Alzheimer's Disease Blog

While doctors already have a couple of questionnaires that can help them identify possible Alzheimer's disease, many of these tests only detect problems when the disease has progressed beyond the mildest stages.

That's one reason that seven psychologists developed the Everyday Cognition Scale (ECog), a 39-item screening tool that identifies problems in everyday living and functioning that could signal cognitive problems such as Alzheimer's.

The psychologists carefully validated the scale and published the results in the July issue of Neuropsychology. The ECog was developed to be sensitive enough to differentiate normal cognitive functioning, mild cognitive impairment (MCI), and dementia. The scale is also unique because a person's score is not heavily influenced by educational level, which has been a problem with previous tests.

The ECog asks a person who knows the older person well -- usually a spouse or adult child -- to rate the older person on his or her ability to perform daily tasks such as sorting the mail, using a map, and following a conversation.

I'm encouraged by the ECog and hope that it proves to be useful in primary care settings and in neuropsychologists' offices as a method of improving diagnosis of Alzheimer's and other dementias and choosing appropriate treatments.

Photo © Administration on Aging

Do you know your cholesterol levels? If not -- and you're middle-aged -- you might want to see if your HDL (the good kind of cholesterol) is high enough.

Researchers from the French National Institute for Health and Medical Research recently reported that over a 5-year period, participants between the ages of 55 and 61 who had low HDL (40 mg/dL or less) showed significant memory decline when compared to those with higher (60 mg/dL or greater) HDL levels.

It's interesting to consider these findings in relation to a study I summarized in a previous blog, where researchers found that people in their 40s with high cholesterol (defined as a total cholesterol level of 249-500 mg) were 1.5 times more likely to develop Alzheimer's disease later in life than those who had total cholesterol levels of 198 mg or lower. Most likely, those with high total cholesterol had more of the bad kind of cholesterol (LDL) than HDL (for more information, see Types of Cholesterol).

If you want to protect your brain by improving cholesterol levels, taking statins may not do the trick. In another blog, I reported that statins may improve your numbers, but they won't necessarily improve or maintain memory functioning.

What's the solution? Unless cholesterol problems are inherited and require medication, our best bet is to raise HDL and lower LDL the old fashioned way: through diet and exercise. To learn how to do this, see the following articles:

• Eat Your Way to a Healthy Brain
• The Basics of a Low Cholesterol Diet
• How to Raise HDL Levels

Illustration © A.D.A.M.

I was really hoping that Flurizan would work, given the enormous amount of time and money invested in evaluating whether the drug could successfully inhibit the buildup of beta amyloid plaques in the brain instead of simply alleviating Alzheimer's symptoms.

However, just one month after announcing that it had teamed up with Danish pharmaceutical company H. Lundbeck to develop and market Flurizan in Europe, Myriad Genetics, Inc. announced that due to the failure of the drug to pass a late-stage clinical trial, it would discontinue the development of the medication.

H. Lundbeck spent $100 million in its partnership with Myriad to develop the drug. The company will now have to write off the loss in its second quarter earnings.

Flurizan was developed under the assumption that the buildup of beta amyloid in the brain was a primary cause of Alzheimer's disease. Does the drug's failure mean that the beta amyloid theory is debunked? Not necessarily, considering that new research suggests that a certain type of beta amyloid is associated with Alzheimer's disease while other beta amyloid varieties are not.

Still, consider this: Flurizan is the third beta amyloid-targeting treatment under development that was discontinued due to inadequate clinical trial outcomes (the other two were Alzhemed by Neurochem and a vaccine by Wyeth and Elan). Is it time to start taking a longer look at other theories about the causes of Alzheimer's, such as the TNF theory that underlies etanercept treatment?

Illustration © Alzheimer's Disease Education & Referral Center

The Centers for Medicare & Medicaid Services (CMS) will be adding a new feature to its Nursing Home Compare website.

CMS announced that by December 2008, America's nursing homes will receive "star" ratings, from one star (much below average) to five stars (much above average). Currently, consumers can search for nursing homes and find individual measures of care quality, staffing, and results of state survey inspections. The new rating system will allow people to find overall assessments of each nursing home; CMS hopes that the rating system will also motivate nursing homes to improve their quality of care.

CMS acknowledges that the rating system should not be used as the only piece of information when choosing a nursing home. Kerry Weems, CMS acting administrator, asserted that there's no substitute for visiting a facility in person and "meeting with staff, residents, and other families."

More About Alzheimer's Services:

• Alzheimer's and Caregiving Organizations
• Goverment Assistance for Alzheimer's Care

Photo © Microsoft

I know this sounds a bit sci-fi, but researchers at the VA Medical Center in Massachusetts are developing a noninvasive device that could differentiate healthy brain tissue from tissue that contains plaques made of beta amyloid and tangles made of tau -- hallmarks of Alzheimer's disease.

The device uses near-infrared spectroscopy, which is based on the theory that abnormal brain tissue scatters light differently than healthy tissue. The laser headband is strapped around the head; low-energy, near-infrared light is flashed onto the person's skull; and a spectrum of reflections is produced that distinguishes unaffected tissue from that which contains plaques and tangles.

The device is still being tested on humans to determine its efficacy. If it proves useful, it would be a noninvasive way to detect abnormalities while the person is still alive. MRI -- while noninvasive -- is not yet sensitive enough to detect plaques and tangles, while PET scans involve injecting a radioactive substance into the brain.

A word of caution, however: Just because someone has plaques and tangles in the brain doesn't mean that they positively have Alzheimer's disease. See my previous blog to find out why.

Illustration © Alzheimer's Disease & Referral Center

We've known for a long time that those with Alzheimer's disease have a build-up of beta-amyloid protein in their brains. However, autopsies have revealed that some people who never developed Alzheimer's also had beta amyloid in their brains. The question of whether beta amyloid actually causes Alzheimer's disease has puzzled scientists for years.

Drs. Ganesh M. Shankar and Dennis J. Selkoe -- along with others at Harvard Medical School, University College of Dublin, and Trinity College of Dublin -- may have discovered a clue to this mysterious phenomenon. By conducting autopsies of those with Alzheimer's, those with another type of dementia, and those with no dementia, they found three different types of beta amyloid in the subjects' brains: one-molecule, two-molecule, and three-molecule. Almost all of the brains contained some level of beta-amyloid protein, but only the two-molecule variety was specifically related to Alzheimer's disease.

This could explain why some people who never develop Alzheimer's disease still have beta amyloid in their brains -- the protein could be the one- or three-molecule type and, therefore, Alzheimer's did not develop.

The study doesn't prove that two-molecule beta amyloid causes Alzheimer's, but it certainly reveals more than we've ever known before about how beta amyloid relates to the disease.

For more information:

• What Is Alzheimer's?
• What Causes Alzheimer's?

Illustration © Alzheimer's Disease Education & Referral Center

National Public Radio recently did a wonderful story on The Intergenerational School -- an inner-city charter school in Cleveland that pairs people with Alzheimer's disease with students from kindergarten through middle school.

The founders, Dr. Peter Whitehouse and his wife, Cathy, think that providing those with Alzheimer's the opportunity to volunteer at the school improves quality of life for them as well as for the students. Notice that I used the word volunteer. The Whitehouses make sure that the Alzheimer's participants -- who range from being in the earliest to the more advanced stages of the disease -- are identified as volunteers who are helping the children and who are fulfilling an important purpose.

And they are. For example, the students recently were given an assignment to interview the volunteers about their life experiences and to document lessons learned. The volunteers talked about going to college, traveling to new places, and making good choices. In other words, they imparted wisdom.

I love creative activities like this because everybody wins, and the dignity and worth of each individual is celebrated. Thanks, Peter and Cathy Whitehouse, for implementing such a great idea. Lets hope that others follow suit.

Related Reading:

• Alzheimer's Activity Ideas
• How to Find the Right Volunteer Opportunity for You

Photo © Microsoft

Usually, moving up the ladder is considered a good thing -- but not when the rungs are the top leading causes of death in the United States.

According to the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics, Alzheimer's disease has moved from the seventh to the sixth leading cause of death in the United States, passing up diabetes, which used to hold the sixth place spot on the list.

While Alzheimer's deaths are on the rise -- the CDC estimated that 72,914 people died of the disease in 2006 -- death rates for other conditions are declining. For example, between 2005 and 2006, deaths from stroke decreased 6.4%, and deaths from diabetes went down 5.3%.

I was happy to hear that death rates for other diseases -- many of which contribute to other types of dementia -- are declining. But why do you think that deaths from Alzheimer's are increasing? More importantly, what should be done about it? Post a comment to this blog, or start a new discussion in the forum.

Photo © Alzheimer's Disease Education & Referral Center

Here's a key player on the Alzheimer's care team that we don't often talk about: your pharmacist. One of the more accessible health care professionals, pharmacists educate customers about diseases and conditions, medications, side effects, and potential drug interactions.

Eisai, Inc. and the Alzheimer's Association have teamed up to offer the C.A.R.E. (Commitment to Alzheimer's. Recognition of Excellence.) Pharmacy Award, which recognizes the valuable contributions of pharmacists to the well-being of families facing Alzheimer's and other types of dementia.

Nominations are being sought for the 2008 C.A.R.E. Pharmacy Award. The winning pharmacist will receive national recognition, and the pharmacist's local Alzheimer's Association will receive a $1,500 donation to support programs and services for Alzheimer's families. Additionally, $1,500 will be donated to the Alzheimer's Association chapter in the region that receives the most nominations.

If you think your pharmacist does an exceptional job helping you and others in your community who are affected by Alzheimer's disease, I encourage you to submit a nomination. Ballots can be completed at the C.A.R.E. Pharmacy Award website through September 2008.

Related Reading:

• Treatments for Alzheimer's Disease
• What to Ask About Alzheimer's Medications

Photo © Microsoft

Banner Alzheimer's Institute and Sun Health Research Institute, both based in Arizona, are enrolling participants in a new study to evaluate the investigational drug Dimebon for the treatment of mild to moderate Alzheimer's disease.

Dimebon works differently than the four medications currently approved by the FDA to treat Alzheimer's: Aricept, Exelon, Razadyne, and Namenda. The study will test the effectiveness of Dimebon when taken in conjunction with Aricept.

People 50 years of age and older with a clinical diagnosis of Alzheimer's disease who have been taking Aricept for at least 60 days may be eligible to participate in the study. For more information, call the Banner Alzheimer's Institute (602-239-6900) or the Sun Health Research Institute (623-875-6500). Information about all of their clinical trials can be found at www.shri.org.

Photo © Microsoft