Brain Today

What is Alzheimer's Disease? Depends who you ask...

noreply@blogger.com (Dennis Fortier) — Tue, 05 Mar 2024 18:49:00 +0000

Contributed by: Dennis Fortier, President, Embic Corporation

The New York Times has a long-running and widely read column called "The New Old Age" that covers topics that are pertinent to our aging population. In today's article about the definition of Alzheimer's disease, I think they have manufactured an unnecessary controversy.

In this article (Apparently Healthy, but Diagnosed with Alzheimer's?), the author takes issue with proposed diagnostic guidelines for researchers studying the earliest stages of the disease when pathology begins to accumulate prior to any observable symptoms. She builds a case against the proposed guidelines and paints a picture of widespread, premature diagnoses in the nation's primary care clinics. She further intimates that the new guidelines are a plot to drive economic benefits to companies that sell therapeutics. Admittedly, such a plot is not far-fetched, but that is not what is going on here.

Within the Alzheimer's scientific ecosystem, it is well understood that a research diagnosis and a clinical diagnosis serve different purposes. In fact, the draft "guidelines document" that is the subject of the NYTimes article clearly states that it is a "research framework" and includes the following, further clarification in it's opening:

"These new criteria do not constitute clinical practice guideline recommendations."

Today's NYT article fails to distinguish the difference between researchers who are studying the earliest stages of Alzheimer's disease, and clinicians who are diagnosing and treating Alzheimer's disease in a symptomatic patient population. These two groups use justifiably different definitions of Alzheimer's disease.

The Pathological Cascade of Alzheimer's Disease

noreply@blogger.com (Dennis Fortier) — Wed, 29 Mar 2023 04:32:00 +0000

By the time you show symptoms of Alzheimer's disease, many irreversible changes have already occurred in your brain. This explains why early detection and timely intervention are so important. As described by the pathological cascade summarized in this post, treatment should ideally begin long before symptoms appear.

The key features of the Alzheimer's disease pathological cascade include the accumulation of two types of abnormal proteins in the brain: amyloid beta (Aβ) plaques and tau tangles. The Aβ plaques are formed by the accumulation of a protein called amyloid beta, which is produced by the breakdown of a larger protein called amyloid precursor protein (APP). The tau tangles are formed by the abnormal accumulation of a protein called tau, which is essential for the normal functioning of the brain's nerve cells.

The accumulation of Aβ plaques in the brain disrupts the normal communication between brain cells and leads to inflammation and the activation of immune cells. As the disease progresses, tau proteins also start to accumulate in the brain, forming tangles that further contribute to the degeneration of brain cells.

A simplified view of the process, which may take years, looks like this:

Protein Accumulation >> Inflammation >> Cell Death >> Symptoms

In an ideal scenario, patients would begin a regimen of disease modifying therapy (currently approved treatments can remove amyloid protein from the brain) as soon as amyloid plaques and tau tangles are present, and before inflammation, cell death, and cognitive symptoms emerge.

Achieving such timely intervention on any meaningful scale will require a proactive mindset toward managing cognitive health along with inexpensive and non-invasive methods for detecting the early stages of the disease. Fortunately, such methods are now becoming available. One promising approach, from Embic Corporation, involves a brief cognitive test with sophisticated scoring that quantifies the unobservable cognitive processes of encoding and retrieval. These processes underly nearly all cognitive function and show clear changes in Alzheimer's patients long before symptoms of memory loss appear.

The good news is that the science of managing Alzheimer's disease, from detection to diagnosis to treatment, is moving forward quite rapidly. The bad news is that progress is happening faster than the healthcare system can embrace. Researchers need to keep racing forward and the care system needs to catch up!

Should We Screen Older Adults for Cognitive Impairment?

noreply@blogger.com (Dennis Fortier) — Thu, 04 Jun 2020 20:54:00 +0000

The US Preventative Services Task Force (USPSTF) recently addressed this question and determined that there is “insufficient evidence to assess the balance of benefits and harms” associated with such screening. In effect, they could not conclude if it was helpful, harmful, or neither.

However, the question, and the conclusion of the USPSTF, both lend themselves to widespread misinterpretation. This brief summary takes a precise look at the issue and offers some clarity.

First of all, the task force defines “screening” in a very specific way. In this case, it means assessing the cognition of individuals with no clear signs or symptoms of a cognitive deficit. There is essentially no debate that doctors should evaluate the cognitive health of patients who do show signs of impairment; the USPSTF would agree. But “evaluating symptoms” is not the same as “screening” and is therefore, not a part of this discussion.

Assessing subjects with no symptoms is “screening” while assessing subjects who do have symptoms is “case finding”. This USTFPS opinion relates strictly to screening.

Second, the term cognitive impairment covers a wide range of disability from very mild (a subtle sense that thinking skills are becoming slower or less vital) to severe (full dementia including a loss of ability to care for oneself). The broad range of severity in this definition is problematic because, as just discussed, the term “screening” only applies to those “older adults” at the extreme mild end of this spectrum. As such, the posed question contains an inherent flaw. Either “screening” is the wrong word because it does not apply to many along the spectrum of cognitive impairment, or the term “cognitive impairment” must be precisely qualified to include only asymptomatic subjects. Otherwise, a sensible answer cannot be derived.

Finally, this discussion is further complicated by the fact that the publications, upon which the USPSTF based their conclusion, evaluated only cognitive assessment instruments designed to detect “dementia”, not the asymptomatic subjects contemplated by the notion of screening. Therefore, an evaluation of the benefits and harms of screening older adults for the full range of cognitive impairment, based on instruments that reliably detect only the most severely impaired, is neither comprehensive nor conclusive.

The bottom line, as emphasized in the accompanying editorials to the USPSTF recommendations published in JAMA, is that wide scale screening of asymptomatic populations over age 65 is not yet warranted by published evidence, but it certainly has strong theoretical appeal.

The USPSTF’s conclusion of “insufficient evidence” should not be interpreted as a recommendation against screening, rather, it is a factual statement about the paucity of studies that have been published in this area. But it should be noted that Medicare mandates the “identification of cognitive impairment” during Welcome to Medicare exams. So when asking if we should screen older adults for cognitive impairment, at least one well-informed branch of government believes that the benefits outweigh the costs.

Did Pfizer "Hide" a Potential Treatment for Alzheimer's Disease?

noreply@blogger.com (Dennis Fortier) — Wed, 19 Jun 2019 22:54:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
Despite the provocative title, this post is largely a summary of a non-story. However, it is worth discussing because this "non-story" has been widely covered in the general media, often in a manner that leans strongly toward the sensational end of the news spectrum.

The facts are fairly non-controversial. Pfizer, a major pharmaceutical drug developer and marketer, performed an analysis of medical insurance data comprised of approximately 254,000 patients with rheumatoid arthritis or another inflammatory disease. The analysis revealed that, among those patients whose inflammatory disease was being treated with Enbrel, a drug marketed by Pfizer in the US, a slightly smaller percentage also had an Alzheimer's diagnosis compared to those who were not treated with Enbrel. Despite the seeming potential for Enbrel to prevent Alzheiemr's disease, Pfizer conducted further internal review and opted not to initiate a clinical trial for the purpose of measuring the efficacy of Enbrel in preventing Alzheimer's disease.

As far as I can tell, no one is disputing those facts. However, how those facts are interpreted has become a matter of creative reporting. One angle that has created a fair amount of reporting (initially in the Washington Post) suggests that, because Enbrel is nearly off patent, after which the drug will be far less profitable, Pfizer made a greedy decision and opted not to pursue a potentially promising Alzheimer's treatment. Most drug development experts disagree with that suggestion.

The noted statistical evidence of a preventative effect of Enbrel against Alzheimer's disease was far smaller than what the drug development industry would generally require before initiating a trial. Furthermore, the effects of anti-inflammatory drugs in the Alzheimer's space have been thoroughly investigated in other studies to no avail. Given that Enbrel does not cross the blood-brain barrier, it is fairly unlikely that a long and expensive trial (see previous summary here of FDA drug approval process) would yield a favorable outcome. In fact, another major marketer of pharmaceutical drugs (Amgen), who holds the rights to Enbrel outside of the US, reviewed the same data and also concluded that further investigation was not warranted.

Overall, small statistical patterns are commonly present in large data sets like the one discussed here. However, such patterns are not necessarily indicative of an underlying treatment with a clinically meaningful effect. In the opinion of most knowledgeable scientists (as summarized here by Derek Lowe), Pfizer made a prudent decision not to further evaluate Enbrel as a potential treatment for Alzheimer's disease.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible. ____________________________________________________________

World Health Organization Issues Guidelines for Reducing Risk of Cognitive Decline

noreply@blogger.com (Dennis Fortier) — Tue, 21 May 2019 01:05:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
As research yields new insights about brain health, and in particular, about medications and lifestyle interventions that preserve cognition in later life, sanctioned guidelines become increasingly important as a means of guiding populations and healthcare systems in a positive direction.

To that end, the World Health Organization (WHO) convened a group of international experts to review the published evidence in support of several commonly discussed approaches to vital brain aging. From a thorough literature review and subsequent discussion, the group unanimously identified several "strong recommendations, and several "conditional recommendations".

The strong recommendations were for physical activity, cessation of tobacco use, and a brain-healthy diet as approaches with supporting evidence of benefits with minimal potential for adverse risks. While the evidence was less clear (in terms of likelihood for reducing risk of cognitive decline), the experts also strongly recommended strict control of hypertension and diabetes; two common chronic conditions that may impair cognition and that can be managed with no known adverse effects to brain health.

The group also made several conditional recommendations that would be appropriate on a case by case basis. These included careful weight management, control of total cholesterol levels, cognitive exercises, and treating alcohol abuse. The group concluded that there was not sufficient evidence to make recommendations about social activity or treatment of depression, although both of those approaches are well supported as beneficial in the larger context of overall health. The full 78-page report, including a concise summary of findings, can be downloaded at the WHO website.

Healthy Brain Resolutions for 2019

noreply@blogger.com (Dennis Fortier) — Thu, 17 Jan 2019 23:21:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation _______________________________________________
It is that season when it is enjoyable, and in some ways instructive, to pause and reflect on the passing of another year. It is also an excellent time for setting priorities and establishing habits that we will be happy to reflect upon twelve months from now.

With that in mind, this article suggests 5 simple practices with clear “brain health” benefits that you may wish to consider as you embark on a fresh new year. To be sure, there are higher ideals than those I have listed here, toward which we could all strive. However, my intention is to provide readers with some ideas that are relatively easy to pursue but can still yield important benefits; the goal is to offer maximal return for minimal effort and sacrifice.

With that said, here are five considerations for starting fresh in 2019:

1. Improve Cardio-Vascular Health

This suggestion is not new but deserves repeating because it has been proven beyond a doubt that good cardio-vascular health leads to better over all health and lower risks for heart disease, diabetes, and Alzheimer’s disease. What is new is certain evidence about how easy it may be to start moving the needle in the right direction. Improving cardio fitness need not involve strenuous exercise and really doesn’t even require that you sweat. Walking is one of the overall best and most underrated forms of exercise and can often be incorporated into daily errands.

Also, don’t think that because walking is easier than running or swimming that you must do it longer to gain a benefit; a daily 30-minute walk is immensely beneficial to a person with no current routine of physical exercise. Especially if the walk can be augmented with a few trips up and down the stairs in lieu of the usual elevator ride.

In terms of staying motivated to maintain a routine of physical exercise, try to find a quantitative measure that will reveal your progress and keep you looking for more gains. In the past, much emphasis has been placed on body weight, a measure that is easy to obtain but can be difficult to improve. As an alternative, check your pulse rate at the end of your work out and track it for one month of daily walks; you might be surprised to see it fall. When you consider how many beats of your heart you can save over the course of a year by keeping your heart rate low, it can be very motivating.

Also, whether or not you suffer from high blood pressure or high cholesterol, be sure to get these measures from your physician during your next check-up and keep track of them as you exercise. Even something as simple as a daily walk is good for your brain and can produce meaningful improvements in both of these bio-markers as you gain better fitness.

2. Reduce Stress

This suggestion might top the all time list of things that are easy to suggest but difficult to achieve. However, it turns out that for many of us, a high percentage of the daily stresses we encounter are self-inflicted. That’s right; choices we make and attitudes we willingly assume end up creating stress that we could otherwise avoid.

Reducing stress is important because we know how detrimental stress can be to our health. Real physical processes are triggered by emotional reactions to stress and, as far as our science can tell, none of those processes are beneficial while all have harmful side effects.

Here is a simple suggestion for reducing stress that, although it won’t work for all of you, must be tried by the rest of you before you can fully believe its effects. Put simply, you should make a conscious decision to drive with patience and courtesy. Look for other drivers trying to cut traffic and motion them in. Don’t speed up to close the gap when another car wishes to enter your lane; slow down and allow them in. Embrace yellow lights for the opportunity they foretell to pause for a moment – this is certainly less stressful than treating them as a threat to your rapid progress. Don’t tailgate or change lanes incessantly seeking opportunities to move one car length closer to the front of the crawling traffic; it is just not worth it. Instead, accept the pace, listen to some music, and keep an eye out for other drivers who might benefit from your courteous cooperation.

If you are not aggressive driver and cannot benefit from that tip, perhaps you can benefit from becoming a less aggressive “parker”. When visiting an establishment with a large parking lot, rather than seeking the spot nearest to the entrance, subjecting yourself to the anxiety of passing up a mediocre spot for the possibility of finding a better one, all the while monitoring the flow of motorists who might be competing for the best spot, try driving to the far end of the lot and parking in the open expanse of remote spots. It is a stress-free approach with the added benefit of a short cardio workout as you walk to your final destination.

While this might seem silly, it’s a step toward avoiding self-inflicted stress that just might carry over into other realms of your life as well. Get the right attitude, reduce your stress, and enjoy a healthier brain and body.

3. Stay Socially Active

While most of us are not in danger of becoming accidental hermits, making new friends and interacting socially are activities that have been documented to decline as we age. We are most prolifically social as young students, followed by fairly intense socialization in adulthood when our children are students, and we tend to be least active when we are older and our children have grown and moved on.

Much research on the benefits of intellectual stimulation, the act of using our brains in challenging ways, has shown a positive correlation with maintained cognitive health. I will write more on that below but will make a separate point here. Meeting people, learning about them, interacting and cooperating with groups, and cultivating relationships are all activities that require deep and comprehensive cognitive activity. In socializing, especially with persons we are still getting to know, we use memory, verbal skills, and judgment along with a poorly understood melding of emotions and executive function. In the opinion of many scientists, socializing may be the best mental activity we have.

Two great ideas for remaining socially active are club membership and volunteering. While you may or may not have interests that lend themselves easily to club membership, a regular card game or social activity with a committed group brings the same benefits. As for volunteering, hospitals, churches, and many non-profit organizations are begging for help in nearly every community. Incidentally, one of the most meaningful gifts you can offer through volunteering is friendship and interaction with a lonely, usually elder, person. Doing so will yield a double benefit because every interaction will be a work-out for both of your brains, not to mention the good it will do for your hearts.

4. Eat Well

You had to know this one was coming. As I did with the section on cardio-vascular fitness, I will try to present this in a new perspective that might be easier to embrace than those perspectives you have heard in the past. Here is my fresh take on eating well.

You needn’t necessarily deny yourself the junk food you’ve grown to love nor worry too much about your daily intake of calories. You do need, however, to worry about getting proper nutrition first. While consuming empty calories is harmful because it leads to weight gain and poor vascular health, the more damaging impact is that it strips away your appetite and prevents consumption of necessary vitamins and nutrients. A fresh approach to diet in the new year might be to focus first on what you should eat and set, as a second goal, the elimination of foods that you should not.

The good news is that the diet shown to produce the best vascular health was also shown this year to also promote the best cognitive health. One should be sure to consume a diet rich in cruciferous and green leafy vegetables, nuts, fish, and tomatoes and low in red meat and high-fat dairy products. Ideally, you will eventually adopt a diet whereby you take in what you need and avoid what you do not, but an easy place to start is to ensure that you get enough fruits and vegetables prior to filling up on junk; this will offer the best opportunity to keep your brain functioning at a high level in the new year.

5. Seek Intellectual Stimulation

If you have pondered the health of your brain at all, you have likely read or heard about the importance of ongoing intellectual stimulation. While it is not yet completely understood, it does appear that active brains decline more slowly with age than those that are relatively unchallenged.

A potential red herring in the discussion is the value of crossword puzzles, sudoku, and the like. Yes, they are mentally challenging activities but they may not produce the rich neural rewards that other activities, such as socializing, might yield. The key seems to be related to the concept of “learning”. If you don’t know the rules of crossword or sudoku then these may be great activities for your brain. However, if you know how the games are played, then merely working through new forms of each puzzle requires no new learning and may offer few benefits to brain health.

Among the most challenging yet rewarding intellectual activities that you pursue are learning to play a musical instrument and learning to speak a foreign language. Both of these have become much easier in the digital age with the advent of tools and software to aid in the learning process. While this might seem counter-intuitive it is actually quite well-grounded. With better tools, the learning becomes easier so the process yields faster proficiency and remains interesting through time. Despite the ease, the learning is real and the brain builds new circuits in accordance with the new learning. The whole process can be great fun, deeply rewarding, and very good for your brain.

So there you have 5 good suggestions to start fresh in the new year and keep your brain healthy in the process. Work on that cardio-vascular fitness, reduce your stress, stay socially active, eat well, and challenge your brain with new learning. If you do so, you can expect that twelve months from now you can look back with clarity and reflect on a year when you made a worthy commitment to the health of your brain. Follow Brain Today on Twitter --------------------------------------------------------------------------------
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible. ____________________________________________________________

Alzheimer's Awareness: Why Bother?

noreply@blogger.com (Dennis Fortier) — Tue, 30 Oct 2018 20:59:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

As you may have read elsewhere, November is National Alzheimer’s Awareness Month. But surely, the public is already well aware of this horrible disease. After all, Alzheimer’s has directly affected approximately 1 in every 2 families and the others must have certainly noted its prominent coverage in the news. We don’t really need more awareness, right?

Wrong.

Some of the information below may surprise you. That is to say, it is information about which you are not presently aware. However, by merely learning the seven facts below you will be helping to reduce the Alzheimer’s problem. That’s right…making you aware of this information and encouraging you to share it with your social networks will facilitate a more informed and more effective approach to combating the threat we face from this disease.

First, here are a few facts and figures that you may already know. Alzheimer’s currently affects more than 5 million Americans and that number is likely to triple by 2050. It is the sixth leading cause of death in the USA and is climbing steadily in the rankings. Also, Alzheimer’s is the leading cause of dementia and accounts for about 65% of all dementia worldwide. These are all sobering facts but perhaps not new to your understanding.

7 Facts You Need To Know
Now, here are some points you may not know but should. It is the following information that I hope will stimulate discussion and promote a better understanding of the disease. With more discourse, we can begin to erode the lingering stigma that currently prevents some people with early symptoms from seeking timely medical attention.

1) We generally detect Alzheimer’s at the end-stage of the disease. On average, Alzheimer’s follows a 14-year course from the onset of the first symptoms until death. There is some variability across patients but 14 years is pretty typical. The more surprising news is that, on average, we diagnose Alzheimer’s in years 8-10 of that disease course. This means that for most patients, symptoms go undiagnosed and untreated for at least seven years, during which time the lesions spread through the brain and cause irreparable damage. Please be aware that we diagnose Alzheimer’s disease far too late to optimize the effects of currently available treatments.

2) Sudden or Severe Memory loss is not a part of normal aging. The point about end-stage detection raises an obvious question about “why” we diagnose this disease so late. There are many contributing factors but most of them can be reduced through awareness and education. Some patients with memory concerns resist medical attention in the early stages because they fear a stigmatizing label or because they are misinformed to believe that Alzheimer’s cannot be treated. Many people, including a startling number of physicians, incorrectly believe that memory loss, even sudden or severe loss, is a normal part of aging. Improving the timeliness of diagnoses for Alzheimer’s is, in many ways, a problem that can be addressed through awareness and education. Please be aware that sudden or severe memory loss is not a part of normal aging and, regardless of the cause of the memory loss, timely medical intervention is best.

3) Current Alzheimer’s drugs are probably more effective than you think. Our widespread practice of late detection has many negative consequences. For example, one of the reasons that current treatments are often deemed ineffective is because they are routinely prescribed for patients with end-stage pathology who already have massive brain damage. With earlier intervention, treatment can be administered to patients with healthier brains, many of whom will respond more vigorously to the recommended therapy. Yes, we need better treatments, but a great start would be to intervene earlier with the treatments we already have. Please be aware that currently approved treatments may be more effective than some headlines indicate.

4) Alzheimer’s disease can be treated. Another treatment related concept about which everyone should be aware is this. Preventing or slowing further brain damage is preferable to letting the damage spread without constraint. Yet, many physicians, patients, and caregivers conclude that any treatment short of a cure is not worthwhile. While today it is true that we have no cure for Alzheimer’s, that does not mean there is no treatment. With a good diet, physical exercise, social engagement, and certain drugs, many patients (especially those detected at an early stage) can meaningfully alter the course of Alzheimer’s and preserve their quality of life. Please be aware that “we have no cure” does not mean “there is no treatment”.

5) The Alzheimer’s drug pipeline is full. Here’s another fact of which you should be aware. Through an intense research effort over the past twenty years, scientists have gained significant insight into Alzheimer’s disease mechanisms and about other factors that increase the risk for the disease. Much has been learned and some very promising drugs, based on sound theoretical approaches, are in FDA clinical trials right now. While much of the disease remains shrouded in mystery and we may still be a long way from better treatments, it is possible that an effective agent is already in the pipeline. Please be aware that, although we don’t know when, better treatments for Alzheimer’s are certainly on the way.

6) Taking good care of your heart will help your brain stay healthy. Know this; the health of your brain is very closely tied to the health of your body, particularly your heart. Researchers have shown conclusively that high cholesterol, high blood pressure, and obesity all confer greater risk for cognitive decline. The mechanisms that keep oxygen rich blood flowing through your body play a key role in maintaining a healthy brain. Everyone should be aware about the close association between vascular health and cognitive health. Please be aware that maintaining good vascular health will help you age with cognitive vitality.

7) Managing risk factors may delay or prevent cognitive problems later in life. There are well-identified risk factors for Alzheimer’s disease that are within our power to manage. These include diabetes, head injuries, smoking, poor diet, lethargy, and isolation. With greater awareness of these facts, we can imagine a world where diabetics take more care to control their blood sugar, where helmets are more prevalent in recreational activities that are likely to cause head trauma, where people smoke less and eat more fruits and vegetables, and where everyone makes a better effort to exercise and to stay socially engaged on a regular basis. While these facts may not be well known, they are all well proven. Galvanizing an effort to publicize them is one purpose of National Alzheimer’s Awareness Month. Please be aware that many risk factors for Alzheimer’s can be actively managed to reduce the likelihood of cognitive decline.

So why bother with Alzheimer’s awareness? Because it is a terrible disease poised to ravage our aging society and the lack of education and awareness has lead to a stigma that prevents a more proactive approach to early intervention. The result is that we diagnose it too late, which hampers the efficacy of available treatments. A more educated public could manage risk factors to minimize the likelihood of Alzheimer’s, could monitor personal cognitive health with greater vigilance, and could seek medical attention at the earliest sign of decline. Physicians could then diagnose problems earlier and prescribe appropriate treatment including diet, exercise, and drugs to slow disease progression as much as possible. In the end, we could have fewer cases, more effective treatment, slower progression, higher quality of life, and lower healthcare costs. The social, emotional, and fiscal benefits of awareness and education in this area are too large to quantify.

By reading this article, you have increased your understanding of the problem and raised your awareness about what can be done. That is a great step in the right direction but you can do one thing more. You can help to spread this message.

In the spirit of National Alzheimer’s Awareness Month, please share this article with your friends to promote more widespread awareness. Post it to your Facebook page, share it with your LinkedIn network, link to it from your Newsletter, Tweet it, or email it. It doesn’t matter how you do your part, it only matters that you get it done.

Follow Brain Today on Twitter

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

New Alzheimer's Drug on Horizon? A Solid Maybe...

noreply@blogger.com (Dennis Fortier) — Fri, 27 Jul 2018 18:27:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A new Alzheimer's drug, being co-developed by Biogen and Easai, has completed a Phase II FDA trial with seemingly positive results. The drug (BAN2401) is a monoclonal antibody that binds to certain forms of amyloid protein, which is considered by many in the field to be a key culprit in the onset and progression of Alzheimer's disease. When the antibody is flushed out of the system, it takes the harmful amyloid protein with it. Over the past five years, several similar drugs have shown glimmers of promise before ultimately failing in Phase III FDA trials.

For perspective, Phase II studies are generally smaller (fewer people enrolled) with the purpose of determining safety for various doses of a drug along with any possible side-effects at each dose of the drug. Phase III studies are generally larger, often longer, and usually a final step prior to "market approval".

Biogen recently presented a snapshot of the data from their Phase II FDA trial at the Alzheimer's Association International Conference in Chicago. While the results showed a reduction in amyloid among subjects receiving the higher doses and a possible slowing of cognitive decline at some stages, the presentation lacked details and many questions remain unanswered.

The primary questions were related to the trial design which appeared to have lower-risk patients in the high dose group and higher risk patients in the untreated (placebo) group. If this was the case, then it would be easier to show that the treatment group fared better (perhaps on both amyloid deposition and cognition) than the placebo group. In defense of this approach, it was taken as a safety measure, not as an attempt to show efficacy through some deceptive trial design. With that in mind, the results are encouraging.

Secondarily, some in the field questioned the validity of the instrument used to measure cognition. The instrument (the ADCOMS) is a composite measure that pulls certain items from various other, well-validated instruments and combines them in a new instrument specifically designed to detect subtle changes. Given the well-documented mediocrity of the instruments historically used to measure cognitive change in FDA clinical trials, concerns about the ADCOMS should be somewhat tempered because the new instrument may not be significantly better than previous instruments, but it is probably no worse either. With this perspective, lingering angst about the ADCOMS may possibly be over-blown.

Overall, the trial results are both PROMISING and PREMATURE. While there is reason for a fair amount of optimism, one should not carry that optimism with an unrealistic amount of conviction.

SAGE: A short test for detecting Alzheimer's?

noreply@blogger.com (Dennis Fortier) — Fri, 18 Jul 2014 00:04:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Self-Administered Gerocognitive Examination (SAGE) has received a fair amount of attention this year. Most of the attention has been driven by PR efforts and a website hosted by The Ohio State University where the test was developed.

Unfortunately, much of the press coverage has been somewhat sloppy and perhaps misleading. While the scientists who developed SAGE described it as "a test to measure thinking abilities", the press has repeatedly characterized it as an Alzheimer's test. As readers of this blog know, dozens of medical conditions can impair memory and other thinking abilities, Alzheimer's disease is merely one of them.

Press mis-characterizations aside, the data supporting the validity of the SAGE is quite minimal. The instrument, a 15-minute self-administered questionnaire, was developed based on responses from a small sample of 63 subjects, and then validated on a sample of 1,047 subjects.

The website and support materials for the SAGE suggest that the instrument can detect dementia with fairly high accuracy of 95%. This has been the root claim for much of the ensuing press coverage. Remember though, the definition of dementia includes "impairment severe enough to interfere with social and occupational function". In this regard, a test that can detect such severe impairment may have little value, especially if it cannot detect more subtle symptoms such as those we see in the earliest stages of Alzheimer's disease.

From a clinical point of view, it is much more important to detect subtle stages of decline called Mild Cognitive Impairment (MCI). MCI is caused by a great many medical conditions and is often confused with normal, age-related changes in cognition. In fact, incorrectly assuming that subtle changes are caused by normal aging, rather than by an emerging medical condition, is the primary foe in our efforts to intervene at early stages against the various conditions that impair memory. Distinguishing the two is key to proactive management of cognitive health. According to the instrument's website, the SAGE is 62% sensitive for detecting MCI, which will provide little help for physicians trying to distinguish MCI from normal aging.

Other well-validated instruments are more useful in detecting MCI. The most accurate test in the published literature is the MCI Screen. It is 97% accurate in distinguishing MCI from normal aging, but it is not self-administered. Rather, it is generally administered by medical staff or a researcher. The ideal would be an instrument with the self-administering ease of the SAGE and the accuracy of the MCI Screen.

Is the Risk for Alzheimer's Disease Declining?

noreply@blogger.com (Dennis Fortier) — Fri, 11 Apr 2014 17:27:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Stop the press! Is this good news about Alzheimer's Disease? It depends on how you look at it.

A recent perspective article*, published in the New England Journal of Medicine, cites several studies supporting the notion that the risk of having Alzheimer's disease is declining. The article notes that the probability of a person of a given age, having any form of dementia today, is lower than it was a few decades ago. That sounds positive.

Despite the tempting headline of "Declining Risk", such a trend is most likely driven by overall improvements in population health. Today's seniors are unquestionably wealthier and better educated than those of the past, they smoke less, have fewer strokes, have better managed cholesterol, and have lower blood pressure. All of those factors affect risk of Alzheimer's disease and other causes of dementia.

Also, while risk at a given age may be declining, the number of people reaching old age (and even very old age) is sharply climbing. Prevalence at a given age may be lower, but incidence at older ages is clearly rising.

There is no reason to believe that the risk of Alzheimer's disease is magically declining. There is much hope, however, that awareness about risk factors and the importance of managing them, is helping us to forestall the ravages of dementing illnesses, and buying time for the nation's R&D efforts to find better treatments.

So keep exercising, eating right, using your brains, and managing your chronic conditions. For now, that is your best strategy for keeping your brain healthy for the longest time.

* n engl j med, 369;24, nejm.org, december 12, 2013

Screening for Cognitive Impairment

noreply@blogger.com (Dennis Fortier) — Tue, 25 Mar 2014 16:20:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Yesterday, the U.S. Preventative Services Task Force (USPSTF) ruled that there is insufficient evidence to make a recommendation, either for or against, routine screening for cognitive impairment in older adults. Today, the press is ablaze with sloppy reporting on the matter.

Many news stories (like this from US News and World Report) are conflating cognitive impairment with dementia, but readers of this blog understand that cognitive impairment may be very mild whereas dementia is, by definition a severe loss of cognitive capacity. Many others (like this from Time), are interchanging dementia and Alzheimer's disease, which inappropriately implies that the two are one in the same, and obscures the fact that Alzheimer's is but one of the many causes of dementia.

To be clear, the USPSTF did not rule against anything. They merely concluded that the evidence is not strong enough to make a recommendation one way or the other. More importantly, their ruling was related to "screening" of "older adults" for "cognitive impairment". In other words, should the healthcare system invest in regular cognitive assessment of all older adults, whether they suspect a problem or not? Their conclusion? They're not sure. They're not for it and not against it.

Rather, the public should monitor their cognitive health vigilantly and promptly report concerns to their physicians for a thorough evaluation. This will allow early intervention against treatable problems like thyroid dysfunction, vitamin deficiency, anxiety/depression, sleep disorders, and out of control diabetes, all known contributors to cognitive deficits. It will also facilitate early diagnosis of Alzheimer's disease.

This is important because Alzheimer's can be effectively managed for a significant percentage of patients. Effective management of Alzheimer's includes early diagnosis, physical exercise, proper diet, strict control of hypertension and diabetes, poly-therapy with a cholinesterase inhibitor and Namenda, ongoing social and intellectual stimulation, and caregiver education. All of these interventions have been shown to promote optimal disease management and, when brought together as a robust therapeutic regimen, can be surprisingly effective.

Time to Redefine Alzheimer's Disease

noreply@blogger.com (Dennis Fortier) — Fri, 21 Mar 2014 18:56:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Daily news stories abound with coverage of new treatments and diagnostic tests for Alzheimer's disease. Many include controversial musings about the value of measuring risks or "predicting" future diagnoses. Most of these discussions are poorly informed, and further limited in their usefulness by a lack of agreement about the definition of Alzheimer's disease. After all, detecting the disease "early" is a relative concept, completely dependent on your definition of when it begins.

As we wrote earlier in a post about when Alzheimer's disease really begins, there are wide disparities in the opinions of scientists, clinicians, patients, and journalists. The scientists look at pathological changes prior to symtoms, the clinicians adhere to a strict definition that includes severe symptoms, patients define it's onset in accordance with minor symptoms, and journalists, often unaware of these nuances, frequently muddy the waters with inadvertent generalizations.

There is strong rationale, in terms of promoting proactive healthcare and enabling an aggressive research agenda to develop better treatments, in favor of universally adopting a definition based on known pathological changes that occur early in the disease process. Doing so would peg the start of the disease at an early time, prior to the development of clinical symptoms. This approach, with which we agree, is highlighted in a clear and objective report from NPR today.

Much Ado About Blood Test for Alzheimer's Disease

noreply@blogger.com (Dennis Fortier) — Mon, 10 Mar 2014 17:22:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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The general press is widely reporting today on a blood test for predicting Alzheimer's Disease (AD). The media coverage is based on a study conducted at Georgetown University Medical Center and published in Nature Medicine. Despite the intense focus, there really may be very little news in this story.

It is unclear why CNN would report this as a "first-of-its-kind" study, when dozens of such studies have been presented and published over the last decade (we wrote in this space about one from Johns Hopkins and another from Scripps). Past studies have been based on various, different elements in the blood but have, in some instances, shown similar levels of predictive accuracy. This study was certainly among the most accurate, but even these results need to be considered in the context of how AD progresses

In terms of AD progression, there seems to be a fairly low level of appreciation, among health reporters, about the underlying nature of the disease. To suggest that we can somehow predict sudden and stark symptoms that mark the beginning of AD, is to ignore decades of research showing that pathological changes associated with the most common forms of the disease, progress slowly for decades before damaging the brain enough to produce symptoms. At best, this new blood test might give insight that a person is in that long, variable process. But bear in mind, autopsy data show that nearly everyone has AD pathology in the brain after age 65, though most do not have any AD symptoms. Therefore, a test to detect what we currently believe to be the pathology, just isn't yet very informative.

Furthermore, a new blood test that suggests those pathological changes are underway is great, but physicians can already detect such murky signs in many ways (MRI scan, spinal tap, PET Scan, etc.). Blood tests have general advantages in terms of cost and convenience, so the reported accuracy of this test is certainly a welcome step forward. But it probably doesn't provide a lot of new insight about whether or not a person is progressing toward the symptomatic stage of AD.

Finally, the fervor from the ethicists about the moral dilemmas associated with AD diagnoses, is misplaced. If some society wants to make a universal decision about whether or not every citizen should or should not have access to such tests, then the ethicists should weigh in. In our society, where people can decide for themselves if they wish to see a doctor and complain about a symptom, there really is no moral dilemma: those who want information will seek out such tests, and those who do not, will not.

Refining the Amyloid Hypothesis

noreply@blogger.com (Dennis Fortier) — Fri, 22 Nov 2013 23:32:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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A leading theory about Alzheimer's Disease (AD) suggests that toxic plaques of beta-amyloid protein accumulate in the aging brain, destroy neurons, and cause declining cognitive function. This theory has been deeply scrutinized and modified over the past two decades of intensive research.

The notable, but poorly understood role of amyloid has driven both treatment strategies and diagnostic strategies for Alzheimer's Disease. In fact, a great majority of efforts to treat Alzheimer's disease have been based on agents that either slow production of amyloid, alter the form of amyloid, or remove amyloid from the brain. Likewise, many diagnostic approaches have been driven by measures of the amount of amyloid in the brain or spinal fluid.

New research from the Penn Medicine Department of Radiology, published in the Neurobiology of Aging, suggests that the location of amyloid plaques in the brain may be more important that the amount of amyloid in the brain. In fact, it has been widely observed (but as yet unexplained) that many older adults, who died with complete cognitive integrity, were shown at autopsy to have massive amounts of amyloid plaques in their brains. Evidence favoring amyloid location over amyloid burden in diagnosing Alzheimer's disease offers a potential explanation for these puzzling observations.

The amyloid hypothesis has evolved considerably since it was first introduced. This research may offer a further refinement and a better understanding of the complex pathology of Alzheimer's Disease.

How Long Does a Concussion Last?

noreply@blogger.com (Dennis Fortier) — Thu, 21 Nov 2013 00:00:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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How long does a concussion last? This is a common question.

Historically, science has tried to answer this question by measuring the duration of concussion symptoms. Often, depending on the severity of the concussing event, symptom such as dizziness, blurred vision, and interrupted sleep are completely resolved within a few days or a couple of weeks.

However, we also know that many injuries, to various tissues in the body, are not completely healed until long after clinical symptoms have faded. This may also be true of injuries to the brain.

In fact, new research from the Mind Research Network in Albuquerque, N.M. supports such thinking. In a paper published in the online edition of Neurology, researchers showed that physical changes to concussed brains persisted for many months after symptoms had resolved.

One implication is that the brain needs longer to heal than the period demarcated by clear symptoms.

A second, and perhaps more important implication, is that brain injury and symptoms of brain injury may not be always correlated. In that regard, the constant, low-impact collisions of many sports may be injuring the brain in ways that are not obvious in terms of symptoms, but are injurious just the same.

No symptom of brain injury doesn't necessarily mean no brain injury.

Perspective on "A Cure for Alzheimer's"

noreply@blogger.com (Dennis Fortier) — Thu, 24 Oct 2013 23:00:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Sometimes the facts are very misleading.

For some reason, when Alzheimer's Disease is discussed in the popular press, the discussion often includes a reference to the fact that "there is no cure" for this disease. This is a true statement, but somewhat misleading.

This is misleading because it establishes "a cure" as the appropriate frame of reference for evaluating our ability to fight against this disease.

However, in medicine, we know this is not true. For example, we have no cure for hypertension, but we treat it effectively for most people. Clearly, the "no cure" frame of reference is not the most meaningful perspective on hypertension.

Also, we have no cure for diabetes, but like hypertension, we control it to a large extent for very many years. We have no cure for the common cold, eczema asthma, allergies, migraine, anxiety, heartburn, cancer, osteoporosis, depression, lupus or a thousand other common, and sometimes deadly, medical ailments. The truth is, cures are very rare in medicine.

To be clear, everyone would love to have a cure for Alzheimer's. It would greatly improve the world and eliminate much tragic suffering But "no cure" is not the same as "no treatment", and we should not allow the "no cure" label to fill us with pessimism.

In fact, with an early Alzheimer's diagnosis (prior to the dementia stage), doctors can often delay disease progression through a robust regimen of proper diet, physical activity, tight control of chronic conditions, and poly-therapy with approved drugs.

At present, we should not despair that there is no cure. Rather, we should keep searching for a cure while embracing the reality that, like so many other medical conditions, Alzheimer's must be vigilantly diagnosed in its earliest stages and treated to the best of our current abilities.

The cure may or may not come, but initial treatments have arrived, and better treatments will follow.

Good Sleep is Vital for a Healthy Brain

noreply@blogger.com (Dennis Fortier) — Fri, 18 Oct 2013 17:10:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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We know this intuitively. We feel foggy when sleep deprived, and mentally sharper when well-rested. Understanding why this is true raises three very important possibilities.

New Findings
Research out of the University of Rochester Medical Center (URMC) sheds light on an important brain cleansing process that occurs during sleep in the brains of mice, and presumably, in human brains as well. The study, published in the online version of Science, describes a cleansing process that becomes very active during sleep.

It appears that a process, whereby brain cells contract to create more space between them and cerebrospinal fluid flows through the spaces to remove proteins, is ten times more active during sleep than during wakefulness. From this, we suggest the following three possible conclusions:

1. Caffeine is Not a Substitute for Good Sleep
This research suggests that the mental fog of sleep deprivation may be partially caused by an excess of proteins in the brain. If so, these proteins may be, in some way, interfering with optimal communication between brain cells. While a jolt of caffeine may increase the intensity of signals between brain cells and allow for improved mental acuity, it won't solve the problem of excess proteins that may be gumming up the communication process. In this regard, sleep trumps coffee.

2. Excess Proteins in the Brain may cause Irreversible Damage
As readers of this blog know, a leading theory about the cause of Alzheimer's disease is the accumulation of beta-amyloid proteins in the brain. Given that the brain seems to actively flush proteins during sleep, including beta-amyloid proteins, it is plausible that sustained periods of sleep deprivation could increase the risk of Alzheimer's disease.

3. Sleep Disorders may be Especially Dangerous
If the brain engages in important processes of maintenance and repair during sleep, and these processes prevent long-term progression toward neurodegenerative diseases, then sleep may me even more important to our health than we previously suspected. If you snore, or wake often in the night, speak to your physician about a sleep study.

Diagnosing Alzheimer's: A Peanut Butter Sniff Test?

noreply@blogger.com (Dennis Fortier) — Wed, 09 Oct 2013 17:36:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

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You cannot accurately diagnose Alzheimer's disease with a smell test. The prospect of doing so makes for tantalizing headlines, but the science does not stand up.

To be fair, the prospect of diagnosing Alzheimer's Disease with a sniff test, including this latest flurry of news based on a peanut butter study at the University of Florida, has a legitimate, scientific underpinning. In fact, many Alzheimer's patients do indeed suffer from impaired smell sensitivity.

However, trying to diagnose Alzheimer's disease based on such a test has two major limitations.

First, many medical conditions cause impaired smell sensitivity, including allergies and normal aging, both of which are far more common than Alzheimer's Disease. So loss of smell sensitivity is certainly not a reliable indicator of Alzheimer's disease.

Second, many Alzheimer's patients retain a sharp sense of smell for many years, so intact olfactory function does not mean that one does not have Alzheimer's Disease.

Stories about smell tests, and their utility as Alzheimer's diagnostics, often get a lot of press. In fact, many experts agree that such stories get more coverage than scientifically merited. It is clear that optimistic stories about medical advances attract an audience, and are therefore interesting to news publishers, but you should read them with full awareness and appropriate expectations.

A peanut butter smell test for Alzheimer's diagnosis is not in our future.

Cancer Drug Not Effective in Treating Alzheimer's

noreply@blogger.com (Dennis Fortier) — Fri, 24 May 2013 17:09:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

The media have widely reported on a recent study showing that Targretin, an FDA approved drug for treating skin cancer, was effective in clearing amyloid plaques from the brains of mice. Given that the presence of amyloid in the brain is a pathological hallmark of Alzheimer's disease, many were optimistic about the potential for a new treatment.

Alas, the scientific process of duplicating results before accepting them as valid, is an important step in generating new knowledge. In this case, three attempts to duplicate the original findings have all failed. That is to say, no other lab has been able to show a reduction of amyloid in the brains of mice treated with Targretin.

The original study with the positive result was conducted at Case Western University Medical Center and published in the journal Science. In its latest edition, the same journal published a technical comment describing the negative results in three other labs.

Your Brain on Green Spaces

noreply@blogger.com (Dennis Fortier) — Wed, 03 Apr 2013 18:21:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

Lot's of things that seem obvious, turn out to be either counter-intuitive, or surprisingly complex. For this reason, we often apply scientific methods to "obvious questions". It is a means of verifying that our expectations are actually grounded in fact.

A recent study, published in the British Journal of Sports Medicine, looked at how green spaces affect our state of mind. The small study has gotten a fair amount of coverage in the press and, in some regards, investigates a fairly obvious question.

The research looked at brain activity, as measured with mobile electroencephalography, on 12 subjects as they walked through three distinct environments: a shopping district, a park, and a business district. The findings showed that the subject's brains were least "engaged", or more suited to meditation, in the park environment. Additionally, subjects showed evidence of being more engaged, excited, and frustrated, while passing through the shopping and business districts.

On one hand, it seems obvious that a more tranquil environment allows the brain to disengage and become more reflective. On the other hand, it is always reassuring to demonstrate scientifically that an obvious conclusion is supported with empirical evidence.

My take-away? Maybe a small effort to give the brain a short rest, by dampening down all the stimulation of a busy urban life, is a useful and re-energizing break for the brain. Take a walk in the woods if you can, and cut through the park whenever possible -- your brain might appreciate the break.

Optimism About New Alzheimer's Drugs

noreply@blogger.com (Dennis Fortier) — Thu, 11 Oct 2012 16:26:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

A few weeks ago, we wrote about the glimmering ray of hope that had emanated from bad news about potential new Alzheimer's treatments.

Both Bapineuzumab and Solanezumab, the two most progressed new drugs in the development pipeline, had both failed the final stage of their respective clinical trials, and would not be approved by the FDA. However, there was some evidence, and much speculation, that both drugs had shown signs of efficacy in secondary data analyses.

Now, as presented at the American Neurological Association's 2012 annual meeting earlier this week, those secondary analyses have been verified and a newfound optimism has swept the field.

Of course, drug approvals require a massive investment of time and money, and drug companies must always weigh the costs of completing that high risk process, against the benefits they might capture during the few remaining years of the drug's patent life, once the process is completed and the drug is commercialized.

Readers might be surprised to learn that drug companies sometimes abandon effective drugs, if the approval process takes too long and the viable (patent protected) period for recouping their investment is too short. This is the decision that Eli Lilly (Solanezumab) and Pfizer (Bapineuzumab) must now face as they consider the time and cost of next steps to bring these drugs to market.

At this point, there are two encouraging signs that each company might push forward and lobby the FDA for an efficient path to near-term approval. One is that the Federal government, under the National Alzheimer's Prevention Act, is committed to identifying new treatments for this disease. The other, is that the Wall Street analysts, ever pessimistic about success of new AD drugs, have pushed Lilly's stock price upwards in the wake of this new information.

Long-Distance Caregiving

noreply@blogger.com (Dennis Fortier) — Fri, 28 Sep 2012 20:58:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

An aging population is the macro-driver of the trend toward increased demand for caregiving. Within that trend, it is cognitie impairment, or declining brain health that is really fueling the growth. A such, caregiving is a topic we watch closely in this blog.

As the geographically dispersed, sandwich generation is increasingly called upon to provide care for an aging parent or relative, long-distance caregiving is also gaining prevalence. Performing this role from afar comes with its own set of challenges, and I am pleased to direct today's readers to the an article posted by Medical E-Compare, a marketer of medical insurance products.

The article offer tips for caregiving from a distance and features a set of practical suggestions for those finding themselves in this role, along with links to additional reources.

The Misdiagnosis of Alzheimer's Disease

noreply@blogger.com (Dennis Fortier) — Thu, 27 Sep 2012 22:34:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

Yesterday we commented on the common misdiagnosis of Lewy Body Disease, a problem often mistaken for Alzheimer's Disease. In keeping with that theme, we look today at results from an international physician survey on Alzheimer's diagnoses.

Based on a survey of nearly a thousand physicians in five countries (USA, Japan, UK, France, and Italy), we are not doing a very good job at diagnosing Alzheimer's disease in clinical practice. In fact, about half of all physicians agreed that the disease is "often misdiagnosed" and that diagnoses are "always or often" made too late to treat in a meaningful way.

None of this is news to regular readers of this blog as late detection of cognitive impairment is one of our frequent themes. However, the survey revealed an interesting perspective from the physicians, in terms of "why" they feel diagnoses are so commonly late.

According to the physicians surveyed, the major contributing factors to late diagnosis are:

lack of a definitive diagnostic test;
lack of communication from patients/caregivers; and
stigma

Not mentioned among their reasons is the one glaring problem that primary care physicians confess to me on a regular basis. I hear frequently from physicians that investigating memory complaints takes too much time, and often leads to a diagnosis of a problem they don't feel they can treat effectively. This perspective often leads them to "just keep an eye on the concern" until symptoms worsen and the need for medical intervention is clear. As the survey noted, this is "too late".

Managing the cognitive health of an aging population is a complex problem, and a difficult one to approach within the confines of our current "fee for service" healthcare system. As new models evolve, like the Accountable Care Organizations described in the Healthcare Reform Act, we will have an opportunity to greatly improve our standards of care in this important field.

Lewy Body Dementia

noreply@blogger.com (Dennis Fortier) — Wed, 26 Sep 2012 19:59:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

While this blog strives to clarify the daily news about brain health, sometimes it serves best by simply "emphasizing" the news about brain health. A very well reported article about Lewy Body Dementia, published in the The New Old Age blog of the NYTimes, is worthy of such emphasis today.

Like Alzheimer's disease, Lewy Body disease is a debilitating brain disorder that impairs cognition and leads to dementia. However, because the symptoms are similar, it is often mis-diagnosed as Alzheimer's disease, and subsequently mis-treated.

A key difference between the two diseases is in their most typical initial symptoms: short term memory disruptions are most typical in Alzheimer's disease, whereas executive function (completing complex tasks) and visual/spatial abilities are most commonly the first impairments noted in Lewy Body disease.

Along with low awareness of Lewy Body disease, symptomatic similarities to Alzheimer's disease are two drivers of mis-diagnosis. Making matters worse, other common symptoms, such as rigidity and altered gait, sometimes lead to mis-diagnoses as Parkinson's disease.

Hopefully, with growing awareness and the formation of organizations like the Lewy Body Dementia Association, clinical efforts to correctly diagnose and treat this disease will continue to gain efficacy.

5 Reasons to Support World Alzheimer's Day

noreply@blogger.com (Dennis Fortier) — Fri, 21 Sep 2012 21:58:00 +0000

Contributed by: Dennis Fortier, President, Medical Care Corporation

What's with every disease and medical condition having a day or month geared toward raising awareness? Are such efforts effective? Wouldn't it be better to put our time and energy into new treatments and cures?

Those are fair questions.

Here's a link to a great argument in support of Alzheimer's awareness, and why awareness matters. The article explains how heightened awareness can drive real benefits in five important ways, each of which are carefully explained in the full article:

1. Low Awareness drives higher medical costs
2. Awareness facilitates timely medical intervention and better treatment outcomes
3. Awareness erodes stigma and further enables timely medical intervention
4. Awareness and management of risk factors can lower incidence of Alzheimer's disease
5. Awareness accelerates scientific progress

It is easy to overlook “awareness” as an important part of the solution to the Alzheimer’s problem. This is especially true given the clear need for better treatment. However, a little reflection on the benefits of awareness, weighed against the relative ease with which we can spread information today, shows the massive benefits of greater awareness.

Awareness matters. Please do your part to increase awareness by clicking through, and then reading and sharing the article with your online social networks.