Telecare services

Today - some more about telecare services for elderly and demented patients. The main goal of this short note is to promote awareness of telecare potential for the users and their families. In many EU countries – also in UK and Poland one may observe fast growth of this sector. I guess in closed future it can become one of the most popular ways of IT use in daily care. I also would like to stress that we all are becoming interested with telecare – as almost each of us has elderly parents or knows someone who has or who may need such a help.

Alzheimer Disease Blogs

As I searched for AD in blogosphere … I found that there are quite professional blogs concerning similar problem. You can get seeking information from US, UK, New Zealand, Spain or Germany. Just by having a short look through dose pages you can be sure that this is the problem for millions of people directly or indirectly suffering from cognitive disturbances.

Lisbon Strategy

The Internet community in EU is growing very fast. Moreover it is stressed that in formation and communication technologies (ICT) may play a key role fore people over 65 as factors improving their living activity (‘Lisbon strategy’). In USA in 2004 and in Norway in 2006 connection to internet was available for 22% of elderly population (it doubled in recent 4 years)…. while in Poland only for 2 %.Nowadays due to Lisbon strategy there are more possibilities of attending free computer or internet courses for elderly people. As they are target group for information concerning memory/health - I found this problem interesting

‘Earthquake’ in Alzheimer disease management in the UK

Below I would like to present some latest information’s about treatment of Alzheimer’s disease. It occurred that the group of the most popular drugs is not recommended for early and late stage of AD any more.

International charities unite for World Alzheimer’s Day21 September 2006 was a World Alzheimer’s Day
A hundred years on from the first description of Alzheimer’s disease, people across the world have united to demand that dementia becomes a global health priority. With the number of people with dementia worldwide set to escalate to 81 million by 2040 there is no time to lose.

‘And Now for Something Completely Different’

Nice decision on Alzheimer’s drugs (2006)

The latest Nice decision
• The final decision states that access to anticholinesterase drugs should be withdrawn from the early stages of Alzheimer's disease and only be prescribed to people in the moderate stages (with an MMSE score of 10-20).
• The prescription of Ebixa on the NHS is completely prohibited.
• People who are currently taking one of the drug treatments should continue to take it until they, their carer and/or specialist consider it appropriate to stop.
• Nice guidance applies to the NHS in England and Wales but may also be implemented in Northern Ireland.

ALZHEIMER’S SOCIETY comment:
This short briefing explains what the Nice decision on Alzheimer’s drugs is and why it is unacceptable.
Why is this decision unacceptable?
• The evidence demonstrates that the drug treatments are clinically and cost effective. They cost £2.50 a day.
• Making people wait until their condition worsens before they can have access to effective drug treatment is cruel and unethical.
• Withdrawing access to anticholinesterase drug treatments in the early stages of Alzheimer's disease is contrary to best practice in dementia care and to what people with dementia and their carers want. Delaying progression in the early stages is the goal of treatment.
• Ebixa can reduce behavioural symptoms such as aggression and agitation. This has not been given adequate weight in the Nice appraisal.
• The partial withdrawal of access to the four drug treatments for Alzheimer’s contradicts the policy of the government to promote the independence and wellbeing of people in all stages of their lives.
• Withdrawing access to drugs in the early stages discourages early diagnosis, contradicting the recent positive work in this area (eg National service framework for older people which states early diagnosis is best practice)

Facts about dementia in the UK
• There are 750,000 people in the UK with dementia
• 55 per cent of these cases will be caused by Alzheimer’s disease
• Over 18,000 people under the age of 65 have dementia
• By 2010 there will be about 870,000 people with dementia in the UK

The drug treatments
• There are four licensed drugs for Alzheimer's disease. Three anticholinesterase drugs (Aricept, Exelon and Reminyl) are licensed for the early-moderate stages. One (Ebixa) is licensed for the moderate to severe stages.
• Around 54,000 people take one of the anticholinesterase drugs


ALZHEIMER’S SOCIETY
• In an Alzheimer's Society survey of over 2,000 people with dementia and their carers, 76 per cent of people said the drugs had worked.
• The Nice review confirmed previous research findings that the drugs are clinically effective.
• The drugs have changed the culture of dementia care, highlighting the importance of early diagnosis and stimulating the creation of a network of ‘memory clinics’, which act as a hub for specialist care.
• Drug treatment can save an hour a day of carer time, if this was costed at the minimum wage it would be more than twice the cost of the drug treatments which is £2.50 a day.

Timeline
• Nice began the appraisal in 2004. They gathered evidence from published literature, patient and professional groups and manufacturers to assess the clinical and cost-effectiveness of the drugs. To inform it’s submission to Nice, the Alzheimer's Society conducted a survey of people with dementia and carers and found that 76 per cent of people who had experience of the drugs believed they worked.
• March 2005 Nice publishes draft guidance recommending that three drugs, Aricept, Reminyl and Exelon, currently available for to alleviate the symptoms of Alzheimer’s disease, should no longer be available to patients via the NHS. It also recommends that Ebixa should not be prescribed on the NHS.
• March 2005 Nice receives more than 8,000 letters/ emails in an unprecedented response to its public consultation. There is near unanimous condemnation of the draft decision.
• July 2005 Nice publishes a summary of its response to the public consultation. The Nice Guidance Executive ruled that the appraisal committee must analyse more data from pharmaceutical companies in order to assess whether there are particular people who benefit more from the drugs than others.
• January 2006 Nice publish a second draft decision stating that the anticholinesterase drugs should only be prescribed to people in the moderate stages of Alzheimer’s (MMSE 10-20) and the prescription of Ebixa is completely prohibited.
• People with dementia, carers and professionals condemn this decision, pointing out that it discourages early diagnosis and is contrary to good practice and what people with dementia want.
• May 2006 Nice publish the Final Appraisal Determination and do not change their decision of January 2006, despite the unanimous criticism of people with dementia, carers and specialists in dementia care.

NICE has dismissed the Society's appeal against the decision to withdraw Alzheimer's drugs from the NHS in the early and late stages of the disease. Campaigners are gearing up to challenge the decision and fight to ensure that people with dementia have access to effective drug treatment. Campaigners will be taking to the streets to protest on Friday 17th November in the UK.

Fish Consumption May Be Linked to Reduced Cognitive Decline

News Author: Laurie Barclay, MD
Charles Vega, MD, FAAFP


Oct. 11, 2005
"Dietary intake of fish and the omega-3 fatty acids have been associated with lower risk of Alzheimer disease and stroke," write Martha Clare Morris, ScD, from Rush University Medical Center in Chicago, Illinois, and colleagues. "Dietary intakes of the omega-3 fatty acids, and especially docosahexaenoic acid (DHA), are essential for neurocognitive development and normal brain functioning."

The Chicago Health and Aging Project followed up residents of a Chicago community who were 65 years and older. The primary outcome was change in a global cognitive score estimated from mixed models and computed by summing scores of four standardized tests. Participants had in-home cognitive assessments three times during six years of follow-up.

Average rate of decline in cognitive scores was 0.04 standardized units per year (SU/year). In mixed models adjusted for age, sex, race, education, cognitive activity, physical activity, alcohol consumption, and total energy intake, fish consumption was associated with a slower rate of cognitive decline. Compared with a rate of decline of -0.100 SU per year for persons who consumed fish less than weekly, the rate was 10% slower (-0.090 SU/year) for persons who consumed one fish meal per week and 13% slower (-0.088 SU/year) for persons who consumed at least two fish meals per week.

Cardiovascular-related conditions or fruit and vegetable intake did not affect the association between fish consumption and slower cognitive decline. However, the association was modified after adjustment for intakes of saturated, polyunsaturated, and trans fats. There was little evidence that omega-3 polyunsaturated fatty acid intake was associated with cognitive change.

"Fish consumption may be associated with slower cognitive decline with age," the authors write. "Further study is needed to determine whether fat composition is the relevant dietary constituent."

Study limitations include possible confounding, bias, and random error, but these were offset by various strengths.

"This study suggests that eating one or more fish meals per week may protect against cognitive decline associated with older age," the authors conclude. "More precise studies of the different dietary constituents of fish should help to understand the nature of the association."

The National Institute on Aging supported this study.

Arch Neurol

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe the effects of fish consumption on the risk of Alzheimer's disease.
Specify factors that alter the effects of fish consumption on the rate of cognitive decline.
Clinical Context
Fish consumption has been demonstrated to reduce the risk of Alzheimer's disease. In a previous study by the authors of the current study, published in the July 2003 issue of the Archives of Neurology, fish consumption at least once per week was associated with a 60% reduction in the risk of Alzheimer's disease compared with eating fish rarely or never eating fish. Fish are rich in omega-3 fatty acids, and this study showed that higher intake of omega-3 polyunsaturated fatty acids and DHA decreased the risk of Alzheimer's disease. However, eicosapentaenoic acid intake did not correlate with the risk of Alzheimer's disease.

Cognitive decline is a common phenomenon in seniors, and the current study authors investigate the effect of fish consumption on the rate of cognitive decline in the same research cohort.

Study Highlights
Study subjects were drawn from the Chicago Health and Aging Project, which is an ongoing study of 6,158 adults aged 65 years or older. Baseline health interviews and cognitive inventories were completed between 1993 and 1997 and were repeated every 3 years.
The current study relates the risk of cognitive decline to fish consumption. Fish consumption was measured through a food frequency questionnaire, which included 4 seafood items. Cognition was measured through the combination of 4 different cognitive assessments, including the Mini-Mental State Examination.
The authors performed a multivariate analysis to account for cognitive activity, physical activity, alcohol consumption, depressive symptoms, heart disease, hypertension, stroke, and diabetes. They also adjusted the results to account for other demographic and dietary factors.
3,718 participants were included in the current analysis. The mean age was 74 years old, and subjects had an average of 12 years of education.
21% of participants reported 2 or more fish meals per week, and 36.3% ate fish once per week. 42.6% of subjects had infrequent or no fish intake. Subjects who ate more fish were more likely to be of black race and have cardiovascular disease. In addition, subjects who ate more fish were less likely to drink alcohol.
The mean rate of annual cognitive decline was approximately 22.2%. Compared with participants who rarely or never ate fish, subjects who ate fish once per week had a 10% slower rate of annual cognitive decline. The group who ate fish twice or more per week reduced their rate of cognitive decline by 13% vs the cohort that rarely or never ate fish. These reductions in cognitive decline correlated with saving 3 to 4 years of cognitive decline related to age.
Adjusting the data for chronic medical conditions did not significantly alter the study results. Adjustment for most dietary factors, such as consumption of vitamin E, niacin, vegetables, and fruit, also did not change the study's main finding. However, the protective effects of fish were attenuated when adjusting for consumption of saturated, polyunsaturated, and trans fats.
The study results did not vary by age, sex, race, or education.
Pearls for Practice
Eating fish once per week can reduce the risk of Alzheimer's disease, and this effect is probably mediated through higher intake of omega-3 polyunsaturated fatty acids and DHA.
Fish consumption at least once per week can slow the rate of cognitive decline in older adults. This effect is attenuated somewhat when adjusting for fat intake.

Accelerated Weight Loss May Precede Diagnosis of Alzheimer's

News Author: Megan RauscherCME Author: Charles Vega, MD, FAAFP

September 15, 2006 — Normal aging is associated with weight loss; however, a new study suggests that weight loss may accelerate before the onset of clinical signs of Alzheimer's disease.
"Our interpretation," Dr. John C. Morris told Reuters Health, "is that there are systemic changes, reflected here by weight loss, related to Alzheimer's disease that are apparent years before the symptoms appear."
Dr. Morris and colleagues from Washington University School of Medicine in St. Louis investigated rates of weight change over six years in 449 healthy older men and women. The subjects provided information about their medical history and were assessed for dementia of the Alzheimer type during the study.
During the study, 125 subjects developed dementia related to Alzheimer's while the 324 remained without dementia.
The investigators report in the September Archives of Neurology that subjects lost about 0.6 pounds per year while dementia-free. However, one year before the first signs of dementia, the rate of weight loss doubled to 1.2 pounds per year.
This association held up in analyses adjusting for other factors that might influence weight loss including age, sex, health status, hypertension, and stroke history.
"Accelerated weight loss — although the overall degree is small — seems to occur even before Alzheimer's disease diagnosis," Dr. Morris told Reuters Health.
"This supports the hypothesis of a preclinical or presymptomatic stage of the illness," he added, "in which brain changes may be developing over many years, perhaps decades, in the absence of symptoms; eventually enough brain damage occurs such that memory loss and other symptoms appear."
"Perhaps more importantly," he said, subjects who eventually developed the disease weighed, on average, 8 pounds less at enrollment than those who did not develop it.
Dr. Morris emphasized that the degree of weight loss experienced annually by both nondemented persons and those who are on the cusp of developing symptoms of Alzheimer's disease is too small to be relevant diagnostically. "That is, no physician should monitor weight loss in the hopes of determining whether someone is developing Alzheimer's disease," he said.
Arch Neurol. 2006;63:1312-1317.
Learning Objectives for This Educational ActivityUpon completion of this activity, participants will be able to:
Describe the incidence and clinical significance of unintended weight loss in older adults.
Compare anthropometric data among older adults who do vs those who do not develop dementia of the Alzheimer type (DAT).
Clinical Context
Unintended weight loss is a common phenomenon in older adults, and it has been demonstrated to be a harbinger of bad outcomes. In a study of 247 community-dwelling men older than 65 years by Wallace and colleagues, the rate of weight loss of more than 4% of body weight per year was 13%. The results, which were published in the April 1995 issue of the Journal of the American Geriatrics Society, demonstrated that clinical data did not predict weight loss and that most weight loss was due to the loss of central vs peripheral mass. Subjects with annual weight loss rates of 4% or more of body weight experienced a relative mortality risk of 2.43 compared with subjects who did not lose weight for a 2-year follow-up period.
Involuntary weight loss may also be associated with the risk for incident DAT. The authors of the current study performed a retrospective study to assess this possible link.
Study Highlights
Researchers focused on a longitudinal study of 449 individuals between the ages of 65 and 95 years. Adults with dementia or disorders that could increase the risk for dementia were excluded from study participation, as were those with major depression.
The main study outcome was the effect of involuntary weight loss on the incidence of DAT, as measured by the Clinical Dementia Rating. The average duration of follow-up was 6 years. The authors adjusted their main result for possible confounders, such as age, sex, appetite change, the presence of the APOE allele, and chronic medical conditions.
125 subjects developed Alzheimer's disease during follow-up. Participants who developed DAT were older at study enrollment vs subjects who did not develop DAT. However, the groups who did and did not develop DAT were similar with regard to sex and health rating at baseline.
Relatively few participants who developed DAT received cholinesterase inhibitors, making an assessment of the medications' effects on weight difficult to determine.
Participants who developed DAT were an average of 8.2 lbs. lighter at baseline vs subjects without incident DAT.
Overall, the entire study cohort lost weight with time (average of 0.65 - 0.68 lbs. per year), but participants who developed DAT experienced a more rapid weight loss in the year prior to being diagnosed (average of 1.34 lbs. per year). This accelerated weight loss then continued with time among subjects with DAT.
The main study results were unchanged when examining the data for possible confounders.
Pearls for Practice
Involuntary weight loss is a common condition among older adults. Most weight loss is central and such weight loss may increase the risk for mortality.
The current study demonstrates that while older patients may be expected to lose weight, the rate of weight loss doubles in the year prior to the diagnosis of DAT.

Mediterranean Diet May Reduce Risk of Developing Alzheimer Disease

News Author: Laurie Barclay, MDCME Author: Charles Vega, MD, FAAFP
April 18, 2006 — Adherence to the Mediterranean diet (MeDi) is associated with a reduced risk of developing Alzheimer disease (AD), according to the results of a prospective study published in the April 18 Early View issue of the Annals of Neurology.
"Previous research in Alzheimer's disease (AD) has focused on individual dietary components," write Nikolaos Scarmeas, MD, from Columbia University Medical Center in New York, and colleagues. "There is converging evidence that composite dietary patterns such as the MeDi is related to lower risk for cardiovascular disease, several forms of cancer and overall mortality. We sought to investigate the association between MeDi and risk for AD.
The investigators prospectively evaluated 2258 community-based, nondemented individuals in New York every 1.5 years. Adherence to the MeDi, scored from 0 to 9 with higher scores indicating higher adherence, was the main predictor in models adjusted for cohort, age, sex, ethnicity, education, apolipoprotein (APOE) genotype, caloric intake, smoking, medical comorbidity index, and body mass index. Mean follow-up was 4 ± 3.0 years (range, 0.2 - 13.9 years).
During follow-up, there were 262 incident cases of AD. Higher adherence to the MeDi was associated with lower risk for AD (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.83 - 0.98; P = .015). Compared with subjects in the lowest tertile for MeDi adherence, subjects in the middle tertile had a HR for AD of 0.85 (95% CI, 0.63 - 1.16), and those at the highest tertile had an HR of 0.60 (95% CI, 0.42 - 0.87; P for trend = .007).
"We conclude that higher adherence to the MeDi is associated with a reduction in risk for AD," the authors write. "The gradual reduction in AD risk for higher tertiles of MeDi adherence also suggests a possible dose-response effect.... Our results support the notion that the beneficial effects of the MeDi are generalizable to different populations."
Study limitations include the use of an a priori distribution-derived MeDi score, possible misclassification of dietary exposure due to limited accuracy, the possibility that diet is related to socioeconomic status or to other habits or characteristics related to better health and a lower risk for AD, the possibility that lower adherence to the MeDi could represent a consequence and not a cause of AD.
"The MeDi may play a role in multiple potential mechanisms including oxidative stress and inflammation, both important in the pathogenesis of AD," the authors conclude. "Complex phenols and many other substances with important antioxidant properties such as vitamins C, E and carotenoid are found in high concentrations in the typical components of the MeDi."
The National Institute for Aging, the Charles S. Robertson Memorial Gift for Research in Alzheimer's Disease, the Blanchette Hooker Rockefeller Foundation, the New York City Council Speaker's Fund for Public Health Research, and the Taub Institute for Research on Alzheimer's Disease and the Aging Brain supported this study.
Ann Neurol. Posted online April 18, 2006.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe qualities of the MeDi that might reduce the risk for AD.
Identify the effect of the MeDi on the risk for AD.
Clinical Context
The MeDi has been associated with multiple healthy outcomes, and the authors of the current study review how such a diet, which emphasizes moderate to high intake of vegetables, fruits, unsaturated fatty acids, and fish, may improve health. The MeDi is rich in antioxidants, including vitamins C and E and carotenoids. It is associated with significantly reduced serum levels of C-reactive protein and interleukin 6, while it can also reduce fibrinogen levels. While originally examined among Mediterranean populations, it appears that the healthy effects of the MeDi cross ethnic and cultural boundaries.
AD is a progressive neurologic disorder associated with intracerebral inflammation and the deposition of neurofibrillary tangles. The authors of the current study examine the effects of the MeDi in the prevention of AD.
Study Highlights
The study was conducted among 2 cohorts recruited in 1992 and 1999 from New York. All participants underwent initial neuropsychiatric testing, and those with evidence of dementia at baseline were excluded from study participation.
Subjects were evaluated at an average rate of every 1.5 years for dementia, which was defined by standard criteria.
Dietary patterns were discerned from a 61-item food questionnaire. This questionnaire was demonstrated to have good internal reliability. The authors used the intake and omission of certain foods to determine a score quantifying the practice of the MeDi.
The main study outcome was the relationship between the MeDi and the incidence of AD. While participants who developed other types of dementia were excluded, patients with both AD and stroke were considered to have developed AD. Results were analyzed after adjustment for multiple possible confounders, including age, sex, education, APOE, smoking, and medical comorbidities.
2885 subjects had an initial evaluation, and 2258 participants had follow-up data available. Participants who lacked follow-up had more medical comorbidities and a higher mortality rate vs those who continued in the study.
294 subjects developed dementia during a mean follow-up of 4 years, and 262 had AD. The average age of subjects was 77 years old at study entry. Participants who developed AD were older, less educated, and had a lower body mass index vs those who did not develop AD.
The proportion of participants who followed the MeDi remained stable during the study. Subjects who followed this diet were less likely to smoke and had lower caloric intake.
Compared with subjects in the lowest tertile of the MeDi score, participants in the middle tertile had a 15% to 21% reduced risk of developing AD, depending on the statistical model used by the researchers. Participants in the highest tertile of the MeDi pattern had a 39% to 40% reduced risk for AD. These results were significant after adjustment for possible confounding factors as well as when subjects with mild cognitive impairment at baseline were excluded. Greater adherence throughout the follow-up period to the MeDi reduced the risk for AD proportionally.
Lower caloric intake was also associated with a reduced risk for AD. Among individual components of the MeDi, mild to moderate alcohol consumption and higher vegetable consumption reduced the risk for AD on unadjusted analyses. However, adjustment for confounding factors rendered these results nonsignificant.
Pearls for Practice
The MeDi is associated with greater intake of antioxidants and reduced levels of serum markers of inflammation and coagulation. The benefits of this diet have been demonstrated in different patient populations.
The current study suggests that the MeDi can prevent AD, and there is a dose-response relationship to this preventive effect.

Exercise May Have Neuroprotective Effect

Laurie Barclay, MDAugust 11, 2006 — Exercise helps maintain brain structure and function with aging and may delay onset of Alzheimer's disease and other dementias, according to a review presented at the 114th annual convention of the American Psychological Association (APA). "There is a diverse body of evidence from retrospective and prospective clinical studies, as well as from animal research, all of which suggests that exercise has beneficial effects from middle age to old age," presenter Arthur F. Kramer, PhD, a faculty member in neuroscience and psychology at the University of Illinois at Urbana in Champaign, told Medscape. "Exercise has neuroprotective effects enabling higher levels of cognition and delaying the onset of various forms of dementia such as Alzheimer's disease in prospective epidemiological studies," Dr. Kramer continued. "It also has positive effects on brain structure and function, both from human research with magnetic resonance imaging (MRI), functional MRI, and event-related potentials, and especially from the animal literature showing proliferation of active capillary beds, new dendritic connections, and even new neurons in selective areas such as the hippocampus."Data ReviewAlong with coauthors Kirk I. Erickson, PhD, and Stanley J. Colcombe, Dr. Kramer reviewed research evidence accumulated during the past 4 decades, including epidemiologic studies of the relationship between exercise and physical activity at various ages with cognitive ability and subsequent probability of developing Alzheimer's disease or other age-related neurologic diseases. They also reviewed longitudinal randomized trials studying the effect of specific fitness training on cognition and brain function in older adults, as well as animal studies of the molecular and cellular basis of exercise effects on brain structure and function. "Clinical data [show that] people who exercise several times per week show a reduced rate of cognitive decline with age [compared with] those who have low levels of activity," Carl Cotman, PhD, director of the Institute for Brain Aging at the University of California, Irvine, told Medscape. Dr. Cotman was not involved with Dr. Kramer's presentation but reviewed it for Medscape as an independent expert. "The best evidence, though, comes from animal studies, where it has been established that voluntary running increases neuroprotective molecules in the brain, such as brain-derived neurotrophic factor (BDNF), and also reduces the accumulation of molecules associated with Alzheimer's disease, such as beta-amyloid." In the review by Dr. Kramer and colleagues, the epidemiologic literature showed a significant protective effect of physical activity on cognitive function and on decreased incidence of dementia, with the benefits lasting up to several decades. A few studies of human subjects older than 65 years showed that exercise lasting at least 15 to 30 minutes, 3 times weekly, reduced the probability of developing Alzheimer's disease, even in subjects who were genetically predisposed. Clinical trials also suggest a relationship between fitness training and improved cognition, more efficient brain function, and prevention of brain atrophy in the elderly. A 4-year study of the relationship between physical activity and cognition and brain function in subjects aged 62 to 70 years showed that those who were still employed and retirees who exercised regularly had sustained levels of cerebral blood flow and superior performance on general measures of cognition compared with inactive retirees. In a 6-month study, elderly subjects who participated in aerobic exercise had a significant increase in gray matter volume in regions of the frontal and superior temporal lobe compared with controls. No Downside to Recommending Exercise"With the human data, there have been enough meta-analyses over the last 10 years suggesting that exercise does have neuroprotective effects and also does tend to decrease depression ratings," Dr. Kramer said. "I don't see any downside to recommending exercise, even if the effects aren't as large or as robust as we think they are, because we already know that exercise tends to reduce mortality and decrease the incidence of cardiovascular disease, type 2 diabetes, and osteoporosis. I think there is no reason not to come up with a set of recommendations based upon both the disease literature and the animal literature." Aerobic exercise appears to confer more positive effects on brain function with aging than do other forms of exercise. In a study of older adults, those who were randomized to a walking group for 6 months performed better on a distractibility task than did those randomized to a stretching and toning control group. Furthermore, the aerobically trained group had increased neural activities in frontal and parietal brain regions mediating attention, and reduced activity in the dorsal region of the anterior cingulate cortex, which is thought to be sensitive to behavioral conflict, or the need for increased cognitive control. Aerobic exercise also appears to help the brain maintain its plasticity. "Physical activities that have a fairly strong aerobic component appear to be associated with spared cognition and delayed onset of dementia," Dr. Kramer said. "Other forms of exercise that have to do with toning and stretching, that lead to increased flexibility and decreased falls in older adults, are also beneficial, but they don't seem to be implicated in the cognitive-sparing effects. The animal literature suggests that learning new psychomotor skills can be beneficial in increasing new dendritic connections."Animal studies offer additional insight into the neuroprotective effects of physical activity because they allow direct observation of morphologic, neurochemical, and neurophysiologic changes associated with exercise. In studies using voluntary wheel running as a measure of aerobic activity, animals with increased wheel running performed better on spatial learning tasks mediated by the hippocampus. In other studies, aged rodents that exercised in a water maze learned and retained information about a hidden platform better than did age-matched controls. Both young and aged animals benefited from exercise, as reflected in increases in nerve growth factor levels that can offset or prevent certain age-related diseases.

Fruit and Vegetable Juices Linked to Delayed Onset of Alzheimer's Disease

News Author: Laurie Barclay, MDCME Author: Charles Vega, MD, FAAFP
August 31, 2006 — Fruit and vegetable juices may delay the onset of Alzheimer's disease (AD), according to the results of a study reported in the September issue of the American Journal of Medicine.
"Growing evidence suggests that oxidative damage caused by the beta-amyloid peptide in the pathogenesis of AD may be hydrogen peroxide-mediated," write Qi Dai, MD, from Vanderbilt School of Medicine in Virginia, and colleagues. "Many polyphenols, the most abundant dietary antioxidants, possess stronger neuroprotection against hydrogen peroxide than antioxidant vitamins."
The Kame Project is a population-based prospective study of 1836 Japanese Americans in King County, Washington, who were dementia-free at baseline (1992 - 1994) and were followed up through 2001.
Comparing subjects who drank juices at least 3 times per week with those who drank juices less often than once per week, the hazard ratio (HR) for probable AD was 0.24 (95% confidence interval [CI], 0.09 - 0.61), after adjustment for potential confounders. For those drinking juices 1 to 2 times per week, the HR was 0.84 (95% CI, 0.31 - 2.29; P for trend < .01).
This inverse association was more apparent in subjects with an apolipoprotein E epsilon-4 allele and in those who were not physically active. No associations were observed for dietary intake of vitamins E, C, or beta-carotene or tea consumption.
"Fruit and vegetable juices may play an important role in delaying the onset of AD, particularly among those who are at high risk for the disease," the authors write. "These results may lead to a new avenue of inquiry in the prevention of AD."
Study limitations include possible residual confounding, somewhat limited sample size, and lack of intake information on each specific type of juice.
"Future studies are necessary to confirm our findings and to investigate how intake of different fruit and vegetable juices relate to the risk of AD," the authors conclude.
Am J Med. 2006;119:751-759.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Identify the effect of donepezil and vitamin E supplements in the prevention of progression of mild cognitive impairment to AD.
Describe the effects of fruit juice and dietary antioxidant intake on the risk for AD.
Clinical Context
Many studies have examined the pathophysiology of AD and how to prevent its devastating effects. In a trial by Petersen and colleagues of 769 patients with the amnestic subtype of mild cognitive impairment, vitamin E at a dose of 2000 IU daily failed to reduce the overall rate of progression to AD when compared with placebo for a 3-year treatment period. The results, which were published in the June 9, 2005, issue of The New England Journal of Medicine, also demonstrated that donepezil at a dose of 10 mg daily similarly failed to reduce the overall rate of progression to AD, but it did reduce the progression to AD at 1 year compared with placebo. Also, donepezil had a significant effect on the 3-year risk for AD among the subset of participants with the apolipoprotein E epsilon-4 allele.
Polyphenols are antioxidants that may be lost in food processing but are present in juices. The authors of the current study perform a retrospective analysis to determine whether fruit and vegetable juice intake might independently reduce the risk for AD.
Study Highlights
Study participants were drawn from the Kame Project, a study of dementia among Japanese populations living in Japan and the United States. All participants in the current analysis were aged 65 years or older at recruitment and lived in Washington State.
Baseline cognitive screening was performed between 1992 and 1994, and at-risk scores prompted more specific studies for the presence and type of dementia. Dietary assessment was accomplished through the use of food frequency questionnaires at baseline.
The main study outcome was the relationship between the consumption of antioxidants, particularly fruit and vegetable juices, and the risk for incident AD. The authors divided tea, wine, and juice consumption into 3 tertiles for statistical analysis, and these tertiles corresponded with consumption less than once per week, once or twice per week, and at least 3 times weekly. Study results were adjusted to account for possible confounders, including tobacco use, alcohol use, age, total fat intake, educational level, physical activity, and apolipoprotein E status. The authors also adjusted results for baseline cognitive scores and olfactory dysfunction, which may signal the advent of a progressive neurologic disorder.
1589 subjects provided data for analysis. The mean age at enrollment was 71.8 years, and 54.4% of the cohort was women.
Participants who drank juices had lower intakes of total fat and had a higher dietary intake of vitamin C compared with subjects who drank less juice. Juice drinkers were also more physically active and were more likely to be nonsmokers, have hypertension, and did not have the apolipoprotein E epsilon-4 allele.
Consumption of tea did not affect the risk for AD.
While there was a trend toward lower risk for AD with higher consumption of wine, few participants were wine drinkers, rendering this result as statistically insignificant.
Drinking juice significantly reduced the risk for AD, with the highest tertile of juice consumption experiencing a HR of 0.24 vs the lowest tertile after adjustment for confounders and dietary antioxidant consumption. However, drinking juice once or twice weekly and dietary consumption of vitamins E, C, and beta-carotene did not significantly affect the risk for AD.
Juice consumption appeared particularly effective in reducing the risk for AD among participants with physical inactivity, a history of tobacco use, and among carriers of the apolipoprotein E epsilon-4 allele.
Pearls for Practice
Previous research suggests that vitamin E supplements are not helpful in reducing the risk for progression from mild cognitive impairment to AD, and donepezil may be effective only for carriers of the apolipoprotein E epsilon-4 allele.
In the current study, drinking fruit and vegetable juices at least 3 times weekly was associated with a reduced risk for AD among older Japanese Americans, while lower levels of juice consumption, tea consumption, and wine consumption were not protective.

Alzheimer's Disease

Alzheimer’s disease (AD) is the most common form of dementia in older people, there are an estimated 4.5 million Americans suffering from this disease. AD affects the parts of the brain that control language, memory and thought. It compromises a person’s ability to learn, reason, and make judgments. People who suffer from AD often lose their memory and are not able to communicate or carry out daily activities. As the disease progresses one may also experience changes in personality and behavior, becoming anxious, suspicious, agitated, and even delusional. Eventually a person with AD will need complete care. Most people die within eight years of showing the first symptoms of AD, but some people have lived as long as 20 years with the disease.
While we do not know how to cure AD or even exactly what causes it, we do know some factors that increase one’s risk of developing this disease. Age, genetics, and heredity can all play a role in determining if you suffer from AD. Research also indicates that certain foods can decrease your risk of developing this disease.
All new medications must go through a very rigorous process, which studies their efficacy and safety. Typically, potential medications are first studied on animals. In some situations, animals may have similar symptoms or diseases to humans. In this case, a potential beneficial effect in human disease can be studied. Often, comparable diseases in animals don’t exist and studies of these medications in animals are simply to determine safety, metabolism, and to plan future studies in humans. For many medications, serious side effects in animals are observed and a decision is made to not invest much more money or time into a particular compound.
Before large scale studies in humans are attempted, small numbers of people are given the drug to study how humans metabolize the medication and to make sure there are no surprise side effects that weren’t identified in animals. Based on these results, large scale studies are then designed. In the United States, the FDA must approve medications before they are marketed. The FDA analyzes safety as well as efficacy. These two issues must be balanced carefully, with regards to the seriousness of the underlying disease, the availability of alternative, effective treatments for a specific disease as well as the seriousness and prevalence of any side effects. Because of highly publicized side effects observed in recently developed medications, the FDA may be under more pressure to scrutinize side effects more carefully.
In response to the question, it is very difficult to know exactly how many compounds are currently being studied. Many pharmacy industry companies cannot publicize medications that are currently in early development, for fear of having other companies steal their secrets. There can literally be thousands of medications being studied in early phases. However, the vast majority of these compounds never make it to human trials.

Introduction

Welcome to Virtual Alzheimer’s Center

As I started to look at different blogs I found interesting those concerning contacts between doctors and patients family. Especially fascinating might be contacts of the group having the same problem with elderly people e.g. suffering from dementia.
It might be a useful tool for many individuals having different problems caused by the disease of the spouse.
Ordinary website for caregivers offer very few helpful information. On the other hand blogs offering direct contact between target group and medical professional are also much more important source of useful and verified information. As a matter of fact assuming that most of caregivers are at the age between 30-40, it is clear that this group has wide range to internet and that it is interested in having the ability of such a contact and exchange of experience.

first step

Wellcome on the board.
Course for future, direction north.