Alzheimer's News and Events

Research Advances from the Alzheimer's Association International Conference 2011

Alzheimer's Association — 2011-07-20

Alzheimer's Association
The Alzheimer's Association is the world's leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. For more information, visit www.alz.org. Learn more about Alzheimer's Association International Conference.

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Alzheimer's Association Welcomes President Nicolas Sarkozy to International Conference

Alzheimer's Association — 2011-07-20

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International Study of Genetic Alzheimer's Disease Gives Clues to Presymptomatic Detection and Progression of the Disease

Alzheimer's Association — 2011-07-20

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International Survey Reveals Attitudes Towards Alzheimer's Diagnosis and Treatment

Alzheimer's Association — 2011-07-20

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Late Breaking Research Results from the Alzheimer's Association International Conference 2011

Alzheimer's Association — 2011-07-20

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New Studies Underscore Global Importance of Mild Cognitive Impairment in Alzheimer's Disease Continuum

Alzheimer's Association — 2011-07-19

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New Global Model of Alzheimer's Risk Suggests a 25 Percent Reduction in Presumed Risk Factors Could Lower Alzheimer's Cases by 3 Million Worldwide

Alzheimer's Association — 2011-07-19

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Women at the Center of the Global Alzheimer's Epidemic

Alzheimer's Association — 2011-07-18

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Brain Injury May More Than Double Dementia Risk in Older Veterans

Alzheimer's Association — 2011-07-18

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Alzheimer's Association TrialMatch Connects More Than 2,500 People with Alzheimer's Clinical Trials Nationwide

Alzheimer's Association — 2011-07-18

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Two Studies Advance Global Standardization of Biomarkers for Alzheimer's Disease

Alzheimer's Association — 2011-07-17

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Alzheimer's Association Presents Lifetime Achievement Awards to Four Researchers

Alzheimer's Association — 2011-07-17

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Falls May Indicate Earliest Stages of Alzheimer's and Need for Further Evaluation

Alzheimer's Association — 2011-07-17

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New diagnostic criteria and guidelines for Alzheimer's disease published for first time in 27 years

Alzheimer's Association — 2011-04-19

New criteria and guidelines for the diagnosis of Alzheimer's disease have been published — for the first time in 27 years — by three expert workgroups spearheaded by the Alzheimer's Association and the National Institute on Aging (NIA) of the National Institutes of Health (NIH).

The workgroups published four articles including ready-to-use clinical diagnostic criteria for Alzheimer's disease dementia and mild cognitive impairment (MCI) due to Alzheimer's. A research agenda was proposed for preclinical Alzheimer's. The use of biomarkers in Alzheimer's dementia and MCI due to Alzheimer's was also proposed as a research agenda only, and is not intended for application in clinical settings at this time.

The articles — collectively, the National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease — expand the definition of Alzheimer's to include two new phases of the disease: (1) presymptomatic and (2) mildly symptomatic but pre-dementia, along with (3) dementia caused by Alzheimer's. This reflects current thinking that Alzheimer's begins creating distinct and measurable changes in the brains of affected people years, perhaps decades, before memory and thinking symptoms are noticeable.

"It is our hope that incorporating scientific knowledge gained and technological advances made over the past quarter century will improve current diagnosis, bring the field closer to earlier detection and treatment and, ultimately, lead to effective disease-modifying therapies," said William Thies, Ph.D., Alzheimer's Association chief medical and scientific officer. "Development and publication of these articles is a major landmark in the field. That said, publication of these articles is not yet the end of the process of developing new diagnostic criteria for Alzheimer's, but is another major step in the process."

"The new guidelines reflect today's understanding of how key changes in the brain lead to Alzheimer's disease pathology and how they relate to the clinical signs of mild cognitive impairment and Alzheimer's disease dementia," said Creighton Phelps, Ph.D., program director of the Alzheimer's Disease Centers Program at the National Institutes of Health. "We are also beginning to be able to detect these changes at a preclinical stage, long before symptoms appear in many people. With further research on biomarkers, as set forth in the new guidelines, we may ultimately be able to predict who is at risk for development of mild cognitive impairment and Alzheimer's dementia, and who would benefit most as interventions are developed."

The proposed new Alzheimer's disease diagnostic guidelines were published online today by Alzheimer's & Dementia: The Journal of the Alzheimer's Association. Hard copy publication is scheduled for the May 2011 issue.

To learn more, visit http://www.alz.org/research/diagnostic_criteria.

National Institute on Aging (NIA)
NIA, part of the National Institutes of Health, a component of the U.S. Department of Health and Human Services, leads the federal government effort conducting and supporting research on aging and the health and well being of older people. For information on age-related cognitive change and neurodegenerative disease, go to the NIA's Alzheimer's Disease Education and Referral (ADEAR) Center at www.nia.nih.gov/Alzheimers. For more on health and on aging generally, go to www.nih.nia.gov. Media contact is Peggy Vaughn, Office of Communications and Public Liaison, at 301.496.1752 or mnianews3@mail.nih.gov.

Alzheimer's Association
The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. For more information, visit www.alz.org.

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E-mail: media@alz.org

NARFE raises $9 million for the Alzheimer's Association

Alzheimer's Association — 2011-04-18

The National Association of Retired Federal Employees (NARFE) has surpassed its goal of raising "$9 Million by NARFE's 90th Birthday 2011" for the Alzheimer's Association. Having surpassed its fundraising goal, NARFE has extended the campaign to "$10 Million in 2012." NARFE forged a relationship with the Alzheimer's Association in 1985 and fulfilled its first $1 million pledge in 1991. Since then, its members have been steadily raising money to fund Alzheimer's research.

"NARFE has been committed to raising funds for vital research to the Alzheimer's Association for over 25 years," said Angela Geiger, chief strategy officer of the Alzheimer's Association. "We thank the thousands of loyal NARFE members for their outpouring support and continued efforts throughout their communities. NARFE's committed fundraising successes will contribute to finding a cure for this national health crisis."

NARFE became a charter member of the Alzheimer's Association's Zenith Fellows, a premier group of donors of $1 million to Alzheimer's research, in 1991. NARFE announced at its 2011 national convention that its new goal will increase by an additional $1 million, bringing the cumulative donation to "$10 million in 2012."

Alzheimer's is the sixth-leading cause of death in the United States, and today as many as 5.4 million Americans are living with the disease. Every 69 seconds, someone in America develops Alzheimer's disease, and by mid-century someone will develop Alzheimer's every 33 seconds. For more information about the Alzheimer's Association, visit alz.org.

NARFE, one of America's oldest and largest associations, was founded in 1921 with the mission of protecting the earned rights and benefits of America's active and retired federal workers. As the largest federal employee/retiree organization, NARFE represents the retirement interests of nearly 5 million current and future federal annuitants, spouses, and survivors.

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New Department of Defense program to fund Alzheimer's research

Alzheimer's Association — 2011-04-15

As the leading voluntary health organization advocating for Alzheimer's care, support and research, the Alzheimer's Association is pleased that Congress has authorized a $15 million investment to be provided to the Department of Defense's Telemedicine and Advanced Technology Research Center (TATRC) to create an Alzheimer's Research Grant Program. The program will provide grants for research that will explore the causes, complications and potential treatments associated with Alzheimer's disease, particularly among those in the military.

The funding will be used to create a peer-reviewed research grant program portfolio which will include traumatic brain injury (TBI), post traumatic stress disorder (PTSD) and other research areas. The Alzheimer's Association joined US Against Alzheimer's in support of the creation of this very important program which will make a significant contribution to greater understanding about Alzheimer's.

Today, an estimated 5.4 million Americans have Alzheimer's disease and that number is expected to climb to 16 million by mid-century without the discovery of disease modifying treatments that prevent, cure or slow disease progression. According to the Alzheimer's Association's 2011 Alzheimer's Disease Facts and Figures report, moderate and severe head trauma, head injury and traumatic brain injury are associated with an increased risk of Alzheimer's disease and dementia.

"We urgently need research that will provide us with a greater understanding of Alzheimer's as well as its impact on current and future military populations. This program is a great step toward achieving that understanding and the progress it will unlock," said Robert Egge, vice president of public policy for the Alzheimer's Association.

Currently the sixth-leading cause of death, Alzheimer's disease is the only cause of death among the top 10 causes without a way prevent, cure or even slow its progression. The need for a greater commitment to research efforts, with endeavors such as the Alzheimer's Research Grant Program within the Defense Department is a step in the right direction. It will help to foster the development of innovative research that will hopefully translate to greater understanding of Alzheimer's and its impact on the military community.

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Media line: 312.335.4078
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Legislation introduced to improve diagnosis of Alzheimer's and strengthen care planning

Alzheimer's Association — 2011-04-07

As the leading voluntary health organization advocating for Alzheimer's care, support and research, the Alzheimer's Association applauds the introduction of the Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act (S. 738/H.R. 1386), which seeks to improve detection and diagnosis of Alzheimer's disease and other dementias and provide access to information and support for newly diagnosed individuals and their families. The Association also commends Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) and Reps. Edward Markey (D-Mass.) and Christopher Smith (R-N.J.) for their leadership in introducing this important legislation.

The introduction of this legislation signals an understanding of how the absence of a formal diagnosis of Alzheimer's deprives individuals of treatments and services that could improve symptoms and help maintain their independence for as long as possible and makes the job of caregivers more difficult.

"Increasing evidence indicates that early diagnosis of Alzheimer's and timely intervention is important, both for people with the disease and their caregivers," said Robert Egge, Alzheimer's Association vice president of public policy. "The later in the disease process individuals receive a diagnosis, the more likely they are to miss opportunities to make key treatment, care and planning decisions,"

Alzheimer's and dementia is a common, costly, and often unrecognized problem in older adults. According to the Association's 2011 Alzheimer's Disease Facts and Figures report, as many as half of those meeting specific diagnostic criteria for dementia never received a diagnosis — and some evidence suggests it could be as high as 80 percent. To provide better medical care and outcomes for people with Alzheimer's and other dementias, the conditions must be detected and diagnosed, followed by care planning and connection to critical services and resources. Also important, a formal and documented diagnosis can begin an important family dialogue about care, financial and legal decisions.

"These conversations allow families to better plan for predictable problems, avoid crises and maintain the best possible quality of life for their loved one," said Egge. "Studies show that when Alzheimer's families work with medical professionals to design a care plan, have access to critical information and are referred to medical and support services, it decreases patient behavioral and psychiatric symptoms and family caregiver anxiety, depression and stress."

With an estimated 5.4 million Americans living with Alzheimer's today and the baby boomer generation growing older — age being the greatest risk factor for the disease — this legislation is a significant step in ensuring that Medicare beneficiaries have access to a broad array of services that include, initial detection of possible dementia, diagnostic evaluation and care planning.

Another key element of the newly introduced HOPE for Alzheimer's Act is the documentation of dementia in medical records. Documentation helps ensure health care providers know they are treating a person with Alzheimer's or other dementia, which is especially critical when a patient is transferred from one care setting to another.

Additionally, most people with Alzheimer's and other dementias have one or more other serious medical conditions. Cognitive impairment caused by Alzheimer's and other dementias can greatly complicate the management of other conditions, resulting in more hospitalizations, longer hospital stays and higher costs. Documentation of cognitive impairment in the medical record allows healthcare providers to adapt treatment regimens accordingly and provide optimal care for Medicare beneficiaries with dementia and other chronic conditions.

The Association is grateful to Sen. Stabenow for crafting this legislation and to Sen. Collins and Reps. Markey and Smith, who also serve as chairs of the Alzheimer's Congressional Task Force. Their sustained leadership on advancing issues that are critical to the growing Alzheimer's community is vital and appreciated. The Association urges members of Congress to co-sponsor and support this important legislation.

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First international collaboration on Alzheimer's disease genetics launched

Alzheimer's Association — 2011-02-01

The launch of the International Genomics of Alzheimer's Project (IGAP) — a collaboration formed to discover and map the genes that contribute to Alzheimer's disease — was announced today by a multi-national group of researchers. The collaborative effort, spanning universities from both Europe and the United States, will combine the knowledge, staff and resources of four consortia that conduct research on Alzheimer's disease genetics.

The four groups are:

The European Alzheimer's Disease Initiative (EADI) in France led by Philippe Amouyel, M.D., Ph.D., at the Institute Pasteur de Lille and Lille University.
The Alzheimer's Disease Genetics Consortium (ADGC) from the United States led by Gerard Schellenberg, Ph.D., at the University of Pennsylvania School of Medicine.
The Genetic and Environmental Risk in Alzheimer's Disease (GERAD) from the United Kingdom led by Julie Williams, Ph.D., at Cardiff University.
The neurology subgroup of the Cohorts for Heart and Aging in Genomic Epidemiology (CHARGE) led by Sudha Seshadri, M.D., at Boston University.

"Identification of genes that contribute to Alzheimer's risk and that influence the progression of disease will help lead us to the cause of the disease, identify proteins and other new targets for drug development, and provide genetic methods for determining which people are at greatest risk for Alzheimer's disease when preventative measures become available," said Dr. Schellenberg.

"This is extremely important work in taking our ability to detect and treat Alzheimer's disease to the next level," said Dr. Amouyel.

While each consortium alone is currently working with thousands of participants — including people with Alzheimer's and those free of dementia — scientists in the four groups recognize that only by working together can they amass a large enough collection of participants to accelerate gene discovery. Formation of IGAP creates a shared resource database that includes genetic data for the more than 40,000 individuals.

Drs. Amouyel, Schellenberg, Seshadri and Williams are enthused about the collaboration that brings together, for the first time, all of the large genetics groups in the world working on Alzheimer's disease. They share high expectations that the cooperative effort will greatly advance knowledge about Alzheimer's disease.

"Working together on this scale will bring us years closer to understanding this cruel disease, and to the development of new Alzheimer's treatments," said Dr. Williams.

The formation of IGAP is supported by the Alzheimer's Association and the Fondation Plan Alzheimer.

"We're pleased to fund this project that will bring together well-established and highly regarded research groups throughout the world to enable an unprecedented sharing and analysis of Alzheimer genetic data," said William Thies, Ph.D., Alzheimer's Association chief medical and scientific officer, and Philippe Lagayette, president of the Fondation Plan Alzheimer in France.

Alzheimer's disease is a progressive, neurodegenerative disorder that is fatal, and has no prevention methods and no cure. Available drugs only marginally affect disease severity, making Alzheimer's disease effectively untreatable. Alzheimer's disease invariably progresses to complete incapacitation and death over a period of several years.

In the World Alzheimer Report 2010, Alzheimer's Disease International estimates that there are now 35.6 million people living with dementia worldwide, increasing to 65.7 million by 2030 and 115.4 million by 2050. According to the Report, the total estimated worldwide costs of dementia are US$604 billion in 2010.

"The skyrocketing prevalence and cost of Alzheimer's disease and related dementias will soon undermine the delivery of healthcare worldwide," said Dr. Schellenberg. "That gives innovative collaborations like this new international genomics project added incentive to act quickly and boldly to make new discoveries."

"Our first efforts will be to bring together all the data from the different groups so that they can be analyzed," said Dr. Amouyel. "The next step will be to perform new analysis on subjects not yet in any genetics studies to further increase the number of people in our studies and to increase the ability to detect new genes."

The International Genomics of Alzheimer's Project (IGAP)
The primary goal of IGAP is to completely understand the role inheritance plays in Alzheimer's disease. To achieve this goal, IGAP will work to identify all the genes that contribute to the risk of developing this disease. IGAP investigators will have access to combined genetic data from a large number of Alzheimer's disease subjects and compare it to genetic data from an equally large number of elderly people who do not have Alzheimer's.

In the initial phase of the work, more than 20,000 people with Alzheimer's and about 20,000 healthy elderly subjects will be compared. As the study progresses, 10,000 additional people with Alzheimer's and the same number of healthy elderly subjects will be added to the study. The subjects for these studies come from different Alzheimer research project locations across Europe, the UK, the US, and Canada. Results from IGAP studies will be presented at scientific meetings and publications as the information is developed. IGAP expects to present its first findings at the Alzheimer's Association International Conference on Alzheimer's Disease (AAICAD) in Paris, July 16-21, 2011.

The ADGC is supported by the National Institute on Aging/National Institutes of Health (NIH). The EADI is supported by the Fondation Plan Alzheimer, the Institut Pasteur de Lille and Inserm. GERAD is supported by the Medical Research Council (UK). CHARGE is supported by the NIH, Erasmus University and others.

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Media line: 312.335.4078
E-mail: media@alz.org

Generation Alzheimer's report calls Alzheimer's defining disease of the baby boomers

Alzheimer's Association — 2011-01-27

Alzheimer News 1/27/2011

Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer's — a devastating, costly, heartbreaking disease. Increasingly for these baby boomers, it will no longer be their grandparents and parents who have Alzheimer's — it will be them.

"Alzheimer's is a tragic epidemic that has no survivors. Not a single one," said Harry Johns, president and CEO of the Alzheimer's Association. "It is as much a thief as a killer. Alzheimer's will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now."

According to the new Alzheimer's Association report Generation Alzheimer's, it is expected that 10 million baby boomers will either die with or from Alzheimer's, the only one of the top 10 causes of death in America without a way to prevent, cure or even slow its progression. But while Alzheimer's kills, it does so only after taking everything away, slowly stripping an individual's autonomy and independence. Even beyond the cruel impact Alzheimer's has on the individuals with the disease, Generation Alzheimer's also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.

"Most people survive an average of four to six years after a diagnosis of Alzheimer's disease, but many can live as long as 20 years with the disease," said Beth Kallmyer, senior director of constituent relations for the Alzheimer's Association. "As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities. This long duration often places increasingly intensive care demands on 11 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security."

The report also offers very personal glimpses into the lives of families who are in the throes of caring for a loved one with Alzheimer's disease, including a son who struggles to change the diapers of the mother who changed his as an infant, and a husband who watches his wife's fascination with the "lady in the mirror," not realizing the lady in the mirror is her.

In addition to the human toll, over the next 40 years Alzheimer's will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America. And while every 70 seconds someone in America develops Alzheimer's disease today, by 2050 someone will develop the disease every 33 seconds — unless the federal government commits to changing the Alzheimer trajectory.

"Alzheimer's, with its broad-ranging impact on individuals, families, Medicare and Medicaid, has the power to bring the country to its financial knees," said Robert J. Egge, Alzheimer's Association vice president of public policy. "But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation, there has been great success. In order to see the day where Alzheimer's is no longer a death sentence, we need to see that type of commitment with Alzheimer's."

The full text of Generation Alzheimer's can be viewed at www.alz.org/boomers.

Contact: Alzheimer's Association
Media line: 312.335.4078
E-mail: media@alz.org

President Obama signs landmark legislation laying the foundation for a national Alzheimer strategy

Alzheimer's Association — 2011-01-04

Alzheimer News 1/4/2010

As the leading care, research and advocacy organization for Alzheimer's disease, the Alzheimer's Association applauds President Obama for signing the National Alzheimer's Project Act (NAPA) into law. NAPA creates for the first time a coordinated national strategy to confront one of America's most feared and costly diseases, a disease that will only plague more baby boomers as they age. Given the scale of the Alzheimer epidemic and the growing number of Americans directly affected every single day, NAPA will provide an essential framework within the government that recognizes the Alzheimer crisis is no longer emerging but is here.

"The Alzheimer's Association is pleased that a much needed plan will now be put into place to address the challenges of Alzheimer's disease, currently the sixth-leading cause of death in this country. In fact, among the 10 leading causes of death, it is by far the fastest growing — increasing more than 50 percent from 2000 to 2007," said Harry Johns, Alzheimer's Association president and CEO. "Given the devastation experienced by millions of families because of this disease and the staggering economic costs, particularly to Medicare and Medicaid, we must have an effective strategy now. The fact that Alzheimer's is the only one of the top 10 causes of death without a way to prevent, cure or even slow it underscores the critical need for the swift, aggressive implementation of this legislation."

Building on the work of the Alzheimer's Association and the recommendations of the Alzheimer's Study Group, an independent, bipartisan panel created to evaluate the government's current efforts to combat the disease, NAPA will lead to the creation of a national strategic plan to overcome the Alzheimer's disease epidemic. It would also establish an inter-agency council to work with the Secretary of Health and Human Services to give a full assessment of what needs to be done to address the threat of Alzheimer's on multiple fronts including care, research and support. NAPA ensures strategic planning and coordination of the fight against Alzheimer's across the federal government as a whole

"Beyond the human impact on families which cannot be underestimated, the economic burden — with total care costs escalating from $172 billion today to more than $1 trillion by 2050 — are significant as well," said Robert J. Egge, Alzheimer's Association vice president of public policy. "Alzheimer's leaves American families, Medicare, Medicaid and our healthcare system defenseless against skyrocketing costs, and it leaves each of us vulnerable to the wide-ranging effects of this devastating disease. We need transformative, cost-effective strategic solutions to tackle a national public health emergency with widespread social and economic consequences. NAPA will help to put the nation on the right track and we commend the Obama administration for recognizing this."

The Alzheimer's Association stands with millions of Alzheimer families in thanking President Obama for signing this legislation into law and looks forward to working with the Secretary of Health and Human Services to fulfill the promise of NAPA.

Contact: Alzheimer's Association
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E-mail: media@alz.org

Regular walking may slow decline of Alzheimer's

Alzheimer's Association — 2010-12-02

Alzheimer News 12/2/2010

First-time inclusion of Alzheimer's and dementia in Healthy People 2020

The Alzheimer's Association is pleased that for the first time since its inception in 1979, the federal government's Healthy People report includes national health goals and objectives related to Alzheimer's disease and other dementias. The report — known as Healthy People 2020 — represents the nation's highest priorities for health promotion and disease prevention and is central to establishing measurable national public health goals for coming decade at all levels of government.

With more than 5 million Americans living with Alzheimer's today and as many as 16 million individuals who could be affected by 2050, inclusion in Healthy People 2020 underscores the recognition of the growing public health threat Alzheimer's and dementia pose to the nation.

Alzheimer's is the sixth-leading cause of death and was the only one of the 10 leading causes of death that did not have a designated topic area in the Proposed Healthy People 2020 Objectives released last fall. A strong grassroots mobilization effort led by the Alzheimer's Association, which included Alzheimer advocates from across the country, a number of the nation's top scientists and researchers, and policymakers from across the political spectrum, has resulted in the inclusion of Alzheimer's and other dementias as a new and separate topic area clearly conveying the importance of Alzheimer's and dementia on a national scale.

The objectives identified in the report include increasing the proportion of persons with diagnosed Alzheimer's disease and other dementias, or their caregiver, who are aware of the diagnosis. Awareness that Alzheimer's or dementia is present is central to ensuring individuals and their families have knowledge of available treatments, care and support services and also greater opportunities to make future care, financial and legal plans. Yet today, fewer than half of those with Alzheimer's have a diagnosis in their medical records.

Another key objective that would contribute to decreasing costs associated with the disease is the goal of reducing the number of preventable hospitalizations for individuals living with Alzheimer's and other dementias. People with Alzheimer's and other dementia typically have higher hospital admissions, longer stays and higher hospital readmission rates — and therefore incur higher costs. Preventable hospitalizations are defined as a hospitalization for a condition that can be prevented altogether or whose course can be mitigated with optimum outpatient management, thus preventing the hospitalization.

"Alzheimer's disease prevalence increases with age, which is why the number of people affected by these conditions will soar rapidly — in lock step with increases in the number of adults age 65 and older from 2011 to 2030," said Robert Egge, Alzheimer's Association vice president of public policy." As the leading research, advocacy and support organization for Alzheimer's disease, the Association has actively sought the inclusion of Alzheimer's and dementia in Healthy People 2020. We recognize the importance of having Alzheimer's clearly represented in the national health framework, as it is central to all levels of government taking action to address the mounting crisis."

The Association recognizes the efforts of its strong network of advocates who made their concerns about the absence of the disease in the proposed draft well-known. Additionally, the Association would like to thank the Healthy Aging Program at the Centers for Disease Control and Prevention (CDC), which worked to educate the Secretary's Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020, the Federal Interagency Workgroup, and other stakeholders about the importance of having Alzheimer's and dementia included in Healthy People 2020.

Contact: Alzheimer's Association
Media line: 312.335.4078
E-mail: media@alz.org

Regular walking may slow decline of Alzheimer's

Alzheimer's Association — 2010-12-01

New research suggests that walking about five miles a week may help slow the progression of cognitive illness among seniors with mild forms of cognitive impairment or Alzheimer's disease.
- Bloomberg News

Children ease Alzheimer's in South Korea

Alzheimer's Association — 2010-11-29

One of the world's fastest-aging countries, with nearly 9 percent of its population over 65 having Alzheimer's, South Korea is training thousands of people, including children, as "dementia supporters," to recognize symptoms and care for people with the disease.
- The New York Times

MetLife Foundation Thanksgiving program to benefit Alzheimer's

Alzheimer's Association — 2010-11-22

During Thanksgiving week, football fans will help determine how much of a $500,000 donation the Alzheimer's Association will receive through the MetLife Foundation's Thanksgiving Charity Score Program.

The promotion began during the New York Jets' game on Nov. 21 and runs through the New York Giants' game on Nov. 28 (and includes the Jets' Thanksgiving Day game); fans attending the games in New York can vote for one of four charities they would like to see receive the largest share, and the public can also participate by voting online at www.metlife.com/thanksgiving.

In addition to the Association, the organizations sharing in this year's special contribution are Food Bank for New York City, Jump Start for Young Children and KaBOOM! The charity with the most votes will receive $175,000 from MetLife Foundation. The charity with the second-highest number of votes will receive $125,000, and the remaining two charities will each receive $100,000. Amounts are subject to change in the event of a tie between any of the charities.

Results of the voting will be announced on Nov. 29.

About MetLife Foundation
MetLife Foundation was created in 1976 by MetLife to continue its longstanding tradition of contributions and community involvement. The goal is to empower people to lead healthy, productive lives and strengthen communities. Underlying the Foundation's programs is a focus on education at all ages and a commitment to increasing access and opportunity. The Foundation makes grants in health, education, civic affairs and culture.

Contact: Alzheimer's Association
Media line: 312.335.4078
E-mail: media@alz.org
- Alzheimer's Association

Alzheimer's and money problems

Alzheimer's Association — 2010-11-18

Dealing with Alzheimer's, Dr. Max Gomez lost his life savings and doesn't remember how it happened. Money problems can be a warning sign of the disease.
- CBS News

New Findings on Relationship between Cholesterol and Alzheimers Risk

Alzheimer's Association — 2010-11-11

Results of a study published in the Nov. 10 online issue of Neurology suggest that large decreases in cholesterol levels in old age could be a predictor of developing Alzheimer's disease. Contrary to what has been found in other research, the findings in this study, which was funded in part by the Alzheimer's Association, suggest that cholesterol level in mid-life may not be linked to later development of Alzheimer's disease.

Based on what we know now, people should still control their cholesterol levels in mid-life. In fact, it is important to keep your cholesterol at healthy levels throughout your life. The authors of the newly published study say, "Cholesterol should still be monitored and treated through diet, exercise and medication for cardiovascular and overall health."

This article does not solve the issue of cholesterol's role in Alzheimer's disease risk, but it does add intriguing data to a complex, ongoing discussion. This article presents somewhat unexpected findings, and we need more research to clarify the issue.

* We need long-term observational studies in Alzheimer's disease — like the Framingham Study in heart disease — to learn more about possible risk factors for Alzheimer's over the course of lives and generations.
* We need controlled clinical trials to know for certain if changing lifestyle or intervening with medicine can reduce the risk of Alzheimer's or change the course of the disease.

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ALZHEIMER'S ASSOCIATION INVOLVEMENT

One of the study's co-authors received the Alzheimer's Association Zenith Award, which provided some of the funding for this research. The Alzheimer's Association has been involved in nearly every major advancement in Alzheimer research since the 1980s and is a leader in the global fight for a world without Alzheimer's.

Waking up to the Realities of Alzheimer's Disease

Alzheimer's Association — 2010-10-21

This week, First Lady of California Maria Shriver and the Alzheimer's Association released "The Shriver Report: A Woman's Nation Takes on Alzheimer's." As a friend of Maria's and a longtime Alzheimer advocate, I was proud to contribute an essay about my experiences with the disease to the report.

My mother, the actress Rita Hayworth, passed away in 1987 as a result of Alzheimer's disease. I'm all too aware of the devastation the disease leaves behind, its growing prevalence and the indisputable effect it has on families and our economy. But our nation as a whole seems to be blissfully unaware of the growing urgency of this problem. Why?

The only thing I can imagine is that we are afraid. And as women, as a nation, we can't afford to let our fear dictate ignorance. We must address Alzheimer's, how it will affect our lives and the lives of our children. We must address how we will care for the 10 million baby boomers who will develop the disease.

And it's women who are at the epicenter of the Alzheimer epidemic. The Alzheimer's Association Women and Alzheimer's Poll, unveiled for the first time in The Shriver Report, reveals that two-thirds of the people who have Alzheimer's -- 3.3 million -- are women. In addition, 60 percent of Alzheimer caregivers -- 6.7 million -- are also women.

It's time to harness the power and ability of women helping other women to start a dialogue around this disease. We've made great strides around treatment and prevention of other diseases, such as breast cancer, AIDS and heart disease. Why not Alzheimer's?

My own experience with the disease began when I was young girl. On visits home from boarding school, I would notice my mother's odd behavior. She would move her personal items from her bedroom to other closets around the house, including mine. She would throw all the food out of cupboards. She imagined that someone was trying to break into her home.

As the disease progressed, her confusion, disorientation and fear worsened. As her panic increased, my own helplessness and guilt became overwhelming. It was a terrible day when we stood together in front of a mirror, and she turned to me and asked, "Who are you?"

It wasn't until she had a complete breakdown that I could step in and take charge of my mother's life. I became her caregiver, and I worried about her all the time.

It was Maria Shiver's mother, Eunice Shriver, who first encouraged me to speak out about Alzheimer's disease. I was initially reluctant to share my painful personal experiences. She told me, "You can't let this disease continue to happen. You have to have the courage to make a difference."

I started working with the Alzheimer's Association in 1981. Together, we developed the Rita Hayworth Galas, a series of events held in major cities across the country to raise funds and awareness to fight Alzheimer's disease. On Tuesday, October 26 we'll host the 27th annual New York City Rita Hayworth Gala. This is my way of honoring my mother. This is my way of creating a dialogue.

The Shriver Report: A Woman's Nation Takes on Alzheimer's echoes other experiences like mine through personal essays and photographs that illuminate the effect of Alzheimer's on our nation. Contributors to the report include everyday Americans and well-known public figures, including Barbra Streisand, Terrell Owens, Soleil Moon Frye, ABC News Nightline anchor Terry Moran, CBS News Correspondent Barry Petersen, former First Lady Laura Bush, President Ronald Reagan's daughter Patti Davis, Alzheimer's Study Group Chairs Newt Gingrich and former Sen. Bob Kerrey, Secretary of Health and Human Services Kathleen Sebelius and Vice President Joseph Biden.

You can read their stories in the e-book version of the report. I wake up to the realities of Alzheimer's disease every morning. I wake up knowing my risk, and the risk that our nation's women face as a whole. Now I'm inviting other American women to wake up to the realities of Alzheimer's -- and to take action.

Families struggles with Alzheimer's

Alzheimer's Association — 2010-10-20

In every hard journey through the shadowlands of Alzheimer's, there is always something else that abides. Something even the shadows cannot darken.

There is life, beauty and abiding love. You can see it in a painting, a needlepoint angel, or a dance. And you can see it around the breakfast table at the Jones family home in Fort Lauderdale, Fla.

Watch ABC News all this week for coverage on Alzheimer's disease.

Mornings at the Jones house are a hectic affair. Daughter Natalie has to get to second grade, wife Laura has to get to work. And husband Jay, just 53 years old, has to live with Alzheimer's. He was diagnosed seven years ago.

"Who would ever expect that a 46-year-old man would have Alzheimer's? It was just completely shocking," said Laura Jones.

Jay Jones is one of 500,000 Americans living with early-onset Alzheimer's, cases in which the disease strikes before the age of 65. There are still plenty of bright moments for the Joneses, but there are also flashes of the isolation to come.

"For me, it's like seeing my husband, someone that I love, he's in quicksand, and I can see the fear in his eyes," said Laura. "I can't reach him. I can't get there. I see him slip a little further, and I can't get to him."

Besides the emotional toll, the disease has brought real financial hardship. After Jay lost his job, Natalie, 7, had to move to a new school. Laura holds down a part-time job as a training consultant for an aviation software company, though she makes just a fifth of her husband's old salary. Still, she refuses to dwell on the future.

"All it does is make me weak, and I can't afford to be weak at any moment in the day," she said. "I don't live in fear. It's a waste of time."

Holding On To Precious Memories

Time is so precious for every family touched by Alzheimer's disease. My mom, Margie Lou Moran, tried to hold onto life's precious meaning as she slipped into Alzheimer's. She would repeat the names of her ten children over and over again, trying to keep the memory alive.

"That was one of the last vestiges of the memory, that she could name us all off, even though she had no clue who we were when we were in the room," said my big sister Peggy.

Mom died ten years ago, but Peggy has kept some of her needlework. It was one of her passions, and she took pride in sewing angels for her grandchildren. We all watched as her ability faded along with her mind.

"These kind of, to me, have always shown the progression of the disease," Peggy said as she showed me some of the needlework again. "This one she made for [granddaughter] Rebecca. You can see how small and well done this is. But by the time she got to [granddaughter] Margarita, she was into this much more coarse-looking work."

Whether coarse or fine, the stitching was a gift of love. And love is who we are.

Husband's Touch Brings Back Fading Memories

Sol and Rita Rogers have been married for 63 years. Sol, 91, began losing his wife to Alzheimer's, but he refused to let go.

"I couldn't talk to her. And she didn't know who I was," Sol recalled. "That was a terrible thing."

He started getting into bed with Rita at the nursing home -- touching her and singing to her.

"She became a new woman. She knew who I was, she could talk and smile and laugh, just like overnight," he said.

That is Alzheimer's, too, and that is the hidden gift for those of us touched by the disease, what we know:

Even in the shadows, there is always love. - ABC News

Living with Alzheimer's: Role of caregiver

Alzheimer's Association — 2010-10-19

Maria Shriver and Dr. Marie Savard talk about the sacrifices Alzheimer caregivers make when caring with loved ones with the disease.
- Good Morning America

Dr. Besser and Maria Shriver talk about Alzheimer's disease

Alzheimer's Association — 2010-10-19

Dr. Richard Besser and Maria Shriver discuss Alzheimer's disease and its effect on women. Shriver and the Alzheimer's Association produced the new report The Shriver Report: A Woman's Nation Takes on Alzheimer's.
- ABC World News Tonight

Shriver Report gives a face to Alzheimer's

Alzheimer's Association — 2010-10-18

Maria Shriver talks about the Shriver Report: A Woman's Nation takes on Alzheimer's as well as new research and treatments for Alzheimer's disease.
- Good Morning America

Seven siblings: Who will get Alzheimer's?

Alzheimer's Association — 2010-10-18

A decade ago, a family volunteered to be part of a study to find genetic markers for Alzheimer's disease. The goal is to identify people in middle age and follow them in the hopes of learning how the disease develops.

During the 11 years that Margaret Albus lived with Alzheimer's disease, the worst moment came in the middle of one night, when she called out to her daughter, panic-stricken: "I just want to know who I am."

"I am almost crying now," said Becky Albus, a 53-year-old optician who was looking after her elderly parents that weekend. "I would have done anything not to let her be scared."

Margaret Albus died on Dec. 31, 2009, at the age of 86. But she had mentally slipped away a decade before. She had seven children.

"It's the disease of the long goodbye. It's a perfect description," said another daughter, Elaine Albus, 51, a team leader for a Minnesota business improvement company.

"The fear in her eyes, it's hard to watch over and over again," she said. "There's nothing you can do about the terror but say, 'Mom, it's all right. We'll take care of you.'"

All seven of Margaret's middle-aged children -- four sisters and three brothers -- are at increased risk for developing Alzheimer's disease.

A decade ago, they volunteered to be part of a study at the University of Wisconsin to find genetic markers for the disease that today affects 5 million Americans.

The goal of the study, the largest of its kind, is to identify people in middle age and follow them in the hopes of learning how the disease develops.

Scientists hope that if they can find markers to predict eventual onset, they can develop early interventions.

"There is no cure, we can only save it off," said Dr. Mark A. Sager, director of the Wisconsin Alzheimer's Institute, who heads the research.

"This is a terrible disease and to have a parent or anyone in the family [with Alzheimer's] leaves an indelible mark," he said. "The loss of identity and loss of personality -- we have an organ called the brain that is who we are."

The disease affects so many people that when the study was announced 10 years ago, the institute got 600 phone calls in the first 24 hours.

"We never had to recruit, that's how much interest there was in the study," he said. "And people have traveled large distances to be a part of it."

Now, the study includes 1,500 participants with a mean age of 53, including all seven of the Albus siblings. The hardest part has been finding those who don't have a family history -- and a compelling reason to participate -- for a comparison group, according to Sager.

Risk factors for the disease include increasing age and abnormalities in the apolipoprotein E gene (APOE), which is on chromosome 19 and has three different alleles, or alternative purposed, like those for eye and hair color.

One -- the e4 allele -- is associated with increased risk. Not all who have this gene will go on to get the disease, but they are more susceptible.

APOE was first recognized for its importance in lipoprotein metabolism and cardiovascular disease, but has more recently been studied for its role in the onset of Alzheimer's disease.

About 44 percent of the study participants have APOE abnormalities. They have more than double the risk of the general population, 15 to 20 percent of whom have that gene sequencing.

"The disease is more prevalent in women because they live longer," said Sager.

Disease onset is typically in the late 70s and early 80s. By age 85, 30 to 50 percent of adults have symptoms.

Margaret Albus, a homemaker, raised her large family in the small Wisconsin town of Lady Smith, where her husband Roger ran a business that made conveyers for farm equipment.

But when she reached 75, her memory began to fail. After tests revealed she had Alzheimer's disease, the siblings called a family conference.

"All of us kids came from wherever we lived and sat around the table," remembers Elaine. "We all knew there was something wrong with Mom, but to have it confirmed is awful. On the ride back I was with one of my sisters who also live in the Twin Cities and we cried. There is nothing you can really do."

"Mom just sat in the meeting, kind of like it wasn't about her," said Elaine. "She never really remembered getting the diagnosis."

Her family meant everything to her, but eventually, Margaret Albus didn't even remember who her children were.

"Once in a while she would say, 'Elaine,' and I would look at her. Wow, where did that come from?" said Elaine. "Sometimes she would know you and sometimes she wouldn't. It's really hard to see your parents -- someone to talk to about what's going on in your life -- and then they're not there anymore."

The Albus children know that one day this may be their fate. Some of them have already bought long-term care insurance and they talk about looking into nursing homes and assisted care facilities after reaching retirement.

"I kind of feel like it's for sure, out of seven of us, a couple of us are going to get it," said Elaine. "So you have to keep telling yourself it could be you, and be prepared for it."

But they say they keep their sense of humor.

"In my family it's become a natural thing to do," she said. "Every time someone forgets, we say, 'It's starting already.' We say we will get rooms next to each other. It's a little bit of denial, joking with each other."

"I fully expect that I will be in a facility," said Elaine, who is single and doesn't have children. "I want my nieces and nephews to get me in early enough. My one big fear is being one of those cat ladies, and the social services come in, and I am living in garbage with animals all over the place."

The Albus family had both the money and manpower to look after their mother, so care giving was not as stressful as it is for some families.

At first, Roger Albus looked after his wife, but soon, the siblings set up a weekend schedule to help give their father some relief.

"Six years ago, Dad was totally stressed out," said Elaine.

Kathy Cronick, 48 and the youngest, lives in Lady Smith. She checked in on her parents each day, handling the shopping and doctors' visits.

The others, who lived across Minnesota and Wisconsin, two or three hours away, set up a rotation, staying with their parents on weekends.

"I cannot imagine how a smaller family does it with not so many people to pitch in," she said. "It would be much more stressful."

Cronick said Alzheimer's disease is "always in the back of my mind.

"But there's nothing you can do about it and there are no cures, so what happens, happens. I just hope I forget quickly," she said. "I know it was really scary to see my Mom, but I don't dwell on it."

The siblings said they were lucky because their mother was "an easy person and always good natured," which is not always the case with Alzheimer's patients.

"She was unhappy when we took the car keys away, then we told her we were going to get the car to get fixed and she accepted that," said Elaine Albus. "I hear others have a personality change or become totally violent."

"As Mom would say, 'We are blessed.' And as awful as it was, it could have been so much worse," she said.

But things started to get more difficult.

"Eventually my dad started not sleeping well and worried about Mom getting up," said Elaine. "We convinced him to get overnight help so he could get a solid night's sleep and they could hear when she wandered."

They blocked off stairs and put locks high on doors so their mother couldn't open them. Her husband put wind chimes on the bedroom door so that he could hear it opening and closing.

Until their mother got pneumonia and died in the hospital, the family was able to keep her at home, where their father, now nearly 94, still lives on his own. "He's pretty sharp for his age," said Elaine.

"Right until the end, she knew Dad was someone important to her, though she didn't know who he was," said Becky Albus. "But we feel really blessed we didn't have to put her in a nursing home."

Some of the Albus siblings are happier about the poking and prodding of the Alzheimer's study than others.

Researchers took fasting blood samples, weight and measurements. Every two or three years, they are subjected to periodic mental tests, repeating word lists and solving math problems.

The follow-up continues "until they lose their funding or make some discovery," according to Elaine.

The study will compare its data, is looking at factors that might contribute to the onset of Alzheimer's, such as lifestyle choices and diet. Exercise is thought to be protective. They keep track of monitor cognition, years of education, biochemical parameters in the blood and rising levels of homocysteine, an amino acid associated with dementia.

"There is good data to suggest that midlife obesity, high levels of cholesterol in midlife and a host of other things that occur in midlife that increase the risk 20 or 30 years later," said study director Sager.

Participants are not told the results of all these tests, and the institute has filed a certificate of confidentiality with the National Institutes of Health, so that personal data can never be released and have an impact on insurance decisions.

At information sessions, Sager and his colleagues tell families like the Albuses, "There's no guarantee [the study] will help you one bit, but we hope your children will be the beneficiary of the research."

"At first, I naively thought this will save Mom -- they'd figure something out," said Becky Albus. "But it was quickly obvious that wasn't going to happen. And it probably won't happen for us either."

But the study has been "remarkable," said Elaine Albus. "I think we are all doing this because we loved our Mom. Mom can't benefit, but we might be able to benefit my 13 nieces and nephews."

"Its' very frightening to know that as the baby boomers age, there will be so many who get Alzheimer's," said her sister, Kathy. "We just wanted to do what we could to help."

To learn more about the work that researchers are doing to untangle the mysteries of neurocognitive disorders, visit the website of the Cleveland Clinic Neurological Institute's Lou Ruvo Center for Brain Health here and the Keep Memory Alive (KMA) website here.
- Good Morning America

A Woman's Nation Takes on Alzheimer's

Alzheimer's Association — 2010-10-18

Karen Parks understood when her 80-year-old mother was losing her memory, but her world came screeching to a sudden and devastating halt when her 56-year-old husband Jerry was diagnosed with early-onset Alzheimer's.

"I could see myself sitting there. I thought to myself, 'should I be putting my arm around my husband? Am I hearing this right?' It just absolutely stops you cold," she said.

Jerry was at the peak of his career as a successful construction executive, but he was laid off when his memory began to fail.

With two of their children still at home, the Parks family was forced to downsize and Karen went back to work as a teacher -- after 20 years away from the profession.

Families like the Parks are the focus of a groundbreaking report by Maria Shriver's A Woman's Nation in collaboration with the Alzheimer's Assocation.

Maria Shriver, the first lady of California, sat down with "This Week" anchor Christiane Amanpour to discuss her extensive new report on Alzheimer's, "The Shriver Report: A Woman's Nation Takes on Alzheimer's," which provides a compelling connection between Alzheimer's and Women. After her father was diagnosed with Alzheimer's in 2003, Shriver's said she began a journey of trying to understand the disease That "turned [her] into…an activist to try to find a cure, bring attention to this disease and reduce some of the stigma."

"Sixty percent of the people who get it are women and they are also doing the caretaking" of people with the disease, Shriver said. And "millions of these women are also working full-time."
-ABC News

Seven siblings: Who will get Alzheimer's?

Alzheimer's Association — 2010-10-18

After Caring for Their Elderly Mother, Brothers and Sisters Enter Study to Help Find a Genetic Marker

"I am almost crying now," said Becky Albus, a 53-year-old optician who was looking after her elderly parents that weekend. "I would have done anything not to let her be scared."

Margaret Albus died on Dec. 31, 2009, at the age of 86. But she had mentally slipped away a decade before. She had seven children.

"It's the disease of the long goodbye. It's a perfect description," said another daughter, Elaine Albus, 51, a team leader for a Minnesota business improvement company.

"The fear in her eyes, it's hard to watch over and over again," she said. "There's nothing you can do about the terror but say, 'Mom, it's all right. We'll take care of you.'"

All seven of Margaret's middle-aged children -- four sisters and three brothers -- are at increased risk for developing Alzheimer's disease.

A decade ago, they volunteered to be part of a study at the University of Wisconsin to find genetic markers for the disease that today affects 5 million Americans.
- Good Morning America

Attacking Alzheimer's

Alzheimer's Association — 2010-10-14

An Alzheimer diagnosis is a terrifying sentence: a slow deterioration of the mind that entwines a loss of self and life – a misery for both the person with the disease and his or her family. More than half of all Americans now know someone with Alzheimer's; for almost 30% of Americans, that person is a family member. And as Alice Park reports in her probing cover story, the aging of the baby-boomer generation will produce an explosion in the number of patients: by 2050, as many as 13.4 million Americans may be affected. That means skyrocketing health care costs and incalculable burdens on the daughters, sons and spouses who may have to give up jobs, savings, time and energy to care for loved ones.

But the bleak landscape of Alzheimer's is changing. In the past two years, advances in the study of the human genome have opened up new avenues of exploration for Alzheimer's researchers in the realms of prevention and possible treatment. Alice's story sheds light on the recent developments in the field — both the failures and the successes — to show where the science is headed and why there's reason for hope. Accompanying her story are dispatches from the front lines of Alzheimer's: by Patti Davis — whose father, former President Ronald Reagan, succumbed to the disease in 2004 — and by Mary Ann Becklenberg, a retired health care professional who is in the early stages of the disease. And in her back-page essay, TIME executive editor Nancy Gibbs examines the considerable economic and emotional impact of Alzheimer's and other degenerative conditions on caregivers. (See how to prevent illness at any age.)

Our special report on Alzheimer's is a collaboration with Maria Shriver, whose study The Shriver Report: A Woman's Nation Takes On Alzheimer's, produced with the Alzheimer's Association, investigates the disease's epidemic with special attention to the outsize burden it places on women as patients and as caregivers. (Maria's father, politician and activist Sargent Shriver, was diagnosed with the disease in 2003.) Our story incorporates poll data from the report, and Maria will first discuss the report's findings on ABC's This Week with Christiane Amanpour on Oct. 17. The full report will be available as an e-book from Simon & Schuster; visit alz.org or shriverreport.com for details. (See the top 10 medical breakthroughs of 2009.)

This week, our coverage of Iraq doubles as a joint homecoming. Bobby Ghosh, our deputy international editor and our Baghdad bureau chief for five years, returned to Iraq with a companion: Nate Rawlings, a graduate student at Columbia University who interned with TIME this summer — and is a former U.S. Army captain who served two tours of duty in Iraq beginning in 2006 and 2008. For nine days, Bobby and Nate saw Iraq through each other's eyes, and the story in the magazine goes back and forth between their voices. For both men, the changes were unexpected — and in the main, heartening. "I prepared myself for the tragic feeling that our losses had been in vain," says Nate. But he found the opposite to be true.
- Time.com

Good news about Alzheimer's

Alzheimer's Association — 2010-10-14

You probably don't think of Alzheimer's as a woman's disease, but it is. Of the 5.3 million Americans who have it, nearly 70 percent are women. That's because the risk of this brain disease doubles every five years after age 65 -- and women live longer than men. Alzheimer's not only strikes us more, but it affects us more because women take on a greater caretaking role than men do. The majority of those caring for affected parents, parents-in-law, grandparents, or other relatives are women, and 34 percent of them have children under age 18 living at home, too. There is some good news, thanks to a wave of breakthrough studies and a landmark report produced by the Alzheimer's Association and Maria Shriver, the first lady of California. The most exciting development? Mounting evidence suggests you may be able to dodge the bullet of Alzheimer's, or at least delay its onset by years, with healthy lifestyle changes. We've rounded up the latest research and the best advice for beating this heartbreaking disease.

Maria's Mission
Women coping with loved ones who have Alzheimer's often feel confused, alone and overwhelmed with learning about treatments and care. Shriver knows these struggles firsthand. Her father, former politician and Peace Corps director Sargent Shriver, was diagnosed with Alzheimer's in 2003; today he doesn't know her name or who she is. Motivated by her experience, she started a personal crusade to raise awareness of the impact Alzheimer's has on the lives of women, both as patients and caregivers. She first wrote a children's book -- What's Happening to Grandpa? -- then produced a four-part documentary for HBO in 2009 titled The Alzheimer's Project. Now her most exhaustive look at the disease to date, prepared in conjunction with the Alzheimer's Association, is being released on awomansnation.com and alz.org. About this latest effort Shriver told us, "I want to send the message that this is a national epidemic. It affects all of us, not just the elderly, and I want sufferers of Alzheimer's and their children, parents, families, husbands, and wives to know they're not alone." In "The Shriver Report: A Woman's Nation Takes On Alzheimer's," you'll find information on the latest advances in research as well as practical advice and personal stories from diverse Americans affected by the disease.

Cutting-Edge Advances

New Insights into Diagnosis
In 2011 the National Institute on Aging and the Alzheimer's Association will release new criteria for diagnosing the disease. The guidelines should help doctors pinpoint cases more accurately -- and promote scientific testing of new methods to detect the disease earlier when it may be more treatable.

Expanding Therapy Options
The Alzheimer's Association estimates there are more than 100 current studies on dementia and Alzheimer's. Dozens of experimental drugs will soon be ready to test.

Immunotherapy Progress
Several experimental vaccines are being tested in Alzheimer's patients. Most are aimed at preventing or reducing the buildup of brain proteins that may cause the disease.

A Step Forward in Early Detection
Researchers are getting closer to the goal of identifying the disease before symptoms are evident (which could pave the way to earlier intervention). A recent study published in the Archives of Neurology found that a sample of spinal fluid contains biomarkers that can accurately predict who will get Alzheimer's. And PET scans of the brain may reveal tell-tale changes in protein structures that begin years, perhaps even decades, before symptoms show up.

Get Moving and More!
Being active physically, mentally, and socially may lower your risk of Alzheimer's. Case in point? A Harvard Medical School study found that any combination of moderate activity, such as climbing stairs, bowling, golfing, or doing yard work or housework for at least an hour a day, reduced the risk of dementia by 45 percent. We checked in with award-winning medical journalist Jean Carper, author of the new book 100 Simple Things You Can Do to Prevent Alzheimer's and Age-Related Memory Loss, for her personal take.

Is the thinking "use it or lose it"?
Yes. Experts believe exercise keeps dementia at a distance by promoting blood flow to the brain and helping to flush away damaging proteins. Learning new things and having an active social life prevent brain cells from atrophying and actually enlarge them.

What kinds of mental activities might really work to protect you?
Anything that gives your brain a good workout, like playing Scrabble, mastering a new musical instrument, or reading difficult books. When I learned that I was at high risk for Alzheimer's, I decided that I would learn Spanish, partly because I'm terrible at foreign languages. It's the effort -- not how well you do -- that helps keep memory and thinking intact. In fact, if you're great at crosswords, you probably should find something more challenging.

Why does socializing matter?
The best answer investigators can come up with is that it keeps the brain's communication and memory skills in good shape. What seems to be important is regular contact with friends and family, since studies show people who feel isolated and lonely are far more likely to experience cognitive decline.

Brain-Saving Diet Shifts
Eating a Mediterranean-type diet can cut your chances of Alzheimer's by 38 percent, says a recent study. There's not just one nutrient that does the trick, though; you've got to follow the whole plan to keep your memory sharp.

EAT LESS OF THESE
Beef, lamb, pork, processed meats
Butter
Processed snacks and sweets
Baked potatoes, French fries, white bread, rice, pasta
Soda, sugary drinks
Whole milk, cheese

AND MORE OF THESE
Lean poultry, fish, beans
Oil and vinegar salad dressing
Nuts, peanut butter, fresh fruit (such as apples, pears, peaches, oranges)
Green leafy vegetables, sweet potatoes, whole-grain bread
Fresh juice, tea
Low-fat dairy products

Mind Your Heart Health
It appears that the same things that affect your heart health also impact brain health, says Maria Carrillo, PhD, senior director of medical and scientific relations at the Alzheimer's Association. It's another good reason to get these risk factors for heart disease and stroke under control.

High Cholesterol
In one study, people in their early 40s with elevated cholesterol were 50 percent more likely to develop dementia in their 60s and 70s. Excess cholesterol in the blood may promote the formation of damaging plaque in the brain.

High Blood Pressure
Readings above 140/90 can increase your risk of Alzheimer's by compromising blood flow to the brain.

Smoking
It doubles your risk of Alzheimer's, according to a Dutch study. But a French study showed quitting brings the risk of cognitive troubles back down.

Diabetes
People with diabetes have a 60 percent higher risk of developing Alzheimer's, according to research from Columbia University. High blood glucose levels might harm brain cells.

HELP DISCOVER THE CURE

To get involved in studies of innovative Alzheimer's treatments, go to alz.org/trialmatch. This new Alzheimer's Association service quickly matches eligible volunteers to clinical trials -- whether they're healthy, at risk for Alzheimer's, or already suffering from the disease.
- Ladies' Home Journal

Report: Worldwide costs of dementia set to soar

Alzheimer's Association — 2010-09-21

The total estimated worldwide costs of dementia are $604 billion in 2010, according to the newly released World Alzheimer Report 2010: The Global Economic Impact of Dementia from Alzheimer's Disease International (ADI), a London-based, nonprofit, international federation of 73 national Alzheimer organizations, including the Alzheimer's Association (U.S.).

Released on World Alzheimer's Day, Sept. 21, the report found that:
* Dementia care costs around 1 percent of the world's gross domestic product (GDP).
   o If dementia care were a country, it would be the world's 18th largest economy (ranking between Turkey and Indonesia).
   o If dementia care was a company, it would be the world's largest by annual revenue, exceeding Wal-Mart ($414 billion) and Exxon Mobil ($311 billion).
* By 2030, worldwide societal costs will increase by 85 percent (a very conservative estimate considering only increases in the number of people with dementia).
* Worldwide, the costs of dementia are set to soar.
    o The report finds that costs in low and middle income countries are likely to rise much faster than in high income countries, because, with economic development, costs will increase towards levels seen in high income countries, and because increases in numbers of people with dementia will be much sharper in those regions.

In the report, costs were attributed to the direct costs of medical care (the costs of treating dementia and other conditions in primary and secondary care), direct costs of social care (provided in residential care settings and by community care professionals) and informal care (unpaid care provided by family caregivers and others).

"This report clearly illustrates that dementia is already affecting health systems around the world, and for the families who are forced to face Alzheimer's the anguish is universal," said Harry Johns, Alzheimer's Association president and CEO. "The World Alzheimer Report 2010 urges all countries — including the United States — to develop national plans to deal with the disease.

"Given the magnitude and the impact of Alzheimer's, the U.S. federal government's response to this crisis has been stunningly neglectful," said Johns. "We know Alzheimer's will place a massive strain on an already overburdened healthcare system, especially Medicare and Medicaid. Substantial investment in Alzheimer research is required to avoid an even more painful future for American families and already overwhelmed state and federal budgets. Yet, the government has no national plan for how to deal with this crisis."

The Association is working to enact critical legislation to address these issues. The National Alzheimer's Project Act (S.3036/H.R.4689) would create a National Alzheimer's Project Office and an inter-agency Advisory Council responsible for developing a national plan to overcome the Alzheimer crisis. This new office would provide strategic planning and coordination for the fight against Alzheimer's across the federal government as a whole, touching on issues from research to care to support, at no additional cost to the government.

"We need all Americans concerned about Alzheimer's disease to tell their representatives in Congress and the president to pass the National Alzheimer's Project Act as a significant step forward in the fight against Alzheimer's," said Robert Egge, Alzheimer's Association vice president of public policy.

This summer, the Alzheimer's Association and the Alzheimer research community have been working —and cycling — together to do just that. The Alzheimer's Association Alzheimer's Breakthrough Ride was originally conceived by Alzheimer researcher Bruce Lamb, Ph.D., of the Department of Neurosciences at the Lerner Research Institutes of the Cleveland Clinic and the Departments of Neurosciences and Genetics at Case Western Reserve University, who shared the idea with the Alzheimer's Association and then enlisted the participation of researchers and scientists from across the country.

"It was a Sunday morning last summer and I was on my usual bike ride," Lamb said. "I felt increasingly concerned about the declining funding for Alzheimer research through the National Institute on Aging. Because of this, many Alzheimer's research laboratories were forced to contract in size and some closed altogether. Even worse, critical research that could provide new insights into potential Alzheimer therapies would not be conducted. Given the increasing number of people affected by Alzheimer's, more research is required, not less."

The Alzheimer's Breakthrough Ride engaged more than 55 researchers and 100,000 Americans to urge Congress to make Alzheimer's a national priority. Demonstrating both the urgency of the issue and the dedication of the research community, these researchers spent 67 days this summer cycling relay-style throughout the United States to raise awareness about Alzheimer's disease.

Today, the Alzheimer's Breakthrough Ride culminates at Upper Senate Park in Washington, D.C., when the Alzheimer's Association and the research riders present a petition with more than 100,000 signatures to Congress.

"A crisis of this magnitude requires commitment and dedication from all of us — from citizens, the scientific community, business and government," said Lamb. "The outpouring of support from the public has been overwhelming as we've cycled across the country. Now we need elected officials to prove they understand what's at stake by developing a comprehensive Alzheimer's disease strategy and investing in research."

In addition to the recommendation for countries to develop national Alzheimer's plans, the 2010 World Alzheimer Report contains six further recommendations, which call on governments to increase dementia research funding, develop policies and plans for long-term care, and ensure access to cost-effective and appropriate healthcare services.

U.S. Alzheimer's disease facts and figures

In the United States, according to the Alzheimer's Association's Alzheimer's Disease Facts & Figures 2010, there are as many as 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer's. In 2010, there will be a half million new cases of Alzheimer's. By 2050, there will be nearly a million new cases of Alzheimer's every year.

Alzheimer's was the seventh-leading cause of death in the country in 2006, the latest year for which final death statistics are available. It was the fifth-leading cause of death among individuals aged 65 and older. From 2000 to 2006, death rates have declined for most major diseases — heart disease (-11.1 percent), breast cancer (-2.6 percent), prostate cancer (-8.7 percent), stroke (-18.2 percent) and HIV/AIDS (-16.3) — while Alzheimer's disease deaths rose 46.1 percent.

The Alzheimer's Association estimates that total U.S. payments for health and long-term care services for people with these conditions will amount to $172 billion from all sources in 2010. Nearly 11 million U.S. family members and other unpaid caregivers provided 12.5 billion hours of care for people with Alzheimer's and other dementias, valued at $144 billion.

2010 World Alzheimer Report

The 2010 World Alzheimer Report is a culmination of the most comprehensive, current data on the prevalence of dementia and the costs associated with care for people affected in different world regions. Methodology used to prepare the 2010 World Alzheimer's Report is explained in the full printed report and can be found online at www.alz.co.uk/research/worldreport/
- Alzheimer's Association

The Shriver Report: A Woman's Nation Takes on Alzheimer's

Alzheimer's Association — 2010-08-25

Maria Shriver, in partnership with the Alzheimer's Association, takes a groundbreaking look into the epidemic's effect on women as caregivers, advocates and people living with Alzheimer's

Maria Shriver, whose California Women's Conference is the preeminent forum by, for and about American women, is joining with the Alzheimer's Association — the leader in Alzheimer care, support and research — to release The Shriver Report: A Woman's Nation Takes on Alzheimer's on Oct. 15. The Shriver Report is a groundbreaking, comprehensive examination of the impact of Alzheimer's disease on American women as caregivers, advocates and people living with the disease.

This is the second in a series for The Shriver Report, an ongoing study of transformational moments in American culture and society. Last year, Maria Shriver and the Center for American Progress published The Shriver Report: A Woman's Nation Changes Everything, a landmark study looking at how Americans live and work today now that mothers are the primary or co-breadwinners in nearly two-thirds of American families. The Shriver Report launched a national conversation continuing today about the far-reaching consequences of women's shifting roles in American life.

This year The Shriver Report: A Woman's Nation Takes on Alzheimer's will provide a pioneering and comprehensive examination of the Alzheimer experience in our country. As the first of 78 million baby boomers are entering their mid-60s, an Alzheimer tsunami is approaching, and it will impact women disproportionately. Women are not only the majority of Alzheimer patients in this country. They are also the overwhelming majority of caregivers for people living with Alzheimer's and other dementias. This presents a huge and growing burden on millions of women — as people living with the disease, as caregivers and as half of the American work force. Is this country ready for the impact on family, the workplace, our healthcare system, our government? Is anyone ready?

The Shriver Report: A Woman's Nation Takes on Alzheimer's will be the first multi-disciplinary look at these questions — and intends to ignite a national conversation by asking questions and answering them in a comprehensive and accessible way. In addition to substantive chapters by scholars and experts mining the data and explaining the breakthroughs and trends in the medical research, the economic impacts, the sociology and the cultural shifts — there will be personal essays, original photography by award-winning photojournalist Barbara Kinney and the results of a new, largest-ever nationwide poll on the effects of Alzheimer's on women and families.

Maria Shriver's own father, Sargent Shriver, was diagnosed with Alzheimer's disease in 2003. "Alzheimer's has had a profound impact on my family," said Shriver. "The Alzheimer's Association tells us as many as 5.3 million people, most of them women, are living with Alzheimer's disease in our country — and unless something is done, by 2050, it will impact up to 16 million families directly and millions more indirectly. We launched this edition of The Shriver Report to shine the spotlight on the fact that Alzheimer's is a national epidemic that affects all of us, not just the elderly, and cuts across economic and age groups to have overpowering implications on all aspects of American life."

The Shriver Report contributors include Barbra Streisand, Jill Eikenberry and Michael Tucker, Soleil Moon Frye, Dixie Chicks lead singer Natalie Maines, ABC News "Nightline" anchor Terry Moran, CBS News correspondent Barry Petersen, former First Lady Laura Bush, President Ronald Reagan's daughter Patti Davis, Alzheimer's Study Group chairmen Newt Gingrich and former Sen. Bob Kerrey, and U.S. Secretary of Health and Human Services Kathleen Sebelius. Personal essays by a diverse group of Americans — including women in their 50s and 60s with younger-onset Alzheimer's — will illuminate with unflinching honesty the effect of Alzheimer's on American families.

"Given the enormous impact Alzheimer's disease has on women and families in this country, we partnered with Maria Shriver to escalate the national conversation about Alzheimer's. Maria's personal experience with Alzheimer's is relatable to the American public and will help bring the disease to the forefront," said Angela Geiger, chief strategy officer of the Alzheimer's Association. "With a new person developing Alzheimer's every 70 seconds and women impacted disproportionately as both people with the disease and caregivers, the Alzheimer's Association sees this as an opportunity to illustrate further the devastating path this disease will continue on without adequate funding for care and research."

The Shriver Report supporters include Deloitte LLP and Visa, Inc., and the report's contributing partners include the UC Berkeley Center on Health, Economic and Family Security and the Families and Work Institute. The Shriver Report release will be accompanied by extensive coverage and outreach by our media partners ABC News, Time and grassroots outreach supporter AARP, which will help amplify the conversation. ABC News will provide a week of coverage across its broadcast platforms.

ABC News president David Westin said, "The ABC family knows how devastating Alzheimer's is and how important it is for families to have access to the information they need to help them cope. We are honored to be partnering with Maria Shriver and the Alzheimer's Association on the release of The Shiver Report and hope our reporting can help shed new light on this heartbreaking disease."

"Our research shows that the average American caregiver is a woman who holds down a paid job and juggles family responsibilities to find the 20 hours a week she devotes to caring for her parent, who has a one in four chance of having Alzheimer's," said Nancy LeaMond, executive vice president of social impact for AARP. "That is why AARP is proud to work with The Shriver Report: A Woman's Nation Takes on Alzheimer's to highlight this conundrum and inspire business, government and community leaders to become aware of this dynamic and get creative in seeking change."

"Time is committed to our ongoing coverage of important health issues like Alzheimer's, and we look forward to working with The Shriver Report to draw attention to the extraordinary challenges this disease presents," said Richard Stengel, Time's managing editor.

The coverage will lead up to Maria Shriver's March on Alzheimer's on Oct. 24, kicking off the annual Women's Conference in Long Beach, Calif. Shriver will be joined there by emcee and Alzheimer advocate Leeza Gibbons, actor Rob Lowe and co-chairs actor Peter Gallagher, Dixie Chicks lead singer Natalie Maines, actress and activist Soleil Moon Frye, Body by Jake CEO Jake Steinfeld and members of the cast of "Glee." Jane Fonda will lead participants in warm-up exercises before they begin the 5K March, which will be followed by refreshments, entertainment and a candlelight vigil honoring those lost to Alzheimer's disease and their friends and families. All proceeds from the March will benefit the Alzheimer's Association. For more information, visit www.womensconference.org/march-on-alzheimer-s/.

About Maria Shriver
Shriver is the author of six books and an Emmy and Peabody Award-winning broadcast journalist currently serving as California's First Lady. Shriver was co-executive producer of last year's Emmy Award-winning four-part HBO documentary series, "The Alzheimer's Project." It took an inside look at cutting-edge research in the country's leading Alzheimer laboratories and examined the effects of this disease on patients and families. One of the Emmy Award-winning films in the series, "Grandpa, Do You Know Who I Am?", was based on Shriver's best-selling children's book dealing with Alzheimer's. "The Alzheimer's Project" one of HBO's most-watched events ever, can be seen at www.hbo.com/alzheimers/the-films.html. A mother of four, Shriver has expanded the California Women's Conference into a star-studded, multi-day event for 30,000 participants, featuring newsmakers, cultural leaders and opinion makers, all with the goal of inspiring and empowering women to be architects of change in their own lives, their communities and the world.
- Alzheimer's Association

Maria Shriver Takes on Alzheimer's Advocacy

Alzheimer's Association — 2010-08-17

For Maria Shriver, a passion for public service and activism comes naturally. She is the daughter of Sargent Shriver, a Democratic presidential candidate in 1972 and the first director of the Peace Corps, and Eunice Kennedy Shriver, the founder of the Special Olympics and sister of President John F. Kennedy and Senators Robert and Ted Kennedy.
- The Huffington Post

Alzheimer's Association statement regarding biomarkers article in Archives of Neurology

Alzheimer's Association — 2010-08-11

This is very well-done article, by a top-level research team, which uses very sophisticated mathematics for identifying and analyzing possible Alzheimer's disease biomarkers in cerebrospinal fluid (CSF). The findings suggest that low levels of beta-amyloid protein and high levels of tau protein in cerebrospinal fluid are a "signature" that is characteristic of Alzheimer's disease, and can also be found in most people with mild cognitive impairment, a condition that often precedes Alzheimer's disease dementia.

The researchers also found that 36 percent of cognitively normal people in the study had the "Alzheimer's signature" biomarkers in their spinal fluid at similar levels to people with Alzheimer's disease. This finding provides further evidence for the idea that there are Alzheimer's-related changes in the brain 10, 15 even 20 years before we see outward symptoms.

No one should be tested now using this biomarker "signature." It needs to be studied further and confirmed in long-term studies.

* For example, this paper may give us good insight into which proteins we need to look at in spinal fluid, but we don't know yet what are normal and abnormal measurements. That is, we do not yet have a widely accepted cut off point as we do, for example, with "200" in total cholesterol.

* Nor is the collecting and measuring of these proteins in CSF standardized in medical practice. The Alzheimer's Association is leading a global effort to standardize procedures in collecting, storing, and measuring Alzheimer proteins in CSF.

* In addition, long-term studies are needed that start with cognitively normal participants who can be followed-up for 10 years or more. In this way, we could see how many of those people who have the biomarker signature but do not have symptoms go on to get Alzheimer's disease dementia.

Here's what is exciting to us now. This research brings us one step closer to our vision of detecting and treating Alzheimer's before symptoms start or in the very mildest of cases so that people (and their families) never have to experience the devastating effects of Alzheimer's dementia.

By clearly indicating that we may be able to detect brain changes related to Alzheimer's before we see outward symptoms of the disease, this article provides support for the current effort to revise the Alzheimer's disease diagnostic criteria that is being driven by the National Institute on Aging (NIA) and the Alzheimer's Association.

The proposed new diagnostic criteria reflect the well-accepted idea of a continuum of Alzheimer's disease — from presymptomatic Alzheimer's, to mild cognitive impairment, to Alzheimer's dementia. It is at the earliest stages of the disease that we hope to be able to eventually intervene with disease modifying treatments, when they become available, and for which we need participants for clinical trials now.

Ultimately, this approach envisions what is now common practice in heart disease, where early signs of risk — blood pressure, cholesterol, genetic markers — can be detected and treated to reduce heart attacks or strokes later on.

To get the answers that we all want about how Alzheimer's works, how we detect and treat it earlier, prevent it and eventually cure it, we need long term studies in Alzheimer's, and the allocation of more research dollars to make those large-scale, long-term studies possible. The Alzheimer's Association supports passage of The National Alzheimer's Project Act, which would launch a campaign within the federal government to overcome Alzheimer's disease.

Additional Background
Finding Alzheimer's-related changes in the brains of cognitively normal people is not unexpected. These results are similar to findings in previously published studies that used PET scans to reveal images of amyloid buildup in the brain. In those studies, many older adults had amyloid plaques in their brains, yet did not yet show Alzheimer's symptoms. Autopsy studies suggest the same thing — that many older adults have plaques and tangles yet do not show dementia symptoms.

The results of CSF beta-amyloid and tau protein measurements do not stand alone as a single diagnostic test for Alzheimer's because they are seen in other diseases, too. Brain amyloid deposits may occur in people who do not have Alzheimer's, such as Parkinson disease and dementia with Lewy bodies, as well as in cognitively normal individuals. High tau protein levels are fairly nonspecific and may be seen after stroke and traumatic head injury, and in Creutzfeldt-Jakob disease.

A biomarker is something that can be measured in the body that indicates or reflects the presence or severity of a disease state. For example, cholesterol levels and blood pressure are considered biomarkers of heart disease. Scientists are working hard to discover, verify and quantify biomarkers for Alzheimer's disease.
- Alzheimer's Association

New Alzheimer diagnostic criteria

Alzheimer's Association — 2010-07-20

The criteria for diagnosing Alzheimer's disease have remained virtually unchanged since the early 1980's. However, last week new guidelines were proposed that would lead to earlier diagnosis. Although this would mean better care for patients, it would also lead to a significant increase in the number of people diagnosed with the disease. Dr. Maria Carrillo, senior director of medical and scientific relations for the Alzheimer's Association, joined us on Tuesday's American Morning to discuss the proposed guidelines.
- CNN

Insulin via nasal spray shows benefit in Alzheimer's patients

Alzheimer's Association — 2010-07-15

New research suggests that insulin given by spray through the nose might benefit Alzheimer's patients.

A new short-term trial of intranasal insulin in Alzheimer's patients and people with mild cognitive decline showed benefits on certain memory and functioning tests, say researchers from the VA Puget Sound Health Care System/University of Washington-Seattle. They presented the research at the Alzheimer's Association International Conference on Alzheimer's Disease in Honolulu this week.

"We believe that restoring normal insulin function in the brain may provide therapeutic benefits to adults with Alzheimer's," researcher Suzanne Craft says.

Intranasal administration enables insulin to access brain regions that are compromised in Alzheimer's, Craft says.

Previous research has suggested that Alzheimer's and insulin resistance are closely related.

In the new study, 109 adults with either mild cognitive decline or early Alzheimer's received either placebo or 20 or 40 IU daily intranasal insulin treatments over the course of four months.

The researchers found that in the insulin-taking groups, cognitive and functional test results improved significantly compared with those who received placebo. Some improvements lasted two months after treatment ended. But the ability to perform activities of daily living was unchanged.

"We're becoming increasingly aware that diabetes, metabolic syndrome, obesity and hyperglycemia are all risk factors for Alzheimer's and memory loss with aging, which is the rationale for this study as a possible therapy," says R. Scott Turner, director of the Memory Disorders Program at Georgetown University Medical Center. Turner adds that intranasal insulin — which is already approved for other uses — needs to be further studied before use as an Alzheimer's treatment.
- USA Today

Early diagnosis of Alzheimer's yields savings

Alzheimer's Association — 2010-07-15

Early diagnosis of cognitive impairment can yield substantial savings in medical costs for Alzheimer's patients, according to a new study unveiled Wednesday.

Patients often aren't diagnosed until they are in the late throes of the disease, when their day-to-day functioning is affected. Meanwhile, as they try to manage on their own, many fail to take medications for such chronic conditions as diabetes, or experience falls and accidents leading to costly hospitalizations.

Simple techniques exist to screen for memory problems but many doctors don't routinely use them. Increasingly, however, efforts are being made to diagnose patients' cognitive impairment earlier to improve the treatment and management of the disease.

To examine the cost-effectiveness of screening and earlier diagnosis, researchers from the Department of Veterans Affairs in the Midwest conducted a standard memory screen on over 8,000 patients aged 70 and older. More than a quarter failed the two-minute screen and were recommended for further evaluation. Of the 700 veterans who were more extensively evaluated, nearly all were found to have significant cognitive impairment.

The results of the large study were presented at the International Conference on Alzheimer's Disease in Honolulu.

In clinics that were trained to recognize dementia, the researchers found the average cost of all medical care for those patients identified with dementia dropped $1,700 in the year after diagnosis compared with the year before, according to Riley McCarten, medical director of the geriatric research education and clinical center at the Minneapolis Veterans Affairs Medical Center, who presented the research. The savings didn't factor in the cost of the memory evaluation, which averaged $800, said Dr. McCarten.

"I think the importance of this demonstration model is that we saved costs in the first year," said Dr. McCarten. "People are afraid that if you implement this screening model, it will break the bank."

The effort is the biggest study so far to examine the reduction of costs by identifying cognitive dysfunction early, according to William Thies, chief medical and scientific officer for the Alzheimer's Association. He said the data show the program is "clearly cost-effective."

The cost savings are likely due to reduced hospitalizations and visits to urgent-care centers because families no longer bring their loved ones to these facilities as frequently as when they didn't understand what was going on, according to Dr. McCarten. The reduced costs may also be related to having a caregiver step in to help the patient better manage chronic health conditions, he said.

"If you know that dad has a terminal disease, you're not going to be dragging him into the hospital for everything," said Dr. McCarten.

Soo Borson, head of the dementia health services research group at the University of Washington in Seattle, said she was surprised by the findings and cautions that more research is needed to understand why the costs decreased over time.

It's unclear still whether these "really important" findings would apply to patients who aren't part of the Veterans Affairs system, or who go to clinics without specialty training in Alzheimer's disease, according to Howard Fillit, executive director of the Alzheimer's Drug Discovery Foundation, who wasn't involved in the study.
- The Wall Street Journal

Rules Seek to Expand Diagnosis of Alzheimer's

Alzheimer's Association — 2010-07-14

For the first time in 25 years, medical experts are proposing a major change in the criteria for Alzheimer's disease, part of a new movement to diagnose and, eventually, treat the disease earlier.

The new diagnostic guidelines, presented Tuesday at an international Alzheimer's meeting in Hawaii, would mean that new technology like brain scans would be used to detect the disease even before there are evident memory problems or other symptoms.

If the guidelines are adopted in the fall, as expected, some experts predict a two- to threefold increase in the number of people with Alzheimer's disease. Many more people would be told they probably are on their way to getting it. The Alzheimer's Association says 5.3 million Americans now have the disease.

The changes could also help drug companies that are, for the first time, developing new drugs to try to attack the disease earlier. So far, there are no drugs that alter the course of the disease.

Development of the guidelines, by panels of experts convened by the National Institute on Aging and the Alzheimer's Association, began a year ago because, with a new understanding of the disease and new ways of detection, it was becoming clear that the old method of diagnosing Alzheimer's was sorely outdated.

The current formal criteria for diagnosing Alzheimer's require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities, like dressing or bathing — along with a pathologist's report of plaque and another abnormality, known as tangles, in the brain after death.

But researchers are now convinced that the disease is present a decade or more before dementia.

"Our thinking has changed dramatically," said Dr. Paul Aisen, an Alzheimer's researcher at the University of California, San Diego, and a member of one of the groups formulating the new guidelines. "We now view dementia as a late stage in the process."

The new guidelines include criteria for three stages of the disease: preclinical disease, mild cognitive impairment due to Alzheimer's disease and, lastly, Alzheimer's dementia. The guidelines should make diagnosing the final stage of the disease in people who have dementia more definitive. But, the guidelines also say that the earlier a diagnosis is made the less certain it is. And so the new effort to diagnose the disease earlier could, at least initially, lead to more mistaken diagnoses.

Under the new guidelines, for the first time, diagnoses will aim to identify the disease as it is developing by using results from so-called biomarkers — tests like brain scans, M.R.I. scans and spinal taps that reveal telltale brain changes.

The biomarkers were developed and tested only recently and none have been formally approved for Alzheimer's diagnosis. One of the newest, a PET scan, shows plaque in the brain — a unique sign of Alzheimer's brain pathology. The others provide strong indications that Alzheimer's is present, even when patients do not yet have dementia or even much memory loss.

Dr. Aisen says he foresees a day when people in their 50s routinely have biomarker tests for Alzheimer's and, if the tests indicate the disease is brewing, take drugs to halt it. That is a ways off but, he said, but "it's where we are heading."

"This is a major advance," said Dr. John Morris, an Alzheimer's researcher at Washington University in St. Louis who helped formulate the guidelines. "We used to say we did not know for certain it was Alzheimer's until the brain is examined on autopsy."

Dr. Ronald Petersen, an Alzheimer's researcher at the Mayo Clinic in Minnesota and chairman of the Alzheimer's Association's medical and scientific advisory council, said adding biomarkers to a diagnosis would be a big improvement.

Today, he says, when a patient comes with memory problems, doctors might say that the person has a chance of developing Alzheimer's in the next decade, a chance of not getting much worse for several years, and a chance of actually getting better.

Tests like brain scans, Dr. Petersen said, "will allow us to be much more definitive." If the tests show changes characteristic of Alzheimer's disease, a doctor can say, "I think you are on the Alzheimer's road."

That can be a difficult conversation, but it can allow patients and their families to plan. "At least it's a conversation the physician can have with the patient," Dr. Petersen said.

Alzheimer's experts welcomed the new criteria.

"Over all, I think this is a giant step in the right direction," said Dr. P. Murali Doraiswamy, a psychiatry professor and Alzheimer's disease researcher at Duke University who was not involved with making the guidelines. "It moves us closer to the cause of the disease rather than just looking at symptoms."

But, he added, it also is a huge change.

"This has implications for everybody alive, anybody who is getting older," Dr. Doraiswamy said. Among other things, he said, it will encourage a lot more testing. And, Dr. Doraiswamy said, "diagnosis rates, like testing rates, only go in one direction — up."

Doctors will have to learn new terms — preclinical Alzheimer's; prodromal, or early stage, Alzheimer's. Patients going to see a doctor with memory problems might be offered biomarker tests, which can be expensive.

The ripple extends beyond doctors and patients, Dr. Doraiswamy said. The new diagnostic criteria also have consequences for lawyers, insurance companies and workers' compensation programs.

And, he said, people have to be prepared for unintended consequences, which always occur when the diagnosis of a disease is changed. For now, he said: "We ought to be cautious that we don't stimulate all this testing before we can give people something to manage their disease. There is no point in giving them just a label."
- The New York Times

How Alzheimer's gets diagnosed may change

Alzheimer's Association — 2010-07-14

Scientists are seeking to revamp the way that Alzheimer's disease gets diagnosed, for the first time in 25 years.

The proposed criteria, presented at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 on Tuesday, would better reflect the various stages of the disease, as well as the Alzheimer's disease biomarkers that have been developed, said the Alzheimer's Association's chief medical and scientific officer William Thies in a statement. Biomarkers indicate signs of Alzheimer's in the brain and can be found with MRI scans, PET imaging and tests of cerebrospinal fluid.

According to the New York Times, that means that even people without obvious symptoms such as memory problems could have brain scans and other tests to detect signs of Alzheimer's.

Some experts predict that the number of people with a diagnosis of Alzheimer's will double or even triple, if these guidelines go into effect, the Times reported. Drug companies developing drugs to combat Alzheimer's could also benefit from the changes, the paper said.

The advances that Alzheimer's research has seen since 1984 include the recognition of changes in the brain driven by Alzheimer's - but also that some people don't show symptoms of dementia even though they have these brain changes, the Alzheimer's Association said. Also, scientists did not have a good understanding of non-Alzheimer's dementia in 1984; today, there is greater knowledge of other kinds of dementia.

After the conference, the National Institutes on Aging and the Alzheimer's Association will seek feedback through this website. Then, the guidelines would have to be published in a peer-reviewed journal, and validated through clinical trials.
- CNN

Race, culture may play role in Alzheimer's disease

Alzheimer's Association — 2010-07-14

Racial and cultural differences may impact how early people with dementia are diagnosed, the type of care they receive and how long they live— and they even impact the way families of Alzheimer's patients deal with grief when their loved one dies, according to several new studies.

Research presented at the Alzheimer's Association International Conference on Alzheimer's Disease in Honolulu, Hawaii, on Monday suggests more culturally-tailored resources could benefit African Americans, Latinos and other minority groups.

"These results have significant implications for caregiver burden and community resources," says Maria Carrillo, the Alzheimer's Association's Senior Director of Medical and Scientific Relations. "Alzheimer's leads so many families through unfamiliar territory. The need for education, information, supportive services is paramount."

Kala Mehta, assistant professor in geriatrics at the University of California, San Francisco, and colleagues examined the relationship between dementia and two factors: nursing home placement and mortality. The Health and Retirement Study followed more than 7,500 older people — 10% were African-American and 6% were Latino — over 10 years.

During the study, 34% of participants died and 49% experienced significant cognitive decline. The researchers found that among the significant cognitive decline group, older African Americans and Latinos had about 50%-80% less placement in nursing homes compared to older whites. They were also less likely than whites to die during the follow-up period. The study does not evaluate why though.

The results — indicating a longer care period and less nursing home placement — suggest families providing caregiving might need and benefit from more culturally-appropriate dementia care resources, Mehta says.

Those resources might include in-home support services and adult daycare centers, for example, that would make Latino and African American families feel comfortable.

Mehta says dollars allocated for support programs are being cut in some places, like California, where she is located.

"We need to advocate for these programs to stay in place and grow, if anything," Mehta says.

Bereavement varies

Other research looked at ethnic differences in how caregivers of Alzheimer's patients cope with death.

Scientists at the University of Pittsburgh's Institute on Aging and the University of Michigan, studied expressions of relief, anger and acceptance in white, Hispanic and African-American caregivers after a patient with Alzheimer's died.

Results suggest that whites and Hispanics are three to five times more likely to report emotional relief when the patient they cared for dies, compared to African-Americans. Hispanics were only half as likely as African-Americans to report feelings of anger, while white caregivers were considerably more likely to report feelings of anger than both the other groups.

Michigan study author James McNally says the findings can help improve resources that will help caregivers throughout all the stages of their loved one's illness and during the final grieving process.

"The bereavement issues are not a surprise. Bereavement is also a risk factor in and of itself," says aging expert Gary Kennedy, of Montefiore Medical Center, in The Bronx.

Dementia diagnosis

Other research presented at the conference also suggests ethnic minority groups often seek a diagnosis much later than their white counterparts.

In a study of 22 families, including 10 black families, seven white families, and five American Indian families, researchers examined the Alzheimer's diagnostic process in each culture.

While all groups recognized the value of having a diagnosis, long delays often occurred between recognition of symptoms of dementia and scheduling a medical evaluation for the patient.

The study found that on average, African-Americans sought a diagnosis six years after dementia symptoms emerged, American Indians sought one after five years, and whites waited two years.

Study results also indicate that whites are more likely to seek support through formal services, while blacks and American Indians turn more often to their faith and spiritual beliefs for support.

"Most caregivers mistakenly believed that having dementia is normal and accepted it as a part of growing old," Dilworth-Anderson says.

In another study by Dilworth-Anderson, which included telephone surveys with 200 black and white caregivers, blacks reported the use of home health care services more than whites, and also reported having a greater availability of church resources. But blacks also reported that no services were available at a higher percentage than whites.

"It is of interest that African-Americans and American Indians seem to be more likely to resist the medical label of dementia compared to the European Americans which might factor into more delays in diagnosis or perhaps not even seeking medical attention and receiving a diagnosis," says R. Scott Turner, Director of the Memory Disorders Program at Georgetown University Medical Center.

Turner says how different populations perceive Alzheimer's and dementia is understudied, but is very important since demographics in the United States are changing.

"Hot Topics" from the Alzheimer's Association International Conference on Alzheimer's Disease 2010

Alzheimer's Association — 2010-07-14

- New Alzheimer's Risk Gene May Affect Memory Scores and Brain Atrophy in Middle Age -

- Clinical Trial of Intranasal Insulin Shows Benefits in Alzheimer's and MCI –

- Known Alzheimer's Risk Gene May Change Shape of Brain Deposits -

Honolulu, Hawaii; July 14, 2010 – Last minute scientific submissions to the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI, known as "hot topics," suggest that (1) a newly-discovered risk gene for Alzheimer's may have early impact on memory skills and brain volume, (2) intranasal insulin may be beneficial in Alzheimer's, and (3) beta amyloid deposits in the brains of people with Alzheimer's disease may take different shapes based on a known Alzheimer's risk gene.

Two studies reported at AAICAD 2010 give us more information about the TOMM40 gene – a newly identified risk gene for Alzheimer's. They found that healthy, middle aged people who have the high risk version of TOMM40 (a) did worse on memory tests and (b) had reduced brain volume in two regions affected early in Alzheimer's.
A short-term trial of intranasal insulin in Alzheimer's and MCI showed statistically significant benefits on certain tests of memory and functioning, but no changes on some others. In those who showed benefits on memory tests, there were also positive changes in Alzheimer's biomarkers in spinal fluid.
Researchers using a new imaging tool suggest that there are different shapes of beta amyloid deposits in the Alzheimer brain based on which version a person has of a well-established Alzheimer's risk gene, known as APOE. This may be especially important because in some recent drug trials the therapy provided benefits in people who had certain types of APOE but were less effective or not effective in others.

"These are some of the fantastic findings from this year's AAICAD, full of potential to move the field forward," said William Thies, PhD, Alzheimer's Association Chief Medical and Scientific Officer. "But there is too little happening in the field, and no plan in place from the federal government to stem the massive wave of Alzheimer's coming with the aging of the Baby Boomers."

"Alzheimer's is clearly the #1 public health challenge of the 21st century and research is the only way to solve this problem," Thies added. "There are more than 5 million Americans with the disease and about 11 million caregivers supporting them. Reliable estimates say that by 2050 those numbers could triple. Government must make an investment in Alzheimer research that proves they understand what's at stake – for individuals, families, the healthcare system, and the nation as a whole."

New Risk Gene for Alzheimer's is Associated with Poorer Memory Function and Grey Matter Loss in Middle Aged Persons Without Dementia

The TOMM40 gene has very recently been shown to influence age of onset in Alzheimer's disease. Two studies reported at AAICAD 2010 give us more information about this newly identified risk gene for Alzheimer's; they found that middle aged people without dementia who have the high risk version of the TOMM40 gene did worse on tests of memory and learning and had reduced brain volume in two regions that are often affected early in the course of Alzheimer's.

"These are exciting, initial results, but the exact role that TOMM40 plays in Alzheimer's remains to be determined," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "The story of TOMM40 is evolving and may give us new insights into Alzheimer's disease."

"We desperately need to know more about the causes of Alzheimer's, and the factors that affect our risk of getting or not getting the disease. This kind of research will provide more targets for therapies and prevention strategies," Thies said.

In one study, Mark Sager, MD, of the University of Wisconsin Medical School, and colleagues studied a total of 726 people in middle-age with a family history of Alzheimer's from the Wisconsin Registry for Alzheimer's Prevention who were genotyped for TOMM40 and APOE, the latter of which is a well-established risk gene for Alzheimer's. Of these, 129 had the low risk version of TOMM40 and 229 had the high risk version. The average age of the study population was 54.

The researchers found that the group with the high risk version of the TOMM40 gene performed significantly worse on the tests of learning and memory (Rey Auditory Verbal Learning Test) than the group with the low risk version. These results remained significant regardless of APOE gene type.

"The deficits shown by the high risk group are similar to the kinds of changes in memory and learning that are seen in very early Alzheimer's," Sager said. "In this study population, TOMM40 genotyping is allowing us to find evidence of very early Alzheimer's disease at least 20 years before people begin to show the outward symptoms. This is a step forward in Alzheimer's prevention research."

In a second study, Sterling Johnson, PhD, also of the University of Wisconsin School of Medicine and Public Health, and colleagues found that among healthy, middle aged adults (mean age 57) who have the APOE e3/e3 gene type, those with the high risk version of the TOMM40 gene had significantly less gray matter volume in two brain regions affected early in Alzheimer's disease than those with the low risk version of the gene.

According to the researchers, the study suggests that there is a connection between TOMM40 and brain cell loss in people who are relatively young and currently not symptomatic.

"This is the first study to associate TOMM40 to brain imaging in people at risk for Alzheimer's disease," Johnson said. "The brain differences between TOMM40 groups were very similar but less severe that what is observed in full-blown Alzheimer's. It may be that the TOMM40 gene will be a useful measure of Alzheimer's risk in middle-age, but additional research with longitudinal follow-up is needed."

Allen Roses, MD, and colleagues at Duke University first discovered that the TOMM40 gene helped explain differences in age of onset among people with sporadic Alzheimer's disease.

Clinical Trial of Intranasal Insulin Shows Some Benefits in Alzheimer's and MCI

Previous research has strongly suggested that Alzheimer's and diabetes/insulin resistance are closely related. For example, Alzheimer's is associated with reduced brain insulin signaling and low levels of insulin in cerebrospinal fluid (CSF).

"These deficiencies may reduce or eliminate insulin's beneficial roles in the brain," said Suzanne Craft, PhD, of VA Puget Sound Health Care System/University of Washington in Seattle. "We believe that restoring normal insulin function in the brain may provide therapeutic benefits to adults with Alzheimer's. Intranasal administration enables insulin to access brain regions that are compromised in Alzheimer's."

Craft and colleagues had previously shown enhanced cognition and daily functioning in adults with MCI and early Alzheimer's using intranasal insulin treatment for 21 days. This new study expanded the time frame to four months, during which 109 participants with MCI or Alzheimer's received either placebo, or 20 or 40 IU daily intranasal insulin treatment.

The researchers found that in the 20 IU dose group (10 IU twice daily) results on a test of delayed story recall significantly improved compared with those who received placebo, as did functional status measured by the Dementia Severity Rating Scale. Improvements in delayed memory recall persisted for two months after the insulin treatment ended. However, memory and learning on the ADAS-Cog and ability to do activities of daily living measured by the ADCS-ADL scores were unchanged.

For 15 of the insulin-treated participants who agreed to have a spinal tap, improved memory and functional status were associated with an improved Alzheimer's biomarker profile as reflected by a lowered CSF tau/Aβ42 ratio.

"These results provide encouraging support for further study of intranasal insulin as a therapy for Alzheimer's," Craft said. "We are currently planning a large, multi-center clinical trial."

New Imaging Compounds for Alzheimer's Protein Deposits in the Brain Show that Different Forms of the APOE Risk Gene Create Different Shapes of Beta Amyloid

A new class of biomarkers has been discovered that can stick to protein structures in the body and emit colors reflecting the different shapes or forms of the proteins. They are called luminescent conjugated oligothiophenes (LCOs) or luminescent conjugated polymers (LCPs). Among other uses, they are currently being employed in test tubes, animal models and autopsied Alzheimer's brains to study the structure of proteins deposits caused by the disease. The new markers bind to the two well-established hallmarks of Alzheimer's – beta amyloid plaques and tau tangles – and glow different colors depending on which forms of the deposits they "stick" to (e.g., plaques often "glow" orange, while tangles "glow" yellowish green).

In this study reported at AAICAD 2010, Sam Gandy, MD, PhD, of Mount Sinai School of Medicine, New York, and colleagues used LCOs/LCPs to investigate the possibility that the shape of brain protein deposits in people with Alzheimer's who have the APOE ε4/ε4 gene type (highest risk) is different from those having APOE ε3/ε3 (neutral risk).

Frozen brain sections from people who died with Alzheimer's were stained using two LCPs/LCOs: pentamer formyl thiophene acetic acid (pFTAA) and polythiophene acetic acid (PTAA). Using PTAA, the researchers observed that Alzheimer patients with APOE ε4/ε4 had core and cerebrovascular amyloid of different shapes, while in people with APOE ε3/ε3 the two amyloid structures had the same shape. Using pFTAA revealed that tau tangle densities in ε4/ε4 Alzheimer patients that were apparently greater than those with ε3/ε3.

"The findings support our hypothesis that APOE genotype changes amyloid structure," Gandy said. "This is important because the different shapes might respond differently to treatments that attempt to clear amyloid deposits from the brain."

In some recent drug trials, the experimental therapy provided benefits in people who had a certain type of the APOE gene (known as ε3) but were less or not effective in another type (ε4).

LCOs/LCPs were pioneered by Peter Nilsson of the Department of Chemistry, Linköping University, Sweden. The study also involved collaborating teams from Charité – Universitätsmedizin Berlin, Germany (led by Frank Heppner), Washington University, St Louis (led by David Holtzman), and other labs at Mount Sinai (led by Patrick Hof and Dara Dickstein).

About AAICAD
The Alzheimer's Association International Conference on Alzheimer's Disease (AAICAD) is the world's largest conference of it's kind, bringing together researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Alzheimer's Association's research program, AAICAD serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.

About the Alzheimer's Association
The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. www.alz.org/icad/
- Alzheimer's Association

Early Detection, Diagnosis & Care Management for People with Dementia May Reduce Healthcare Costs

Alzheimer's Association — 2010-07-14

Honolulu, Hawaii; July 14, 2010 – Early detection, diagnosis and care management for people newly diagnosed with cognitive impairment and dementia reduces outpatient costs by almost 30 percent, according to new research reported today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu.

Dementia is loss of memory and other mental abilities severe enough to interfere with daily life. According to the Alzheimer's Association, dementia is a common, costly, and often unrecognized problem in older adults. In order to provide better medical care and outcomes for people with Alzheimer's and other dementias, the conditions must first be detected and diagnosed, and needed care management must be provided.

"Research suggests that when the family of someone who is officially diagnosed with Alzheimer's becomes educated about the disease, and they work together with medical professionals on a care plan, it can reduce the patient's difficult behavioral and psychiatric symptoms," said Maria Carrillo, PhD, Senior Director of Medical and Scientific Relations at the Alzheimer's Association. "It can also lower the family caregiver's anxiety, depression and stress."

Generally, care management in Alzheimer's provides assistance for people with the disease and their families in finding resources, making decisions, and managing stress. For example, a care manager can help families with decisions about in-home health services, or long-term care whether at home or in a nursing facility.

"We see in this study's findings that early diagnosis and case management in dementia may also significantly lower healthcare costs. This could have a reverberating positive impact throughout the entire healthcare system," Carrillo said.

Demonstration Project Shows Early Diagnosis and Care Management Can Lower Costs

The Dementia Demonstration Project (DDP) was an interdisciplinary effort led by the Geriatric Research, Education and Clinic Center at the Minneapolis Veterans (VA) Medical Center. Seven VA Medical Centers took part in the project, which was created to increase detection and diagnosis of dementia in primary care and provide information, support, and care coordination for veterans with newly diagnosed dementia. An Advanced Practice Registered Nurse trained in dementia – the Dementia Care Coordinator – led a dementia care team that became part of a primary care clinic in each of the seven VA Medical Centers participating in the project.

The DDP added a brief, three-item memory test to regularly scheduled primary care visits for veterans age 70 and older without a diagnosis of Alzheimer's or another dementia. Among the 8,278 veterans who received the memory test, 26 percent failed. Thirty-four percent of those who failed the test returned for a comprehensive evaluation; 95 percent of that group were diagnosed with cognitive impairment, including 76 percent with dementia.

In the DDP clinics, following evaluation, the dementia care team met with the patient and family to review the results, discuss the diagnosis, and outline treatment recommendations. Interventions were targeted to the severity of dementia and the specific needs of the patient and their caregivers. Informational material, assistance in identifying needed services, and direct support and training from team members was provided, as needed.

Healthcare costs data for one year before and after diagnosis were available for 347 DDP patients and 1,260 patients from non-DDP clinics in the same VA Medical Centers.

Veterans diagnosed in the DDP clinics saw their average outpatient healthcare costs decline by about 29 percent (-$1,991) in the year after diagnosis of cognitive impairment compared with the year before diagnosis.
Veterans diagnosed in the non-DDP clinics also saw declines in average outpatient healthcare costs, but not as much (-$406).

"In our study, the cost decreases were more dramatic in patients who were identified through cognitive evaluation and who subsequently had case management available by a dementia care team," said J. Riley McCarten, MD, the project's lead physician. He added that the cost of the DDP intervention to the VA was captured in the patient care costs reported.

"The most important goals of the program were making sure that all family members understood the disease and were on the same page, that patients remained physically active and socially engaged, and that caregivers had the support they needed," McCarten said.

New Research Advances from the Alzheimer's Association International Conference on Alzheimer's Disease 2010

Alzheimer's Association — 2010-07-14

Honolulu, Hawaii; July 14, 2010 – This week, nearly 4,000 scientists from around the world gathered to report and discuss the latest advances in research on treatments, risk factors, and diagnosis for the health epidemic of the 21st century – Alzheimer's disease – at the Alzheimer's Association's 2010 International Conference on Alzheimer's Disease (AAICAD 2010) in Honolulu.

"With an aging baby boomer generation, the Alzheimer's disease crisis will continue to touch more lives and create an unsustainable fiscal toll on the nation's healthcare system – particularly Medicare and Medicaid," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association.

"This week we saw promising investigations being pursued on a variety of fronts – avenues that could very well lead to significant changes in Alzheimer diagnosis and treatment. However, the chronic underinvestment in Alzheimer research continues to be the greatest obstacle to bringing new, more effective therapies to people," Thies said.

"Every day, researchers go to work with the sole purpose of advancing our understanding and knowledge about Alzheimer's, which is the defining disease of the baby boomer generation. We need a government response that shows equal commitment by providing the level of funding for research that will get us better diagnostic tests, treatments, and a cure," Thies added.

Highlights from the AAICAD 2010 included:

The Alzheimer's Association announced the launch of Alzheimer's Association TrialMatchTM, a confidential, free, and interactive tool that provides comprehensive clinical trial information and an individualized trial matching service for people with Alzheimer's disease and related dementias. The Internet (www.alz.org/trialmatch) and phone-based (800-272-3900) program provides a first-of-its-kind service in Alzheimer's by delivering individualized matches to clinical trials for people with Alzheimer's, their healthcare professionals, caregivers, and healthy volunteers.
The Dementia Demonstration Project (DDP), an interdisciplinary effort led by the Geriatric Research, Education and Clinic Center at the Minneapolis Veterans (VA) Medical Center, found that early detection, diagnosis and care management for people newly diagnosed with cognitive impairment and dementia can reduce outpatient costs by almost 30 percent. Veterans in the study who were diagnosed in the DDP clinics saw their average outpatient healthcare costs decline by an average of $1,991 in the year after diagnosis of cognitive impairment compared with the year before diagnosis. In the DDP clinics, following evaluation, the dementia care team met with the patient and family to review the results, discuss the diagnosis, and outline treatment recommendations. Informational material, assistance in identifying needed services, and direct support and training from team members was provided, as needed.
Evidence from three long-term, large-scale studies (Framingham Study, Cardiovascular Health Study, NHANES III) supports the association of physical activity and certain dietary elements (tea, vitamin D) with possibly maintaining cognitive ability and reducing dementia risk in older adults. Plus, a new study in an animal model of Alzheimer's reported today at AAICAD 2010 suggests that an antioxidant-rich diet with walnuts may benefit brain function. Research has pointed towards a number of factors that may impact our risk of Alzheimer's and cognitive decline, the strongest being reducing cardiovascular risk factors. The Alzheimer's Association and others have repeatedly called for longer-term, larger-scale research studies to clarify the roles that these factors play in the health of the aging brain. These studies from AAICAD 2010 are some of the first reports of this type in Alzheimer's, and that is encouraging, but it is not yet definitive evidence.
Scientists at AAICAD 2010 presented the first draft reports from three workgroups – covering Alzheimer's disease dementia, mild cognitive impairment (MCI) due to Alzheimer's disease, and preclinical Alzheimer's disease – convened by the National Institute on Aging (NIA) and the Alzheimer's Association to update the diagnostic criteria for Alzheimer's disease for the first time in 25 years. The proposals would change the existing criteria by better reflecting the various stages of the disease and the inclusion of Alzheimer's disease biomarkers. While the role of biomarkers differs in each of the three stages, much remains to be understood concerning their reliability and validity in diagnosis. This makes it critical that any new recommendations be thoroughly tested. Further input will be solicited by the NIA and the Association through a website launched immediately after the AAICAD presentations at www.alz.org/research/diagnostic_criteria.
The primary therapeutic target in Alzheimer's disease has been the beta amyloid peptide, which clusters outside cells in the brain to form sticky clumps known as plaques. Recently, more attention has been given to the tau protein, which aggregates inside the brain cells of people with Alzheimer's, forming neurofibrillary tangles. Four new, though very preliminary, research studies reported at AAICAD 2010 described experimental immunotherapies for Alzheimer's – two of which target tau directly and two of which may reduce tau even though their primary target was beta amyloid. Importantly, these studies teach us more not only about tau-targeted therapies but also about the progression of Alzheimer's disease. It may be that amyloid changes in the brain happen early in Alzheimer's, and tau-related changes happen "downstream" where they have a more direct effect on cognitive function. Thus, immunotherapy treatments targeting amyloid may also alter neurodegenerative processes that occur later in the disease. However, this is still to be determined.
In an early finding reported at AAICAD 2010, a gene known as FTO, which appears to be correlated with obesity in humans, may also increase risk of Alzheimer's disease and dementia. When a person has certain variants of both FTO and a recognized Alzheimer's risk gene known as APOE, the risk of Alzheimer's could be doubled. FTO has previously been shown to affect body mass index (BMI) and the risk for diabetes. These vascular risk factors have also been associated with risk of Alzheimer's disease. However, the researchers found that the increased risk was independent of these traits, suggesting that there is a different mechanism by which FTO is associated with an increased risk for Alzheimer's. We need to see these results confirmed by other researchers. In fact, we need to know more, in general, about the genetics and other causes of Alzheimer's so that we have additional targets for therapies and preventions.
Last minute scientific submissions to AAICAD 2010, known as "hot topics," suggested that (1) a newly-discovered risk gene for Alzheimer's may have early impact on memory skills and brain volume, (2) intranasal insulin may be beneficial in Alzheimer's, and (3) beta amyloid deposits in the brains of people with Alzheimer's disease may take different shapes based on a known Alzheimer's risk gene.
- Two studies reported at AAICAD 2010 give us more information about the TOMM40 gene – a newly identified risk gene for Alzheimer's. They found that healthy, middle aged people who have the high risk version of TOMM40 (a) did worse on memory tests and (b) had reduced brain volume in two regions affected early in Alzheimer's.
- A short-term (4 months) clinical trial of intranasal insulin in Alzheimer's and mild cognitive impairment (MCI) showed statistically significant benefits on certain tests of memory and functioning, but no changes on others. In those who showed benefits on memory tests, there were also positive changes in Alzheimer's biomarkers in spinal fluid. Larger, longer-term studies are planned.
- Researchers using a new imaging tool suggest that there are different shapes of beta amyloid deposits in the Alzheimer brain based on which version a person has of a well-established Alzheimer's risk gene, known as APOE. This may be especially important because in some recent drug trials the therapy provided benefits in people who had certain types of APOE but were less effective or not effective in others.
Two new studies from AAICAD 2010 suggest that having Alzheimer's disease may increase the risk of getting other potentially disabling health conditions, including seizures and anemia. Researchers in one study found that that the rate of seizures, per 1,000 people per year, in a study population that included 14,838 people with Alzheimer's aged 50 years or older and 14,838 randomly-selected, age- and sex-matched people without Alzheimer's, was 9.1 among patients with Alzheimer's compared with 1.4 for those without Alzheimer's – an incidence rate that was 6.4 times higher. In a second study of 1,112 older adults (768 healthy controls, 133 MCI, 211 Alzheimer's), people with anemia were found to have an increased risk of Alzheimer's (odds ratio: 2.56). And people with Alzheimer's in the study were found to have an increased risk of being anemic (odds ratio: 2.61). If Alzheimer's also increases risk of other disabling conditions, then its impact may be more devastating than we've envisioned as the global population ages and as more countries become westernized in their habits and lifest
Racially and ethnically diverse older adults are one of the fastest growing population segments in the United States. New research presented AAICAD 2010 revealed that older African-Americans and Latinos with significant cognitive impairment have a lower likelihood of nursing home placement and longer survival than White older adults in the study. These results have significant implications for caregiver burden and community resources. There is a greater than anticipated need for culturally-appropriate dementia care resources and home and community- based services for these populations.
- These findings are particularly compelling since African-Americans are about two times more likely and Latinos about one and one-half times more likely to develop Alzheimer's and dementia than Whites, according to the Alzheimer's Association's 2010 Alzheimer's Disease Facts and Figures report.
- Another study reported at AAICAD 2010 suggests that the bereavement process and mourning experience for Alzheimer caregivers after the death of their loved one varies greatly among different racial and ethnic groups.
- A third research report suggested that cultural and spiritual beliefs of African-Americans, American Indians and Whites greatly influence how long it takes for a family to seek a medical diagnosis of Alzheimer's.

National Institute on Aging and Alzheimer's Association Lead Effort to Update Diagnostic Criteria for Alzheimer's Disease

Alzheimer's Association — 2010-07-13

- News briefing/Q&A: AAICAD 2010, Tuesday, July 13, 2010, 11:45 am-12:45 pm
Hawai'i Convention Center, Room 321A, 1801 Kalakaua Avenue, Honolulu -

Honolulu, Hawaii, July 13, 2010 – Scientists at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) today presented the first draft reports from three workgroups convened by the National Institute on Aging (NIA) and the Alzheimer's Association to update the diagnostic criteria for Alzheimer's disease for the first time in 25 years.

The current criteria for the diagnosis of Alzheimer's were established by a National Institute of Neurological Disorders and Stroke (NINDS)/Alzheimer's Disease and Related Disorders Association (ADRDA) workgroup in 1984. These criteria were almost universally adopted and have been useful; they have survived intact without modification for more than 25 years. However, experts note, the field has evolved to a great extent since then.

"Important scientific discoveries have been made in Alzheimer's, and there have been significant changes in our knowledge and conception of the disease," said Creighton H. Phelps, Ph.D., Director of the Alzheimer's Disease Centers Program, Division of Neuroscience, National Institute on Aging at the National Institutes of Health. "The NIA and the Alzheimer's Association, after consultation with the Alzheimer's scientific and medical community, concluded that the diagnostic criteria may need to be revised to incorporate scientific advances. We decided to convene workgroups to examine the literature and make recommendations."

At AAICAD 2010, leaders of the three workgroups – which covered Alzheimer's disease dementia, mild cognitive impairment (MCI) due to Alzheimer's disease, and preclinical Alzheimer's disease – presented preliminary reports at a special session for initial comment by the Alzheimer's community.

"The proposals would change the 1984 criteria by better reflecting the various stages of the disease and the inclusion of Alzheimer's disease biomarkers," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "While the role of biomarkers differs in each of the three stages, much remains to be understood concerning their reliability and validity in diagnosis. This makes it critical that we thoroughly test any new recommendations."

Further input will be solicited by the NIA and the Association through a website launched immediately after the AAICAD presentations at www.alz.org/research/diagnostic_criteria. After that input is incorporated, next steps are publication in a peer-reviewed journal followed by systematic validation through incorporation of the criteria into clinical trials.

"The proposed criteria for Alzheimer's disease dementia must be flexible enough to eventually be used – once they are validated – by both general health care providers without access to neuropsychological testing, advanced imaging, and CSF measures, as well as specialized investigators involved in research or clinical trial studies with access to these measures," said Guy McKhann, MD, of John Hopkins University School of Medicine, who chaired this workgroup.

The Importance of Moving to Earlier Diagnosis

Alzheimer's is thought to begin years, perhaps even decades, before symptoms are noticeable. But there is no single, generally accepted way to identify the disease in its earliest stages – before symptoms are evident.

According to Phelps, earlier detection of people at highest risk for Alzheimer's and those who have the earliest forms of the disease will facilitate finding the right individuals to participate in risk reduction and prevention research studies.

"The NIA and the Alzheimer's Association hope this process of updating and revising the Alzheimer's diagnostic criteria with modern technologies and the latest advances will provide standards that move the field further in the direction of early detection and treatment," Thies said.

Significant Advances in Alzheimer Research Since 1984

Among the most important advances in the Alzheimer's field since the publication of the 1984 NINDS/ADRDA diagnostic criteria are:

Alzheimer's-driven changes in the brain, as well as the accompanying cognitive deficits, develop slowly over many years with dementia representing the end stage of years of pathology accumulation. At the same time, we know that some people have the brain changes associated with Alzheimer's and yet don't show symptoms of dementia.
Predictive genes in early onset Alzheimer's indicate that the initial events ultimately leading to both clinical symptoms and pathological brain changes begin with disordered beta amyloid metabolism.
The e4 allele of the APOE gene is well accepted as a major genetic risk factor for late onset Alzheimer's disease, which is defined as onset at 65 or older.
Biomarkers for Alzheimer's have been developed and are being validated. These fall into several categories:
- Biomarkers of beta amyloid pathology, including amyloid PET imaging and levels of beta amyloid in cerebrospinal fluid (CSF).
- Biomarkers of neuronal injury, including levels of CSF tau and phospho-tau.
- Biomarkers of neuronal dysfunction, including decreased uptake of FDG on PET scans.
- Biomarkers of neurodegeneration, including brain atrophy on structural MRI scans.

In addition, it has been only in the past decade that a better understanding of the distinctions and overlaps of Alzheimer's with non-Alzheimer's dementias has begun to emerge. Knowledge of the non-Alzheimer's dementias was rudimentary in 1984, and the current diagnostic criteria are vague in defining distinctions between Alzheimer's and the major alternatives. The common co-existence of Alzheimer's and cerebrovascular disease is now appreciated. Much more is known about dementia resulting from Lewy Body disease, and also about Pick's disease and other frontotemporal dementias.

Three Work Group Reports Present New Ideas for Research Criteria and Better Define Early Stages of Alzheimer's Disease

The NIA/Alzheimer's Association working groups were organized around the three stages of Alzheimer's disease that are commonly thought to exist today – pre-clinical Alzheimer's, mild cognitive impairment (MCI) due to Alzheimer's, and Alzheimer's dementia.

Pre-clinical – The group is laying out a research agenda to identify methods of assessment that may help predict risk for developing the disease. Biomarkers and other clinical assessment tools to identify early cognitive decline are being investigated to establish the presence of Alzheimer's brain changes in people with no overt symptoms and to identify those who may eventually develop the disease.
Mild cognitive impairment – The group is refining the MCI criteria, which will help to indicate cognitive change before dementia and better differentiate MCI from Alzheimer's. Research is underway to better understand the cognitive changes taking place, how they may relate to biomarkers, and which of these methods best indicate the likelihood of imminent progression to Alzheimer's dementia.
Alzheimer's dementia – The group is revising the existing criteria for diagnosing Alzheimer's to include possible biomarkers and other assessments that may aid in diagnosis.

Alzheimer's Disease may Increase Risk of Anemia and Seizures

Alzheimer's Association — 2010-07-13

- Global Impact Could Multiply As The Population Continues to Age -

Honolulu, Hawaii; July 13, 2010 – Having Alzheimer's disease may increase the risk of getting other potentially disabling health conditions, including seizures and anemia, according to new research presented today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI.

"Alzheimer's disease is a global health crisis with devastating effects on individuals, families, and national healthcare systems," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "If, in fact, Alzheimer's also increases risk of other disabling conditions, then its impact may be more devastating than we've envisioned as the global population ages and as more countries become westernized in their habits and lifestyles."

According to the 2009 World Alzheimer Report from Alzheimer's Disease International, a London-based nonprofit, international federation of 71 national Alzheimer organizations including the Alzheimer's Association, the number of people with Alzheimer's or another dementia, currently 35 million, is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

Worldwide, the economic cost of dementia has been estimated as $315 billion annually. (Wimo, et al. "An Estimate of the Total Worldwide Societal Costs of Dementia in 2005." Alzheimer's & Dementia: The Journal of the Alzheimer's Association. Vol. 3, Issue 2, April 2007.)

Alzheimer's is Associated with Increased Incidence of Seizures

Some small studies have shown Alzheimer's to be a risk factor for seizures. H. Michael Arrighi, PhD, of Janssen Alzheimer Immunotherapy Research & Development; Nicole Baker, MPH, Pfizer; and colleagues conducted an observational study to estimate the incidence rate of seizures among a large cohort of people with Alzheimer's. The researchers used anonymized electronic medical records from nearly 400 primary medical practices in the United Kingdom. The study population included 14,838 people with Alzheimer's aged 50 years or older and a comparison cohort of 14,838 randomly-selected, age- and sex-matched patients without Alzheimer's. People with Alzheimer's were followed for an average of 2.3 years; non-Alzheimer's patients were followed for an average of 3.4 years.

Over that time period, the researchers found that the rate of seizures, per 1,000 people per year, was 9.1 among patients with Alzheimer's disease compared with 1.4 for those without Alzheimer's – an incidence rate that was 6.4 times higher. In addition, they found that the incidence rate of seizures was highest among the youngest Alzheimer's patients, and that it decreased with age. Incidence among non-Alzheimer's patients increased slightly with age.

"The increased risk of seizures among patients with Alzheimer's disease was seen in all age groups, but there was a substantial increase among the youngest patients. It is especially important for these patients and their caregivers to be aware of this risk," Baker said.

"The connection between Alzheimer's and seizures provides additional avenues for research into the basic biology of both diseases, and possibly interventions and therapies to respond to the overall impact of Alzheimer's disease" Arrighi said.

Alzheimer's is Associated with Lower Hemoglobin Levels and Anemia

Studies suggest that iron accumulates in the tau tangles in the brains of people with Alzheimer's, and that overall levels of iron are elevated in both Alzheimer's and Mild Cognitive Impairment (MCI) brains. However, it is not clear from the scientific literature if this altered brain iron profile is reflected in plasma iron levels.

Noel Faux, PhD, of the Mental Health Research Institute, Parkville, Australia, and colleagues examined hemoglobin, iron and other blood-based measurements in the 1,112 participants (768 healthy controls, 133 MCI, 211 Alzheimer's) of the Australian Imaging Biomarkers and Lifestyle (AIBL) study of Ageing. Participants also completed questionnaires on diet and medication intake (including supplements). Results were then correlated with measures of short-term, long-term and total memory, and global cognition.

The researchers found that people with Alzheimer's in the study had significantly lower levels of hemoglobin, mean cell hemoglobin concentration (MCHC), and packed cell volume compared with healthy controls, after adjustment for age and gender. Consistent with these data, the erythrocyte sedimentation rate (ESR) was significantly higher in Alzheimer's compared to healthy controls.

Participants with anemia in the study were found to have an increased risk of Alzheimer's (odds ratio: 2.56). And people with Alzheimer's in the study were found to have an increased risk of being anemic (odds ratio: 2.61). Self reported iron intake was not different in the two groups.

"In our population, we found that people with Alzheimer's disease were more likely to be anemic, and this was not explained by dietary iron deficiency," Faux said. "This suggests that hemoglobin production is deficient in Alzheimer's patients."

"Alzheimer's had not previously been recognized as a risk factor for anemia, which is a common clinical problem for the elderly and can contribute to problems such as heart failure and renal failure," Faux continued. "The cause of anemia in Alzheimer's is still uncertain, but we speculate that Alzheimer's is a disease that affects both brain and blood. We are currently investigating this intriguing possibility."

Exercise and Alzheimer's: Working Out May Cut Dementia Risk in Half

Alzheimer's Association — 2010-07-13

MILWAUKEE, Wisconsin (CBS/AP) If you are worried about Alzheimer's, it looks like hitting the gym might be your best bet.

At least for now.

Scientists have found that moderate to heavy exercise may cut the risk of developing dementia in half. That comes from data pulled from the long-running Framingham Heart Study.

"That seems to be as good as anything" for preventing dementia, said Dr. Richard Mayeux, a Columbia University neurologist and conference leader at this week's Alzheimer's conference in Hawaii.

Other studies have also found a positive link between exercise and keeping Alzheimer's at bay.

Alzheimer's is a form of dementia that affects 26 million worldwide. It usually occurs in seniors, but a less common form can strike as early as the 30s.

So remember to hit the gym, before you can't remember where you put the car.

More information at the Alzheimer's Association.
- CBS News

Match service aims to speed Alzheimer's research

Alzheimer's Association — 2010-07-13

(Reuters) - A new online service designed to match Alzheimer's patients with clinical trials may help address a big bottleneck in developing new drugs -- a lack of people to test them on, U.S. researchers said on Monday.

The Alzheimer's Association estimates there are more than 100 clinical trials in Alzheimer's drugs and dementia taking place, and dozens more experimental drugs that will soon be ready to test. Yet too few people sign up for the studies.

"We're going to need over 10,000 Alzheimer's patients over the next five years to enroll just the trials that are already planned," Dr. Reisa Sperling of Brigham and Women's Hospital and Massachusetts General Hospital in Boston said in an interview at the Alzheimer's Association meeting in Honolulu.

Sperling said it takes drug companies an average of one to two years to enroll enough patients in their mid-stage and late-stage clinical trials.

"If it takes 18 months to enroll and the trials are 18 months long, that is three years for every single drug," she said. "That is just too long. That means at this rate we will not be able to test all these drugs until 2030 when we have triple the number of people with Alzheimer's disease."

The Alzheimer's Association estimates that from 2010 to 2050, the cost of caring for Americans 65 and older with Alzheimer's disease will increase more than six times to $1.08 trillion per year.

Current drugs help manage symptoms but no treatment can stop the progression of Alzheimer's, which can start with vague memory loss and confusion before progressing to complete disability and death.

"Many medical centers and pharmaceutical companies and universities around the world are trying to develop therapies that are disease-modifying," said Dr. Ronald Petersen of the Mayo Clinic in Rochester, Minnesota, who heads the Alzheimer's Association's medical and scientific advisory council.

"The single biggest barrier is the recruitment of an adequate number of subjects," he told a news conference.

Doctors are part of the problem, Sperling said.

An Alzheimer's Association poll found that nearly 75 percent of doctors had referred their patients to clinical trials, but only 25 percent had referred them to Alzheimer's disease trials, she said.

The new matching service, called TrialMatch, works a bit like an online dating site. Patients or their caregivers fill out a basic profile, and then get a list of potential matches.

Patients who want to move ahead can then speak to a trained operator who will help them get in touch with doctors in their area looking for patients for their studies.

The Alzheimer's Association is spending $1.2 million on the service, which can be found at www.alz.org/trialmatch.
- Reuters

Gene linked to obesity may also raise dementia risk

Alzheimer's Association — 2010-07-13

But finding is early and needs to be replicated in other research, experts say

TUESDAY, July 13 (HealthDay News) -- A variant of the obesity-related gene FTO may increase the risk of Alzheimer's disease and dementia, finds a new Swedish study.

Previous research has shown that the FTO gene affects body mass index (BMI), levels of leptin (a hormone involved in appetite and metabolism), and the risk for diabetes -- all vascular risk factors that have also been linked with the risk of Alzheimer's disease.

This new study, conducted by the Karolinska Institute in Stockholm, included more than 1,000 Swedish people, aged 75 and older, who were followed for nine years. They all underwent genetic testing at the start of the study.

Participants who carried an AA gene variant in the FTO gene had a 58 percent increased risk of developing Alzheimer's and a 48 percent increased risk for dementia, compared to those without the variant.

The researchers also said the risk could be 100 percent higher for a person with the FTO-AA variant and a gene mutation called APOE4, which is the highest-risk variant of the known Alzheimer's-related gene called APOE.

"One of the intriguing aspects of the results is that the increased risk was independent of the traits previously associated with FTO, such as obesity and diabetes measured at baseline," wrote Dr. Caroline Graff and colleagues at the Karolinska Institute, in a news release. "Our results suggest that the mechanism by which FTO is associated with an increased risk for Alzheimer's and dementia may be different from how it increases the risk for obesity."

The study was slated to be presented July 12 at the Alzheimer's Association International Conference on Alzheimer's Disease.

"This is a fascinating early finding, which fits with the known connections between heart health and brain health," Maria Carrillo, senior director of medical and scientific relations at the Alzheimer's Association, said in an association news release. "However, we do need to see these results confirmed by other researchers."
- HealthDay

Four New Research Studies Describe Experimental Immunotherapies for Alzheimer's

Alzheimer's Association — 2010-07-13

- Two Target Tau; Two May Reduce Tau Though Their Target Was Amyloid -

Honolulu, Hawaii, July 13, 2010 – The primary therapeutic target in Alzheimer's disease has been the beta amyloid peptide, which clusters outside cells in the brain to form sticky clumps known as plaques. Recently, more attention has been given to the tau protein, which aggregates inside the brain cells of people with Alzheimer's, forming neurofibrillary tangles. Precisely how these proteins interact in causing the disease is unclear.

Four new research studies reported today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI describe experimental immunotherapies for Alzheimer's two of which target tau directly and two of which may reduce tau even though their primary target was beta amyloid.

"It is very important that we have a variety of therapeutic targets in the fight against Alzheimer's disease," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "The more opportunities that we investigate to intervene and change the relentless and progressive course of Alzheimer's, the better chance that we will find something that works."

"Importantly, these studies teach us more not only about tau-targeted therapies but also about the progression of Alzheimer's disease," Thies added. "It may be that amyloid changes in the brain happen early in the disease and tau-related changes happen ‘downstream' where they have a more direct effect on cognitive function. However, this is still to be determined."

"We need more basic research about what causes Alzheimer's, as well as therapy-related studies, to fill the front end of the drug pipeline and get us the better treatments and prevention strategies that we so desperately need to head off the epidemic of Alzheimer's," Thies said.

Beta Amyloid Immunotherapy with Bapineuzumab in Alzheimer's May Also Reduce Tau

Bapineuzumab (Janssen Alzheimer Immunotherapy and Pfizer) is an antibody to the beta amyloid plaques that are associated with Alzheimer's disease, and is currently in Phase 3 testing as a treatment for mild to moderate Alzheimer's. An abnormal form of the tau protein known as phospho-tau (P-tau) forms into tangles which are the other established lesions in the brain of people with Alzheimer's. The amount of P-tau in cerebrospinal fluid (CSF) is believed to be a marker of active loss of brain cells in people with Alzheimer's; prior studies have shown increases in P-tau in people with mild cognitive impairment who later develop Alzheimer's. P-tau was studied as a therapeutic biomarker in the Phase 2 clinical trials of bapineuzumab.

The pooled exploratory analysis reported at AAICAD 2010 by Kaj Blennow, MD, PhD, of the University of Gothenburg, Sweden, and colleagues included a subgroup of participants from two randomized, multicenter, double-blind, placebo-controlled, multiple-ascending-dose studies conducted in the United States (Study 201) or in the United Kingdom and Finland (Study 202). Study 201 enrolled 35 patients (20 bapineuzumab, 15 placebo) in the CSF substudy, and Study 202 enrolled 11 patients (7 bapineuzumab, 4 placebo) in the CSF substudy. CSF was collected at baseline and 2 weeks after the week 52 infusion.

The researchers found that Study 201 showed a trend (p=0.0564) towards a decrease in CSF P-tau in bapineuzumab-treated compared with placebo-treated cases. In Study 202, no significant treatment effects were seen. When they combined data from both studies, they found a statistically significant decrease (p=0.0270) in P-tau in bapineuzumab-treated compared with placebo-treated patients.

"These observations suggest that immunotherapy treatment targeting amyloid may also alter neurodegenerative processes that occur later in the disease process and that are more directly associated with loss of function," Blennow said. "However, this was a small study and these findings need to be confirmed."

Another Immunization Therapy for Alzheimer's with Beta Amyloid Also Reduces Tau

AN1792 (Elan) showed early promise as a beta amyloid immunotherapy for Alzheimer's. In 2002, a Phase 2 trial reported that about 6 percent of participants developed serious brain inflammation symptoms resembling meningoencephalitis. The trial was stopped as was further clinical development. However, participants in the first AN1792 trial continue to be observed.

Delphine Boche, PhD, of the University of Southampton's School of Medicine, UK, and colleagues studied the levels of beta amyloid and phospho-tau in six regions of cerebral grey matter that are affected by Alzheimer's pathology in the brains of 10 people with Alzheimer's who were immunized with AN1792 and compared the findings with 28 unimmunized Alzheimer cases. They had previously shown a reduction of beta amyloid in people treated with AN1792 and now looked to see if it had any effect on tau.

The researchers found statistically significant reductions in tau and beta amyloid in the immunized patients compared with untreated Alzheimer's. The reduction in tau appeared to be specifically in the dendrites, which are the branched projections of a neuron that conduct the electrochemical stimulation received from other nerve cells to the cell body. In contrast, tau in the bodies of the nerve cells, where the tangles form, seemed unaffected.

"The findings show that treatment aimed at beta amyloid may also modify tau changes in Alzheimer's," Boche said. "The lack of change in tau in the bodies of nerve cells might explain why the people in the original AN1792 trial didn't experience an improvement in cognitive functioning even though we saw amyloid clearance."

"This study demonstrates a link between these two Alzheimer's-related proteins, which has been suspected but not clearly demonstrated in the human brain. The findings give us more basic information about the interaction between beta amyloid and tau in Alzheimer's and may clarify how the disease progresses in the brain," Boche said.

Tau Antibodies Reduce Brain Tangles in Alzheimer-Model Mice

Allal Boutajangout, PhD, of the New York University School of Medicine, and colleagues previously reported that active tau immunization clears tau tangles from the brain and reduces or prevents functional impairments in two different tangle-model mice. In a study reported at AAICAD 2010, they assessed the efficacy of passive immunization for 13 weeks with the PHF1 antibody to tau in a mouse model of Alzheimer's tangles.

The researchers found that weekly injections of PHF1 in the tangle mice reduced the amount of tau aggregates in the brain and decreased functional impairment. The treated mice performed better than controls on the traverse beam task (p<0.03), and had 58 percent less tau pathology in the hippocampus (p=0.02). Plasma levels of PHF1 were inversely related to levels of tau pathology in two brain sections – the brain stem (p<0.01) and motor cortex (p=0.06) – indicating that higher dose of antibodies may have a greater therapeutic effect.

"Targeting hyperphosphorylated tau by immunotherapy is emerging as a promising approach to treat tau-related diseases such as Alzheimer's disease and frontotemporal dementia," Boutajangout said. "Further studies are needed to determine the feasibility of this approach with other tau antibodies and in different tangle models that more closely resemble Alzheimer's."

Alzheimer's Tau Vaccine Shows Promise in a New Rat Model of the Disease

Scientists led by Prof. Michal Novak, MDV, PhD, DSc, of the Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia and Co-Founder and Chief Scientific Officer of the Axon Neuroscience GmbH, Vienna, Austria, have developed a new transgenic rat model of Alzheimer's that, according to Novak, for the first time expresses non-mutated tau and generates Alzheimer's neurofibrillary tangles. Axon is using the rat for early, preclinical development of an Alzheimer's tau vaccine.

In a study reported at AAICAD 2010, Axon transgenic rats were immunized with phospho-tau. The scientists measured changes in functions related to behavior and learning, levels of phosphorylated tau in cerebrospinal fluid, and level of tangle pathology in the rat brains. They found that tau immunization significantly reduced the amount of insoluble tau, prevented development of neurofibrillary tangles, and produced a statistically significant delay of progressive impairment in learning behaviors.

"The Axon Alzheimer Rat may offer new avenues in developing the next generation of therapies and diagnostics for Alzheimer's," Novak said.

About AAICAD The Alzheimer's Association International Conference on Alzheimer's Disease (AAICAD) is the world's largest conference of it's kind, bringing together researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Alzheimer's Association's research program, AAICAD serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.
- Alzheimer's Association

An Obesity Gene, Known as FTO, Also May Increase Risk of Alzheimer's Disease and Dementia

Alzheimer's Association — 2010-07-12

A gene known as FTO, which appears to be correlated with obesity in humans, may also increase risk of Alzheimer's disease and dementia, according to new research presented today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI. And when a person has certain variants of both FTO and a recognized Alzheimer's risk gene known as APOE, the risk of Alzheimer's could be doubled.

"While scientists know Alzheimer's involves progressive brain cell failure, they have not yet identified any single reason why cells fail," said Maria Carrillo, PhD, senior director of Medical and Scientific Relations at the Alzheimer's Association. "However, there is evidence about certain factors that may increase the likelihood of developing Alzheimer's."

"Some of these factors we can't control, such as age, family history, and genetics," Carrillo said. "Others we may be able to influence, including heart health, tobacco and alcohol use, and head injury."

FTO has previously been shown to affect body mass index (BMI), leptin levels (a protein hormone that plays a key role in appetite and metabolism), and the risk for diabetes. These vascular risk factors have also been associated with risk of Alzheimer's disease.

In the study reported at AAICAD 2010, Caroline Graff, MD, PhD, and colleagues at the Karolinska Institutet, Sweden, explored the direct role of the FTO gene on Alzheimer's and dementia risk in old age. In addition, a possible interaction of FTO with the APOE gene, a well-established genetic risk factor for Alzheimer's, was assessed. The researchers followed 1,003 people aged 75 years and older without dementia from the Kungsholmen project, Sweden, for nine years to detect new cases of Alzheimer's and dementia. All participants had been genotyped for FTO and APOE on DNA sampled at the beginning of the study.

They found that people in the study population who carried the AA gene-variant in the FTO gene had a 58 percent increased risk for developing Alzheimer's and a 48 percent increased risk for developing dementia compared with those who did not have this genetic variant, after adjustment for age, gender, education, and APOE genotype.

The findings also suggest that the risk-effect of FTO-AA on dementia is further elevated to 100 percent increased risk in the presence of APOE ε4, which is the highest risk variant of the APOE gene. The effect of the FTO-AA genotype on Alzheimer's and dementia risk remained after additional adjustment for diabetes, BMI, cardiovascular disease and physical inactivity.

"One of the intriguing aspects of the results is that the increased risk was independent of the traits previously associated with FTO, such as obesity and diabetes measured at baseline," Graff said. "Our results suggest that the mechanism by which FTO is associated with an increased risk for Alzheimer's and dementia may be different from how it increases the risk for obesity."

"This is a fascinating early finding, which fits with the known connections between heart health and brain health," Carrillo said. "However we do need to see these results confirmed by other researchers. In fact, we desperately need to know more, in general, about the genetics and other causes of Alzheimer's so that we have additional targets for therapies and preventions. One major positive step in that direction would be for the federal government to address its chronic underfunding of Alzheimer's disease research."

Older African-Americans and Latinos with Cognitive Impairment Live Longer than Whites; Less Likely to be in Nursing Homes

Alzheimer's Association — 2010-07-12

Racially and ethnically diverse older adults are one of the fastest growing population segments in the United States and new research presented today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu reveals that older African-Americans and Latinos with significant cognitive impairment have a lower likelihood of nursing home placement and longer survival than White older adults in the study.

"These results have significant implications for caregiver burden and community resources," said Maria Carrillo, Ph.D., Alzheimer's Association's Senior Director of Medical and Scientific Relations. "If, as the study suggests, more African-American and Latino families are taking care of their loved ones with significant cognitive impairment in their homes for longer periods of time, there is a greater than anticipated need for culturally-appropriate dementia care resources and home and community- based services for these populations."

"These findings are particularly compelling since we found that African-Americans are about two times more likely and Latinos about one and one-half times more likely to develop Alzheimer's and dementia," Carrillo said. This was reported in March in the Alzheimer's Association's 2010 Alzheimer's Disease Facts and Figures report, a comprehensive compilation of national statistics and information on Alzheimer's disease and related dementias.

Another study reported today at AAICAD 2010 suggests that the bereavement process and mourning experience for Alzheimer caregivers after the death of their loved one varies greatly among different racial and ethnic groups. A third research report suggested that cultural and spiritual beliefs of African-Americans, American Indians and Whites greatly influence how long it takes for a family to seek a medical diagnosis of Alzheimer's.

"Alzheimer's leads so many families through unfamiliar territory. The need for education, information, supportive services is paramount," Carrillo said. "The more we learn about the similarities and differences that exist in how various groups perceive and experience Alzheimer's, the more effective we can be in developing culturally-appropriate information, services, and tools that are respectful of these perceptions and closely held values, and that contain authentic relevance that empowers families."

Racial Differences in Nursing Home Placement and Mortality
Few studies have examined how significant cognitive decline impacts minority older adults in the United States. Kala M. Mehta, DSc, MPH, at the University of California, San Francisco, and colleagues examined the relationship between significant cognitive decline and two health consequences – nursing home placement and mortality – in a representative sample of U.S. older adults participating in the Health and Retirement Study. More than 7,500 older people, 10 percent African-American and six percent Latino, were assessed over an 8-year period.

During the study, 23 percent of participants died and 14 percent experienced significant cognitive decline. The researchers found that the proportion of persons with significant decline did not vary by race. However, of those with significant cognitive decline, older African Americans and Latinos had statistically significantly less placement in nursing homes compared to older Whites, and were statistically significantly less likely than similar Whites to die during the follow up period.

"Our results may indicate that African-American and Latino adults have a higher burden from significant cognitive decline than White older adults," Mehta said. "This may impact the adults themselves, their caregivers and their communities. Thus, our findings support the need for culturally-appropriate dementia care, support services and home care resources for African-American and Latino communities in the U.S."

Ethnic Variations in the Bereavement and Mourning Experience
Little is known about the caregiver's bereavement and mourning experience after a family member with Alzheimer's dies. REACH, the Resources for Enhancing Alzheimer's Caregiver Health project led by Richard Schulz, PhD of the University of Pittsburgh's Institute on Aging, provides some of the most comprehensive and systematic information available to date about Alzheimer caregivers.

The Bereavement Component of REACH studied caregivers in three distinct racial/ethnic groups: Hispanics, African-Americans and Whites. James McNally, PhD, of the University of Michigan examined the variations among these groups, including differences in expressions of relief, anger and emotional acceptance.

Study results showed that Whites and Hispanics are three to five times more likely to report a sense of emotional relief at the death of the care recipient, compared to African-Americans. The study also found that Hispanics were only half as likely as African-Americans to report feelings of anger towards the deceased caregivers while White caregivers were considerably more likely to report feelings of anger than both the other groups. Factors such as relationship to the person with Alzheimer's, the emotional and physical health of the caregiver and their sociodemographic characteristics moderated these effects to some degree, but significant differences in the bereavement process remained among the ethnic populations examined.

"For those caring for a family member with Alzheimer's, the process of bereavement often begins long before the family member's physical death," McNally said. "These results bring into sharper focus some distinct social and cultural responses to the bereavement process, and help increase our understanding of the emotional costs of Alzheimer's. This understanding can help to inform and improve culturally competent resources to help caregivers not only throughout all stages of their loved one's illness, but also in finding a healthy resolution to grieving."

Alzheimer's Disease Diagnosis in a Cultural Context
Increasing evidence suggests that early diagnosis of Alzheimer's and timely intervention is beneficial, both for people with the disease and their caregivers. Earlier Alzheimer and dementia diagnosis could allow for earlier use of medications and other interventions that could help to maintain the person's independence longer. Delays in diagnosis also mean that many miss the opportunity to make legal, financial and care plans while they are still capable.

One study of 22 families, including Whites (seven), Blacks (10) and American Indians (five), examined the Alzheimer diagnostic process in a cultural context and found that ethnic minority groups often seek a diagnosis much later than their White counterparts. Led by Peggye Dilworth-Anderson, PhD, of the University of North Carolina at Chapel Hill, the study found that while all groups recognized the value of having a diagnosis, long delays often occurred between family members' recognition of symptoms of dementia and the scheduling of a medical evaluation. The study found that, on average, African-Americans sought a diagnosis six years after dementia symptoms emerged, American Indians sought one after five years, and Whites after two years. Study results also indicated that Whites were more likely to seek support through formal services, while Blacks and American Indians turned more often to their faith and spiritual beliefs for support.

"Many caregivers did not recognize the early signs of dementia because they thought it was a part of their loved one's normal behavior," said Dilworth-Anderson. "Most caregivers mistakenly believed that having dementia is normal and accepted it as a part of growing old. A medical diagnosis of dementia is often only sought after a cultural understanding is developed by the cultural group."

In another quantitative study on dementia care led by Dilworth-Anderson, which involved telephone surveys with 200 Black and White caregivers, about 48 percent of caregivers in the study reported that the care recipient had received a diagnosis of dementia. Among those diagnosed, racial differences in access to care services were observed. Whites reported higher care recipient and caregiver service availability than Blacks, particularly direct care services (such as respite care and caregiving facilities). Blacks reported the use of home health care services for the care recipient more than Whites, and also reported having a greater availability of church resources. Additionally, Blacks reported no services being available at all at a higher percentage than Whites.

Alzheimer's Association Launches TrialMatch™ – First-of-its-Kind Clinical Trials Matching Service in Alzheimer's

Alzheimer's Association — 2010-07-12

The Alzheimer's Association announced today the launch of Alzheimer's Association TrialMatch™, a confidential and free interactive tool that provides comprehensive clinical trial information and an individualized trial matching service for people with Alzheimer's disease and related dementias. The Internet (www.alz.org/trialmatch) and phone-based (800-272-3900) service debuted during the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI.

There are as many as 5.3 million Americans living with the Alzheimer's and every 70 seconds someone in America develops the disease, according to the Association's 2010 Alzheimer's Disease Facts and Figures. This year, there will be one half million new cases of Alzheimer's; in 2050, there will be nearly a million new cases annually.

"Alzheimer's disease is clearly the #1 public health challenge of the 21st century and research is the only way to solve this problem," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association.

Recruiting and retaining trial participants is one of the greatest obstacles to developing the next generation of Alzheimer's treatments, perhaps second only to lack of funding.

"If patients are not enrolling in trials, there can be no advances in diagnosis, treatment and prevention, making the lack of study participants a significant public health issue," Thies said. "Alzheimer's Association TrialMatch provides a first-of-its-kind service in Alzheimer's by delivering a user-friendly and individualized guide to clinical trials for people with Alzheimer's, their healthcare professionals, caregivers and healthy volunteers."

More than 100 clinical studies in Alzheimer's and dementia are currently taking place and dozens more experimental compounds are moving from the laboratory to clinical testing. For people with Alzheimer's and their caregivers, clinical trials present an opportunity to play a more active role in their own treatment – ultimately contributing to scientific discovery and benefiting future generations.

About Alzheimer's Association TrialMatch
Alzheimer's Association TrialMatch is designed to be easy to use for people with Alzheimer's, with web and phone support, specially trained staff, and tools developed with input from people with Alzheimer's.

The strength of this Web- and national 800 line-based service is that Alzheimer's Association TrialMatch contains a comprehensive, constantly updated database of institutional review board-approved Alzheimer's, mild cognitive impairment and other dementia trials taking place across the U.S. Specialists at the Alzheimer's Association's national Helpline – available 24-hours a day – assist in the process of matching individuals to clinical trials for which they are eligible based on study inclusion/exclusion criteria, diagnosis, treatment history and location.

By Association policy, telephone specialists will not recommend any particular clinical trial, but will describe all studies for which the person is eligible. They will answer questions about the trial process and connect individuals with trial sites based on their unique profile. Patients and caregivers will be encouraged to share their trial matches with their healthcare professionals to help decide whether a clinical trial is appropriate.

"We're looking to physicians to play a leadership role in referring their patients to Alzheimer's clinical trials and to Alzheimer's Association TrialMatch," said Marilyn Albert, PhD, Professor of Neurology at Johns Hopkins and Director of their Division of Cognitive Neuroscience. "As healthcare professionals, there is more we can do to help our Alzheimer's patients post-diagnosis by offering access to potential cutting-edge research and treatments being tested."

Alzheimer's Association TrialMatch can be accessed at www.alz.org/trialmatch or by calling toll-free, (800) 272-3900.

The technology and platform for Alzheimer's Association TrialMatch is provided by EmergingMed.
- Alzheimer's Association

Alzheimer's Association Launches New "Research Center" Website to Expand Public's Knowledge About Alzheimer Research

Alzheimer's Association — 2010-07-12

A new website showcasing the latest in Alzheimer's disease research and science - www.alz.org/research - is being unveiled at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu.

The website, called the Alzheimer's Association "Research Center," presents an extensive portfolio of information designed for a public searching for more knowledge about the current state of Alzheimer research, including both the latest news from the global research effort and how to volunteer for local Alzheimer's clinical trials.

Equally attractive to scientists and medical researchers, the site will also host valuable information that they can use, including highlights from Alzheimer's and Dementia: The Journal of the Alzheimer's Association, and information about scientific grants available from the Association.

"As I travel the country and talk to people whose families are affected by Alzheimer's disease, and as I read my daily e-mails, it is strikingly apparent that a wide range of people are genuinely interested in learning about what's happening in Alzheimer's science and when the next breakthroughs are going to come," said Angela Geiger, Chief Strategy Officer at the Alzheimer's Association. "The Alzheimer's Association is exploring innovative ways to advance research and also to engage and educate all kinds of people. This new website is an extension of this ever-expanding effort."

The innovative website seamlessly combines rich visuals with easy-to-understand content on a broad array of topics including:

* What Alzheimer's is, and how the disease progresses.
* Advances in treatments, diagnosis and prevention.
* How to volunteer for Alzheimer's clinical trials.
* Updates on key local, national and global research initiatives.

Important concepts about Alzheimer's the disease are explained and illustrated. Leading scientists are profiled. All of this and more is found at the "Research Center" in an easy-to-navigate presentation that enables users to quickly discover and connect with the information that matters most to them. Regular updates will include new information, interviews, graphics, and videos.

"Research is the most critical aspect of solving the Alzheimer crisis. This is why it is vital to have a place where people can go to find out about the latest Alzheimer research," Geiger said. "We listened to our constituents who said they wanted to know, learn and understand more. We hope this site serves as a catalyst for deeper understanding about Alzheimer research and a long-term dialogue with the public that encourages hope and engages them in the Alzheimer's cause."

To learn more, visit www.alz.org/research.
- Alzheimer's Association

Four Researchers Given Lifetime Achievement Awards by the Alzheimer's Association

Alzheimer's Association — 2010-07-11

The Alzheimer's Association recognized four scientists for their extraordinary achievements in advancing Alzheimer research at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, Hawaii.

Honorees for their professional and scientific contributions to Alzheimer research are:
* Takeshi Iwatsubo, MD, Department of Neuropathology, Graduate School of Medicine at the University of Tokyo.
* Karen H. Ashe, MD, PhD, Department of Neurology and Neuroscience Director at the University of Minnesota.
* Marsel Mesulam, MD, Dunbar Professor of Neurology and Psychiatry and Director of the Cognitive Neurology and Alzheimer's Disease Center at Northwestern University.
* Marilyn Albert, PhD, Director of the Division of Cognitive Neuroscience in the Department of Neurology at Johns Hopkins University School of Medicine.

"We are beginning to reap the benefits of Alzheimer's scientific advancements made in the last two decades, including a robust pipeline of anti-dementia drug therapies and advances in early detection," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "These leading researchers, who have been in the vanguard of scientific advancements in Alzheimer's disease, have devoted their professional careers to greater understanding of this disease. Their dedication and commitment will help us defeat Alzheimer's – the public health threat of the 21st century – and create a world where future generations will not have to experience this progressive and fatal disease."

Lifetime Achievement Awards in Alzheimer's Disease Research
Henry Wisniewski, MD, PhD; Khalid Iqbal, PhD; and Bengt Winblad, MD, PhD, founded AAICAD in 1988. Lifetime Achievement Awards named in their honor are given to three outstanding scientists who have dedicated their careers to helping millions around the world through their research.

At AAICAD 2010, the 2010 Henry Wisniewski Lifetime Achievement Award was presented to Dr. Takehsi Iwatsubo, whose significant research with the Japanese Alzheimer's Disease Neuroimaging Initiative (J-ADNI) is creating a longitudinal workup of standardized neuroimaging, biomarker and clinico-psychological surveys. Designed to maximize compatibility with US-ADNI, it is hoped that this work along with other global ADNI efforts will establish rigorous, quantitative descriptions of the natural course of Alzheimer's in its very early stages.

The 2010 Khalid Iqbal Lifetime Achievement Award was presented to Dr. Karen Ashe, whose research focuses on animal and cellular models of Alzheimer's. These transgenic animal models enhance understanding of how amyloid and tau proteins – thought to be the keys to the cause and progression of Alzheimer's – impact memory and cognition. Transgenic mice have been a mainstay in the preclinical investigation of new treatments for Alzheimer's.

The 2010 Bengt Winblad Lifetime Achievement Award was presented to Dr. Marsel Mesulam. His research addresses the connectivity of the monkey brain, the organization of human cholinergic pathways, the representation of cognitive functions by large-scale neurocognitive networks, and the neurobiology of dementias. Dr. Mesulam's work on cholinergic pathways has been groundbreaking in understanding Alzheimer's. He is a world expert in Primary Progressive Aphasia.

Zaven Khachaturian Award
In addition to these three awards, Dr. Marilyn Albert was recipient of the 2010 Zaven Khachaturian Award at AAICAD. Named in honor of noted scientist, administrator, consultant, lecturer and author, Zaven Khachaturian, PhD, this award recognizes an individual whose compelling vision, selfless dedication, and extraordinary achievement has significantly advanced the field of Alzheimer science.

Dr. Albert's distinguished career includes more than two decades as a faculty member at Harvard University Medical School. Her research has primarily focused on the cognitive and brain changes associated with aging and Alzheimer's. The scope has also encompassed investigating potential methods of early identification of Alzheimer's and lifestyle factors that may maintain mental abilities with advancing age.

Large-Scale, Long-Term Studies Support Roles of Physical Activity and Diet in Dementia and Cognitive Decline

Alzheimer's Association — 2010-07-11

Also, Antioxidant–Rich Diet Improves Memory and Learning in Alzheimer's Mice

Honolulu, Hawaii, July 11, 2010 – Evidence from three long-term, large-scale studies supports the association of physical activity and certain dietary elements (tea, vitamin D) with possibly maintaining cognitive ability and reducing dementia risk in older adults, according to new research presented today at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) in Honolulu, HI.

Plus, a new study in an animal model of Alzheimer's reported today at AAICAD 2010 suggests that an antioxidant-rich diet with walnuts may benefit brain function.

"Research has pointed us towards a number of factors that may impact our risk of Alzheimer's and cognitive decline, the strongest being reducing cardiovascular risk factors," said William Thies, PhD, Chief Medical and Scientific Officer at the Alzheimer's Association. "The Alzheimer's Association and others have repeatedly called for longer-term, larger-scale research studies to clarify the roles that these factors play in the health of the aging brain."

"These are some of the first reports of this type in Alzheimer's, and that is encouraging, but it is not yet definitive evidence," Thies continued. "Longitudinal studies and clinical trials are expensive, and I'm deeply concerned that the trials we need will not happen because of the chronic underfunding of Alzheimer research by the federal government."

Framingham Study Shows Physical Activity Lowers Risk of Dementia, Especially in Men

Several long-term epidemiological studies have related physical activity and cognitive decline, dementia and/or Alzheimer's disease, although the results of published research studies thus far are not entirely consistent and several large studies failed to show an association. Most of these studies followed participants for less than six years or had significant loss to follow-up. Still needed are studies including long-term follow-up in older persons in age brackets at higher risk of incident Alzheimer's to elucidate the true relationship.

One such long-term trial is the Framingham Study, a population-based study that has followed participants residing in the town of Framingham, Massachusetts since 1948 for cardiovascular risk factors, and is now also tracking cognitive performance. Framingham is widely acknowledged as a premier longitudinal study; it has continued to yield valuable information for more than 40 years.

Zaldy Tan, MD, MPH, of Brigham and Women's Hospital, GRECC, VA Boston, and Harvard Medical School, and colleagues estimated the levels of 24-hour physical activity of more than 1,200 elderly participants from the Framingham Study (742 female; age 76 +\-5) during the study's 20th examination cycle (1986-87) and followed them for the development of dementia. They divided the participants into five groups based on level of physical activity, from lowest (Q1) to highest (Q5).

Over two decades of follow-up (mean 9.9 +/-5 years), 242 participants developed dementia (of which 193 were Alzheimer's). The researchers found that participants who performed moderate to heavy levels of physical activity had about a 40 percent lower risk of developing any type of dementia. Further, people who reported the lowest levels of physical activity were 45 percent more likely to develop any type of dementia compared to those who reported higher levels of activity. Similar results were seen when analyses were limited to Alzheimer's alone. Analyses showed that the observed associations were largely evident in men in the study.

"This is the first study to follow a large group of individuals for this long a period of time," Tan said. "It suggests that lowering the risk for dementia may be one additional benefit of maintaining at least moderate physical activity, even into the eighth decade of life."

Tea Consumption Slows Cognitive Decline in the Cardiovascular Health Study

Observational studies have shown associations between consumption of either tea or coffee and cognitive function in older adults, but data including long-term follow-up and rate of change in cognitive function are lacking.

Lenore Arab, PhD, of UCLA, and colleagues used data on more than 4,800 men and women aged 65 and older from the Cardiovascular Health Study to examine the relationship between consumption of tea, coffee, and change in cognitive function over time. Study participants were followed up for up to 14 years for naturally-occurring cognitive decline using the Mini-Mental State Examination (3MSE) administered at baseline and annually up to 8 times. People scored on the average 1.17 points less per year. Tea and coffee drinking were assessed using a food frequency questionnaire.

The researchers found that people who consumed tea at a variety of levels had significantly less cognitive decline (17-37 percent) than non-tea drinkers. More specifically, study participants who drank tea 5-10 times/year, 1-3 times/month, 1-4 times/week, and 5+ times/week had average annual rates of decline 17 percent, 32 percent, 37 percent, and 26 percent lower, respectively, than non-tea drinkers.

According to the scientists, coffee consumption did not show any effect except at the very highest level of consumption – where it was associated with significantly decreased decline of 20 percent.

"The suggestion of a positive effect of tea consumption in slowing cognitive decline requires further investigation," Arab said. "Interestingly, the observed associations are unlikely to be related to caffeine, which is present in coffee at levels 2-3 times higher than in tea."

Vitamin D Deficiency Increases Risk of Cognitive Impairment

Recent European studies suggest vitamin D deficiency is associated with increased odds of cognitive impairment and dementia in later life, although previous findings from the U.S. have been mixed. Interest in vitamin D has intensified recently as research has suggested that it may play a role in a variety of age-associated diseases.

David Llewellyn, PhD, of the University of Exeter Peninsula Medical School (UK), and colleagues examined information from 3,325 adults aged 65 years and older from the Third National Health and Nutrition Examination Survey (NHANES III), a study that was carefully designed to accurately represent the U.S. non-institutionalized population. Vitamin D levels were measured from blood samples and compared with performance on a measure of general cognitive function that incorporated tests of memory, orientation in time and space, and ability to maintain attention.

The researchers classified participants as being cognitively impaired if they scored in the worst 10 percent of older adults in the study. They found that the odds of cognitive impairment were about 42 percent higher in those people who were deficient in vitamin D, and 394 percent higher in people who were severely deficient.

"It appears that the odds of cognitive impairment increase as vitamin D levels go down, which is consistent with the findings of previous European studies," Llewellyn said. "Given that both vitamin D deficiency and dementia are common throughout the world, this is a major public health concern."

According to Llewellyn, the majority of older U.S. adults have insufficient vitamin D levels because skin becomes less efficient at producing vitamin D with age and sunlight (UVB radiation) levels are limited for much of the year.

"Vitamin D supplements have proven to be a safe, inexpensive and effective way to treat deficiency. However, few foods contain vitamin D and levels of supplementation in the U.S. are currently inadequate. More research is urgently needed to establish whether vitamin D supplementation has therapeutic potential for dementia," Llewellyn said.

Antioxidant–Rich Diet with Walnuts Improves Memory and Learning in Alzheimer's Mice

It has been suggested that oxidative stress may have a key role in Alzheimer's disease. Oxidative stress occurs when the production of free radicals exceeds the antioxidant capacity of a cell. Reports have suggested that beta amyloid can increase oxidative stress leading to brain cell death.

Walnuts are source of -linolenic acid (a plant-based omega-3 fatty acid) and have high content of antioxidants. In March 2004, the U.S. Food and Drug Administration said that "Supportive but not conclusive research shows that eating 1.5 ounces of walnuts per day, as part of a low saturated fat and low-cholesterol diet, and not resulting in increased caloric intake, may reduce the risk of coronary heart disease."

Abha Chauhan, PhD, and colleagues at the New York State Institute for Basic Research in Developmental Disabilities, examined the effect of diet containing 6 percent or 9 percent walnuts (equivalent to 1 oz. and 1.5 oz. daily intake of walnuts in people) on the cognitive, emotional and motor functions in a transgenic mouse model of Alzheimer's. The mice were fed custom-mix diets from the age of four months for nine to 15 months. Control mice were fed diet without walnuts. The experimental and control mice were examined at the age of 13 to 14 months and 18 to 19 months for spatial memory and learning ability, position discrimination learning ability, motor coordination, and anxiety-related behavior.

The researchers found that Alzheimer's transgenic mice on the diet without walnuts at both testing periods showed memory deficits, anxiety-related behavior, and severe impairment in spatial learning ability, position discrimination learning ability and motor coordination. The Alzheimer's transgenic mice on 6 percent walnuts diet and 9 percent walnuts diet showed significant improvement in learning, memory, emotional regulation and motor coordination compared to transgenic mice that did not eat walnuts. The effects of 6 percent and 9 percent walnuts diets were similar.

"Our results suggest protective effects of walnuts in the Alzheimer's mice," Chauhan said. "Dietary supplementation of walnuts may have beneficial effect on brain function, and deserves further study."
- Alzheimer's Association

Statement on the passing of Dr. Robert Butler, former Alzheimer's Association national board member

Alzheimer's Association — 2010-07-09

The Alzheimer's Association extends its deepest sympathies to the family of Dr. Robert Butler, a leading expert on aging, on his passing on Sunday, July 4. While serving as the first director of the National Institute on Aging at the National Institutes of Health, Dr. Butler helped support the origination of a national Alzheimer organization, which became the Chicago-based Alzheimer's Disease and Related Disorders Association (Alzheimer's Association) founded by a small group of individuals led by Jerome Stone.

Dr. Butler was an early leader of the Alzheimer's Association, joining the national board in 1983. Two years later, he became a member the Alzheimer's Association Medical and Scientific Advisory Council. He also served on the Alzheimer's Association International Journal Board.

Currently, there are as many as 5.3 million Americans living with Alzheimer's disease, and that number is expected to grow to as many as 16 million by 2050. Alzheimer's disease is the seventh-leading cause of death in the United States.

While there is still no cure for Alzheimer's or treatments that stop or even slow the progression of the disease, there has been scientific progress and a greater understanding about the disease. While the pursuit of effective disease therapies continues, families nationwide are receiving care, information and support because of the contributions of advocates like Dr. Butler.
- Alzheimer's Association

Experts maintain optimism about solving Alzheimer puzzle

Alzheimer's Association — 2010-07-07

Research into Alzheimer's disease has reached a point of significant potential, even as the disease's looming impact on society grows more and more dire, experts say.

Some leading scientists, in fact, worry that we may not be doing enough to press forward with key advances and new insights into Alzheimer's, the most common type of dementia among older people.

An estimated 5.3 million U.S. residents have the disease, which results from the deterioration of nerve cells in the brain and leads to memory loss, impaired judgment, wandering and, as it progresses, to the inability to perform such normal daily functions as dressing, bathing and eating.

As the population ages, the number of people with Alzheimer's is expected to spike dramatically. Today, someone in the United States develops Alzheimer's every 70 seconds, according to the Alzheimer's Association -- a number expected to rise to once every 33 seconds in a few decades.

Scientists researching early detection and treatment for the disease, though, say they are on the verge of substantial advances.

Despite some disappointments, a large slate of Alzheimer's drugs are undergoing human trials, said Dr. John C. Morris, a professor and director of the Alzheimer's Disease Research Center at the Washington University School of Medicine in St. Louis and a spokesman for the American Academy of Neurology.

"There has never been a period in which we had more potential drugs to alter the disease course of Alzheimer's," Morris said. "We have lots of highly promising drug candidates."

The drugs focus mostly on amyloid, a protein that clumps in the brains of people with Alzheimer's.

"Many scientists believe eliminating that accumulation will eliminate Alzheimer's," said William H. Thies, chief medical and science officer for the Alzheimer's Association. "We've seen amyloid accumulation as one of the key markers in the development of Alzheimer's. It's really the first step in taking the basic science of Alzheimer's and using it to develop therapeutics."

However, three of the first anti-amyloid drugs to be tested on people all failed to produce results. Treatment with AN-1792, Flurizan and tramiprosate did not significantly improve the symptoms of people with Alzheimer's.

Part of the problem could have been that the drugs were tested on people with advanced Alzheimer's, Morris said, adding that they might be more effective if given to people in earlier stages of the disease.

But that requires a means to detect Alzheimer's disease early in its development or even to flag people who are at risk for developing the disease. The only way doctors have been able to diagnose Alzheimer's is when symptoms appear, and by then the damage has already been done, Morris and Thies said.

That might be about to change. Work is being done on scans and tests that could lead to the early detection of Alzheimer's.

Researchers are identifying substances that bind with amyloid deposits and make them visible to imaging scans, such as the PET, or positron emission tomography, scan. Previously, amyloid clumps have been invisible to scanning technology, and the only way doctors have been able to detect their presence in a human brain was during an autopsy, Morris said.

Researchers also are identifying genetic and biological markers that could indicate that a person is at increased risk for developing Alzheimer's.

"The excitement in the field is, yes, new imaging technology, and studies of amyloid beta in the spinal fluid of elderly and middle-age people do seem to identify people who, if they continue to live, will develop dementia," Morris said. "This will set the stage for targeting people at high risk of developing dementia if they live long enough."

Thies sees these two areas of research -- detection and treatment -- spurring each other along as progress is made.

"There's no doubt in my mind that, as an effective therapy emerges that slows down the course of the disease, we will find the marker for it," Thies said. "The two are linked almost arm-in-arm and will develop together. Advances in one will drag the other along."

Some people, however, question the direction of research -- worrying that efforts have been too tightly focused on eliminating amyloid from the brain, particularly given the failures in early trials.

"People who work in the field raise the question, 'Should we be doing all this amyloid work?'" Thies said. "But it's the most mature of the ideas so you have to follow it through."

Questions also have arisen as to whether Alzheimer's research is getting enough attention. Money spent by the government on Alzheimer's, for instance, lags behind research funding for other major diseases. The U.S. National Institutes of Health expects to spend $527 million on Alzheimer's disease research in the current fiscal year, compared with $6.1 billion on cancer research, $3 billion on HIV/AIDS and $1.9 billion on heart disease research, according to spending data released Feb. 1.

This disparity in spending on Alzheimer's stems in part from the fact that the United States does not have a national plan aimed at tackling research and treatment, Harry Johns, chief executive of the Alzheimer's Association, told HealthDay. England, France and Australia have such plans, but the United States does not, he said.

That might be in part because many Americans see Alzheimer's as an inevitable end-of-life disease. "A lot of people still equate getting older with loss of cognitive process," Morris said. "They consider it a part of getting older. They don't see it as a disease that reduces life span."

Whatever the reason, researchers say that the aging of the U.S. population means that Alzheimer's needs to be tackled now or the United States will face a public health crisis later.

"Alzheimer's is not only an awful disease, it's also very expensive," Thies said, noting that a person aging with Alzheimer's disease will require care that costs up to three times as much as care for a person aging normally.

"With the aging of our population, we are going to have an immense increase in Alzheimer's disease over the next 40 years," he said. "If we don't deal with this, it could bankrupt our government and wreck our health-care system."

More information

The U.S. National Institute on Aging has more on Alzheimer's disease.

SOURCES: John C. Morris, M.D., professor, neurology, pathology and immunology, physical therapy and occupational therapy, and director, Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, Mo.; William H. Thies, Ph.D., chief medical and science officer, Alzheimer's Association; Feb. 1, 2010, news release, U.S. National Institutes of Health; Alzheimer's Association (www.alz.org)
- HealthDay

Three strategies for tackling Alzheimer's

Alzheimer's Association — 2010-06-16

It is truly amazing how many people come up to me as soon as they learn I work for the Alzheimer's Association and tell me about their mother, father, grandmother or another relative who has Alzheimer's disease.

It's hard to find anyone who hasn't been touched by the disease. In fact, the Alzheimer's Association estimates there are as many as 5.3 million Americans with the disease and about 11 million caregivers supporting them. And that's just today.

Reliable estimates suggest that by 2050 those numbers could triple and there could be as many as 16 million Americans living with Alzheimer's.

And there will be many millions more family caregivers who provide unpaid and often unrecognized support. These are caregivers who will experience the unrelenting, year-by-year deterioration of a loved one with Alzheimer's that eventually leads to death.

In addition to the human toll, Alzheimer's takes a huge financial toll on families, the economy and our healthcare system, particularly Medicare and Medicaid. This year, the total annual costs of care for people with Alzheimer's will be $172 billion; this number will soar to more than $1 trillion in 2050, with Medicare costs increasing more than 600 percent and Medicaid costs increasing 400 percent. Driving these exploding costs is that, by 2050, nearly half of all the people with Alzheimer's will be in the severe stage of the disease, when more expensive, around-the-clock care is often necessary.

When the numbers get to be this big, tens of millions of individuals affected, tens of millions of families devastated, inadequate facilities and manpower to provide care and support, and a seismic impact on the entire healthcare system, they can be hard to understand. It becomes easy to intellectualize the issue because you have no real frame of reference.

It is when you look at the real human tragedy caused by Alzheimer's disease that you see things that no one should have to stand for. That includes lives, families and plans totally disrupted; exhaustion and depression; life savings run completely through. People try to put Band-aids on the problem, but they will soon burst. The opportunity is here to act decisively and with forethought now. This is the early warning. We need to get going.

Alzheimer's is clearly the Number 1 public health challenge of the 21st century and research is the only way to solve this problem. Here are the steps to take:

1) Adequate funding for basic research. Government must ensure that funding for Alzheimer research matches the magnitude of the disease and this is something we just haven't seen. This year the National Institutes of Health is expected to spend less than $500 million on Alzheimer research. This represents less than one-half of one percent of the annual cost of the disease. In fact, for every $25,000 the government spends on care for people with Alzheimer's and dementia, it spends only $100 for Alzheimer research. This is the equivalent of sending one life boat to save all the passengers on the Titanic. Government must make an investment in Alzheimer research that proves they understand what's at stake—for individuals, families, the healthcare system, and the nation as a whole.

2) Clear pathways for the investigation and approval of new medications. For example, currently there is no consensus on therapeutic targets in Alzheimer's, and we don't know how far we have to move them. How do we know when someone is better, and what is better enough? There is no agreement on what to measure and how to measure it. We are beginning to take steps to address these questions, but regulators, academics, industry and voluntary health organizations must work together. The Alzheimer's Disease Neuroimaging Initiative, the Coalition Against Major Diseases, and the Alzheimer's Association's Research Roundtable are all good examples of collaborations working to share data and experience in order to overcome shared obstacles to developing new therapies. These are good first steps, but we need more.

3) Greater public participation in clinical trials. Recruiting and retaining participants for Alzheimer clinical studies is now one of the greatest obstacles to developing the next generation of treatments. The immediate need for advances in Alzheimer treatment, diagnosis and prevention has led to an unprecedented call for clinical trial participants.

A couple came up to me recently after I gave a talk about Alzheimer's at a conference. The husband had been diagnosed with younger-onset Alzheimer's and both he and his wife wanted to know how they could participate in clinical trials. Both of them were ready, willing and able to do what they could to help end this disease. Honestly, I think a lot more people are ready, willing and able, they just don't know where to go or what to do to become involved in clinical trials. This information needs to be made easily available and accessible to the public.

The Alzheimer's Association is critically aware of the information needs of people who want to participate in Alzheimer research studies and a new initiative in this area is planned for this summer.

The only way to control costly outcomes is to prevent them in the first place. We know what lies ahead if we continue on with our present course: more lives lost and an unsustainable financial burden on the nation. We know how to solve it: more Alzheimer research, collaboration among stakeholders, and greater clinical trial participation to get to breakthrough therapies.

CNBC will be covering the 2010 International Conference on Alzheimer's Disease (ICAD) July 10 through 15 in Honolulu.
- CNBC

Potential cause of Alzheimer's could lead to treatments

Alzheimer's Association — 2010-06-16

Researchers have discovered that the mutation of a gene associated with early onset Alzheimer's may block a key recycling process necessary for brain cell survival -- a finding that points the way to possible treatment for the disease.

When it's working properly, this gene -- called presenilin 1 (PS1) -- performs a crucial house-cleaning service by helping brain cells digest unwanted, damaged and potentially toxic proteins. But in its mutated form, the gene fails to help cells recycle these potential toxins, suggesting an explanation for the damage to the brain characteristic of Alzheimer's disease.

"We believe we have identified the principal mechanism by which mutations of PS1 cause the most common genetic form of Alzheimer's disease," study co-author Dr. Ralph A. Nixon, professor in the departments of psychiatry and cell biology as well as director of NYU's Center of Excellence on Brain Aging and the Silberstein Alzheimer's Institute, said in a university news release.

"Presently, no effective treatment exists to either slow or prevent the progression of Alzheimer's disease," added Nixon, also director of the Center for Dementia Research at the Nathan S. Kline Institute for Psychiatric Research in New York City. "This discovery has the potential of identifying such a treatment."

Mutations of the PS1 gene have previously been thought to increase production of the toxic beta amyloid protein that appears to collect in the brains of Alzheimer's patients. In turn, scientists have theorized that by preventing amyloid deposits from accumulating, they might be able to slow or prevent Alzheimer's progression.

However, the current investigation into PS1 behavior side-steps this potential scenario -- without questioning its validity -- by focusing on the possibility that abnormal PS1 function may cause cell death unconnected to beta amyloid buildup. PS1 mutations and other factors could, therefore, promote Alzheimer's in entirely different ways, the team said.

"There is an urgent need now to see Alzheimer's disease as [caused by multiple factors] and approach the treatment from that perspective," said Nixon, who added that the current finding opens up a new target for Alzheimer's interventions down the road. Focusing on how to restore brain cells' normal recycling system is a promising therapeutic approach, he said, since its disruption appears to promote Alzheimer's.

Nixon and his colleagues report their findings in the June 10th online issue of the journal Cell.
- HealthDay

Report: Alzheimer's disease to cost United States $20 trillion over next 40 years

Alzheimer's Association — 2010-05-19

A new report from the Alzheimer's Association, Changing the Trajectory of Alzheimer's Disease: A National Imperative shows that in the absence of disease-modifying treatments, the cumulative costs of care for people with Alzheimer's from 2010 to 2050 will exceed $20 trillion, in today's dollars. The report, which examines the current trajectory of Alzheimer's based on a model developed by the Lewin Group for the Alzheimer's Association, also shows that the number of Americans age 65 and older who have this condition will increase from the 5.1 million today to 13.5 million by mid-century.

"We know that Alzheimer's disease is not just ‘a little memory loss' — it is a national crisis that grows worse by the day," said Harry Johns, president and CEO of the Alzheimer's Association. "Alzheimer's not only poses a significant threat to millions of families, but also drives tremendous costs for government programs like Medicare and Medicaid."

Total costs of care for individuals with Alzheimer's disease by all payers will soar from $172 billion in 2010 to more than $1 trillion in 2050, with Medicare costs increasing more than 600 percent, from $88 billion today to $627 billion in 2050. During the same time period, Medicaid costs will soar 400 percent, from $34 billion to $178 billion. One factor driving the exploding costs by 2050 is that nearly half (48 percent) of the projected 13.5 million people with Alzheimer's will be in the severe stage of the disease — when more expensive, intensive around-the-clock care is often necessary.

Changing the Current Trajectory
The new report is not all bad news, however, as it shows that Medicare and Medicaid can achieve dramatic savings — and lives could be significantly improved — with even incremental treatment improvements. Based on the same Lewin Group model, the report explores two alternate scenarios: one in which a disease-modifying treatment could delay the onset of Alzheimer's by five years, and another in which a hypothetical treatment could slow the progression of this condition.

"Today, there are no treatments that can prevent, delay, slow or stop the progression of Alzheimer's disease," said Johns. "While the ultimate goal is a treatment that can completely prevent or cure Alzheimer's, we can now see that even modest improvements can have a huge impact."

Impact of a Hypothetical Treatment Delaying Onset
A treatment breakthrough that delays the onset of Alzheimer's by five years — similar, perhaps, to the effect of anti-cholesterol drugs on preventing heart disease — would result in an immediate and long-lasting reduction in the number of Americans with this condition and the cost of their care. A breakthrough that delays onset by five years and begins to show its effect in 2015 would decrease the total number of Americans age 65 and older with Alzheimer's from 5.6 million to 4 million in 2020.

Assuming the breakthrough occurred in 2015:

The number of people age 65 and older with Alzheimer's would be reduced by 5.8 million in 2050 — 43 percent of the 13.5 million Americans who would have been expected to have the condition in that year would be free of the conditions.
In 2050, the number of people in the severe stage would also be much smaller with the treatment breakthrough — 3.5 million instead of the expected 6.5 million. Annual Medicare savings compared to current trends would be $33 billion in 2020 and climb to $283 billion by mid-century, while annual Medicaid savings would increase from $9 billion in 2020 to $79 billion in 2050.

Impact of Hypothetical Treatment Slowing Progression
A treatment breakthrough that slowed disease progression — much as we have managed to do with HIV/AIDS and several cancers — would result in far fewer people with Alzheimer's disease in 2050 in the severe stage when care demands and costs are greatest. Assuming the breakthrough occurred in 2015:

In 2020, the number of people age 65 and older with Alzheimer's disease in the severe stage would drop from 2.4 million to 1.1 million. In 2050, the number of people in the severe stage would decline from an expected 6.5 million to 1.2 million.
Annual Medicare savings compared to current trends would be $20 billion in 2020 and jump to $118 billion in 2050, while Medicaid savings would be $14 billion in 2020 and $62 billion in 2050.

Addressing the Chronic Underinvestment in Research
Ultimately solving the Alzheimer crisis will mean addressing the chronic underinvestment in research. This forecast of a rapidly aging population and dramatic rise in the number of Alzheimer cases in the coming years should catapult the government into action.

"Given the magnitude and the impact of this disease, the government's response to this burgeoning crisis has been stunningly neglectful," said Johns. "Alzheimer's is an unfolding natural disaster. The federal government has sent a token response and has no plan. Immediate and substantial research investments are required to avoid an even more disastrous future for American families and already overwhelmed state and federal budgets. For the human effects and the country's fiscal future, we must change the trajectory of the Alzheimer crisis."

"The impact of Alzheimer's disease — both in terms of lives affected and costs of care — is staggering. As government leaders contend with the best approaches to rein in Medicare and Medicaid costs, we know Alzheimer's will place a massive strain on an already overburdened healthcare system," said Robert J. Egge, vice president of public policy for the Alzheimer's Association. "This report highlights that while we strive for the ideal — a treatment that completely prevents or cures Alzheimer's disease — even more modest, disease-modifying treatments would provide substantial benefits to families and contribute to the solvency of Medicare and Medicaid."

The Association is working to enact critical legislation to address these issues. The National Alzheimer's Project Act creates a National Alzheimer's Project Office and an inter-agency Advisory Council responsible for developing a national plan to overcome the Alzheimer crisis. Drawing on the expertise residing in various government agencies as well as individuals living with the disease, caregivers, providers and other stakeholders, this office would provide strategic planning and coordination for the fight against Alzheimer's across the federal government as a whole, touching on a broad array of issues from research to care to support.

The full text of the Alzheimer's Association's Changing the Trajectory of Alzheimer's Disease: A National Imperative report can be viewed at www.alz.org/trajectory.
- Alzheimer's Association

Clumps of protein may cause Alzheimer's disease

Alzheimer's Association — 2010-05-04

New research could change the way scientists view the causes -- and potential prevention and treatment -- of Alzheimer's disease.

A study published online this month in the Annals of Neurology suggests that "floating" clumps of amyloid beta (abeta) proteins called oligomers could be a prime cause of the disorder, and that the better-known and more stationary amyloid-beta plaques are only a late manifestation of the disease.

"Based on these and other studies, I think that one could now fairly revise the 'amyloid hypothesis' to the 'abeta oligomer hypothesis,'" said lead researcher Dr. Sam Gandy, a professor of neurology and psychiatry and associate director of the Alzheimer's Disease Research Center at Mount Sinai School of Medicine in New York City.

The new study could herald a major shift in Alzheimer's research, another expert said.

Maria Carrillo, senior director of medical and scientific relations at the Alzheimer's Association, said that "we are excited about the paper. We think it has some very interesting results and has potential for moving us in another direction for future research."

According to the Alzheimer's Association, more than 5.3 million Americans now suffer from the neurodegenerative illness, and it is the seventh leading cause of death. There is no effective treatment for Alzheimer's, and its origins remain unknown. For decades, research has focused on a buildup of amyloid beta plaques in the brain, but whether these deposits are a cause of the disease or merely a neutral artifact has remained unclear.

The new study looked at a lesser-known factor, the more mobile abeta oligomers that can form in brain tissue. In their research, Gandy's team first developed mice that only form abeta oligomers in their brains, and not amyloid plaques.

Based on the results of tests gauging spatial learning and memory, these mice were found to be impaired by Alzheimer's-like symptoms.

Next the researchers inserted a gene that would cause the mice to develop both oligomers and plaques.

Similar to the oligomer-only rodents, these mice "were still memory impaired, but no more memory impaired for having plaques superimposed on their oligomers," Gandy said.

Another result further strengthened the notion that oligomers were the prime cause of Alzheimer's in the mice.

"We tested the mice and they lost memory function, and when they died, we measured the oligomers in their brains," Gandy said. "Lo and behold, the degree of memory loss was proportional to the oligomer level," he said.

Gandy noted that PET scans are not able to detect oligomers in the human brain, but they do see amyloid plaques. This could help explain why recent trials of the experimental Alzheimer's drug bapineuzumab showed a reduction in plaques, but no improvement in patients' cognitive function, Gandy said.

Bapineuzumab is targeted to amyloid plaques. Whether the drug also affected the oligomers is not known, Gandy said, because the PET scans could not see them. "We don't even know whether bapineuzumab 'sees' them," he said.

The new study could help change the focus of ongoing research. "Our new 'oligomer only' mice may enable the development of imaging agents and drugs that lower oligomer levels without having plaques around to muddy the picture," Gandy said.

Researchers have long been trying to figure out the stages that lead up to plaques and tangles, Carrillo noted. "We [now] know that plaques and tangles are really the end stage of this disease," she said.

Oligomers are "toxic clumps" that could be the cause of Alzheimer's disease, Carrillo said. This study confirms for the first time that these toxic clumps are a cause of memory problems, she said.

Carrillo noted that these results also confirm that the disease starts developing 10 to 15 years before it is diagnosed. This understanding could lead to new ways of diagnosing and treating the illness, she added.

"Perhaps future therapeutics attacking oligomers instead of plaques would be a strategy," Carrillo said.

One expert did have some reservations about that possibility, however.

"The larger unresolved issue is how these oligomers relate to people where plaques accumulate many years prior to disease onset," said Greg M. Cole, professor of medicine and neurology and associate director of the UCLA Alzheimer's Center. "One would expect the little oligomer aggregates to arise prior to the bigger plaque aggregates, that is, decades before important memory problems [surface]."

That could mean that "targeting oligomers may work best for prevention," rather than the treatment of existing disease, he said. "Ongoing efforts to track and specifically target the oligomers in clinical trials with memory deficit patients should soon tell us how much good we can do hitting the oligomers. It may be a huge success or too little, too late."
- HealthDay

Association statement on NIH state-of-the-science report on preventing Alzheimer's and cognitive decline

Alzheimer's Association — 2010-04-28

Alzheimer's disease is one of the most critical unaddressed health issues in America. Yet we are so far from meeting the challenges of this looming crisis.

According to the Alzheimer's Association's 2010 Alzheimer's Disease Facts and Figures, there are as many as 5.3 million Americans living with Alzheimer's, and every 70 seconds someone in America develops the disease. Alzheimer's was the seventh-leading cause of death in the country in 2006, the latest year for which final death statistics are available.

It is critical that we, as a nation, significantly increase investments in Alzheimer research. In addition to the devastating impact on families, Alzheimer's also threatens the nation's healthcare system because of its significant costs.

Again, according to Facts and Figures, the total payments for health and long-term care services for people with Alzheimer's and other dementias will amount to $172 billion from all sources in 2010. The average per person Medicaid payments were nine times higher; Medicare payments were three times higher; and private insurance was 26 percent higher for older people with Alzheimer's and other dementias compared to other older people. If nothing is done to stop this disease, by mid-century as many as 16 million Americans will have Alzheimer's disease. America simply cannot afford this human, social and economic burden.

There are still many unanswered questions about the causes of Alzheimer's disease and cognitive decline in aging. Biomarkers, diagnostics, progression models, quality indicators and longitudinal clinical trials are critically necessary, and are all expensive and challenging areas of science. Unless we dedicate significant funding to these efforts, we will continue struggling to conduct this research.

There is a growing body of evidence that strongly suggests Alzheimer's disease can be prevented in the future. Robust funding to explore this area of science is also necessary. In the meantime, existing evidence-based guidance about brain health and maintaining cognitive abilities as we age must be promoted to the general public today to increase critical knowledge about Alzheimer's and help separate fact from myth.

Discovering effective interventions that prevent onset or delay disease progression takes on an all encompassing urgency as the nation braces for an aging baby boomer generation. Alzheimer's disease, unlike any other, has the power to undermine all of our best efforts to control healthcare costs. We know what the future will bring if we do nothing — more lives lost, overloaded nursing homes, overworked caregivers and an overwhelmed healthcare system.

The good news is that we, as a nation, know how to rise to meet such an overwhelming challenge. Although there is more work to be done, we can learn from the successes as a result of the war on cancer and the concerted effort to understand, prevent and treat HIV/AIDS. In fact, as the panel mentioned, from 2000 to 2006, death rates have declined for most major diseases, including some cancers and HIV/AIDS, while Alzheimer's disease deaths rose 46.1 percent. We must stem the tide. We must create a national, coordinated effort with commensurate, appropriate strategic investment in Alzheimer research funding to meet this crisis. It is the only way forward.

The Association is working to enact critical legislation to address these issues. The Alzheimer's Breakthrough Act will provide $2 billion in Alzheimer research funding at NIH; the National Alzheimer's Project Act will launch a coordinated campaign in the federal government and creates an inter-agency Advisory Council responsible for creating a national plan to overcome the Alzheimer's disease crisis. These solutions are critical to securing necessary resources and providing the strategic planning and coordination to the fight against Alzheimer's disease and meet the burgeoning public health need.
- Alzheimer's Association

Study: Abnormal heart rhythm linked to Alzheimer's

Alzheimer's Association — 2010-04-28

People with atrial fibrillation, a form of abnormal heart rhythm, are more likely than others to develop dementia, including Alzheimer's disease, a new study finds.

The presence of atrial fibrillation also predicted higher death rates in dementia patients, especially among younger patients in the group studied, meaning under the age of 70.

"This leaves us with the finding that atrial fibrillation, independent of everything else, is a risk factor [for dementia]," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City. "This is adding one more brick in the road toward understanding that cardiovascular disease is a major risk factor for dementia."

"Alzheimer's disease, in particular, is one where we don't quite understand the risk factors and what causes it, so studies [like this] that try to investigate the causative effect will help us understand that and ultimately design therapies and approaches to prevent or minimize disease," added Dr. Jared Bunch, lead author of a study appearing in the April edition of the HeartRhythm Journal and a cardiologist/ electrophysiologist with Intermountain Medical Center in Murray, Utah.

This study, however, was not specifically set up to establish a direct cause-and-effect relationship.

The authors looked at 37,025 patients without atrial fibrillation or dementia, aged 60 to 90, over a five-year period.

Individuals who developed atrial fibrillation had a higher risk of all types of dementia, even when other risk factors were taken into account. Alzheimer's disease is by far the most common form of dementia.

More surprising was that those in the younger group -- under age 70 -- who had atrial fibrillation had the highest risk of developing dementia, even though dementia is normally associated with aging. People in this group were also at a 38 percent higher risk of dying.

Among the 764 patients who developed both conditions, diagnosis of atrial fibrillation usually happened first, followed by a diagnosis of dementia. Sometimes the diagnoses occurred simultaneously, the researchers noted.

The authors hypothesized that both atrial fibrillation and dementia may arise from the same risk factors, such as hypertension. Another possibility is that atrial fibrillation increases inflammation, and dementia has been shown to be higher in people with signs of systemic inflammation. Investigating whether treatment of hypertension and/or inflammation in AF patients might help curb the risk of dementia is an area of future study, the researchers added.

"From a public health perspective, the best thing we can do to decrease the coming epidemic of Alzheimer's disease is to do a much better, more aggressive job of helping people with heart disease," Kennedy said. "That means diet and exercise, of course -- everyone knows that. We need to look at obstacles that people encounter beyond their own behavior, obstacles we put up environmentally in the workplace, in the school, that keep people from having better diet and exercise. A heart-healthy diet and lifestyle are really the best means we have available to prevent dementia."

About 2.2 million Americans have atrial fibrillation, while an estimated 5.5 million suffer from Alzheimer's.
- HealthDay

David Hyde Pierce honored with special Tony Award

Alzheimer's Association — 2010-04-21

Alzheimer Champion David Hyde Pierce is the 2010 recipient of the Tony Awards® Isabelle Stevenson Award, recognizing an individual from the theater community who "has made a substantial contribution of volunteered time and effort on behalf of one or more humanitarian, social service or charitable organization, regardless of whether such organizations relate to the theater." It is among a number of awards that will be presented at the 2010 Tony Awards on June 13.

Pierce is being honored for his work with the Alzheimer's Association in the fight against Alzheimer's disease. A former member (and now an honorary member) of the Association's national board, Pierce has regularly participated in the Alzheimer's Action Summit in Washington, D.C., meeting with elected officials to advocate for increased investment in Alzheimer research.

The actor won a Tony Award for his performance in Curtains and has also been seen on Broadway in Accent on Youth, Spamalot, The Heidi Chronicles and Beyond Therapy. He is also an Emmy winner for his work on "Frasier."
- Alzheimer's Association

New tools to detect Alzheimer's

Alzheimer's Association — 2010-04-19

Companies specializing in medical imaging are pushing to develop chemical agents to detect Alzheimer's disease from brain scans, a process that one day may make it possible to predict who will suffer from the progressive ailment before symptoms appear.

Avid Radiopharmaceuticals Inc., a tiny imaging company based in Philadelphia, and multinationals like Bayer AG and General Electric Co., are among those working on imaging compounds to help doctors spot signs of the memory-robbing disease. Such chemical compounds would be a first of their kind and would help their makers tap into the multibillion dollar Alzheimer's diagnostic market.

Currently, Alzheimer's disease can be diagnosed definitively only by taking samples of brain tissue after death and looking for signs of sticky substances called amyloid plaques. An accumulation of such plaque between brain cells is thought to contribute to the disease. However, whether the plaque causes Alzheimer's is much debated.

The imaging compounds under development are molecules with radioactive markers attached, which bind to amyloid plaques. After patients are injected with the compound, regions of the brain take on color under scanning devices, showing where the chemical has adhered and presumably indicating Alzheimer's-related plaque.

The market for diagnosing and treating Alzheimer's is estimated to grow to nearly $10 billion globally in 2014 from $8 billion in 2009, according to BCC Research, a technology market research firm based in Wellesley, Mass. The diagnostics and biomarker segment alone is expected to climb to $2.8 billion in 2014 from $1.1 billion in 2009.

Some 7.7 million Americans older than 65 are expected to have the disease by 2030, up from 5.1 million in 2010 because of the aging population, according to the Alzheimer's Association. Currently available treatments work to treat symptoms, such as memory loss, but don't actually slow the course of the disease. Development of imaging compounds are important for increasing early detection for Alzheimer's patients, although the cost of and access to diagnostic scanning devices are concerns, according to Maria Carrillo, a neuroscientist and spokeswoman for the Alzheimer's Association

Doctors today must try to diagnose the disease based on their clinical assessment of the patient's memory and cognitive functioning. Some experts estimate that 15% to 20% of people labeled as Alzheimer's patients are misdiagnosed, which can lead to inappropriate treatments.

The hope is that these imaging agents will be "the first time we're able to definitively look inside someone's brain and say, 'Yeah, this is an Alzheimer's patient,' " said Richard Pither, head of research and development for GE's diagnostics division.

These diagnostic tools will be important to developing new treatments as well. Many experimental Alzheimer's treatments appear to work better in patients with less severe forms of the disease but are too weak to have an effect on patients by the time they are diagnosed today.

Closely-held Avid Wednesday presented preliminary data from a late-stage clinical trial showing that the company's compound, called florbetapir, binds to indicators of Alzheimer's in the brain and correctly identified which patients had the disease. These results, presented at the American Academy of Neurology annual conference in Toronto, were the first for this type of experimental compound in a Phase 3 trial, a key step before applying to regulators for approval of a new treatment.

The Avid trial compared the brain scans of six patients with and without memory impairment with findings from their autopsied brains after death. The correlation between the amount of amyloid detected and the brain regions where it was found by brain scans of florbetapir patients was "very strong" compared with the later autopsies, according to neuropathologist Daniel Skovronsky, Avid's chief executive and co-founder. Final results from the study are expected late this year. Because the scans are being compared with usually reliable autopsy findings, meaningful results can be obtained with relatively few subjects.

Bayer is testing florbetaben, a molecule licensed from Avid, and is also in late-stage development. Preliminary data on 150 patients in a Bayer midstage trial, presented Friday, showed that the compound correctly identified those whose doctors had also diagnosed them as having Alzheimer's disease compared with healthy patients. The company began a late-stage clinical trial at the end of 2009 that will compare brain images to autopsies; results are expected near the end of 2011, according to Bayer.

Bayer is also looking to develop molecular imaging targets for cancer, particularly certain solid tumors, as well as other neurodegenerative diseases. For Bayer's health-care division, its diagnostics and imaging unit is one of the four main areas of research and development. The German company expects peak sales of florbetaben could range from €250 million to €500 million, or about $341 million to $683 million a year.

Results from a midstage trial of GE's product, flutemetamol, have also been promising. Brain scans of patients using flutemetamol were found to have more amyloid plaques while healthy participants had virtually none.
- The Wall Street Journal

Focus on the present helps couple handle Alzheimer's

Alzheimer's Association — 2010-04-07

Bob Blackwell and his wife, Carol, settle comfortably in for tea and cookies at a Barnes & Noble cafe.

They're the kind of couple you'd like to have as your grandparents: kind, caring and generous. But on this mid-March afternoon, they're a bit weary, too. They've just come off a busy week in Washington, D.C., advocating for Alzheimer's disease, a memory-destroying condition that Bob was diagnosed with in 2006 at age 64 — a decade or more earlier than most who develop the illness.

VIDEO SERIES: What you should know about the disease
LIVING WITH ALZHEIMER'S Read the Blackwells' blog
STAGE BY STAGE: What Alzheimer's caregivers can expect

USA TODAY has been following the Blackwells' journey with Alzheimer's for almost two years, and the two of them have been blogging about it as well.

Their whirlwind week included a march up the Capitol steps to visit with politicians in an effort to raise awareness and money for research; meetings with fellow members of the Alzheimer's Association early-stage advisory committee; a candlelight vigil; and the association's annual gala.

"We sat down with Rep. Frank Wolfe (D-Va.) and Sen. Mark Warner's (D-Va.) staff in their office and talked for a long time, maybe 30 minutes," Bob says.

Every family is different

Alzheimer's, which is classified into three stages — early, middle and late — takes no single pathway in all patients, but the average life span of a person after diagnosis is about seven years, says Alzheimer's expert Murali Doraiswamy, professor of psychiatry at Duke University Medical Center. By the end, the brain shuts down, leaving the patient unable to eat or breathe.

For the nearly 11 million family members and friends who, according to the Alzheimer's Association, now care for a loved one with the disease, coping with a diagnosis differs greatly from family to family as the disease progresses, says Beth Kallmyer, senior director of constituent services for the Alzheimer's Association in Chicago.

"The reality is it's different for everybody. The way it impacts caregivers depends on the relationship they had with that person before," says Kallmyer, who adds that the non-linear progression of the disease is most challenging.

Carol says that at first the diagnosis was shocking and confusing. It changed how she perceived her husband. "He had this A on his forehead. But day by day I realized Bob wasn't suddenly some alien. He's still making decisions."

Now, she says, she prefers to focus on the present. "Our life has gone on pretty much the same. We work in the yard, we have pleasant conversations, we laugh together."

And indeed, Bob is trim and continues to exercise, attend classes and meet friends for breakfast. He and Carol flew to Russia this past year, a country Bob specialized in during his long career at the CIA.

His favorite hobby, nature photography, has blossomed, too. This month, he'll be selling his photos at a local arts and crafts show, he says.

Making adjustments

But as time passes, the two have had to make some small adjustments. Bob has had more trouble finding the words he wants to say than he did two years ago.

When talking about one of his favorite television shows, 24, for example, he has more difficulty remembering names of characters, so he tends to refer to them as "he" or "she." In conversation, spontaneous hand gestures of a companion may surprise him.

Carol says he became confused driving to a class recently. "He got turned around and couldn't find the street he needed. He was able to find his way home, but now I take him to that particular course. He is able to easily manage the other two in the area." They've also put up a white board to remind him of the daily schedule.

Filling in the gaps

And there's something increasingly symbiotic about their relationship. When asked a question the answer to which he struggles to recall, he turns more often than in the past to Carol, who fills in the gaps.

But he's still happy to do his own thing when Carol is at work. Recently, when she left town for an aunt's funeral, Bob fixed his own meals. "I just had to call to remind him to take his medicine," she says.

For caretakers living with those in later stages of the disease, the challenges can be greater.

"As a person moves into the middle stage, they may need help with shaving, personal care. A family member may need to lay their clothes out," Kallmyer says.

Kathy Hatfield, 40, lives outside Winston-Salem, N.C., and cares for her father, Lyman, 81. She says humor and patience help her navigate the ups and downs of living with a dad who has had Alzheimer's for 11 years. For example, because incontinence is a growing problem, she gets him to use the bathroom regularly by telling him they're going on a long car trip. That always motivates him to "make a pit stop."

ON THE WEB: Kathy Hatfield blogs about living with Dad

"By the time he's gone to the bathroom, he's forgotten that I told him we're going on a trip," she says, laughing.

Hatfield, who also blogs about her life with Alzheimer's, says she was not close to her New York stockbroker father as a child, but now, despite the hard times, she cherishes their relationship.

Her father, she says, is "the sweetest man on Earth."

Doraiswamy says caretakers (a label Carol prefers not to use for herself) should lean on the help of friends, family and health professionals and be alert to when it's time to provide extra care and safety measures for a loved one.

"There's usually a sentinel event in every family's life," Doraiswamy says.

The unanticipated incident is slightly different for each family but often takes the form of the patient getting completely lost in the neighborhood, he says.

Carol is not going to let it get her down.

"The patient can't choose whether or not they get the disease, but the caregiver can choose his or her attitude. I truly do believe that. Everyone has some 'down' times, but if you let the down times in too frequently, then Alzheimer's wins."
- USA Today

Alzheimer's Association named one of America's best nonprofits to work for

Alzheimer's Association — 2010-04-01

The Alzheimer's Association has been recognized as number 11 in the top 50 nonprofits to work for as determined by The NonProfit Times, the leading information provider for the nonprofit sector.

The NonProfit Times, in collaboration with Best Companies Group, conducted a national survey and recognition program dedicated to finding and recognizing the best employers in the nonprofit industry. Nonprofit organizations from across the country were involved in this employee assessment process to determine which nonprofits are ranked highest by their employees.

"The Alzheimer's Association is honored to be named one of the best companies to work for by The NonProfit Times," said Harry Johns, Alzheimer's Association president and CEO. "Currently there are more than 5 million Americans living with Alzheimer's disease. As baby boomers age, the number of individuals impacted as well as the cost to address this disease will increase exponentially. Our staff and volunteers are committed to the success of our organization and to our vision of a world without Alzheimer's."

As one of the best nonprofits to work for, the Chicago-based Alzheimer's Association raises awareness of Alzheimer's disease and is the leader in Alzheimer care, support and research. The organization offers a comprehensive benefits package including retirement, and a commitment to diversity, inclusiveness and a collegial, cooperative and professional work environment.

Alzheimer's Association

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. For more information, visit www.alz.org.
- Alzheimer's Association

Needs of Alzheimer population addressed in healthcare reform legislation

Alzheimer's Association — 2010-03-22

As the leading care, research and advocacy organization for Alzheimer's disease, the Alzheimer's Association applauds Congress for including significant provisions in the final healthcare reform legislation to address the health concerns of a growing Alzheimer population. While the Association did not endorse any specific healthcare reform legislation, the Association did work to ensure that all bills under consideration contained the strongest provisions possible to address the particular challenges and concerns of the more than 5 million Americans with Alzheimer's. Several provisions in the final measure would deliver substantial benefits to those with Alzheimer's and other dementias and to their caregivers.

"Many aspects of the final healthcare reform legislation will greatly serve the Alzheimer community," said Robert Egge, vice president of the Alzheimer's Association's Public Policy and Advocacy Division. "We are particularly pleased with those elements that improve the healthcare delivery system through the promotion of care coordination, transitional care and long-term care services."

Most of the Alzheimer population has one or more other serious medical condition. Coordinated care is critical because so many with Alzheimer's are also managing multiple chronic conditions, like coronary heart disease or diabetes. Cognitive impairment greatly complicates the management of these other conditions, resulting in more hospitalizations, longer hospital stays, and higher costs than for those with these same conditions but not Alzheimer's disease. In fact, Medicare costs are three times higher than for those without Alzheimer's disease, while Medicaid costs are nine times higher.

Elements in the final healthcare reform legislation would begin to address these issues:

* Alzheimer families will be helped by the creation of a national voluntary insurance program, known as the CLASS Act, which provides benefits for long-term care services and support, such as respite care, home care aides and accessible transportation. This new insurance program will help individuals with Alzheimer's disease to remain as independent as possible within their homes and communities for as long as they can and is a great first step in addressing long-term care issues and in assisting families.

* Creating a new demonstration project, known as the Innovation Center, to examine ways to promote care coordination in the Medicare program, including for individuals with Alzheimer's and other dementias. "Care coordination is a process for ensuring effective communication among medical and community care providers and connecting an individual and their family with the services they need," Egge said. "The new Innovation Center will pilot new programs and identify which programs work best for individuals with dementia."

* Establishing a Medicare pilot program to provide transitional care to seniors at a high risk, including those with cognitive impairment, of re-entering a hospital.

"Cognitive impairment due to Alzheimer's and other causes increases the complexity of care transitions and post-acute care, resulting in increased risk for medication errors and hospital readmissions," said Egge. "Alzheimer families need assistance with planning and managing discharge and post-acute care, including arranging and monitoring in-home medical treatment and supportive services."

The Association commends the fact that the legislation takes steps to address individuals with younger-onset Alzheimer's disease — those under the age of 65 — who have a difficult time getting and keeping private health insurance. Currently, almost 29 percent of individuals with younger-onset Alzheimer's disease have no health insurance, causing a great financial burden on their families. The healthcare reform legislation would make health insurance available to those with pre-existing conditions, and there would also be guaranteed issue and renewability.

"We are glad to see provisions ensuring that individuals with younger-onset Alzheimer's can more easily obtain, maintain and retain health insurance," said Egge.

The Association is pleased with how these various provisions included in the final healthcare reform measure would benefit the growing number of Alzheimer families. But ultimately solving the Alzheimer crisis — with its far reaching impact on families, business, Medicare, Medicaid and the nation as a whole — will require investment in research to develop effective treatments that prevent, stop or cure the disease. While healthcare reform was never designed to address this challenge, it does include an important step called the Cures Acceleration Network. This $500 million research program is aimed at developing treatments and cures for high need diseases, such as Alzheimer's, with an emphasis on bridging the gap between laboratory discoveries and actual treatments.
- Alzheimer's Association

Could lowering blood pressure help stop dementia?

Alzheimer's Association — 2010-03-19

In the ongoing struggle to find treatments -- and maybe one day even a cure -- for dementia, researchers are focusing their attention on high blood pressure, long a culprit for a variety of other ills and an ailment for which many drugs are already available.

This coming fall, the U.S. National Institutes of Health will start enrolling participants in the largest trial thus far to see if lowering blood pressure even below current recommendations can reduce not only the risk of age-related cognitive decline, but also the risk of cardiovascular and kidney diseases.

The Systolic Blood Pressure Intervention Trial (SPRINT) will involve 7,500 people aged 55 and over who will be followed for a minimum of four years. The NIH is investing $114 million in the endeavor.

"We have a number of effective and safe medications to lower blood pressure," said Dr. Lawrence Fine, chief of the clinical applications and prevention branch in the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute. "For the average person right now, the recommendation is a blood pressure of 140/90 or lower. SPRINT will compare that with a goal of 120 as the top number. Will the rate of dementia for people in the lower-goal arm be lower than standard?"

Current clinical guidelines recommend systolic pressure (the top number in a blood pressure reading) of less than 140 millimeters of mercury (mm Hg) for healthy adults, and 130 mm Hg for adults with kidney disease or diabetes.

"Hypertension is very easy to medicate and very easy to measure, so they want to see if just by modifying that simple thing they could reduce the incidence of dementia," said Ian Murray, an assistant professor of neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine in College Station.

The timing is critical, as over the next several decades huge numbers of aging Baby Boomers will develop Alzheimer's disease and other forms of dementia.

Besides sparing thousands of Americans needless suffering, "if you could reduce that number by 10 percent, your cost savings would be immense," said William Thies, chief medical and scientific officer for the Alzheimer's Association in Chicago.

Although experts have long suspected a link between high blood pressure and dementia, without trial data those suspicions inevitably remain hypotheses.

"What we do know is that there's an association between high blood pressure and a higher rate of dementia -- it's not a large increased risk but there is some increase," Fine said.

"A whole bunch of epidemiologic data says there's a link, and one trial actually showed that if you lowered people's blood pressure it decreased the amount of dementia," added Thies.

That particular trial used blood pressure drugs known as calcium-channel blockers, one in an extensive armamentarium of medications for the condition. Still, no one really knows why treating high blood pressure would lower the odds of dementia if, in fact, it really does.

"We'd really like to know the answer because it would give us our first confirmed pathway to modifying the amount of dementia by treating people with known agents," Thies said. "That would be very important."

The SPRINT trial will randomize participants -- all of whom have systolic blood pressure of 130 mm Hg or higher -- either to a group taking more intensive drug therapy (three or four medications) to try to get their blood pressure under 120, or a control group taking about two medications to maintain blood pressure at the currently recommended 140.

"We may discover lower blood pressure will not reduce the rate of dementia, but if the lower goal did reduce the rate of dementia by 10 or 20 or 30 percent, that would be an important observation because we don't have other good treatments for dementia," Fine said. "SPRINT should provide some additional science to inform us whether lowering blood pressure to the lower goal will, in fact, reduce the rate of developing dementia."

"There are a lot of reasons why we ought to control blood pressure anyway, but this gives us another very important reason," Thies added.
- HealthDay

Alzheimer caregiver shares story on Capitol Hill

Alzheimer's Association — 2010-03-16

Karen Henley took her two teenage children to Washington, D.C., for the Alzheimer's Action Summit so they could tell congressional members how the disease has impacted their lives.
- Newsday (paid subscription required)

New report says African-Americans and Hispanics more likely to have Alzheimer's disease than whites

Alzheimer's Association — 2010-03-09

According to the Alzheimer's Association's® 2010 Alzheimer's Disease Facts and Figures, African-Americans are about two times more likely and Hispanics are about one and one-half times more likely than their white counterparts to have Alzheimer's and other dementias. Although whites make up the great majority of the more than five million people with Alzheimer's and other dementias, African-Americans and Hispanics are at higher risk for developing the disease.

There are no known genetic factors that can explain the greater prevalence of Alzheimer's and other dementias in African-Americans and Hispanics than in whites. On the other hand, conditions, such as high blood pressure and diabetes, which are known risk factors for Alzheimer's and other dementias in all groups, are more common in African-Americans and Hispanics than in whites. Socioeconomic factors, such as having a low level of education and low income are also associated with greater risk for Alzheimer's and other dementias in all groups. Data from a federal survey of older Americans shows that African-Americans and Hispanics are disproportionately represented among socioeconomically disadvantaged people in this country. The Association's new report points out that these health and socioeconomic factors probably contribute to the greater prevalence of Alzheimer's and other dementias in African-Americans and Hispanics.

'Alzheimer's disease is the single largest, looming, unaddressed public health threat facing the nation, but we now know the threat is even more substantial in the African-American and Hispanic communities," said Harry Johns, Alzheimer's Association President and CEO. 'These groups are more likely to have Alzheimer's, less likely to know it and, as a result, less likely to receive available treatments and supportive services that can help them cope with the disease." High blood pressure and diabetes are potentially modifiable conditions. Better management of these conditions could help to reduce the prevalence of Alzheimer's and other dementias, especially if treatment were begun in people who have these conditions in midlife. Since high blood pressure and diabetes are more common in African-Americans than whites and diabetes is more common in Hispanics than in whites, effective treatment for these potentially modifiable conditions could be especially beneficial for these groups.

Socioeconomic disparities, such as lower income, translate into reduced access to health care and therefore, reduced opportunities to avoid or better manage high blood pressure and diabetes that, in turn, increase Alzheimer risk.

Underdiagnosis of Alzheimer's and Dementia in African-Americans and Hispanics
Although African-Americans and Hispanics are more likely than whites to have Alzheimer's and other dementias, the report reveals that African-Americans and Hispanics are less likely than whites to have a formal diagnosis of their condition. National data show that African-Americans and Hispanics with Alzheimer's and other dementias are less likely than whites to report that a doctor has told them they have a 'memory related disease" (45 percent of whites with Alzheimer's or other dementias compared with 33 percent of African-Americans and 34 percent of Hispanics with these conditions).

Research shows that many African-American family members recognize the value of having a diagnosis; but long delays often occur between family members' recognition of symptoms of cognitive impairment and the scheduling of a medical evaluation. The same is true for Hispanics. Delays in diagnosis mean that African-Americans and Hispanics are not getting treatment in the earlier stages of the disease, when the available treatments are more likely to be effective and do not have an opportunity to make legal, financial and care plans while they are still capable.

'The Association is committed to increasing awareness about risk factors for Alzheimer's and other dementias among all Americans," said Johns. 'Greater understanding about the importance of proper management of diseases like high blood pressure and diabetes will allow individuals to make more informed health care decisions and adopt healthy life style behaviors that can also help to reduce Alzheimer and dementia risk."

Growing Impact of Alzheimer's Disease and Dementia
According to the report, there are 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer's disease. By mid-century someone will develop Alzheimer's every 33 seconds. In 2010, there will be a half million new cases of Alzheimer's, and there will be more new cases in each subsequent year. In 2050, there will be nearly a million new cases.

Alzheimer's was the seventh leading cause of death in the country in 2006, the latest year for which final death statistics are available. It was the fifth leading cause of death among individuals aged 65 and older. From 2000-2006 death rates have declined for most major diseases – heart disease (-11.1 percent), breast cancer (-2.6 percent), prostate cancer (-8.7 percent), stroke (-18.2 percent) and HIV/AIDS (-16.3) while Alzheimer's disease deaths rose 46.1 percent.

'Strategic investments in research for diseases such as heart disease, breast cancer, prostate cancer, stroke and HIV/AIDS have all resulted in declines in deaths. We have not seen the same type of significant strategic investment in Alzheimer's and because of that, deaths from Alzheimer's disease continue to soar," said Johns. 'Discovering effective treatments that prevent onset or delay disease progression takes on an all encompassing urgency as the nation braces for an onslaught of aging baby boomers. This disease, unlike any other, has the power to undermine all of our best efforts to control health care costs."

People with Alzheimer's and other dementias are high users of hospital, nursing home and other health and long term care services, translating into high costs for all payers. The Alzheimer's Association estimates that total payments for health and long-term care services for people with these conditions will amount to $172 billion from all sources in 2010. Medicare costs are almost three times higher for people with Alzheimer's and other dementias than for other older people, and Medicaid costs are almost nine times higher. Most people with Alzheimer's also have one or more additional serious medical conditions, such as diabetes or coronary heart disease. Their Alzheimer's greatly complicates medical management for these other conditions, resulting in more hospitalizations and higher costs.

Impact of Alzheimer's and Dementia on Caregivers
According to the new report, in 2009, nearly 11 million family members and other unpaid caregivers provided 12.5 billion hours of care for people with Alzheimer's and other dementias, an amount of unpaid care valued at $144 billion. In fact, Alzheimer's and dementia caregivers provided care valued at more than $1 billion in each of 36 states, and nine states saw an Alzheimer and dementia caregiver contribution valued at $5 billion or more per state.

'Alzheimer's disease often progresses in a slow, unrelenting pace exacting a tremendous emotional, physical and financial toll on caregivers. Every day these caregivers rise to meet the challenges of Alzheimer's," said Robert J. Egge, Alzheimer's Association Vice President of Public Policy. 'The uncompensated care they provide is valued at $144 billion, which is more than the Federal government spends on Medicare and Medicaid combined for people with Alzheimer's and other dementias."

More than 40 percent of family and other unpaid Alzheimer and dementia caregivers rate the emotional stress of caregiving as high or very high, compared with 28 percent of caregivers of other older people. Caregivers often report a decline in their own health as they try to balance the demands of caregiving with their own work responsibilities. In 2009, 60 percent of Alzheimer and dementia caregivers were employed full-time or part-time and among those employed, two-thirds said they had to go in late, leave early or take time off because of caregiving; 14 percent had to take a leave of absence and 10 percent had to reduce their hours or take a less demanding job. Juggling the demands of caregiving, particularly in these financially difficult times, has placed additional stress on caregivers as their caregiving duties threaten their own job security.

Ultimately solving the Alzheimer crisis – with its far-reaching impact on families, Medicare, Medicaid and the health care system – will mean addressing the chronic underinvestment in research. A rapidly aging population and dramatic increases in the number of Alzheimer cases in coming years should catapult the government into action. 'We know what the future will bring if we do nothing – more lives lost, overloaded nursing homes, overworked caregivers and an overwhelmed health care system," said Egge. 'Our country must increase its investment in research and scientific innovation if we hope to soon live in a world together with Alzheimer survivors."

The full text of the Alzheimer's Association's 2010 Alzheimer's Disease Facts and Figures can be viewed at http://www.alz.org/alzheimers_disease_facts_figures.asp. The full report will also appear in the March 2010 issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association (volume 6, issue 2).
- Alzheimer's Association

Alzheimer's Association honors SSA commissioner Astrue with Humanitarian Award

Alzheimer's Association — 2010-03-08

Social Security Administration (SSA) commissioner Michael Astrue is the recipient of the Alzheimer's Association's 2010 Humanitarian Award. The award is given each year to a public official who has made a significant contribution to help those who are struggling with Alzheimer's disease. This year, the award will be given to Commissioner Astrue in recognition of his exceptional leadership in creating the Compassionate Allowances Initiative and the decision to include early-onset Alzheimer's disease and other dementias in that initiative.

"Commissioner Astrue has worked tirelessly to ensure that disabled Americans receive the Social Security disability benefits they've earned in a timely way. I congratulate Mike for receiving this honor, and I know he joins me in admiration for the tremendous work that the Alzheimer's Association does every day," said President Obama.

Harry Johns, president and CEO of the Alzheimer's Association, thanked President Obama for his comments about the Alzheimer's Association and echoed the president's praise for Commissioner Astrue: "Social Security benefits are crucial to individuals under age 65 with Alzheimer's disease because they lose their jobs, income and health coverage at the very same time they face the biggest challenge of their lives: the reality of living with Alzheimer's. On behalf of all the individuals who now won't have to go through a long decision process and multiple lengthy appeals to obtain their benefits, the Alzheimer's Association is proud to honor Commissioner Astrue for establishing this initiative which helps to ease the burden of so many families."

Under Astrue's leadership, the Social Security Administration has committed to "fast-tracking" certain conditions to reduce the backlog of disability claims and streamline the application process. The commissioner's insight and understanding that the diagnosis of Alzheimer's indicates significant cognitive impairment that interferes with daily living activities, including the ability to work, will now ensure early-onset families won't have to endure the financial and emotional toll of a long decision process.

The Alzheimer's Association urges all individuals affected by Alzheimer's to use their VOICE to educate the public about their experience. The Association is grateful for Commissioner Astrue's willingness to listen and to provide a platform for these individuals to share. During the public hearing on this issue, Commissioner Astrue and his colleagues heard from those living with Alzheimer's and Alzheimer researchers about the terminal nature of the disease, the disabilities that often prohibit work in even the earliest stages of the disease, and the lack of effective treatments that modify or halt disease progression. Another 600 advocates submitted written testimony about their experience trying to obtain disability benefits.

Commissioner Astrue will receive his Humanitarian Award during the Alzheimer's Association's 22nd Annual Advocacy Forum, the Alzheimer's Association's premier advocacy event that brings together advocates from across the country in three momentous days of action in the fight against Alzheimer's.

Past recipients of the Alzheimer's Association's Humanitarian Award include President Ronald Reagan; Sens. Arlen Specter, Tom Harkin, Mark Hatfield, Barbara Mikulski, Jay Rockefeller, Charles Grassley and Blanche Lincoln; Reps. Steny Hoyer and Edward Markey; and Josefina Carbonell, Health and Human Services assistant secretary for aging.
- Alzheimer's Association

Statement on negative Phase III trial results for Dimebon

Alzheimer's Association — 2010-03-02

"The Alzheimer's Association is disappointed to learn of the negative results from the Phase III clinical trial of latrepirdine (Dimebon)," said William Thies, Ph.D., Alzheimer's Association chief medical and scientific officer. "People with Alzheimer's, their families and caregivers desperately need more and better treatment options for this devastating, fatal brain disease."

Nonetheless, the Alzheimer's Association remains optimistic about the future prospects for better Alzheimer treatments and prevention strategies. Several dozen other compounds are in the pipeline for Alzheimer's disease. We remain encouraged by the fact that drugs in the pipeline for Alzheimer's attack the disease from a variety of angles.

"The population is aging, and we need to make significant advances soon in the treatment and prevention of Alzheimer's. It is an overwhelming epidemic, already claiming millions of individuals, and it is on track to deplete our healthcare resources and devastate Medicare," Thies said. "The current level of federal research funding for Alzheimer's is unacceptable considering the many millions of people this disease affects and the huge financial impact on our economy and society. And, these numbers will grow exponentially with the aging of our population."

According to the Association, in order to get better diagnosis, treatments and prevention for Alzheimer's, we must address two important issues:

(1) We must address the chronic underinvestment in research to ultimately solve the Alzheimer crisis. We need to get more Alzheimer drugs in the pipeline. To do this, we must increase the research investment in Alzheimer's to levels similar to other leading causes of death, such as cancer and heart disease. Only then will we have the chance to see the same type of progress - such as declining death rates, and viable lifestyle-based prevention strategies - and stop this epidemic. If we do not invest now, the cost of Alzheimer's disease to taxpayers in Medicare and Medicaid costs will be $20 trillion dollars over the next 40 years -equal to 25 economic stimulus bills.

(2) In addition to increasing funding, it is imperative that people volunteer for Alzheimer clinical trials. Later this year, at the Alzheimer's Association 2010 International Conference on Alzheimer's Disease (ICAD), the Association is planning to launch a first of its kind tool to help match people with Alzheimer's and caregivers with Alzheimer clinical trials.

Next week, the Alzheimer's Association is bringing together advocates from across the country at the Alzheimer's Action Summit to encourage legislators to increase funding for Alzheimer's disease. Join us in Washington, D.C. or take action virtually at alz.org.
- Alzheimer's Association

Alzheimer's Association Applauds Social Security Administration for adding early-onset Alzheimer's to its Compassionate Allowance Initiative

Alzheimer's Association — 2010-02-11

The Social Security Administration (SSA) has added early-onset/younger onset Alzheimer's to the list of conditions under its Compassionate Allowance Initiative, giving those with the disease expedited access to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The Alzheimer's Association, a longtime advocate for those with early-onset Alzheimer's, has played an integral role in this movement to reduce the length of disability decision process.

Application Process

If you are affected by early-onset Alzheimer's, use our helpful checklist to make sure you have information and resources you need to apply for Social Security Disability and Supplemental Income benefits.

What is the Compassionate Allowance Initiative?

Under this initiative, the Social Security Administration (SSA) finds individuals with certain diseases/conditions eligible for Social Security disability (SSDI) and Supplemental Security Income (SSI) benefits by the nature of the disease. While applicants still have to meet other SSDI criteria and/or SSI criteria, when it comes to the disability criterion, they are considered eligible by virtue of the disease and fast-tracked for a favorable decision about their eligibility for SSDI and SSI benefits.

What is Social Security Disability Insurance (SSDI)?

Social Security disability benefits (SSDI) are paid to individuals who have worked for enough years and have a condition that is so severe that they are able to work and longer. Administered by the SSA, SSDI makes monthly payments to eligible disabled individuals and is a significant benefit for individuals with early-onset (younger-onset) Alzheimer's disease. In addition to a monthly payment, it serves as entry to Medicare benefits for those under the age of 65. Family members (e.g., spouses and minor children) may also be eligible for benefits based on the applicant's work record.

What is Supplemental Security Income (SSI)?

Supplemental Security Income benefits (SSI) are paid each month to individuals who are aged, blind or disabled and have limited income and resources (assets). The "disability" criteria for SSI are the same as for SSDI benefits. Unlike SSDI, eligibility for SSI is not based on prior work experience. In addition, in most states, individuals who receive SSI are also automatically eligible for Medicaid (medical assistance) benefits.

Why is this important to individuals with early-onset Alzheimer's disease and related dementias?

Social Security disability benefits are very important to those with early-onset (younger-onset) Alzheimer's and related dementias because these individuals are often initially denied benefits – but usually win on appeal. Those affected by early-onset Alzheimer's are often simultaneously faced with the enormous challenges that the disease presents, while also undergoing a long disability decision process that is financially and emotionally draining. By adding Alzheimer's disease to the list of "Compassionate Allowance" conditions, it will simplify and streamline the SSDI/SSI application process and should result in receiving SSDI/SSI benefits in an expedited manner.
- Alzheimer's Association

Study: Smoking is an Alzheimer risk factor

Alzheimer's Association — 2010-02-02

A UCSF analysis of published studies on the relationship between Alzheimer's disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of AD, while independent studies showed that smoking increased the risk of developing the disease.

Study findings were published online today in the January issue (19:2) of the Journal of Alzheimer's Disease. An abstract of the paper is available at the link below.

"For many years, published studies and popular media have perpetuated the myth that smoking is protective against the development of AD. The disease's impact on quality of life and health care costs continues to rise. It is therefore critical that we better understand its causes, in particular, the role of cigarette smoking," said Janine K. Cataldo, PhD, RN, assistant professor in the UCSF School of Nursing and lead author of the study.

According to the Alzheimer's Association, 5.3 million Americans currently have the disease, and that number will escalate rapidly as the baby boom generation ages. AD also triples health care costs for Americans aged 65 and older, the organization states.

The UCSF team reviewed 43 published studies from 1984 to 2007. Authors of one-fourth of the studies had an affiliation with the tobacco industry.

The UCSF team determined that the average risk of a smoker developing AD, based on studies without tobacco industry affiliation, was estimated to be 1.72, meaning that smoking nearly doubled the risk of AD. In contrast, the team found that studies authored by individuals with tobacco industry affiliations, showed a risk factor of .86 (less than one), suggesting that smoking protects against AD. When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

Previous reviews of the association between smoking and AD have not controlled for study design and author affiliation with the tobacco industry, according to Cataldo. To determine if study authors had connections to the tobacco industry, the UCSF team analyzed 877 previously secret tobacco industry documents.

The researchers used an inclusive definition of "tobacco industry affiliation" and examined authors' current or past funding, employment, paid consultation, and collaboration or co-authorship on a study with someone who had current or previous tobacco industry funding within 10 years of publication.

"We know that industry-sponsored research is more likely to reach conclusions favorable to the sponsor," said Stanton A. Glantz, PhD, of the UCSF Department of Medicine and a study co-author. "Our findings point to the ongoing corrosive nature of tobacco industry funding and point to the need for academic institutions to decline tobacco industry funding to protect the research process."

Judith J. Prochaska, PhD, MPH, of the UCSF Department of Psychiatry, also is a co-author. The team's research was supported by grants from the California Tobacco Related Disease Research Program, the National Cancer Institute, and the National Institute on Drug Abuse.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions , and excellence in patient care.
- Behavioral Health Central

Singer Etta James has Alzheimer's

Alzheimer's Association — 2010-02-01

Singer Etta James is hospitalized for treatment of a serious infection, but her son said Friday he's more concerned with her Alzheimer's diagnosis.

James, 72, was diagnosed with MRSA -- a bacterial infection resistant to many antibiotics -- by doctors at a Los Angeles hospital where she was admitted for treatment last week, Donto James told CNN.

Life has been difficult for James, best known for her 1961 hit "At Last," since she was diagnosed with Alzheimer's disease a year ago, he said.

"Right now she is very confused," her son said.

He described his mother as "quite combative ... fighting, biting -- I'm talking way off the chart."

"I am going to end up losing my mother if it keeps going on like this," he said.

Donto James said he's hoping for more information about his mother's condition.

"There has to be another doctor out there who can tell me what is going on with my mother," he said.

Etta James' illness, he said, led her to the controversial comments at a concert a year ago where she suggested pop star Beyonce should be "whipped" for singing "At Last" for President Obama's inaugural ball.

"I can't stand Beyonce," she told a Seattle, Washington, audience. "She has no business up there, singing up there on a big old president day, gonna be singing my song that I've been singing forever."

She was upset about the inaugural, her son said, because "mother was supposed to be hired, but she wasn't well."

He said she was also suffering from "drug-induced dementia," a result of painkiller medications for a back injury. She has stopped taking the drugs, he said.

Her son, who plays in Etta James' band, said he's been frustrated because they've had to cancel several important shows -- including one last summer at the Hollywood Bowl.

"I want my mother back onstage again," he said. "I know it can happen."

Donto James said he was talking freely to CNN about his mother's medical problems because he's hoping someone can help him understand what is going on.

"It's 2010 and we should know something, should be able to diagnose," he said.
- CNN

Study to test evidence linking high blood pressure to dementia

Alzheimer's Association — 2010-01-27

If the cardiologist's warnings don't scare you, consider this: Controlling blood pressure just might be the best protection yet known against dementia.

In a flurry of new research, scientists scanned people's brains to show hypertension fuels a kind of scarring linked to later development of Alzheimer's disease and other dementias. Those scars can start building up in middle age, decades before memory problems will appear.

The evidence is strong enough that the U.S. National Institutes of Health soon will begin enrolling thousands of hypertension sufferers in a major study to see if aggressive treatment - pushing blood pressure lower than currently recommended - better protects not just their hearts but their brains.

"If you look ... for things that we can prevent that lead to cognitive decline in the elderly, hypertension is at the top of the list," Dr. Walter Koroshetz, deputy director of NIH's National Institute of Neurological Disorders and Stroke, told The Associated Press.

Age is the biggest risk factor for Alzheimer's disease and other forms of dementia that affect about one in eight people 65 or older.

Scientists have long noticed that some of the same triggers for heart disease - high blood pressure, obesity, diabetes - seem to increase the risk of dementia, too. But for years, they thought that link was with "vascular dementia," memory problems usually linked to small strokes, and not the scarier classic Alzheimer's disease.

Now those lines are blurring as specialists realize that many if not most patients have a mix of the two dementias. Somehow, factors like hypertension - blood pressure readings of 140 over 90 or higher - that weaken arteries also seem to spur Alzheimer's disease-like processes.

One suspect: Scarring known as white matter lesions. White matter acts as the brain's telephone network, a system of axons, or nerve fibres, that allow brain cells to communicate with each other. Even slightly elevated blood pressure can damage the tiny blood vessels that nourish white matter, interrupting those signals.

Among the strongest new studies:

-MRI scans showed women 65 and older with high blood pressure had significantly more white matter lesions in their brains eight years later. The study included 1,403 women who were enrolled in a memory subset of the landmark Women's Health Initiative that tracked postmenopausal health. The worse their blood pressure, the higher volume of white matter damage, says the study published online last month in the Journal of Clinical Hypertension.

"This is a silent disease in the brain," says lead researcher Dr. Lewis Kuller of the University of Pittsburgh. "It's evolving over time and it leads to very bad outcomes."

-The journal Stroke just published similar evidence from a Johns Hopkins University-led study that tracked 983 people for more than 15 years, starting in middle age. The longer people spent with uncontrolled high blood pressure, the more white matter damage they accumulated. The researchers could see a change with each 20-point jump in too-high systolic pressure, the top number in a blood-pressure reading.

Clearly, hypertension alone doesn't doom someone to later dementia. Far more people, nearly one in three U.S. adults, have hypertension.

And there are plenty of other reasons to lower blood pressure: Hypertension is a leading cause of heart attacks, strokes and kidney failure.

But while some studies have found hypertension treatment lowered the dementia risk, others haven't.

Enter the NIH's SPRINT study, which in a few months is to begin enrolling 7,500 hypertension patients age 55 and older around the country. The test: Whether aggressive treatment to lower systolic blood pressure below 120 - what's considered normal - will prove healthier than today's guidelines that urge getting it below 140, or 130 for diabetics.

The main focus is on heart and kidney health. But all participants will be screened for dementia, and a subset will undergo repeated cognitive testing and MRI scans to tell if lowering blood pressure also protects against a slide toward dementia. Another question: If older patients can tolerate bigger than usual blood pressure drops without side effects, such as falls.

With dementia rising fast as the population greys, even a small effect from better blood pressure control could have a big public health impact, says Dr. William Thies of the Alzheimer's Association.

Other dementia-preventing efforts, such as targeting the sticky amyloid plaques in Alzheimer's patients brains, haven't panned out so far - while hypertension control has little downside, notes Pittsburgh's Kuller.

"Until I can tell you how to get rid of amyloid in your brain, take care of the blood pressure."
- Associated Press

Frequent mental lapses may precede Alzheimer's

Alzheimer's Association — 2010-01-25

The Alzheimer's Association extends its deepest sympathies to Sen. Mark R. Warner (D-Va.) and the entire Warner family on the passing of his mother Marjorie Johnston Warner, who died Saturday, January 23, 2010 after a courageous battle with Alzheimer's.

In his distinguished career, Warner has paid homage to his mother by providing leadership on a number of areas important to Alzheimer families. As co-chair of the bipartisan Congressional Task Force on Alzheimer's Disease, along with Sen. Susan Collins (R-Maine) and Reps. Ed Markey (D-Mass.) and Chris Smith (R-N.J.), Warner has worked to bring Alzheimer issues to the forefront of the Congressional agenda, including research funding, care and supportive services.

Before becoming a Senator, Warned championed SeniorNavigator.com, an online portal and volunteer network, which provides Virginia families with health and aging resources, information, and tools. He also was instrumental in cofounding the Virginia Health Care Foundation, an organization created to improve access to health care and shore up local delivery systems for Virginia's uninsured and underserved. Warner also served as the governor of Virginia from 2002-2006.

Currently there are 5.3 million Americans living with Alzheimer's disease and that number is expected to grow to as many as 16 million by 2050. Alzheimer's disease is the seventh leading cause of death in the United States. Researchers are closer than ever to developing accurate ways to diagnose and treat Alzheimer's, but current Alzheimer funding is nowhere near what is necessary to achieve this goal.
- Alzheimer's Association

Frequent mental lapses may precede Alzheimer's

Alzheimer's Association — 2010-01-20

Mental lapses among older adults occur more often among those developing Alzheimer's disease than healthy elders, new research finds.

Excessive daytime sleepiness, staring into space and disorganized or illogical thinking are other mental fluctuations that often precede Alzheimer's, say researchers from Washington University School of Medicine in St. Louis.

"For many years, people have jokingly attributed mental lapses, or incidents when the train of thought temporarily seems to jump its tracks, as 'senior moments,'" said lead researcher Dr. James Galvin, an associate professor of neurology. "It has never been clear as to whether these lapses could lead to the development of Alzheimer's disease.

"We demonstrate clearly, for the first time, that such episodes are more likely to occur in persons who are developing Alzheimer's disease," he said.

But this doesn't mean that everyone who has a "senior moment" is on the verge of dementia, Galvin stressed.

"While these lapses or fluctuations don't by themselves mean that you have Alzheimer's disease, our results suggest that they are something your doctor needs to consider if he or she is evaluating you for problems with thinking and memory," he said.

The study is published in the Jan. 19 issue of Neurology.

For the study, Galvin's team collected data on 511 seniors, average age 78, with memory problems. The researchers tested these adults with standard thinking and memory tests and also interviewed family members about their relative's daytime sleepiness, disorganized or illogical thinking, or episodes of staring into space for long periods. Three or four symptoms were seen in 12 percent of participants, indicating cognitive fluctuations.

People with those symptoms were 4.6 times more likely to be diagnosed with Alzheimer's and to have more severe Alzheimer's symptoms, Galvin's group found. They also performed worse on thinking and memory tests than people without these lapses.

Among 216 people diagnosed with very mild or mild dementia, 25 had mental lapses, while only two of the 295 without dementia had the fluctuations.

These mental lapses are common in a type of dementia called dementia with Lewy bodies -- the second most common cause of dementia after Alzheimer's disease, Galvin said. "But until recently we really did not know how frequently they occurred in people with Alzheimer's disease or what effect fluctuations might have on their thinking abilities," he said.

Cognitive fluctuations occur in Alzheimer's disease and can significantly affect clinical rating of the severity of dementia and performance on memory and thinking tests. Assessing these fluctuations should be considered in evaluating patients for cognitive disorders, Galvin said.

Experts had mixed views on the significance of the findings.

"It is commonly observed that some Alzheimer's disease patients can go through stages where they have apparent episodes of lucidity, when they can perform at much higher levels on 'good days,'" said Greg M. Cole, a neuroscientist at the Greater Los Angeles VA Healthcare System.

This suggests that the cellular and molecular machinery required for higher performance has not been entirely lost but is frequently suboptimal, he said. "I find this quite hopeful as it suggests therapeutics might evoke more of these good days or moments," said Cole, who is also associate director of the Alzheimer's Disease Research Center at the University of California Los Angeles David Geffen School of Medicine.

But another expert said the finding adds nothing new to the diagnosis of Alzheimer's disease.

Once many of these fluctuations start happening, "you are well on your way to dementia," said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City.

The hope for improving the diagnosis and treatment of Alzheimer's hinges on finding physical markers that indicate disease progression and the effectiveness of treatment, another expert said.

"The finding is a terrific ad for the need for biomarkers in Alzheimer's disease," said William Thies, vice president for medical and scientific affairs at the Alzheimer's Association.

These mental fluctuations may be common, but are not an exact measurement of whether Alzheimer's disease is present or how far it has progressed, he said.

"We would like something better, something that has more precision, less variation," Thies said.
- HealthDay

Early Alzheimer intervention

Alzheimer's Association — 2010-01-15

Go inside the life of former Alzheimer's Association Early-Stage Advisor Mary Ann Becklenberg, who has Alzheimer's disease.
- ABC News

Where America Stands: Finding a cure for Alzheimer's

Alzheimer's Association — 2010-01-14

CBS News chief medical correspondent Dr. Jon LaPook reports on how Americans are dealing with the heartbreaking disease of Alzheimer's.
- CBS News

Senior moment or Alzheimer's?

Alzheimer's Association — 2010-01-13

It's said that everything comes with a price. The average American now lives almost thirty years longer than a hundred years ago. But for millions of people, the price of longevity has been Alzheimer's disease. The greatest fear my patients express to me is, "I think I'm losing my mind." They usually relate small lapses of memory. "I was making a phone call and I couldn't remember who I was calling." "I saw somebody I know like the back of my hand and I couldn't think of her name." "I lost my train of thought mid-sentence." Are they overloading their synapses with all the multi-tasking they do, is it normal aging, or is the beginning of Alzheimer's, the most common form of dementia? Researchers now have some tools that can help them answer this question - and some ideas on how we all might be able to prevent or delay Alzheimer's.

For the past several months, I have been preparing the most extensive segment I have been involved with since becoming a medical correspondent for the CBS Evening News with Katie Couric in 2006. CBS is leaving no doubt about its commitment to covering a disease that affects over five million Americans and could afflict as many as 16 million by 2050. It's devoting six minutes out of a 22 minute broadcast to "CBS Reports: Where America Stands"- a look at the latest research in Alzheimer's that will air tonight.

There is no cure for Alzheimer's disease. Average lifespan is about eight years. The five Alzheimer's drugs currently approved usually don't help for long and only treat symptoms. There are medications that can help treat the anger, anxiety, and depression that often accompany the disease. But so far, no medication has been proven to slow the progression of Alzheimer's.

CBS producer, Amy Burkholder, and I flew down to New Orleans, where we met three generations of women in one family who have been devastated by the disease. Two of the women have Alzheimer's and are in the cruel stage where they can still understand what they have lost and can see the silhouette of what's to come. All three sat together across from me at their kitchen table, clutching each other's hands, talking about their love for each other and their fears of what the future might hold. It was a snapshot of scenes that are playing out all across America and the world.

In order to understand the latest thinking about the diagnosis, treatment, and prevention of Alzheimer's, we spoke to experts, combed the world's literature and visited several laboratories doing cutting edge research. The Alzheimer's Association and the National Institute on Aging have been especially helpful. We visited Dr. Dennis Selkoe, Professor of Neurology at Brigham and Women's Hospital, who has spent decades pursuing the cause of Alzheimer's. He explained that a sticky protein called amyloid is present in all patients with Alzheimer's and described his efforts to prove that removing it from the brains of mice and humans can improve memory. We had unprecedented access to mice studies looking at whether exercise and a stimulating environment can help prevent or reverse the disease.

What about my patients who complain of mild memory loss? Much of the time such lapses do turn out to be just a normal part of aging. But doctors can be too dismissive of such complaints, saying, "That happens to me, too." It's important for patients to discuss all their symptoms - including memory issues - with their healthcare providers. And doctors need to become better educated about how to recognize and evaluate memory problems. There can be easily treatable causes for dementia, such as low thyroid or overmedication. Relatively simple "neurocognitive" testing, including the use of standardized mental status scales such as the Mini-Mental State Examination (MMSE), can help screen patients and determine whether further evaluation by a specialist is indicated.

It turns out that changes in the brain probably start to occur about 10-15 years before the onset of Alzheimer's disease symptoms. Dr. Reisa Sperling, Associate Professor of Neurology, Harvard Medical School and Director of Clinical Research, Memory Disorders Unit at Brigham and Women's Hospital, has done extensive research into ways of detecting Alzheimer's early - even before there is obvious memory loss. She's using special imaging tests called "PET scans" to detect amyloid in the brains of living patients; previously it could only be found at autopsy. She's also using a brain scan called a "functional MRI" that can measure how well the brain is working and spot problems much sooner than the CT's and MRI's of the head that are currently in wide use.

The hope of Dr. Sperling and others is that diagnosing and treating Alzheimer's much earlier will give medications a better chance of working. Dr. Sperling compared preventing and treating Alzheimer's to preventing and treating heart disease. You need to identify patients at high risk and treat them early. If you wait until somebody has had five heart attacks and is in heart failure, giving Lipitor isn't going to do much good.

The "Alzheimer's Disease Neuroimaging Initiative" (ADNI) is a nationwide effort studying scanning and other ways to diagnose patients and see if treatment is working. Eventually simple tests - perhaps of blood, urine, spinal fluid, or even skin - may help predict Alzheimer's disease before symptoms begin.

We met Adrian Ivinson, PhD, the Director of the Harvard Neurodiscovery Center. He's not willing to bet the farm that getting rid of amyloid is all that's needed to successfully treat Alzheimer's. He wants alternatives in case anti-amyloid drugs don't work. So, using robots, he's sifting through thousands of chemicals that theoretically might interrupt crucial steps in the development of the disease. "Here we have 150,000 mostly anonymous chemicals," he told me, "but among them may be the starting blocks - first steps - to developing drug." In two weeks, his robots can do what used to take humans a year. He's looking to develop a new pipeline of medications.

Is it possible to prevent Alzheimer's with lifestyle? That is one of the most fascinating areas of investigation and one that is very hard to test scientifically. "What's good for the heart is good for the brain" is a common slogan right now. Elevated cholesterol, diabetes, hypertension, obesity, smoking, poor diet, and lack of exercise have all been linked to an increased risk of Alzheimer's. A recent study found that patients in their late 70's who exercised the most and adhered to a Mediterranean diet had a nine percent risk of Alzheimer's. Those who didn't had a 21 percent risk. And research suggests that exercise improves the function of memory centers in the brain.

Despite all the recent progress, there are way too many unanswered questions. Dr. Richard J. Hodes, Director, National Institute on Aging, says the need to make progress in Alzheimer's disease is increasingly urgent: "As the population ages, the numbers of people developing Alzheimer's disease is expected to increase dramatically without more effective interventions soon." One of the greatest challenges is the extraordinarily difficult and heart-wrenching issue of caregiving. With Alzheimer's, annual Medicare costs triple. And it's impossible to put a price tag on the extraordinarily difficult and heart-wrenching issue of caregiving. To get an idea of what people go through, I suggest you take a look at the message board of the Alzheimer's Association website or check out the caregiving section of the AARP website.

It's clear we need to make curing Alzheimer's disease a national priority and devote sufficient resources to head off what is obviously an impending disaster.

Finally, there is an island where Alzheimer's disease is virtually unheard of. To find out where that is and what clues it might hold for us, tune in tonight to the CBS Evening News with Katie Couric. In the meantime, please click here to see this week's CBS Doc Dot Com, an interview with the Alzheimer's Association Chief Medical Officer, Dr. William Thies.
- CBS News

Anti-Alzheimer's "cocktail" meets with disdain

Alzheimer's Association — 2010-01-08

A new study touting the benefits of a nutrient cocktail in preventing Alzheimer's disease is drawing fire from experts who say the results are being misrepresented.

The drink, known as Souvenaid, was developed by the French company Danone, known as Dannon in the U.S., and was based on research done at the Massachusetts Institute of Technology. It is not currently on the market.

To conduct the study, researchers in the Netherlands gave Souvenaid, which includes B vitamins, phospholipids and antioxidants, to 225 patients with Alzheimer's disease. After 12 weeks, the cocktail appeared to show a slight benefit to patients who had taken it versus those in a placebo group.

The researchers said that the "proof-of-concept study justifies further clinical trials." Indeed, several such studies are currently under way.

However, numbers in the study indicated a reasonably high probability that some of the results could be due to chance, and some of the drink's apparent benefits seemed to disappear quickly, critics say.

"I see little evidence to support the use of this beverage to improve memory in [Alzheimer's disease patients]," said Dr. Paul Aisen, a noted Alzheimer's disease expert and professor at the University of California, San Diego. "It was a small study of treatment-naïve [Alzheimer's] patients lasting only 12 weeks." By 24 weeks, the memory differences seen after 12 weeks had disappeared.

The study was published in the most recent issue of the journal Alzheimer's & Dementia.

Experts also pointed out that some of the memory tests failed to show any improvement in people using the cocktail.

"This is a study which I would look at as negative," said Dr. Constantine Lyketsos, director of the Neuropsychiatry Service at Johns Hopkins Medical Institution. "The major outcome measures showed no effect at any time point."

Dr. Richard Besser, senior medical editor for ABC News, noted some troubling aspects of the study that related to its potential marketing, including conflicts of interest by the authors.

"They hold the patent on the nutritional cocktail and some serve on the advisory board for Dannon. The study was funded by Dannon," he said.

Other experts, too, were critical of the study.

"While everyone would clearly like to have some safe and easy to take method to stave off Alzheimer's disease, there are several features of this study that should raise concerns," said Dr. Clifford Saper, chairman of the Department of Neurology at Beth Israel Deaconess Medical Center in Boston. "They would include the involvement of the commercial sponsors at every level of this study, including writing the first draft of the paper; and the relatively low level of improvement on a single test out of a large battery of examinations."

Study co-author Dr. Richard Wurtman of MIT in Boston said he didn't think the sponsor was overly involved, but added he -- as a basic scientist -- was himself not deeply involved in the clinical aspect of the trial.

And in an e-mail, study author Dr. Philip Scheltens of VU University Medical Center in Amsterdam, the Netherlands, said the trial is "a proof of concept that urges further study, which we are doing."

He added that the study was indeed analyzed by the sponsor, but also by an external statistician, who is also a co-author of the paper.

There has been a strong desire for an effective Alzheimer's drug, given the number of people who suffer from the ailment -- a number that will grow if demographic trends continue.

"There is a tremendous unmet need since existing drugs offer only symptomatic benefits," said Dr. Murali Doraiswamy, chief of the division of biological psychiatry at Duke Medical Center.

However, he cautioned, "At this point I would not recommend that anyone get excited by this or start medicating themselves with these ingredients till we have results from more definitive studies. At best, this study offers some grounds for further testing."

He noted that while the ingredients had been suspected of having brain benefits in the past, "none of the ingredients have been shown to work in prior large scale trials of people with Alzheimer's."

Also, Doraiswamy said, a trial would need to be significantly longer for a product to be seriously considered.

"The typical standard for a definitive FDA trial is six-month duration," Doraiswamy said.
- ABC News