Category Archives: Alzheimer’s

Geriatricians question common treatments, including dementia drugs

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This is an interesting post in the New Old Age blog of the New York Times about five common treatments questioned by geriatricians.  At the top of this year’s list are cholinesterase inhibitors — such as Aricept, Exelon, and Razadyne — which are prescribed for those with Lewy Body Dementia and some of the other disorders in our group.

See last year’s list of five things here:

www.brainsupportnetwork.org/five-things-physicians-and-patients-should-question-geriatrics-hospice/

Here are some excerpts from the article about cholinesterase inhibitors:

Topping this year’s list is a caution against dementia drugs called cholinesterase inhibitors — Aricept is the most widely used — without following up to see whether they’re really helping.

[While] the drug may produce cognitive improvement that is statistically significant in a clinical trial, “it’s not clear that it’s big enough for a caregiver to even notice, or big enough to make a difference in a patient’s quality of life,” Dr. Lee said. “We’re learning, after more experience with these drugs, that they benefit a minority of patients.”

On the other side of the equation, most patients who take them will experience gastrointestinal problems like nausea, cramping and diarrhea that often cause weight loss. So the society urges extensive discussion before doctors prescribe cholinesterase inhibitors and suggests no more than a three-month trial. If there’s no meaningful improvement by then, there won’t be later. “This is not a medication to start and then forget about,” Dr. Lee cautioned.

Here’s a link to the full article:

newoldage.blogs.nytimes.com/2014/03/07/geriatricians-question-five-common-treatments

Geriatricians Question Five Common Treatments
New York Times
By Paula Span
March 7, 2014 3:49 PM

Robin

 

Different Types of Alzheimer’s Disease (based on Mayo Brain Bank)

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A couple of years ago (September 2011), the Mayo Clinic published interesting research on the different types of Alzheimer’s Disease, based on neuropathologic findings.  Of course there’s the “typical” type of AD that most of us are familiar with.  There are two other types that are new to me —

  • hippocampal sparing (HpSp)
  • limbic predominant (LP)

One of Brain Support Network’s missions is to assist families around the United States with brain donation.  We have helped over 150 families donate a loved one’s brain.  We occasionally see these two non-typical AD diagnoses on neuropathology reports.  We look forward to more publications describing these two non-typical types of Alzheimer’s.

In this study, 889 cases of AD at the Mayo Clinic brain bank were examined.  Just over 11% of the cases were hippocampal sharing, and 14% of the cases were limbic predominant.  So these two non-typical AD types represent 25% of all AD cases.

Because the “hippocampal sparing (HpSp)” type had less hippocampal atrophy than typical AD, this meant that memories were relatively more preserved than with typical AD.  “Patients with hippocampal sparing AD were younger at death (mean 72 years) and a higher proportion of them were men (63%). … HpSp had a shorter disease duration. … A non-AD clinical diagnosis was more frequent (30%) in HpSp than LP and typical AD. Examples of non-AD clinical diagnoses included behavioral variant of frontotemporal dementia (12%) and other focal cortical syndromes (13%), such as progressive nonfluent aphasia, semantic dementia, posterior cortical syndrome, and corticobasal syndrome, as well as parkinsonian disorders (4%), such as progressive supranuclear palsy and Parkinson’s disease dementia.”

“[Those] with limbic-predominant AD were older (mean 86 years)and a higher proportion of them were women (69%).”  Disease duration was the same as with typical AD.  “LP most often had an antemortem clinical diagnosis of AD (94%). Of the 6% of LP who were given a non-AD clinical diagnosis, only a few were considered to have behavioral variant of frontotemporal dementia (n=2) or focal cortical syndromes (n=1), but they were comparable on parkinsonian diagnoses (n=4).”

“Neither initial, nor final MMSE scores assessed within three years of onset and death, respectively, were different among the AD types. When MMSE scores were evaluated with respect to disease duration, apparent differences were observed for HpSp. Figure 4 shows rapid progression of deterioration on MMSE in HpSp, with many patients progressing from normal to impaired values in a few years, declining at a rate of 5 points per year on the MMSE. On average, HpSp cases showed a steeper slope than both LP and typical AD.”

As for genetics, the researchers found:

“Microtubule-associated protein tau (MAPT) H1H1 genotype was more common in limbic-predominant AD (70%) than in hippocampal sparing AD (46%, but did not differ significantly between limbic-predominant and typical AD (59%). Apolipoprotein E (APOE) ɛ4 allele status differed between AD subtypes only when data were stratified by age at onset.”

The researchers argue that these distinct AD clinicopathological subtypes “should be considered when designing clinical, genetic, biomarker, and treatment studies in patients with AD.”

The full article is available online at no charge:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3175379/

Robin

Imaging Tau with PET Scans

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Some news was released yesterday about using a PET scan to detect tau in the brain.  Tau is the protein involved in PSP and CBD.  Tau is one of the two proteins involved in Alzheimer’s Disease; the other is amyloid.

If I’m counting correctly, yesterday’s news is a third approach to detecting tau in the brain with a PET.  This third approach was developed largely by Japanese scientists.  The second approach was developed by UC Irvine and uses Siemens technology.  And the first approach was developed by UCLA but that approach seems to have no endorsement outside of UCLA.  (I was told by some local neurologists that the UCLA approach is a “non-starter.”)

The third approach was described in the journal Neuron yesterday.  Here’s a link to the abstract and the figures and tables from the article, but not the article itself:

www.sciencedirect.com/science/article/pii/S0896627313006612

From the abstract and highlights of the article, we know that the Japanese researchers used this PET imaging approach to illuminate tau tangles in mice with a tauopathy and in living Alzheimer’s patients, comparing them to normal controls.  They also saw tau illuminated in a corticobasal syndrome patient who did not have amyloid plaques, based on a different PET scan.

I believe this new tau ligand (or radioactive substance) is known as PBB.  This is very confusing because the amyloid ligand is known as PIB.

Below I’ve copied links to two very understandable lay articles on this tau imaging study — one from the BBC and one from Forbes magazine.  The angle in both of these articles is Alzheimer’s Disease as that’s where lots of research dollars are going.

Robin

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www.bbc.co.uk/news/health-24142691

Alzheimer’s brain scan detects tau protein
BBC News
By James Gallagher, Health and science reporter
18 September 2013

www.forbes.com/sites/alicegwalton/2013/09/19/new-brain-imaging-for-alzheimers-disease-may-kickstart-early-treatment-diagnosis/

PHARMA & HEALTHCARE
New Brain Imaging For Alzheimer’s Disease May Pave The Way For Earlier Diagnosis
Forbes
Alice G. Walton, Contributor
9/19/2013 @ 12:47PM

Subjective Cognitive Decline (research)

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There was an interesting article this week in the New York Times about worldwide research into “subjective cognitive decline” – where an individual believes he/she is suffering from cognitive decline but there is no objective evidence of this.

The article reported that Brigham and Women’s Hospital researchers “found that people with more concerns about memory and organizing ability were more likely to have increased levels of amyloid, a key Alzheimer’s-related protein, in their brains.”  

At Mayo Rochester, something similar was seen:  “those who had a concern about their memory in fact had more likelihood of later developing mild cognitive impairment, an early phase of dementia.”

A German researcher, convinced of the existence of “subjective cognitive decline” for years, said that:

“[In] diseases from arthritis to Parkinson’s, people often feel something is wrong before others notice. In most phases of dementia, family members and friends see deficits, but the disease has usually stolen the person’s ability to recognize them. But at the subjective phase, studies suggest family members may miss problems; the person may feel his mind working harder, but he still functions well.”

 The New York Times article says:  “Experts also are not yet suggesting doctors regularly screen people for ‘subjective cognitive decline’ because much more research is needed and no effective dementia treatment now exists.”

Here’s a link to the article:

www.nytimes.com/2013/07/18/health/looking-for-early-signs-of-dementia.html

Looking for Early Signs of Dementia? Ask the Patient
New York Times
By Pam Belluck
Published: July 17, 2013

Robin

Decline in Dementia in Europe

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There was an interesting New York Times article this week about the lower rate of dementia in two recent European studies.

I hadn’t planned on sharing the article as it is more about Alzheimer’s than any of the non-AD dementias in our group, but the PBS NewsHour had a very nice interview tonight (July 17, 2013) on this news.  The PBS NewsHour interviewed Dr. Murali Doraiswamy, an Alzheimer’s researcher at Duke University, who was mentioned in the rate of dementia article below.

The PBS NewsHour segment is only seven minutes.  You can find a link to the segment plus a transcript here:

www.pbs.org/newshour/bb/health/july-dec13/dementia_07-17.html

(When I was watching the NewsHour live, the lead-in video showed Dr. Adam Boxer at UCSF.  But today’s segment was not about UCSF research.)

On the NewsHour, Dr. Doraiswamy noted that:

“We have to differentiate is the risk vs. the total numbers.  The total numbers of Alzheimer’s disease are going to climb upwards quite dramatically because older age and the rising number of people who live into their 70s, and 80s and 90s is a huge risk factor for Alzheimer’s.  But within each generation, what we’re seeing is a given person’s risk for developing Alzheimer’s might actually reduce and go down.”

Plus, Dr. Doraiswamy surmised that the decline in dementia was probably due to decline in vascular dementia “because we now have better ways to treat cardiovascular disease.”

Here’s a link to the New York Times article on these research findings:

www.nytimes.com/2013/07/17/health/study-finds-dip-in-dementia-rates.html

Dementia Rate Is Found to Drop Sharply, as Forecast
By Gina Kolata
New York Times
Published: July 16, 2013

Robin