Heart Disease a Risk Factor for Alzheimer's....

     U.S. Experts Publish Brain Health 'Road Map'....

     Better Education Spurs Alzheimer's Patients to Try Risky Treatments....

     100 Million Worldwide May Have Alzheimer's by 2050....

     Study Probes Role of Stroke, Head Trauma in Alzheimer's....

     Blood Marker Could Point to Alzheimer's Risk....

     Can an Omega-3 Fatty Acid Slow the Progression of Alzheimer’s Disease?....

An active brain may help keep Alzheimer's at bay

Thursday, June 28, 2007

NEW YORK (Reuters Health) - The results of a new study support a number of previous studies that have shown that staying mentally active reduces the risk of developing Alzheimer's disease and the mild impairments that precede the condition.

As part of the Rush Memory and Aging Project in Chicago, more than 700 elderly subjects who were an average of 80 years old underwent yearly testing to detect any mental declines. The subjects were tested for up to 5 years and provided information on any current and past problems with their memory or thought processes.

They were also asked about their activities, such as visiting a library or museum; reading newspapers, books or magazines; attending a concert, play or musical; and writing a letter," Robert S. Wilson told Reuters Health.

Ninety of the study subjects developed Alzheimer's disease. In the current issue of the medical journal Neurology, Wilson of Rush University Medical Center, Chicago, and colleagues report that the frequent participation in activities that involve mental processes was associated a 50-percent reduced incidence of Alzheimer's disease.

A mentally inactive person in old-age was 2.6-times more likely to develop Alzheimer's disease than one who was mentally active, the team found.

This relationship remained after controlling for past mental issues, lifespan socioeconomic status, current social and physical activity, and also low mental function at the beginning of the trial, investigators report. Frequent mental activities also protected against mild impairments.

"Our results suggest that regardless of how mentally active people have been prior to old age, higher level of mental activity in old age reduces the risk of developing an Alzheimer's disease-like dementia and...impairment," Wilson said.

Brain autopsy performed in 102 subjects who died during the study failed to show a correlation between level of mental activity and neuropathology findings.

It is likely, Wilson said, that mental inactivity is "truly a risk factor for Alzheimer's disease and not simply an early consequence of the disease" -- because mental activity was not related to Alzheimer's disease pathology "and people with early Alzheimer's disease symptoms did not show accelerated decline in mental activity."

The findings of this study underscore the importance of being mentally active in old age, the clinicians conclude.

Sharpening Your Wits Could Outwit Alzheimer's

Elderly who enjoy games, reading are much less likely to get the disease, study suggests   

WEDNESDAY, June 27 (HealthDay News) -- Doing plenty of mentally-stimulating activities -- such as playing chess, reading a newspaper, or attending a play -- in old age helps reduce the risk of Alzheimer's disease, according to a study of more than 700 elderly Americans.

The Chicago residents, who averaged 80 years of age at the start of the study, underwent annual cognitive testing for up to five years. During the study, 90 people developed Alzheimer's disease, and 102 died.

However, the Rush University Medical Center researchers found that those who were "cognitively active" were 2.6 times less likely than those who got minimal mental stimulation to develop Alzheimer's disease.

The study, published June 27 in the journal Neurology, also found that frequent mental stimulation was associated with a reduced risk of mild cognitive impairment -- a transitional stage between normal aging and dementia -- and less rapid decline in cognitive function.

The researchers said their findings may help in the development of strategies to prevent or delay Alzheimer's disease.

Earlier diagnosis and targeted therapies are coming, researchers say

TUESDAY, June 12 -- Doctors may soon have new tests to detect Alzheimer's early on, as well as better medications to help treat the mind-wasting disease, researchers say.

A number of advances against the disease were highlighted Monday at the Alzheimer's Association's International Conference on Prevention of Dementia in Washington, D.C.

In one presentation, researchers reported that a new test may spot Alzheimer's early. And as effective therapies become available, earlier diagnosis will be key, experts say.

"Alzheimer's disease is very difficult to diagnose when it is in its early stages," said lead researcher Geert De Meyer, a senior biostatistician at Innogenetics in Gent, Belgium. "That's a pity because therapy might be most effective when it is applied in an early stage."

In the study, De Meyer's team tested a new diagnostic test, called INNO-BIA, that detects and measures the amount of various forms of amyloid-beta protein in blood. A buildup of amyloid-beta in the brain is a hallmark, and possible cause, of Alzheimer's.

The Belgian group tried the early detection test on blood samples taken from 556 people who had come to memory clinics with the early symptoms of dementia, including mild cognitive impairment.

According to the researchers, people at risk for Alzheimer's had significantly different amyloid-beta levels in their blood compared with people who did not show risk of Alzheimer's. For example, the ratio of amyloid-beta 1-42/amyloid-beta 40 was decreased by about 20 percent in patients at risk for Alzheimer's, compared to those not at risk.

"This is really a first step," De Meyer said. "The test could be used as a screening test or a risk-factor-determining test for Alzheimer's disease that can be followed up with other tests."

Another report focused on a phase II trial that tested LY450139, a drug being developed by Eli Lilly and Company. The medication is a potential treatment for Alzheimer's because it inhibits an enzyme, known as gamma-secretase, which contributes to the formation of amyloid-beta.

The trial was led by Dr. Eric Siemers, medical director of the Eli Lilly Alzheimer's Disease Team in Indianapolis. Siemers and his colleagues randomly assigned 51 patients with mild to moderate Alzheimer's to either 100 milligrams or 140 milligrams of the drug for six to 12 weeks.

The result: Levels of amyloid-beta 1-40 were reduced by 58 percent for the 100 milligram group and by 64 percent for the 140 milligram group.

However, no differences were seen in patients' cognitive function. But Siemers isnt disheartened by that outcome, he said, since "this was too short of a period to see a disease-modifying effect."

"This is the most robust effect of amyloid-beta in blood of any drug that is currently under development," he added. "The drug was safe, but we found some things that we will continue to monitor as we go into phase III studies, which will start early next year."

A third study presented Monday tackled Alzheimer's disease from a whole different angle. Experts know that glucose is the primary energy source for brain cells. However, in people with Alzheimer's, scientists have now discovered that a dramatic dip in glucose use in certain brain areas starts 10 to 20 years before any symptoms of Alzheimer's appear.

Deprived of their primary energy source, these stricken neurons suffer irreparable damage.

"This is a very novel approach to the treatment of Alzheimer's disease," said lead researcher Lauren Costantini, vice president for clinical development at Accera, in Broomfield, Colo. "The problem that we are focusing on is reduced brain glucose metabolism that has been shown to be an early event in Alzheimer's disease."

To replace this loss, scientists at Accera have developed a milkshake-like drug called AC-1202 (Ketasyn) that provides glucose-deprived neurons with an alternative energy source, known as ketone bodies. The researchers believe that increasing the availability of ketone bodies will improve memory problems and other functional losses that occur with Alzheimer's.

Costantini's team found that, after 45 days, people who took AC-1202 had statistically significant improvement in cognition compared with people taking a placebo. The best response was seen among people who did not have the E4 variant of the apolipoprotein gene (ApoE4), which occurs in half of all Alzheimer's patients.

Those who continued to take the drug for nine months had very little disease progression, especially among the people without the E4 variant, Costantini reported.

"We see this as a potential co-therapy with other strategies," Costantini said.

That could help both patients and researchers, experts say

 
MONDAY, June 11  -- Three groups of researchers are reporting progress on the early detection of Alzheimer's disease -- advances that, if validated, could aid patients and drug developers alike, experts said.

In one study, a Norwegian team identified a gene expression "signature" that distinguishes people with Alzheimer's from healthy individuals with an up-to-85 percent accuracy.

In other research, U.S. scientists reported that a combination of brain imaging techniques with sophisticated "pattern recognition software" could differentiate those with mild cognitive impairment (an early form of Alzheimer's) from those without the condition with 100 percent accuracy.

Finally, another U.S. study reveals that key diagnostic algorithms can predict an individual's six-year risk of developing dementia with at least 87 percent accuracy.

The results were announced Sunday at the Alzheimer's Association's International Conference on Prevention of Dementia in Washington, D.C.

There currently is no cure for Alzheimer's disease, which the Alzheimer's Association now estimates affects nearly five million Americans. Existing treatments can slow progression of the brain-wasting disease, but by the time an individual has been diagnosed the disease has typically been at work for years and extensive, irreparable tissue damage has already occurred. Diagnosis is currently done simply by observing patients and is only about 80 percent accurate.

According to Greg Cole, associate director of research for the Geriatric Research Education and Clinical Center at the Greater Los Angeles Veterans Administration Medical Center, early detection of Alzheimer's disease can aid both patients and those scientists searching for a cure.

Patients benefit, he says, because earlier treatment can minimize tissue loss and thus improve quality of life.

"It's like termite damage," he said. "You want to repair the damage before they destroy your house, you will be so much better off."

Pharmaceutical companies, on the other hand, can more confidently identify affected populations, which can reduce the size and cost of clinical trials, and thus enable them to perform more of them.

The Norwegian study, led by Anders Lonneborg, research director at DiaGenic ASA in Oslo, focused on gene expression profiling of an individual's blood.

Using a 1,200-gene DNA microarray, his team could distinguish those with Alzheimer's disease from those who were healthy with 85 percent accuracy. Using a smaller set of genes (fewer than 96) and a technique called RT-PCR, the team achieved an accuracy of 79.5 percent.

But that was using samples from individuals whose disease was so far advanced that they could be diagnosed clinically, anyway. It remains to be seen, Cole said, if the test can pick out individuals much earlier in the disease process, when treatment might be more effective.

That, Lonneborg added, is the next step. "Now we will test [the diagnostic] on risk groups who have minor memory problems and see if we can predict who will develop Alzheimer's disease in a few years. This will be very interesting to see how it works," he said.

A second study tackled early diagnosis using sophisticated brain imaging. The technique was developed by a team led by Christos Davatzikos, of the department of radiology at the University of Pennsylvania in Philadelphia.

Combining MRIs of brain structure with positron emission tomography (PET) measurements of cerebral blood flow, the new test uses pattern recognition software to identify spatial patterns that pinpoint with 100 percent accuracy whether an individual does or does not have mild cognitive impairment.

Using data from the Baltimore Longitudinal Study of Aging, Davatzikos' team gained access to individual patients' brain images and blood work from over a period of years.

"We found that even before the most subtle clinical symptoms, when they were healthy, we were able to see abnormality scores that were indicative of mild cognitive impairment in at least half of them," said Davatzikos. "So there were early signs."

Cole applauded this test's accuracy, but noted that it is unlikely to have wide application because of its cost -- several thousand dollars. Davatzikos said his team is now working to balance the test's accuracy and cost, for instance, by optimizing the accuracy of MRI-based tests alone.

Finally, a team led by Deborah Barnes, assistant professor of psychiatry at the University of California, San Francisco, is using a special "bedside" algorithm, or formula, to try and predict an individual's dementia risk.

This tool -- akin to similar methods for calculating the risk of cardiovascular disease or diabetes -- predicts with up to 88 percent accuracy whether an individual will develop dementia over the next six years.

Based on such variables as age, cognitive function and physical performance, the index is an inexpensive, fast and practical algorithm that groups individuals into low-, medium-, and high-risk categories. Those in the low-risk group have a 6 percent risk of developing dementia, compared to 54 percent for those in the high-risk category.

According to Barnes, such an index can provide comfort to those least likely to develop disease while motivating those at higher risk to adopt a healthier lifestyle.

At the same time, it provides information so their families may begin planning for whatever the future may bring, she added.

Less travel helps caregivers allow patient participation, study finds

 
MONDAY, June 11 -- Home visits by researchers may help increase the number of caregivers who are willing to enroll Alzheimer's disease patients in clinical trials, a new study finds.

It could also boost the number of patients who stay enrolled in trials, the University of Pennsylvania researchers added.

The team interviewed 108 caregivers of Alzheimer's patients who lived in the community. Caregivers were asked about their willingness to enroll their loved ones in hypothetical studies which differed according to four variables: location of study; method of transportation to study visits; chance of receiving a drug or placebo; and level of risk of the study drug.

Of the 108 caregivers, 17 percent were willing to take part in a high-risk clinical trial with no amenities. That increased to 27 percent when home visits were added and to 60 percent when low risk, home visits, and a higher chance of the patient receiving an active treatment were included, the study found.

The option of having home visits (which eliminates the inconvenience of traveling to a clinic) offset the negative study features, such as taking a high-risk drug. It also made caregivers of sicker patients more willing to sign up for studies, the researchers said.

"Altering studies to include home visits could result in shorter recruitment periods and increased patient retention rates," study author Jason Karlawish, associate professor of medicine and associate director of the PENN Memory Center, said in a prepared statement.

"The amount of time we save through these alterations could offset the added costs of the home visits, and, in fact, we may save considerable time and expense if the participants don't have to come in to the clinic so often," he said.

The study was to be presented at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

"Other than lack of sufficient funding, recruiting and retaining clinical volunteers is now the single greatest impediment to developing better treatment and prevention strategies for Alzheimer's," William Thies, vice president for medical and scientific relations at the Alzheimer's Association, noted in a prepared statement.

Heart Disease a Risk Factor for Alzheimer's

Patients treated for vascular trouble had better cognition, study found   

SUNDAY, June 10 (HealthDay News) -- There's more evidence that cardiovascular problems help drive Alzheimer's disease, scientists say, and that treating the heart might help protect the brain.

The findings "represent hope that interventions with well-known drugs can interfere with the disease's progression," said lead investigator Yan Deschaintre, a neurologist and research fellow at the University Regional Hospital Center in Lille, France.

In fact, cognitive impairment, as measured by a standard test, stayed in the low end of the mild range over 36 months for Alzheimer's patients who got treatments for both the neurological disease and their cardiovascular problems, the researchers reported.

In contrast, Alzheimer's patients with vascular trouble who did not receive these medications experienced declines in cognition that approached the severe level, Deschaintre's team found.

They were slated to present the findings Sunday at the Alzheimer Association's International Conference on Prevention of Dementia, in Washington, D.C.

According to the National Institute on Aging, about 4.5 million Americans have Alzheimer's disease. Rates rise steadily with age, and experts estimate that "nearly half of those 85 and older may have the disease." One recent study from the World Health Organization, released this week, warned that Alzheimer's -- which currently has no cure -- could affect 100 million people worldwide by 2050.

The new study was based on chart reviews of 891 French patients diagnosed with either Alzheimer's disease, cardiovascular disease plus Alzheimer's disease, or vascular dementia. The cognitive risk factors included in the study were high blood pressure, diabetes, high cholesterol, atherosclerotic disease and tobacco smoking.

Treatment was defined as receiving an antihypertensive drug, insulin or drugs to lower blood sugar, a cholesterol-lowering statin, or anti-clotting medications. The patients with Alzheimer's disease typically received medications aimed at temporarily curbing their symptomsthat included Aricept, Exelon or Reminyl.

Deschaintre's findings represent "pretty exciting work," because cardiovascular risk factors are "something we can do something about," said Dr. Sam Gandy, director of Emory University's Center for Neurodegenerative Diseases. Gandy also is chairman of the Alzheimer's Association's National Medical and Scientific Advisory Council.

The work done by Deschaintre's team is consistent "with what we've been hearing over the past three to five years" about vascular risk factors increasing the risk for Alzheimer's, Gandy said. The new study, "really nails that down by looking at the other side of the coin by establishing that treating vascular risk factors slows the progression of cognitive decline," he added.

He suggested that physicians begin to take vascular risk factors seriously as they treat patients with Alzheimer's. The vascular risk factors for early Alzheimer's patients "certainly should be treated" because it "seems to slow progression," Gandy said.

Another expert agreed.

The Lille results "reinforce the treatment guidelines for these vascular conditions, such as hypertension and diabetes, and emphasize that Alzheimer's and demented patients should be treated, too," said Hugh C. Hendrie, a professor of psychiatry at the Indiana University Medical School and a scientist at its Center for Aging Research.

However, Deschaintre and Hendrie both noted that physicians at times may not treat vascular risk factors in Alzheimer's patients, for a variety of reasons. For example, Alzheimer's disease often leaves patients apathetic, so they may neglect to tell their physicians about vascular symptoms, Hendrie said.

And Deschaintre noted that, in the clinic where the research was done, patients with Alzheimer's were less likely than other patients to be treated for vascular risk factors. The reverse was true, as well -- patients with vascular dementia were more likely to be treated for heart risk factors, but not for Alzheimer's.

But, "since the majority of patients have both Alzheimer's disease and cerebrovascular disease, and since patients with pure Alzheimer's do seem to benefit from treatment of vascular risk factors, the message is to treat both conditions rather than to focus only on one," he said.

Hendrie remained cautious about the scientific impact of Deschaintre's study, however. He said results from a clinical epidemiological study, such as the Lille research, aren't as conclusive or compelling as those from randomized, controlled clinical trials.

Two other studies scheduled for release at the Alzheimer's conference on Sunday also emphasized the role of the brain-body connection in cognitive impairment and dementia.

Weight loss may signal the onset of Alzheimer's, and the rate of weight loss could be early warning of dementia severity, according to a new review of data from what's known as the Nun's Study. That effort followed health outcomes for a group of 537 non-demented Catholic sisters, aged 75 to 102, for 10 years.

In the study, a team led by Dr. James Mortimer, a professor of epidemiology and biostatistics at the University of South Florida, Tampa, found that unexplained weight loss late in life was often linked to Alzheimer's neuropathology in the brain and not to any change in eating habits linked to Alzheimer's.

Mortimer explained that, "early weight loss appears to result from the Alzheimer's disease process itself before that process leads to dementia. That's why it is a marker of impending dementia."

In a third study, a team from the Mayo Clinic in Rochester, Minn., found an increased risk of mild cognitive impairment (MCI) or dementia among 70- to 89-year-olds who have had a carotid endarterectomy (surgical clearance of the carotid artery, which brings blood to the brain) or a stroke or "mini-stroke," also known as a transient ischemic attack (TIA).

In the study, the team compared the medical histories of 295 people with MCI and 590 age and sex-matched controls. "Elderly subjects who have had a carotid endarterectomy or stroke or TIA are about two times more likely to have MCI," lead researcher Dr. Rosebud O. Roberts, a Mayo epidemiologist, said in a prepared statement.

U.S. Experts Publish Brain Health 'Road Map'

It calls for more research into Alzheimer's, other threats   

SUNDAY, June 10 (HealthDay News) -- Experts at the U.S. Centers for Disease Control and Prevention and the Alzheimer's Association are releasing their brain health "road map," designed to maintain and improve the cognitive performance of American adults.

Officials from the two organizations said the National Public Health Road Map to Maintaining Cognitive Health emphasizes that maintaining and improving individuals' cognitive health is important to the overall health of the nation.

The Road Map calls for a coordinated approach to raising public awareness about cognitive health and a national commitment to prevent cognitive decline.

The document was slated to be unveiled Sunday at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

"Public health has a key role to play in ensuring that added years for older Americans are quality years, including both physical health and cognitive health," CDC Director Dr. Julie Gerberding said in a prepared statement.

She said the Road Map, "represents a reason for optimism coupled with a clear need for action. The Road Map provides critical action steps that organizations and agencies can take to move cognitive health into the public health arena in a strategic, coordinated manner."

The Road Map offers 44 recommendations including:

Reviews of research literature to determine types and amounts of physical activity that are most effectively enhance cognitive function.

Support for research into how physical activity and cardiovascular risk affect cognitive function.

Establish a Web site to provide the public and healthcare professional with accurate and valid information about cognitive health.

Develop a national population-based surveillance system to collect information about the burden of cognitive decline at the community level and to develop targeted strategies to assist people in specific communities.

Cognitive decline can range from memory loss and mild cognitive impairment to Alzheimer's disease and other forms of dementia. Currently, about 5 million Americans have Alzheimer's. The number of people with Alzheimer's and other cognitive problems is expected to increase substantially as the baby boomer generation continues to age.

Better Education Spurs Alzheimer's Patients to Try Risky Treatments

The more they know about their disease, the more open they are to possible side effects, study shows   

SUNDAY, June 10 (HealthDay News) -- Alzheimer's disease patients who have a better understanding of their condition seem to be more willing to accept potentially risky treatments, a U.S. study finds.

Researchers at the University of Pennsylvania interviewed 34 people with mild to moderate Alzheimer's who lived in the community. The patients were asked if they would want to take medications that would delay the progression of Alzheimer's for one year. The patients were told the risk of the treatments ranged from a 30 percent chance of pain to a 10 percent chance of death.

Patients with more insight into their symptoms, diagnosis and prognosis were generally more risk-tolerant, the study found. Patients who were willing to accept increased risk also were more likely to be judged competent to make a treatment decision and more capable of analyzing the risks, benefits and purpose of a medication.

"From the patient perspective, the willingness to take a risky Alzheimer's treatment is more driven by their awareness of their illness and their capacity to understand, appreciate and reason through a treatment's purpose, benefits and risks to themselves, and not so much on the severity of their Alzheimer's disease," study author Jason Karlawish, an associate professor of medicine and associate director of the university's Memory Center, said in a prepared statement.

The study was to be presented at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

This type of research may help drug companies, doctors and regulatory agencies better understand Alzheimer's patients' willingness to accept risky treatments, he said.

Karlawish noted that several treatments currently being tested may "present more than minimal risks to patients. For example, researchers had to stop one of the early studies of the anti-amyloid vaccination because subjects developed encephalitis, a dangerous inflammation of the brain."

In a second study presented at the conference, researchers conducted an Internet survey of 2,146 Americans, aged 60 and older. They found they were willing to accept a 46.8 percent increase in the risk of death or disability for treatments that would prevent mild Alzheimer's from progressing to more serious stages.

"This survey is the first to our knowledge that is able to quantify this fear of Alzheimer's in a manner that could be useful to health authorities as they plan for the increase in Alzheimer's brought on by the aging of our population," study author Reed Johnson, senior fellow and principal economist at RTI Health Solutions, said in a prepared statement.

100 Million Worldwide May Have Alzheimer's by 2050

40% of patients will require high-level care, researchers add   

SUNDAY, June 10 (HealthDay News) -- Currently, 26.6 million people worldwide have Alzheimer's disease and that number could grow to more than 100 million people by 2050, a new analysis shows.

More than 40 percent of those 100 million Alzheimer's patients will have late-stage disease that requires a high level of care, such as that provided in nursing homes, researchers add.

"The number of people affected by Alzheimer's disease is growing at an alarming rate, and the increasing financial and personal costs will have a devastating effect on the world's economies, health-care systems and families," William Thies, the Alzheimer's Association's vice president of medical and scientific relations, said in a prepared statement.

The findings were to be presented Sunday at the Alzheimer's Association International Conference on Prevention of Dementia, in Washington, D.C.

Using United Nations worldwide population forecasts and data on Alzheimer's prevalence, researchers created a multi-state mathematical computer model. The team was led by Ron Brookmeyer, a professor of biostatistics and chairman of the Master of Public Health Program at The Johns Hopkins Bloomberg School of Public Health in Baltimore.

The computer model also indicated that:

Delaying Alzheimer's disease onset by one year would reduce the number of Alzheimer's cases in 2050 by 12 million.

Delaying both Alzheimer's onset and progression by two years would reduce the number of cases by 18 million. Most of that decrease -- 16 million cases -- would involve late-stage cases the require the most intensive care.

"A global epidemic of Alzheimer's disease is coming. However, even modest advances in preventing Alzheimer's or delaying its progression can have a huge global public health impact," Brookmeyer said.

And Thies noted that several new drugs currently in clinical trials show great promise in slowing or halting Alzheimer's progression. Such new treatments, combined with advances in diagnostic methods, could help lessen the global impact of Alzheimer's disease.