New guidelines for Alzheimer’s could lead to earlier diagnosis

NEW YORK — For the first time in 25 years, medical specialists are proposing a major change in the criteria for Alzheimer’s disease, part of a new movement to diagnose and, eventually, treat the disease earlier.The new diagnostic guidelines, presented yesterday at an international Alzheimer’s meeting in Hawaii, would mean that new technology such as brain scans would be used to detect the disease before there are evident memory problems or other symptoms.

If the guidelines are adopted in the fall, as expected, some specialists predict a two- to threefold increase in the number of people diagnosed with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it.

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

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the disease and new ways of detection, it was becoming clear that the old method of diagnosing Alzheimer’s was sorely outdated.

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

But researchers now believe the disease is present a decade or more before dementia.

“Our thinking has changed dramatically,’’ said Dr. Paul Aisen, an Alzheimer’s researcher at the University of California at San Diego, who is helping formulate the new guidelines. “We now view dementia as a late stage in the process.’’

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

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

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

Aisen says he foresees a day when people in their 50s routinely have biomarker tests for Alzheimer’s and, if the tests indicate the disease is brewing, take drugs to halt it. That is not expected soon, he says, but “it’s where we are heading.’’

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

By Gina Kolata
New York Times / July 14, 2010

I HAVE MOVED

ALL-

I HAVE MOVED THIS BLOG TO WWW.SENIORRESOURCEGUIDE.BLOGSPOT.COM PLEASE GO TO THAT SITE - THANK YOU

Giving Care for Parents

I had heard this ad on the radio several times but had not had a chance to look at it. Rite Aid Pharmacy has a new section devoted to caring for our parents. It has lots of great information and articles. Check it out:

http://giving-care.riteaid.com/giving-care/

Have a great week.
Kathi

If Parents Had Alzheimer's, Aging May Come Early

I saw this article and found it interesting. As a granddaughter of an Alzheimer's patient it worries me and I try to stay on top all education material that is out there. Hope you find it interesting.


Middle-age people whose parents had Alzheimer's and who carry the so-called Alzheimer's gene might very well have the memory of someone 15 years older, a new study has found.


This memory decline was not detected in people of middle age whose parents had Alzheimer's but who do not carry the gene, known as ApoE4, according to the study.


About 20 percent to 25 percent of the population have at least one copy of the ApoE4 gene, but not all people with the gene develop Alzheimer's, said study co-author Dr. Sudha Seshadri, an associate professor of neurology at Boston University School of Medicine.


The study involved 715 participants in the ongoing Framingham Heart Study, including 282 whose parents, one or both, had been diagnosed with Alzheimer's or other dementia. The participants averaged 59 years old and were healthy, with no memory complaints, said Seshadri, who is also a senior investigator with the Framingham study.


But when given a battery of cognitive tests, those who logged the lowest scores on verbal and visual memory tasks were people who were carriers of the ApoE4 gene and had parents with dementia.


Seshadri stressed that the neuropsychological tests and brain imaging conducted as part of the study offered a sensitive measurement of memory. The participants were "performing older than they're expected," she said, but added that there were "no memory symptoms associated with this." Participants still tested within the normal range for memory and were living normal lives, she said.


The results suggest that the Alzheimer's gene is facilitating the expression of some other gene, Seshadri said. "It's just giving us a clue that whatever [other] gene we find is going to have an interaction with ApoE," she said.


Finding other genes will require a sample of 10,000 to 20,000 people and the collaboration of several research groups, Seshadri said. But, she predicted that "within the next year or two, I think we are going to find more genes."


The study, which was funded by the U.S. National Institutes of Health and released Wednesday, is to be presented at the American Academy of Neurology's annual meeting, from April 25 to May 2, in Seattle.


But the findings should not send people scurrying for genetic testing, Seshadri and another expert said.


Alzheimer's is "not like Huntington's, where if you have the bad gene and you live long enough you're going to get it," Seshadri said. "E4 explains only part of the risk. Clearly there are other genes out there, but they probably have much smaller effects than ApoE4."


Dr. Gary J. Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, said that the finding "needs to be seen with considerable caution so it doesn't get over interpreted."


For starters, he said, the study has not been peer-reviewed, meaning it has not been scrutinized and evaluated by other experts in the field, a process that precedes publication of research in a major medical journal.


Also, statistics in the abstract of the study do not indicate how big a risk factor carrying the ApoE4 gene is for those whose parents had dementia or Alzheimer's, Kennedy said, and the brain scans of the study participants did not show any volumetric changes. "If they saw volumetric changes, that would be scary," Kennedy said.


The bottom line then, according to Seshadri, is that 50-somethings who begin to lose their car keys don't need to start worrying as a result of this study.


"Those of us who lose our keys actually have pretty good memories," she said. "We remember we lost our keys." Besides, she said, people lose their keys "mainly because we were thinking of 15 other things when we put our keys down."

Ideas from Candice Miele - Fariview Park Senior Center

These ideas are from Candice Miele the Social Worker at Fairview Park Senior Center. Thanks Candice for your contribution.

1. The Reality Check System: This is something I have devised and used with my seniors who get scammed by people who want them to send money for various reasons. They need to have a designated person to be their "Reality Check Person." When they are asked for money (except for ongoing bills they are used to paying), they need to call that person. They will tell the person what they are being asked to donate money to or invest in. That trusted person (a close friend or family member) will tell them whether they think it is a scam or a worthy cause. Seniors have, for the most part, generous hearts and they help support many of the great causes that keep research and treatment going. However, I have encountered more and more cases where they are being intimidated and coerced to send money to scam artists. Since the decline of the economy, the problem has become so much worse. Tell them never to send money without a reality check first!

2. How do you get a person with Alzheimer's disease or any form of Dementia to take a bath or shower with the least resistance? The best way I have found (and this has been tried and true in many of my past cases) is to have the bathing assistant (formal or informal caregiver) use a matter-of-fact tone, and state boldly ahead of time (a few hours before, then again a couple minutes before the event - repeat as necessary) that it is time for the bath or shower. Then, as the time approaches, just keep the stance that this is a routine event that must be done. Most people with dementia welcome this kind of firm but caring guidance. They usually just go along with the program. The first couple times may be the most difficult, but once the scheduled bathing day comes along every week for a few weeks, they will store it in their long-term memory and they will just think of it as part of their week.
A second suggestion related to bathing is to ask the person: "Would you like to take a shower now, or in five minutes?" The usual response, especially for resistant people, is "five minutes." Then, you must be consistent. Watch the clock with them and count down the five minutes and follow through with the bath or shower at that time. This helps them maintain control and the power of limited choice.

High Blood Pressure May be to Blame for Mental Confusion, Study Reveals

High Blood Pressure May be to Blame for Mental Confusion, Study Reveals

By Geoffrey Moore from the Home Instead Senior Care office in North Olmsted

Q. My 79-year-old father seems to be getting more confused all the time. I’m very worried he is getting Alzheimer’s disease and, since he lives alone, I don’t know what to do. Help!

First, don’t jump to conclusions. Various reasons could explain your father’s disorientation and there’s no reason to panic until you know the medical facts. Ask your dad to make an appointment with his doctor. Or, if he balks, suggest that you help him set that up. Maybe he is fearful of finding out the truth as well.

There could be a logical and medically treatable explanation. For instance, diabetes can cause disorientation. And, according to a study from North Carolina State University, high blood pressure spikes can lead to a decline in mental function.

In fact, increased blood pressure in older adults is directly related to decreased cognitive functioning, particularly among seniors with already high blood pressure, research reveals. This means that stressful situations may make it more difficult for some seniors to think clearly.

Dr. Jason Allaire, an assistant professor of psychology at North Carolina State, who co-authored the study, explains that study subjects whose average systolic blood pressure was 130 or higher saw a significant decrease in cognitive function when their blood pressure spiked.

However, Allaire notes, study subjects whose average blood pressure was low or normal saw no change in their cognitive functioning – even when their blood pressure shot up.
Specifically, Allaire says, the study shows a link between blood pressure spikes in seniors with high blood pressure and a decrease in their inductive reasoning.

Depending on what his doctor says, your dad might also want to heed this advice from Asenath LaRue, a senior scientist at University of Wisconsin School of Medicine and Public Health (SMPH). While there aren’t many controlled clinical trials on ways to keep your brain in shape, she says a variety of observational studies point to three main preventive actions: be physically active, challenge your brain and stay socially active.

Old Age or Not?

I was touring a couple the other day, it was an adult child and his wife looking for his parents. As we started to talk about the needs of each of his parents his wife added that the mother was having some memory issues. The husband became very defensive. Adding that it was just a part of old age. I thought he could really use some education about Alzheimer's. Sometimes it is just the aging process and sometimes it's not. Below is a list I have download from www.alz.org this is the official site of the Alzhiemer's Assoc. There is so much information available to you. One bit of information that helped me over years is, when I first started working in senior care our nurse was talking about a resident that was having some confusion. It wasn't normal for this woman. She stated she was going to have a urine check done because it might be a UTI (urinary tract infection). I asked her what does that have to do with anything. She educated me that seniors with UTI's can show signs of ALZ. Over the years I can't tell you how many residents have had a UTI and onset confusion and after a round of antibiotics they are back to their selves. I hope this helps and please utilize the ALZ Association they have a great staff to help with any questions or resources.

Memory loss.
Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later.
What's normal? Forgetting names or appointments occasionally.

Difficulty performing familiar tasks.
People with dementia often find it hard to plan or complete everyday tasks. Individuals may lose track of the steps to prepare a meal, place a telephone call or play a game.
What's normal? Occasionally forgetting why you came into a room or what you planned to say.

Problems with language.
People with Alzheimer's disease often forget simple words or substitute unusual words, making their speech or writing hard to understand. They may be unable to find their toothbrush, for example, and instead ask for "that thing for my mouth."
What's normal? Sometimes having trouble finding the right word.

Disorientation to time and place.
People with Alzheimer's disease can become lost in their own neighborhoods, forget where they are and how they got there, and not know how to get back home.
What's normal? Forgetting the day of the week or where you were going.

Poor or decreased judgment.
Those with Alzheimer's may dress inappropriately, wearing several layers on a warm day or little clothing in the cold. They may show poor judgment about money, like giving away large sums to telemarketers.
What's normal? Making a questionable or debatable decision from time to time.

Problems with abstract thinking.
Someone with Alzheimer's disease may have unusual difficulty performing complex mental tasks, like forgetting what numbers are and how they should be used.
What's normal? Finding it challenging to balance a checkbook.

Misplacing things.
A person with Alzheimer's disease may put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl.
What's normal? Misplacing keys or a wallet temporarily.

Changes in mood or behavior.
Someone with Alzheimer's disease may show rapid mood swings – from calm to tears to anger – for no apparent reason.
What's normal? Occasionally feeling sad or moody.

Changes in personality.
The personalities of people with dementia can change dramatically. They may become extremely confused, suspicious, fearful or dependent on a family member.
What's normal? People’s personalities do change somewhat with age.

Loss of initiative.
A person with Alzheimer's disease may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities.
What's normal? Sometimes feeling weary of work or social obligations