated effectiveness in both early and later stages of Alzheimer's in the mice. This is important because most medications currently approved to treat Alzheimer's are helpful only in the early stages of the disease.

This drug is clearly effective in mice. What remains to be seen, but is surely hoped for, is its affect on people. Since the medication is already approved by the FDA, it is anticipated that clinical trials in humans will be able to occur relatively soon.

This study was published in the online journal Science.

Locally, the news reported a story about a man who is 82 years old, has a diagnosis of dementia, and went missing on Monday. He lives at an adult foster care home and was last seen leaving the facility with a visitor. For the past two days, it has not been known where he was, if he was receiving the medications he requires for his other medical concerns, or if his life was in danger.

The good news? He was found safe today near Chicago and has been receiving care there. I don't know the rest of the story, but I do know it's great to hear that he's been located and is safe.

This story serves as a reminder about a couple of things:

• If you are taking a friend or family member out of a facility or away from his home, remember to communicate these plans with those responsible for caring for him. Many facilities have a sign-out sheet to document if a resident is on a leave of absence.

• Additionally, about 60% of people with dementia will wander at some time as their disease progresses. If your loved one has Alzheimer's or another kind of dementia, she is at risk.

Although this latest incident with the missing man was not due to wandering away, many cases are. So, here are some helpful tips on that note:

• Practical and Effective Tips to Prevent Wandering
• How to Respond to Attempts to Wander (Also thought of as: "Help! My dad is trying to leave.")
• How to Search for a Missing Loved One with Dementia

If you have any other tips or strategies, feel free to share them here.

A recent article in Neurology reported that a revised definition of mild cognitive impairment has been developed by a work group from the Alzheimer's Association and National Institutes of Aging. The previous distinction between mild cognitive impairment (MCI) and early stages of Alzheimer's disease relied on this difference: in MCI, the person's cognitive deficits, like memory, for example, did not interfere with activities of daily living (which includes skills such as dressing, bathing, eating meals).

Historically, MCI has been thought of as the dysfunction that may occur between normal cognition and the development of a dementia such as Alzheimer's. With this new definition, the line between Alzheimer's and MCI is blurred since both can now exhibit cognitive problems and daily functioning challenges.

One reason the group is making this change is because they found that even though a diagnosis of MCI required a person to exhibit normal functioning in daily life, research demonstrated that many people with MCI were experiencing impairments in their activities of daily living.

The take-away? Some people already diagnosed as having Alzheimer's or another dementia in the early stages may now fit the criteria for MCI instead. While this change gives the clinician more authority to use his or her judgment in diagnosing, it also reduces uniform definitions of both MCI and Alzheimer's since the previous boundary of impairment in daily living skills - that key distinction - has been removed.

We took a big step today in the fight against Alzheimer's. The Obama administration announced that they are making $50 million available this year for Alzheimer's research, and an additional $80 million for next year. This research, among other things, will include work on targeting specific genes that increase the risk of Alzheimer's as well as work on developing and testing drugs through increased clinical trials.

The government also promised $26 million in caregiver support, healthcare training and public awareness.

One criticism previously levied against the draft of the National Alzheimer's Plan was that funding was not indicated or promised anywhere. The step taken today is a small victory and one step forward in our goal of effectively treating and preventing Alzheimer's and other related dementias.

When we consider early onset Alzheimer's disease (where symptoms appear before the age of 60) and late onset, there is a tendency to categorize early onset as familial, meaning that it has a strong hereditary component, and late onset as sporadic, meaning that it is much more random.

However, based on what researchers are learning, we may need to rethink this. A recent study discovered similar gene mutations in cases of both early and late onset Alzheimer's disease. This indicates that there may be a higher amount of heredity in late onset Alzheimer's disease than we have traditionally thought. These researchers also point to evidence that people with Alzheimer's often have multiple relatives who have Alzheimer's, other kinds of dementia, or a neurological disorder such as Parkinson's.

Additionally, the study, published in PLoS One, found evidence that some people who were diagnosed with Alzheimer's actually had gene mutations more consistent with frontotemporal dementia (FTD). FTD is an umbrella term that encompasses several disorders including behavioral variant FTD, primary progressive aphasia, progressive supranuclear palsy and corticobasal degeneration. These disorders affect people's behavior, mobility, and communication. Often it's not until the later stages of FTD that memory is impaired.

As we learn more about how to treat these disorders, being able to distinguish between them will become increasingly important.

What if we knew how Alzheimer's progressed in the brain, and could put up a roadblock to stop it? The latest research presented in the online journal PLoS ONE outlines a study that suggests that this may become possible.

In this study, researchers engineered mice to have a human gene that developed abnormal tau protein in the brain's temporal lobe. This lobe is where it seems that the tau protein first accumulates, based on the early symptoms of Alzheimer's. They then observed the brains as the mice aged and found that the tau spread through the brain from one area to the next, traveling like a virus. It appears that the tau jumps across the synapses in the brain, which help neurons communicate with each other.

This research is important because it has potential implications for early treatment of the disease. If we're able to physically stop the spread of the tau through the brain, eventually we may be able to stop the progression of Alzheimer's disease.

Now, that would be even more exciting than the upcoming Super Bowl...

Estimates range that anywhere from 2 to 10 million older Americans are abused every year. That includes the different kinds of elder abuse such as neglect, financial, physical, sexual, emotional, involuntary seclusion, and abandonment. While an accurate number of cases is difficult to find because there's no way to ensure comprehensive reporting and compiling of those statistics, it pays to be aware of the risk factors and signs of abuse.

You or your loved one may be at risk for elder abuse if:

• You have to rely on someone for your physical care needs
• You live in your own home and are socially isolated
• You have adult children who have problems with finances, drugs or alcohol
• You live with someone with a history of controlling and abusive behavior
• You have a diagnosis of Alzheimer's or another dementia

Take a minute to review the different kinds of abuse and related statistics, as well as learn how to spot and respond to possible abuse or neglect.

While I don't want to focus on the negative too much, I do want to take this opportunity to raise awareness. If it makes a difference in one person's life, it's clearly well worth it.

Feel free to comment here. You can also email me at alzheimers.guide@about.com if you have other questions.

_Source:

_{National Center on Elder Abuse}

A new robotic baby invention called a Babyloid was recently developed in Japan to "interact" with nursing home residents. The goal is to help alleviate depression in nursing home residents, perhaps by providing something for them to care for and nurture.

Babyloid has a simplistic, non-realistic face and responds to being rocked or held using sensors that turn his cheeks red when he's happy and blue when he's sad. Babyloid might even fall asleep if it's being rocked or cry LED tears if upset. More than 100 different sounds are programmed in Babyloid. The inventor, Masayoshi Kanoh, apparently recorded his youngest child's baby sounds and used them in developing Babyloid.

Preliminary research was conducted at a nursing home, concluding that residents who held and interacted with Babyloid for eight minute intervals for a total of 90 minutes a day experienced a reduction in their symptoms of depression. The estimated price for Babyloid is $1300 USD.

You can see pictures of the Babyloid here.

I've recommended before that baby dolls be used to provide comfort for people who have Alzheimer's or another kind of dementia. They can also be beneficial when offered as something to hold on to while care is being provided, especially if your loved one has some behavioral challenges.

I'm all for reducing the loneliness and depression that is sometimes present for older adults in facilities, but I'm not quite ready to jump on this bandwagon yet. There's certainly something important about providing people with the chance to be a caregiver and have meaningful activity, but it feels almost like they're trying to replace human interaction and affection with science fiction-like inventions. How about we take the time to hold someone's hand, to bring our cat or dog (with facility permission) to visit the pet-lovers, or bring our children to visit our older loved ones?

What do you think?

Think you're too young to try to prevent Alzheimer's disease? Think again.

The latest research published in the Archives of Neurology journal concludes (as have other studies) that brain exercise is an important tool in reducing your risk of Alzheimer's. But this time, researchers looked at the level of mental exercise in early and middle life as self-reported by 65 participants with an average age of 76. They found that individuals who reported an active cognitive lifestyle (defined by reading, writing and playing games) in their early and middle years displayed fewer beta-amyloid deposits on current PET scans. Beta-amyloid deposits are found in abundance in the brains of people with Alzheimer's disease and are a main component of amyloid plaques, one of the diagnostic hallmarks of the disease. Interestingly, no correlation was found with current mental activity and beta-amyloid deposits.

Most of the other research up to now has connected current mental fitness and activity levels with the absence of symptoms of Alzheimer's. This new research is significant in two ways:

• It correlates brain exercise in the early and middle years of life with outcomes later in life.
• It demonstrates a reduction in the physiological development of brain plaques that accompany Alzheimer's disease.

If our brains are impacted decades before Alzheimer's develops and we can reduce the risk simply by working out mentally, that's a pretty time and cost-efficient way to work towards prevention of a disease that affects over 5.3 million Americans.

Wondering where to start? Here's a list of 12 ways to exercise your brain.