September 20, 2015

Alzheimer’s: The New Frontier – Part III

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
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Despite the discouraging fact that Alzheimer’s disease is on the rise and that many attempts to find a cure have met with failure, renewed attention to the devastating brain disease may be yielding some promising results.

With a growing and increasingly older population in the United States and worldwide, Alzheimer’s, which primarily affects people over 65, has reached a crisis point.

Current medications only relieve symptoms temporarily, and scientists still have not pinpointed why some people get Alzheimer’s and why some don’t or why the majority affected are women. As a Medical News Today article says, “This is certainly not through lack of trying.”

Indeed, scientists recently restored memory and learning deficits in mice with Alzheimer’s. Others recognized how vitamin D deficiency could increase the risk of developing dementia. Still other researchers showed how DNA methylation in the brain is linked to Alzheimer’s.

New lines of research have opened up. Scientific American’s white paper report, “Health after 50: Memory,” covers advances and theories on Alzheimer’s including  the effect of cholesterol-lowering medications, diabetes and dementia, estrogen therapy, early detection, research using stem cells, self-monitoring exercises, a vaccine to stimulate the immune system to produce antibodies against the tau protein found in Alzheimer’s patients and much more.

Studying the brain properly has been uniquely challenging. Only last year, The New York Times reported, were researchers able to grow human brain cells in a petri dish and manipulate them to develop the telltale structures of Alzheimer’s disease. The article calls this step “a real game changer” and “a paradigm shifter.”

Lead researcher Rudolph E. Tanzi of the Massachusetts General Hospital in Boston, “is now starting an ambitious project to test 1,200 drugs on the market and 5,000 experimental ones that have finished the first phase of clinical testing — a project that is impossible with mice, for which each drug test takes a year. With their petri dish system, Dr. Tanzi said, ‘we can test hundreds of thousands of drugs in a matter of months.’”

Other researchers are looking at the immune system for clues. A study in July 2015 by researchers at the University of California San Francisco and Stanford School of Medicine published in Science Daily found “a molecule, named B2M, that increases in abundance as we age, blocks the regeneration of brain cells and promotes cognitive decline.”

Scientists also discovered that connecting the circulatory system of a young mouse to that of an old mouse could reverse the declines in learning ability that typically emerge as mice age. Additionally, blood from older animals appears to contain “pro-aging factors” which can contribute to cognitive decline. “We are interested in developing antibodies or small molecules to target this protein late in life,” said study co-author Dr. Saul Villeda.

The Telegraph reported that a team at the Imperial College has discovered how to turn off an enzyme that is driving many incurable diseases including Alzheimer’s and cancer. Scientists at Ulster and Lancaster Universities found that diabetes drugs Liraglutide and Lixisenatide prevent Alzheimer’s characteristic and destructive amyloid plaques from forming in mice brains.

Other research on genetics and the immune system found a link between a rare mutation in the TEM2 gene called TREM2, which helps trigger immune system responses, and an increased risk for developing Alzheimer’s disease.

There are also new drugs in the pipeline: NitroMemantine, a combination of nitroglycerin and memantine (the latter is already used for Alzheimer’s), “appears to restore synapses — the connections between neurons — lost in the disease process,” said the author of a recent article in the Orlando Sentinel.

Calling the new research ‘very promising,’ Dr. David Smuckler, geriatrician and medical director of Orlando Health’s Center for Aging and Memory Disorder Center, said he would welcome a new treatment. “The medications we have now are not very good. A lot of patients don’t respond, but they’re the best we have,” Smuckler said. “They don’t do much to slow the process, and they definitely don’t reverse it.”

What about older people with really good memory? This year, an article in The New York Times reported results of a study of older people with “peculiar, oversize brain cells known as von Economo neurons.” There were almost five times the number of these large cells in the older people with exceptionally good memory versus the average person. Accordingly, they were dubbed the SuperAgers. No one really knows how these large neurons affect memory, but it has already become yet another starting point in the search for an Alzheimer’s cure.

September 16, 2015

Alzheimer’s: The Current Standard of Care – Part II

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
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In the United States, some 5 million people aged 65 and over suffer from Alzheimer’s, a degenerative neurological disease. Incidence of the disease is expected to triple to 16 million by 2050, and most of the patients will be women.

Progress in treating Alzheimer’s has fallen far behind other scourges of aging, including cancer. Alzheimer’s now is the sixth leading cause of death among the elderly, yet the disease gets relatively little attention and funding, leaving the medical community struggling to find effective treatments, preventative measures and a cure.

Available medications regulate neurotransmitters, the brain chemicals that carry messages between neurons but don’t slow or stop the disease. They only work to alleviate some symptoms for some people, some of the time.

Among treatments approved by the U.S. Food and Drug Administration for mild cases of Alzheimer’s are Donepezil (Aricept®), rivastigmine (Exelon®), and galantamine (Razadyne®). Memantine (Namenda®), is used to treat moderate-to-severe cases.

Newer drugs have proved disappointing, even after extensive research. The New York Times recently reported that “Johnson & Johnson and Pfizer abandoned a drug they were jointly developing after it showed virtually no effect in large trials. Eli Lilly and Roche are continuing to test their respective drugs despite initial failures. Experts say there is some suggestion the drugs might work if used early enough, when the disease is still mild.”

During the Alzheimer’s Association International Conference on July 22, 2015, Biogen and Eli Lilly announced promising data for drugs they are developing. While the data looks promising, these drugs are not close to a cure or won’t be available any time soon.

Some people with a genetic predisposition to Alzheimer’s are modifying their lifestyles in significant ways – and early – in the hope of pushing off the onset of the disease.

A recent article in The Washington Post reported on a nonprofit group, Beating Alzheimer’s By Embracing Science (BABES), which raises money and awareness about dementia, a catch-all term that refers to loss of certain brain functions including speech and memory.

BABES’ founder, Jamie Tyrone, who carries the at-risk gene, started working out, taking nutritional supplements and changing her eating habits, the newspaper reported, adding: “She began taking fish oil, vitamin D, vitamin B12, curcumin, turmeric and an antioxidant called CoQ10. She started meditating and working mind-bending puzzles, such as Brain HQ. She joined a health clinic whose regimen is shaped by a UCLA medical study on lifestyle changes that can reverse memory loss in people with symptoms of dementia.”

However, recent research casts doubt on the long-held theory that keeping your mind active helps prevent dementia. Nevertheless, there are not a lot of options. An article in The New York Times quoted Richard Lipton, a neurologist and director of the Einstein Aging Study, which has tracked cognition in elderly Bronx residents since the 1980s, who said that “a number of people have been interested in modifiable lifestyle factors for years.” But interest has increased lately. Lipton added: “It’s at least in part a reflection of disappointing drug trials.”

All kinds of theories are being evaluated. A study conducted in Denmark on stress and Alzheimer’s noted that “those with the highest perceived stress on the scale had two-and-a-half times the risk of dementia, compared with those who were less stressed.” Other studies focused on links between dementia and high blood pressure. Apparently people with high blood pressure are less susceptible to Alzheimer’s, possibly because of hypertension medications.

Orlando Health’s Center for Aging in central Florida offers a holistic approach that addresses the burden faced by those who care for loved ones with Alzheimer’s. When a patient and caregiver arrive at the center, both participate in an assessment by a multidisciplinary team. Orlando Health offers community outreach programs and safe-driving programs.

With the elderly population becoming larger and living longer and the economic and human cost of Alzheimer’s growing every year, there is increasing pressure to find a cure. The medical community, it seems, is gearing up for a fresh round of research.

Next: The New Frontier

September 4, 2015

Alzheimer’s: What You and I Need to Know – Part I

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog
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Alzheimer’s  is the only cause of death in the top 10 that we currently do not have a way to prevent, stop or slow its progression.”

That stark assessment in Medical News Today, from Heather Snyder, director of medical and scientific operations at the Alzheimer’s Association, proved chilling and disappointing to many. “To put this in perspective, Alzheimer’s disease currently kills more people each year than prostate cancer and breast cancer combined,” she said

Yet the younger members of our society are generally ignorant about the disease because it doesn’t affect them directly. This series will discuss what you and I need to know about Alzheimer’s, including current treatments and research.

A Crisis on the Rise

Alzheimer’s is a degenerative disease in which the brain forms abnormal clumps called amyloid plaques, along with tangled bundles of fibers. Neurons stop functioning, lose connections with other neurons and die. The cause of this phenomenon so far has eluded the medical community.

The symptoms – significant memory loss, disorientation, personality changes and cognitive decline, among others – make Alzheimer’s a frightening prospect for patients and the members of their family members who will care for them.

Alzheimer’s is a crisis on the rise. During the next 20 years, you and I likely will know someone suffering with Alzheimer’s. One reason is that more people are living longer – long enough to be victimized by this brain-wasting disease. Earlier generations didn’t live long enough for large numbers of people to suffer the disease.

The population of senior citizens is growing fast as the Baby Boom generation ages out. The 65-plus age group increased 25 percent between 2003 and 2013. The 85-plus age group is projected to triple – to almost 15 million people – by the year 2040. The ratio of senior women to men is expected to be two to one.

Since old age is the biggest known risk factor for Alzheimer’s, the projected number of cases is expected to triple to 16 million by 2050. Figures are similar worldwide: By 2050, more than 115 million people will be diagnosed.

“The bad news is we think Alzheimer’s affects half of everyone over 85,” said Eric Reiman, executive director of the Banner Alzheimer’s Institute in Phoenix. “So we’re all in this together.”

The cost of managing Alzheimer’s is staggering, projected to be $1 trillion in 2050. Caregivers are so overwhelmed that Alzheimer’s organizations have devoted time, money and entire departments to helping those who help patients with Alzheimer’s.

Unfortunately we know very little about the disease.

Researchers believe there is a genetic component. As the National Institute of Health describes it: “The apolipoprotein E (APOE) gene is involved in late-onset Alzheimer’s. This gene has several forms. However, carrying the ApoE-4 form of the gene does not mean that a person will definitely develop Alzheimer’s disease, and people with no ApoE-4 may also develop the disease.”

Gender is another risk factor. Women are twice as likely to develop Alzheimer’s.

Researchers at Stanford University found women carrying the ApoE-4 gene are twice as likely to develop Alzheimer’s than men. No one is sure why, and studies on Alzheimer’s and the hormone estrogen yielded mixed results: In some subjects there was a decrease in the onset age of dementia for those on estrogen supplements right after menopause, but there was a higher-than-average incidence of dementia for the women who started taking estrogen later, between ages 65 to 79.

Lack of funding and national attention have hampered progress. A recent USA Today article refers to the “Alzheimer’s epidemic” and cites inadequate government support: “Funding for the disease was $606 million. But it trails other diseases: HIV at $3 billion and cancer at $6 billion.” Breast cancer alone received more funding than Alzheimer’s.

Studying the brain also has proved to be problematic. Alzheimer’s organizations cite an urgent need for volunteers.  But it seems efforts are ramping up at last, with promising new research on the horizon, efforts to offer more clinical trials and more support for families. The Alzheimer’s Association is running a program called TrialMatch, to recruit patients and caregivers into appropriate clinical trials.

In 2013 President Obama launched the BRAIN Initiative, with the objective to accelerate research into the brain and neurological disorders. The goal is to “produce a revolutionary new dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space. With nearly 100 billion neurons and 100 trillion connections, the human brain remains one of the greatest mysteries in science and one of the greatest challenges in medicine.”

Next: The Current Standard of Care

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