dementiatoday

Relationships between Caloric Expenditure and Gray Matter in Cardiovascular Health Study

March 27, 2016

J Alzheimers Dis. 2016 Mar 11. [Epub ahead of print]

Longitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study.

Raji CA¹, Merrill DA², Eyre H^3,⁴, Mallam S³, Torosyan N³, Erickson KI⁵, Lopez OL⁶, Becker JT^5,^6,⁷, Carmichael OT⁸, Gach HM⁹, Thompson PM¹⁰, Longstreth WT¹¹, Kuller LH¹².

Abstract

Background

Physical activity (PA) can be neuroprotective and reduce the risk for Alzheimer’s disease (AD). In assessing physical activity [swimming, hiking, aerobics, jogging, tennis, racquetball, walking, gardening, mowing, raking, golfing, bicycling, dancing, calisthenics, and riding an exercise cycle], caloric expenditure [kilocalories per week] is a proxy marker reflecting the sum total of multiple physical activity types conducted by an individual.

Objective

To assess caloric expenditure, as a proxy marker of PA, as a predictive measure of gray matter (GM) volumes in the normal and cognitively impaired elderly persons.

Methods

All subjects in this study were recruited from the Institutional Review Board approved Cardiovascular Health Study (CHS), a multisite population-based longitudinal study in persons aged 65 and older.

We analyzed a sub-sample of CHS participants 876 subjects (mean age 78.3, 57.5% F, 42.5% M) who had i) energy output assessed as kilocalories (kcal) per week using the standardized Minnesota Leisure-Time Activities questionnaire, ii) cognitive assessments for clinical classification of normal cognition, mild cognitive impairment (MCI), and AD, and iii) volumetric MR imaging of the brain.

Voxel-based morphometry modeled the relationship between kcal/week and GM volumes while accounting for standard covariates including head size, age, sex, white matter hyperintensity lesions, MCI or AD status, and site. Multiple comparisons were controlled using a False Discovery Rate of 5 percent.

Results

Higher energy output, from a variety of physical activity types, was associated with larger GM volumes in frontal, temporal, and parietal lobes, as well as hippocampus, thalamus, and basal ganglia. High levels of caloric expenditure moderated neurodegeneration-associated volume loss in the precuneus, posterior cingulate, and cerebellar vermis.

Main effect of increasing caloric expenditure on gray matter structure in the Cardiovascular Health Study. Red and yellow colors reflect larger gray matter volumes in the frontal, temporal, and parietal lobes (Above).

Main effect of change in physical activity over time on gray matter structure. Areas that demonstrated more gray matter volume with increased physical activity over time include the left inferior orbital frontal cortex and left precuneus (Above).

Conclusion

Increasing energy output from a variety of physical activities is related to larger gray matter volumes in the elderly, regardless of cognitive status.

Citation

http://content.iospress.com/articles/journal-of-alzheimers-disease/jad160057?resultNumber=0&totalResults=22&start=0&q=Longitudinal+Relationships+between+Caloric+Expenditure+and+Gray+Matter+in+the+Cardiovascular+Health+Study&resultsPageSize=10&rows=10

Keep Moving to Halve the Risk of Alzheimer’s

March 27, 2016

(MedicalNewsToday) To dramatically reduce your chances of getting Alzheimer’s, grab your gear and get down to the gym, out into the garden or even down to the local dance spot. A new study, published in the Journal of Alzheimer’s Disease, finds that any kind of exercise can improve brain volume and cut the risk of the disease by 50%.

The Alzheimer’s Association estimate that Alzheimer’s disease currently affects 5.1 million Americans. Numbers are expected to rise to 13.8 million over the next 30 years, as the aging population expands.

There is currently no cure, and interventions focus on prevention through lifestyle management.

Dr. Cyrus A. Raji, PhD, of the University of California-Los Angeles (UCLA) Medical Center, and colleagues teamed up with researchers from the University of Pittsburgh in Pennsylvania to find out more about the effect of aerobic exercise on the brain.

They looked at a cohort of 876 patients enrolled in the 30-year Cardiovascular Health Study, across four research sites in the US. The average age of participants was 78 years.

The team examined details of participants’ memory over time and administered standard questionnaires about their physical activity habits, which varied widely and included gardening, dancing and riding an exercise cycle at the gym.

MRI Scans Reflect Benefits of Exercise on the Brain

The investigators also carried out brain scans through magnetic resonance imaging (MRI), and they analyzed them using advanced computer algorithms. This enabled them to measure the volumes of those brain structures, such as the hippocampus, which are associated with memory and Alzheimer’s.

They then correlated the participants’ physical activities to their brain volumes and summarized the weekly caloric output from these activities.

Results showed that the more physical activity an individual did, the larger the brain volumes in key parts of the brain, and specifically the frontal, temporal and parietal lobes, including the hippocampus. Moreover, individuals whose brains benefitted from additional physical activity had a 50% lower risk of Alzheimer’s dementia.

Around 25% of the participants had mild cognitive impairment associated with Alzheimer’s. Increasing their physical activity was also found to boost their brain volumes.

George Perry, PhD, who is the editor-in-chief of the Journal of Alzheimer’s Disease, hopes that the current study will be the first step toward objective biological measurement in the field of Alzheimer’s.

Dr. Raji adds:

“We have no magic bullet cure for Alzheimer’s disease. Our focus needs to be on prevention.”

Citation

http://www.medicalnewstoday.com/articles/307757.php

Written by Yvette Brazier

Longitudinal Relationships between Caloric Expenditure and Gray Matter in the Cardiovascular Health Study Cyrus A. Raji et al., Journal of Alzheimer’s Disease, doi: 10.3233/JAD-160057, published 11 March 2016.

IOS news release, accessed 10 March 2016.

MediLexicon International Ltd, Bexhill-on-Sea, UK

For Older Adults with Dementia, Transitions in Care Can Increase Risk for Serious Problems

March 27, 2016

(American Geriatrics Society via ScienceDaily) A transition is a physical move from one location to another with a stay of at least one night. For older adults, especially those with dementia, some transitions may be unavoidable and necessary. However, unnecessary transitions are linked to problems such as medication errors, hospital readmissions, and increased risk of death.

What’s more, good dementia care emphasizes the need for familiar people and familiar environments, and this can be more difficult to support when too many transitions take place. Having coordinated care and a long-term care plan in place that considers the needs of a person with dementia may reduce unnecessary transitions, say the authors of a study published in the Journal of the American Geriatrics Society.

In their study, researchers from the UBC Centre for Health Services and Policy Research in Vancouver, British Columbia, followed 6,876 people aged 65 and older who were diagnosed with dementia between 2001 and 2002. The researchers analyzed healthcare data from 2000 until the study ended in 2011. Besides dementia, 23 percent of the group had no other chronic diseases at the beginning of the study, while 44 percent of the group had two or more chronic diseases.

The researchers found a spike in the number of transitions during the first year of dementia diagnosis. Sixty-five percent of the study participants experienced at least one transition during the year of their diagnosis; 17 percent experienced three or more transitions, most of which were hospitalizations. More than 60 percent of people were hospitalized in the year of their diagnosis, and these hospital stays generally lasted for a month or longer.

In addition to data regarding the year of diagnosis, the researchers also uncovered that people experienced a higher number of transitions the year prior to and the year of their death. Receiving a prescription for an antipsychotic medication or benzodiazepine, as well as living in more rural areas, were linked to a higher number of transitions, too.

The researchers learned that receiving ongoing care from a known primary care physician and receiving care consistent with dementia guidelines were linked to fewer transitions. Depending on each person’s needs, guideline recommendations include:

Receiving recommended lab tests
Seeing a dementia specialist
Having a physical exam
Participating in counseling

The researchers concluded that, for people with dementia and their caregivers, the year of diagnosis is often overwhelmingly stressful. Still, steps can be taken to lessen transitions and improve care. These include:

Connection to an ongoing primary care provider
Early, advanced care planning consistent with one’s wishes
Having a patient advocate who can help with care coordination
Increasing caregiver and provider awareness of community support systems

Citation

https://www.sciencedaily.com/releases/2016/03/160322100426.htm

Journal Reference

Saskia N. Sivananthan, Kimberlyn M. McGrail. Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them. Journal of the American Geriatrics Society, 2016; 64 (3): 569 DOI: 10.1111/jgs.14033

Alzheimer’s Disease: Managing Eating, Drinking, and Swallowing Problems

March 27, 2016

(Alzheimer’s Australia) Meal times provide us with an opportunity to spend time with our family and friends, as well as sharing food together. When caring for someone with dementia meal times can sometimes become stressful. Loss of memory and problems with judgment can cause difficulties in relation to eating and nutrition for many people with dementia. There are many ways to improve the situation.

Loss of Appetite

Forgetting how to chew and swallow, ill-fitting dentures, insufficient physical activity, and being embarrassed by difficulties can all result in a loss of appetite.

What to try

Check with the doctor to make sure that there are no treatable causes for loss of appetite, such as acute illness or depression
Offer meals at regular times each day
Allow the person to eat when hungry
Encourage physical exercise
Provide balanced meals to avoid constipation
Try a glass of juice, wine or sherry, if medications permit, before the meal to whet appetite
Offer ice cream or milk shakes
Try to prepare familiar foods in familiar ways, especially foods that are favourites
Encourage eating all or most of one food before moving on to the next: some people can become confused when the tastes and textures change
Try to make mealtimes simple, relaxed and calm. Be sure to allow enough time for a meal. Assisting a very impaired person can take up to an hour
Consult a doctor if there is a significant weight loss (such as 2.5kg in 6 weeks)
Check with the doctor about vitamin supplements.

Overeating or Insatiable Appetite

What to try

Leaving snack foods on the table may be enough to satisfy some people
Try 5-6 small meals each day
Have low calorie snacks available, such as apples and carrots
Consider whether other activities such as walks, or increased social contacts may help
Lock some foods in cupboards, if necessary.

Sweet Cravings

What to try

Check medications for side effects. Some antidepressant medications can cause a craving for sweets
Try milk shakes, egg nogs or low calorie ice cream.

Mouth, Chewing, and Swallowing Problems

Some causes of problems with eating may relate to the mouth. A dry mouth, or mouth discomfort from gum disease or ill-fitting dentures are common problems.

What to try

Have a dental check up of gums, teeth and dentures
Moisten food with gravies and sauces if a dry mouth is causing problems
For chewing problems, try light pressure on the lips or under the chin, tell the person when to chew, demonstrate chewing, moisten foods or offer small bites one at a time
For swallowing problems, remind the person to swallow with each bite, stroke the throat gently, check the mouth to see if food has been swallowed, do not give foods which are hard to swallow, offer smaller bites and moisten food
Consult the doctor if choking problems develop.

At the Table

Pouring a glass of juice into a bowl of soup, buttering the serviette or eating dessert with a knife indicate that a person with dementia is having difficulty at the dinner table.

What to try

Serve one course at a time and remove other distracting items from the table such as extra cutlery glasses or table decorations
Ensure that the crockery is plain and is a different colour to the plain table cloth
If the use of cutlery is too difficult serve finger food
Eat with the person with dementia so that they can copy you
Make sure that they are not rushed
Keep noise and activities in the environment to a minimum
Ensure there is adequate lighting
Serve familiar food.

Other Considerations

Keep eating simple. Not all food has to be eaten with cutlery if this is becoming difficult. Finger food can be a nutritious and easy alternative
Keep in mind a person’s past history with food. They may have always had a small appetite, been a voracious eater or had a sweet tooth Watch food temperatures. While warm food is more appetising, some people with dementia have lost the ability to judge when food is hot or cold. Beware of using Styrofoam cups which not only hold the heat for a long time, but also tip over easily
Spoiled food in the refrigerator, hiding food or not eating regularly may all be signs that someone living alone is in need of more support
Many people with dementia do not get enough fluids because they may forget to drink or may no longer recognise the sensation of thirst. Be sure to offer regular drinks of water, juice or other fluids to avoid dehydration
Many eating problems are temporary and will change as the person’s abilities deteriorate.

Citation

Adapted from Understanding difficult behaviours, by Anne Robinsons, Beth Spencer and Laurie White.

Alzheimer’s Australia

http://www.fightdementia.org.au/services/eating.aspx

Four Ways to Deal with Stress Right Now

March 27, 2016

(American Heart Association) Here are four simple techniques for managing stress:

1. Positive Self-Talk

Self-talk is one way to deal with stress. We all talk to ourselves; sometimes we talk out loud but usually we keep self-talk in our heads. Self-talk can be positive (“I can do this” or “Things will work out”) or negative (“I’ll never get well” or “I’m so stupid”).
Negative self-talk increases stress. Positive self-talk helps you calm down and control stress. With practice, you can learn to turn negative thoughts into positive ones.

For example:

Negative	Positive
“I can’t do this.”	“I’ll do the best I can.”
“Everything is going wrong.”	“I can handle things if I take one step at a time.”
“I hate it when this happens.”	“I know how to deal with this; I’ve done it before.”

To help you feel better, practice positive self-talk every day — in the car, at your desk, before you go to bed or whenever you notice negative thoughts.

Having trouble getting started? Try positive statements such as these:

“I’ve got this.”
“I can get help if I need it.”
“We can work it out.”
“I won’t let this problem get me down.”
“Things could be worse.”
“I’m human, and we all make mistakes.”
“Some day I’ll laugh about this.”
“I can deal with this situation.”Remember: Positive self-talk helps you relieve stress and deal with the situations that cause you stress.

2. Emergency Stress Stoppers

There are many stressful situations — at work, at home, on the road and in public places. We may feel stress because of poor communication, too much work and everyday hassles like standing in line. Emergency stress stoppers help you deal with stress on the spot.Try these emergency stress stoppers. You may need different stress stoppers for different situations and sometimes it helps to combine them.

Count to 10 before you speak.
Take three to five deep breaths.
Walk away from the stressful situation, and say you’ll handle it later.
Go for a walk.
Don’t be afraid to say “I’m sorry” if you make a mistake.
Set your watch five to 10 minutes ahead to avoid the stress of being late.
Break down big problems into smaller parts. For example, answer one letter or phone call per day, instead of dealing with everything at once.
Drive in the slow lane or avoid busy roads to help you stay calm while driving.
Smell a rose, hug a loved one or smile at your neighbor.
Consider meditation or prayer to break the negative cycle.

3. Finding Pleasure

When stress makes you feel bad, do something that makes you feel good. Doing things you enjoy is a natural way to fight off stress.You don’t have to do a lot to find pleasure. Even if you’re ill or down, you can find pleasure in simple things such as going for a drive, chatting with a friend or reading a good book.Try to do at least one thing every day that you enjoy, even if you only do it for 15 minutes.

Such as:

Start an art project (oil paint, sketch, create a scrap book or finger paint with grandchildren).
Take up a hobby, new or old.
Read a favorite book, short story, magazine or newspaper.
Have coffee or a meal with friends.
Play golf, tennis, ping-pong or bowl.
Sew, knit or crochet.
Listen to music during or after you practice relaxation.
Take a nature walk — listen to the birds, identify trees and flowers.
Make a list of everything you still want to do in life.
Watch an old movie on TV or rent a video.
Take a class at your local college.
Play cards or board games with family and friends.

4. Daily Relaxation

Relaxation is more than sitting in your favorite chair watching TV. To relieve stress, relaxation should calm the tension in your mind and body. Some good forms of relaxation are yoga, tai chi (a series of slow, graceful movements) and meditation.Like most skills, relaxation takes practice. Many people join a class to learn and practice relaxation skills.Deep breathing is a form of relaxation you can learn and practice at home using the following steps. It’s a good skill to practice as you start or end your day. With daily practice, you will soon be able to use this skill whenever you feel stress.

Sit in a comfortable position with your feet on the floor and your hands in your lap or lie down. Close your eyes.
Picture yourself in a peaceful place. Perhaps you’re lying on the beach, walking in the mountains or floating in the clouds. Hold this scene in your mind.
Inhale and exhale. Focus on breathing slowly and deeply.
Continue to breathe slowly for 10 minutes or more.
Try to take at least five to 10 minutes every day for deep breathing or another form of relaxation.

Citation

http://www.heart.org/HEARTORG/GettingHealthy/StressManagement/FourWaystoDealWithStress/Four-Ways-to-Deal-with-Stress_UCM_307996_Article.jsp

NFL Acknowledges, for First Time, Link between Football, Brain Disease

March 22, 2016

(ESPN) The NFL’s top health and safety officer acknowledged Monday there is a link between football-related head trauma and chronic traumatic encephalopathy, or CTE — the first time a senior league official has conceded football’s connection to the devastating brain disease.

The admission came during a roundtable discussion on concussions convened by the U.S. House of Representatives’ Committee on Energy and Commerce. Jeff Miller, the NFL’s senior vice president for health and safety, was asked by Rep. Jan Schakowsky, D-Ill., if the link between football and neurodegenerative diseases like CTE has been established.

“The answer to that question is certainly yes,” Miller said.

He said he based his assessment on the work of Dr. Ann McKee, a Boston University neuropathologist who has diagnosed CTE in the brains of 176 people, including those of 90 of 94 former NFL players. The disease can only be diagnosed after death.

“I think the broader point, and the one that your question gets to, is what that necessarily means, and where do we go from here with that information,”

Miller said, noting that little is known about the prevalence of the disease or the risk of incurring it.

On Tuesday, the NFL released this statement:

“The comments made by Jeff Miller yesterday accurately reflect the view of the NFL.”

In 2009, an NFL spokesman told the New York Times that it is

“quite obvious from the medical research that’s been done that concussions can lead to long-term problems.”

But when pressed by Congress and in interviews, NFL commissioner Roger Goodell and other league representatives have for years avoided taking a position, repeating that the league would let the medical community decide. The league had never expressly linked playing football to CTE.

During Super Bowl week, Dr. Mitch Berger, a San Francisco neurosurgeon who leads the NFL subcommittee on long-term brain injury, asserted that there is still no established link between football and CTE.

Schakowsky seized on Berger’s remarks during the informal discussion, in which several brain injury experts gathered around a rectangular table to discuss the science surrounding concussions.

“The NFL is peddling a false sense of security,” Schakowsky said.

“Football is a high-risk sport because of the routine hits, not just diagnosable concussions. What the American public need now is honesty about the health risks and clearly more research.”

She then asked McKee and Miller to answer “yes” or “no” about whether a connection between football and CTE has been established.

“I unequivocally think there’s a link between playing football and CTE,” McKee said.

“We’ve seen it in 90 out of 94 NFL players whose brains we’ve examined, we’ve found it in 45 out of 55 college players and six out of 26 high school players. No, I don’t think this represents how common this disease is in the living population, but the fact that over five years I’ve been able to accumulate this number of cases in football players, it cannot be rare. In fact, I think we are going to be surprised at how common it is.”

Schakowsky then turned to Miller. After acknowledging the link, he said: “But there’s also a number of questions that come with that.”

As he tried to continue, Schakowsky interrupted.

“Is there a link?” she said.

“Yes, sure,” Miller responded.

“Because we feel — well, I feel — that was not the unequivocal answer three days before the Super Bowl by Dr. Mitchel Berger,” Schakowsky said.

“Well, I’m not gonna speak for Dr. Berger,” Miller said.

Miller declined to elaborate on his remarks after the session. As reporters tried to ask follow-up questions, he left accompanied by a league spokeswoman, Jill Pike.

Hours after Miller’s comments, a lawyer representing seven former players objecting to the proposed settlement of the concussion lawsuit against the NFL sent a letter to the Third Circuit Court of Appeals.

The letter argued that Miller’s acknowledgement of a link and of McKee’s work reflects a “stark turn” from the league’s position, underscoring the objectors’ argument that CTE was not adequately addressed in the settlement. Attorney Steven Molo wrote that Miller’s comments “directly contradict” the NFL’s position in the case.

A judge previously approved a settlement between the league and thousands of former players who were suing the NFL for allegedly concealing the link between football and brain disease. The settlement is on hold while the objections are being considered.

The roundtable convened more than a dozen concussion experts and included representatives of the federal government, the military, the scientific community and the NCAA. Several of those present were affiliated with the NFL.

The conversation focused on the growing debate over the seriousness of the concussion issue, and what should be done about it. Some of the speakers said that awareness and treatment of concussions has never been better, and that the risks of playing contact sports like football have been overstated.

“The sky is not falling,” said Dr. David Cifu, chairman of Virginia Commonwealth University’s Department of Physical Medicine and Rehabilitation, noting that the risk of children incurring health issues such as obesity is greater by not playing sports than the risk of incurring a devastating concussion.

Others cautioned against conflating concussions with CTE, a distinct neurodegenerative disease that has only been found in people who have been exposed to head trauma, usually on multiple occasions.

“We don’t know how common this is; we are desperate to find a way to diagnose it in [living] people,” said Dr. Walter Koroshetz, director of the National Institute for Neurological Disorders and Stroke.

The roundtable comments came on the same day survey results were released showing that participation in youth tackle football had stabilized in the past year. After years of decline, participation among children ages 6-14 years old nudged up 1.9 percent to 2.1 million, according to the Sports & Fitness Industry Association.

Tom Cove, CEO of SFIA, urged caution in interpreting the results, noting that most youth sports benefitted in the past year from a demographic bulge. The year 2007 was a peak year for births, and those children are now at an age when youth football programs are offered for the first time.

More compelling to Cove was a significant jump in flag football participation, which rose 8.7 percent for the same age group.

“Preliminary indicators suggest flag for kids may be rising on a regional basis,” he said.

“For example, in the Pacific Northwest we’re hearing growth of youth flag leagues for young players, but not so much in South where traditional tackle remains strong.”

Citation

http://espn.go.com/espn/otl/story/_/id/14972296/top-nfl-official-acknowledges-link-football-related-head-trauma-cte-first

Steve Fainaru, ESPN Senior Writer. ESPN investigative reporters Mark Fainaru-Wada and Tom Farrey contributed to this report.

10 Early Signs of Alzheimer’s: When to Call the Doctor

March 22, 2016

(WebMD) Are you worried about your mental sharpness? Or maybe that of a loved one’s?

Mild forgetfulness can be a normal part of aging. If you have trouble remembering someone’s name but it comes to you later, that’s not a serious memory problem.

But if memory problems are seriously affecting your daily life, they could be early signs of Alzheimer’s disease. While the number of symptoms you have and how strong they are vary, it’s important to identify the early signs. You need to ask yourself some tough questions.

1. Memory loss

This is the most common symptom. Do you easily forget information you just learned? Do you lose track of important dates, names, and events? Do you forget big things even happened? Do you ask for the same information over and over? Do you rely heavily on memory aids like Post-it notes or reminders on your smartphone?

2. Trouble planning and problem solving

Do you have trouble making plans and sticking to them? Is it tricky to follow a recipe, even one you’ve used many times? Is it hard to concentrate on detailed tasks, especially if they involve numbers? For example, can you keep track of your bills and balance your checkbook?

3. Daily tasks are a challenge

Even familiar things can become hard. Do you have trouble driving to a location you go to often? Can you complete an ordinary task at work? Do you forget the rules of your favorite game?

4. Times and places are confusing

Can you fully grasp something that’s not happening right now? Are you disoriented? Do you get lost easily? Do you forget where you are? Do you remember how you got there?

5. Changes in vision

Is it harder to read the words on the page? Do you have trouble judging distance? Can you tell colors apart? This is important because it can affect your driving.

6. Words and conversations are frustrating

Vocabulary becomes hard. Can you find the right word you’re looking for? Or do you call things by the wrong name?

Conversations can be a struggle. Do you avoid joining in? Are you able to follow along? Do you suddenly stop in the middle of a discussion because you don’t know what to say? Do you keep repeating yourself?

7. You lose things

Everyone misplaces things from time to time, but can you retrace your steps to find them again? Do you put things in unusual places, like your watch in the refrigerator? Do you accuse people of taking things?

8. Lapse in judgment

Have you made poor decisions lately? Do you make mistakes with money, like giving it away when you normally wouldn’t?

Are you showering as often? Do you take less care of yourself? Do you dress for the wrong weather?

9. Social withdrawal

Are you scaling back on projects at work? Are you less involved with your favorite hobbies? Do you lack motivation? Do you find yourself watching television or sleeping more than usual?

10. Mood changes

Do you get upset more easily? Do you feel depressed, scared, or anxious? Are you suspicious of people?

Seeing Your Doctor

If you notice these signs, talk with your doctor. She will evaluate your physical and mental health. She will look over your medical history and do a mental status test, which looks at your memory, ability to solve simple problems, and thinking skills. She may also do blood or brainimaging tests.

She may then refer you to someone who specializes in Alzheimer’s, like a neurologist (a doctor who specializes in treating the brain and nervous system), psychiatrist, psychologist, or geriatrician (a doctor who specializes in treating older people).

You can also find a specialist through your local Alzheimer’s Association or Alzheimer’s Disease Centers.

Why You Should Make an Appointment Now

The sooner you know, the better. Starting treatment may help relieve symptoms and keep you independent longer.

It also helps you plan better. You can work out living arrangements, make financial and legal decisions, and build up your support network.

Citation

http://www.webmd.com/alzheimers/guide/early-warning-signs-when-to-call-the-doctor-about-alzheimers?page=1
View Article Sources

Reviewed by Neil Lava, MD on January 15, 2015

An Implant to Prevent Alzheimer’s

March 22, 2016

(École Polytechnique Fédérale de Lausanne) One of the hypothesized causes of Alzheimer’s is the over-accumulation of the protein amyloid beta (Abeta) in different areas of the brain. This results in the deposition of aggregated protein plaques, which are toxic to neurons.

One of the most promising ways to fight the plaques is to “tag” the Abeta proteins with antibodies that signal the patient’s own immune system to attack and clear them. To be most effective, this treatment has to be given as early as possible, before the first signs of cognitive decline. But this requires repeated vaccine injections, which can cause side effects. EPFL scientists have now solved the problem with an implant that can deliver a steady and safe flow of antibodies to the patient’s brain to clear Abeta proteins. The work is published in the journal Brain.

The lab of Patrick Aebischer at EPFL has developed a bioactive capsule containing cells that have been genetically engineered to produce antibodies against Abeta. The capsule is implanted in the tissue under the skin, and over time the cells produce and release a steady flow of antibodies into the bloodstream, from where they cross over into the brain to target the Abeta plaques.

The capsule itself is based on a design from Aebischer’s lab published in 2014. It is referred to as a “macroencapsulation device” and it is made of two permeable membranes sealed together with a polypropylene frame. The complete device is 27-mm long, 12-mm wide and 1.2-mm thick, and contains a hydrogel that facilitates cell growth. All the materials used are biocompatible, and the lab specifically used a method that is easily reproducible for large-scale manufacturing.

The cells inside the capsule are important. Not only must they be able to produce antibodies, but they also have to be compatible with the patient, so as to not trigger the immune system against them, like a transplant can. This is where the capsule’s membranes come into play, shielding the cells from being identified and attacked by the immune system. This protection also means that cells from a single donor can be used on multiple patients.

Before going into capsule, the cells are first genetically engineered to produce antibodies that specifically recognize and target Abeta. The cells of choice are taken from muscle tissue, and the permeable membranes let them interact with the surrounding tissue to get all the nutrients and molecules they need.

In Alzheimer’s mouse models, the implantable capsule significantly reduced levels of beta-amyloid protein and plaques in mice. Image credit: Patrick Aebischer (EPFL)

The researchers tested the device on mice with great success. The mice – a genetic line that is commonly used to simulate Alzheimer’s disease – showed dramatic reduction of Abeta plaque load. Indeed, the constant flow of antibodies produced by the capsule over a course of 39 weeks prevented the formation of Abeta plaques in the brain. The treatment also reduced the phosphorylation of the protein tau, another sign of Alzheimer’s observed in these mice.

The proof-of-concept work is a landmark. It demonstrates clearly that encapsulated cell implants can be used successfully and safely to deliver antibodies to treat Alzheimer’s disease and other neurodegenerative disorders that feature defective proteins.

This work involved a collaboration between EPFL’s Neurodegenerative Studies Laboratory (Brain Mind Institute), the Swiss Light Source (Paul Scherrer Institute) and F. Hoffmann-La Roche. It was funded by the Swiss Commission for Technology and Innovation and F. Hoffmann-La Roche Ltd.

Citation

http://actu.epfl.ch/news/an-implant-to-prevent-alzheimer-s/

Written by Nik Papageorgiou

Reference

Lathuilière A, Laversenne V, Astolfo A, Kopetzki E, Jacobsen H, Stampanoni M, Bohrmann B, Schneider BL, Aebischer P. A subcutaneous cellular implant for passive immunization against amyloid-β reduces brain amyloid and tau pathologies.Brain 08 March 2016. DOI: 10.1093/brain/aww036