RSS

Category Archives: health

Guidelines For The Diagnosis And Treatment Of Dementia

People with mild to moderate dementia (and Alzheimer’s) are usually cared for by the family personal care physician and the patient’s family. The personal care physician is often very busy and is not a specialist in the area. The family is often ill equipped to take on this task due to lack of formal training, education, and experience. Family caregivers and the primary caregiver usually take a learn as you go approach. A team of physicians, teachers, and researchers have created a set of guidelines for personal care physicians on how to manage dementia once a diagnosis is made. This article should be read by physicians but I found it very helpful as a caregiver. From the caregiver perspective it will help you understand the services you need and help you interact with your family physician to assure that appropriate actions are being taken and treatments rendered.

Guidelines for the diagnosis and treatment of dementia (PDF)

Canadian Medical Association Journal Press Release

People with mild to moderate dementia are cared for largely by family physicians as well as the patient’s own family, and management of care can be complex and challenging. A team of clinicians, teachers and researchers from the University of Calgary, Dalhousie University, McGill University, Sunnybrook Health Sciences and the University of Toronto, University of Ottawa, University of Western Ontario, Universite de Montreal, University of Saskatchewan and affiliated institutions have created comprehensive guidelines for family physicians on how to manage dementia once a diagnosis has been made. This approach focuses on supporting both the patient and the primary caregiver.

From Diagnosis and treatment of dementia: Approach
to management of mild to moderate dementia

Recommended actions to assist patients with a mild to moderate
dementia and their families after a diagnosis has been made

• Inform the patient and his or her family (if present and appropriate) of the
diagnosis (this would include general counselling and responding to specific
questions)

• Identify the presence of a family caregiver, what support this person can
offer, his or her status (i.e., evidence of strain) and his or her needs (this
would include trying to deal with any identified needs) — ongoing activity

• Decide on the need for referrals for further diagnostic and management
assistance (e.g., referral to genetic clinic for suspected familial cases) —
ongoing activity

• Assess for safety risks (e.g., driving, financial management, medication
management, home safety risks that could arise from cooking or smoking,
potentially dangerous behaviours such as wandering) — ongoing activity

• Determine presence of any advance planning documents (e.g., will, enduring
power of attorney, personal directive). If there are no such documents, advise
that they be drafted. Note that this may include assessing the patientís capacity
to either draft these documents or whether they should be put into effect.

• Assess the patient’s decision-making capacity — ongoing activity

• Refer the patient and family to the local office of the Alzheimer Society of
Canada (www.alzheimer.ca/english/offices/intro.htm [English] or
http://www.alzheimer.ca/french/offices/intro.htm [français])

• Provide information and advice about nonpharmacologic and pharmacologic
treatment options and availability of research studies*

• Develop and implement a treatment plan with defined goals; continually
update plan

• Monitor response to any initiated therapy

• Monitor and manage functional problems (e.g., urinary incontinence) as they
arise

• Assess and manage behavioural and psychological symptoms of dementia as
they arise

• Monitor nutritional status and intervene as needed

• Deal with medical conditions and provide ongoing medical care

• Mobilize community-based and facility-based resources as needed (this
includes being knowledgeable about supportive housing and long-term care
options and the appropriate timing, and process, for facility placement)

David B. Hogan MD, Peter Bailey MD, Sandra Black MD, Anne Carswell MSc PhD, Howard Chertkow MD,Barry Clarke MD, Carole Cohen BA MD, John D. Fisk PhD, Dorothy Forbes RN PhD,Malcolm Man-Son-Hing MSc MD, Krista Lanctôt PhD, Debra Morgan RN PhD, Lilian Thorpe MD PhD

Contact: Dr. Hogan, University of Calgary, 403-220-4578, dhogan@ucalgary.ca

Original content the Alzheimer’s Reading Room.

Advertisements
 

Worried about Alzheimer’s? Rule # 1 Exercise

It is getting more and more difficult for me to get my mother to exercise. Recently one of her best friends, now 79, received a scare when her good friend told her she was starting to get forgetful. She asked me what I thought she should be doing to help protect herself against dementia and Alzheimer’s. My answer to this is question is always the same–Rule #1 Exercise.

Our friend decided on the spot to take my advice and join Gold’s gym. She did so immediately. We decided to attend the Silver Sneakers exercise class the next morning. I had trouble getting my mother to go to the gym class so I asked our friend to come over and help me convince her. It worked, thank goodness.

On the way to the gym the best way I can describe my mother is zombie like. She could barely walk, kept telling me she was going to faint, and said she was sick. I could barely get her out of the car. When we walked out of the gym my mother was standing straight, had a smile on her face, and was communicating. It is rather hard for me to describe this unless you see it for yourself. This happens every time. Exercise works for my mother who suffers from Alzheimer’s and the benefits are obvious. Our friend upon seeing this in person for the first time decided she will attend the class at least three times per week.

The experience reminded me of an article I read a while back that discussed the positive effect that exercise had on nursing home residents suffering from Alzheimer’s disease.

“Nursing home residents with Alzheimer’s disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown.”



Reuters Health: Exercise slows decline in Alzheimer’s patients

Nursing home residents with Alzheimer’s disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown.

Dr. Yves Rolland, of Hospital La Grave-Casselardit in Toulouse, France, and colleagues examined the effects of a program of exercise for one hour twice weekly on activities of daily living, physical performance, nutritional status, behavioral disturbance and depression among 134 Alzheimer’s disease patients in nursing homes.

The patients were 83 years old on average. They were assigned to the exercise program, which focused on walking, strength, balance and flexibility training, or to routine medical care for 12 months.

As reported in the Journal of the American Geriatrics Society, 110 participants completed the study. Among the 56 subjects in the exercise group who completed the study, the rate of adherence to the program was about 33 percent on average.

At the end of the 12 months, the average activities-of-daily-living score was significantly more improved in the exercise group than in the routine medical care group, Rolland’s team reports.

In addition, average walking speed improved significantly more in the exercise group than in the routine medical care group at 6 months and 12 months.

However, the exercise program had no apparent effect on behavioral disturbance, depression or nutritional assessment scores.

SOURCE: Journal of the American Geriatrics Society, February 2007.

Read more about Alzheimer’s at the Alzheimer’s Reading Room

Amazon.com Widgets

 
 

LY450139, A Phase III Clincal Trial on the Progression of Alzheimer’s Disease

This clinical trial is worth considering. Patients who initially receive placebo (inactive sugar pill) will at a certain point in the study be switched over to active drug, LY450139. This means every participant gets the drug. Additionally, all patients who complete this study will have the option to continue receiving LY450139 by participating in an open label study.This means you can continue receiving the drug free of charge after participation in the clinical trial.

LY450139 is being tested to see if it can slow the progression associated with Alzheimer’s disease by inhibiting gamma-secretase, an enzyme that can create a sticky protein called amyloid beta. Slowing the rate of disease progression could preserve independent functioning and quality of life for Alzheimer’s patients in the milder stages of the disease, potentially delaying the onset of the severe stages of the disease.


Primary Outcome Measures: Alzheimer’s Disease Assessment Scale – Cognition (ADAS-Cog). Alzheimer’s Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL)

Secondary Outcome Measures:

All of these test will be conducted throughout the study.

* The Clinical Dementia Rating Scale (CDR)

* Neuropsychiatric Inventory (NPI)

* Resource Utilisation in Dementia – Lite Questionnaire

* Quality of Life in Alzheimer’s Disease (Qol-AD)

* Mini-mental State Examination (MMSE)

* A chemical marker of AD in the blood which may be lowered by LY450139.

* Energy usage (metabolism) seen on a brain scan called FDG-PET

* Brain size (volume) seen with AD on a brain scan called vMRI

* Amount of brain amyloid plaque using a brain scan called AV-45-PET

* A chemical marker (tau) known to be elevated in the spinal fluid in AD

* To measure levels of LY450139 and their effect on safety, chemical markers and effectiveness.

This is a very thorough clinical trial.

To get the specifics of the clinical trial including: purpose, eligibility, inclusion criteria and available locations go to Effects of LY450139, on the Progression of Alzheimer’s Disease as Compared With Placebo (IDENTITY-2)

Here is some additional information from the Eli Lilly website.

Eli Lilly and Company (NYSE: LLY) has announced today the start of a Phase III clinical trial studying LY450139, an investigational gamma secretase inhibitor for the treatment of mild to moderate Alzheimer’s disease. LY450139 is being tested to see if it can slow the progression associated with Alzheimer’s disease by inhibiting gamma-secretase, an enzyme that can create a sticky protein called amyloid beta. Current Alzheimer’s disease theory is that subtypes of amyloid beta clump together into plaques that eventually kill off brain cells. By blocking gamma secretase, there is less amyloid beta formed, potentially slowing brain-cell death.

Slowing the rate of disease progression could preserve independent functioning and quality of life for Alzheimer’s patients in the milder stages of the disease, potentially delaying the onset of the severe stages of the disease. Currently available treatments for Alzheimer’s disease have no documented effect on amyloid beta. They provide modest improvements in symptoms but do not slow the underlying disease process.

The IDENTITY Trial – Interrupting Alzheimer’s Dementia by EvaluatiNg Treatment of AmyloId PaThologY

IDENTITY is a randomized, double-blind, placebo-controlled trial that will be conducted in the U.S. and 21 additional countries. As part of IDENTITY, 1,500 patients will be studied for 21 months, and an open-label extension will be available to all participants completing the study. Patients who are taking currently available symptomatic treatments for Alzheimer’s disease can continue treatment during their participation in IDENTITY. Because the IDENTITY study also incorporates a “randomized delayed start” design, even those subjects initially assigned to the placebo arm of the study will be started on active LY450139 treatment sometime before the end of the 21-month study period. Both the subjects and investigators will be blinded to the exact timing of this delayed start of study drug administration.

“Alzheimer’s is a devastating disease that destroys brain cells, affecting everything from a patient’s memory to their work and social life. Currently available medications treat the symptoms of Alzheimer’s disease but have not been shown to change its underlying progression, creating an urgent unmet medical need. Today, we are proud to announce the start of the IDENTITY clinical trial and hold hope that LY450139 will represent an advance in the attempt to slow the progression of this fatal disease. We encourage patients or their caregivers to review the enrollment criteria for IDENTITY to see if they are eligible to participate,” said Eric Siemers M.D., Medical Director, Alzheimer’s disease research for Eli Lilly and Company.

Alzheimer’s disease is a progressive neurodegenerative condition that is the most common cause of dementia in patients over 65 years of age. Estimates show that 6-8% of people over age 65 are affected by Alzheimer’s disease(1), totaling approximately 5 million people in the United States alone(2). Every 72 seconds, an American is developing Alzheimer’s disease(3), and it is the seventh-leading cause of death in the United States(4). The direct and indirect health care costs associated with Alzheimer’s disease in the U.S. are estimated to be about $150 billion(5). In 2005, the total cost worldwide was estimated at $315.4 billion(6).

Given the aging population, without the availability of medicines that delay or prevent the onset of Alzheimer’s disease, the number of affected people is expected to at least triple by the year 2050 in developed nations(7). The average duration between onset of symptoms and death due to complications of Alzheimer’s disease is about 8-10 years(8). The burden to caregivers and health care costs can increase dramatically in the late stages of Alzheimer’s disease, when patients cannot maintain independent function and are frequently bedridden.

To more completely characterize the disease-modifying effects of LY450139, a number of optional biomarker sub-studies will be available to patients. These optional sub-studies will utilize new brain-scanning techniques to determine the amount of amyloid beta plaque in the brain, employ other, more established scanning techniques to examine brain structure and function, and evaluate a number of additional biochemical measures of Alzheimer’s disease. By determining the effect of LY450139 on these objective biomarkers, a more complete understanding of the effect of LY450139 on underlying Alzheimer’s disease pathology is possible.

Additional information regarding the IDENTITY trial, including global recruitment sites, may be found by visiting www.clinicaltrials.gov or www.lillytrials.com, or by calling 1-877-CTLilly (1-877-285-4559).

About LY450139

LY450139 inhibits gamma secretase, an enzyme that cuts a protein, creating a shorter, sticky protein called amyloid beta. Alzheimer’s disease theory suggests that some subtypes of amyloid beta clump together into plaques that eventually kill off brain cells. Clinical studies have examined the effect of LY450139 on amyloid beta in blood and cerebrospinal fluid. The most frequently occurring side effects experienced in earlier clinical studies with LY450139 include diarrhea, upset stomach, and fatigue. For a more complete listing of potential side effects, prospective clinical trial participants should refer to the informed consent document.

Original content the Alzheimer’s Reading Room

 

Euthanasia for End-Stage Alzheimer’s? How About Humanity Instead

Paula Spencer posted this interesting article on Caring.com.

People with advanced dementia have “a duty to die.” Or so says Baroness Mary Warnock. My first reaction, after the shiver of shock finished running down my spine, was that whoever this woman is, surely as a baroness she can afford decent care for loved ones in the late stage of disease! And then I discovered that in addition to being a British government adviser, Lady Warnock is its “leading moral philosopher.”

Read Euthanasia for End-Stage Alzheimer’s? How About Humanity Instead

To read more on this controversial topic go to Baroness Warnock: Dementia sufferers may have a ‘duty to die’

This is likely to become a major health issue in the United States as baby boomers age. Feel free to add your opinion here or on Caring.com.

 

New Alzheimer’s Disease Survey Reveals Disparities between Beliefs and Behavior In Pursuing Diagnosis

The Alzheimer’s Disease Screening Discussion Group (ADSDG) recently conducted a survey. They found that most adults 55 and over lack knowledge about Alzheimer’s disease.

* About 75 percent thought they could identify signs of Alzheimer’s disease in themselves or a loved one.

* Yet, when presented with a list of symptoms, more than 90 percent were confused about which symptoms were associated with early signs of Alzheimer’s.

According to the study:

* 34 percent have a loved one who they suspect might have Alzheimer’s.

* Yet of those people, only about 40 percent encouraged their loved one to talk to a doctor about it.


NEW ALZHEIMER’S DISEASE SURVEY REVEALS DISPARITIES BETWEEN BELIEFS AND BEHAVIOR IN PURSUING DIAGNOSIS

Results Indicate the Need for Adults Age 55 and Over to Know the Signs of Alzheimer’s and Take Immediate Action Once Symptoms are Suspected

Despite overwhelming support for early Alzheimer’s disease (AD) screening and detection, there are striking differences between intentions and actual behavior, according to a new online survey of 1,040 adults age 55 and over titled, “Alzheimer’s Disease: Current Attitudes, Perceptions, and Knowledge.” Nearly 95 percent agree that they would encourage a loved one to seek early diagnosis upon suspecting signs of AD.1 However, of the 34 percent who previously thought a loved one had the disease,1 only about one-quarter prompted that person to take an AD screener1 and less than 40 percent encouraged initiating a conversation with his or her doctor.1

The survey also found that more than 90 percent of adults age 55 and over are unable to identify the difference between early disease symptoms, late disease symptoms, and symptoms unrelated to AD,1 despite the fact that 78 percent believe they could recognize signs of the disease in themselves or a loved one.1

The online survey was conducted by Harris Interactive and commissioned by the Alzheimer’s Disease Screening Discussion Group (ADSDG), a consortium of multi-disciplinary experts in AD and senior health. The ADSDG issued a consensus statement in November 2007, recommending routine memory screenings for Americans 65 years of age and older and encouraging increased public education about AD. This year, the group commissioned this national survey as a next step to better understand public perceptions, attitudes, and knowledge about the disease, screening, and diagnosis. Both the survey and the ADSDG were sponsored by Eisai Inc. and Pfizer Inc.

“Last year the Alzheimer’s Disease Screening Discussion Group encouraged seniors to become more familiar with the first signs of Alzheimer’s in order to facilitate earlier screening and diagnosis,” said Dr. Richard Stefanacci, founding executive director, Geriatric Health Program, University of the Sciences in Philadelphia, survey co-chair and member of the ADSDG. “This new survey shows us that close friends and relatives are not encouraging their loved ones to take action, and perhaps that’s because they’re not confident in their ability to identify Alzheimer’s symptoms. The unfortunate result is that many patients may not get diagnosed until the disease is in its later stages.”

In support of this theory, another key survey finding was that while the majority of adults age 55 and over recognizes that family members of the person with AD are most likely to notice the need for screening,1 many admit they are not very knowledgeable about the disease,1 and are confused about its symptoms.1 Moreover, nearly one-third of those surveyed are not aware that there are AD medications currently available1 and about 85 percent of those who are aware do not understand how treatment works.1

“There are many reasons to seek out an Alzheimer’s diagnosis soon after first symptoms are suspected,” said Dr. Paul R. Solomon, professor, department of psychology and program in neuroscience, Williams College; clinical director, The Memory Clinic in Bennington, VT; and survey co-chair and member of the ADSDG. “Not only are there treatments that can slow the progression of symptoms, but an early diagnosis also gives the patient and their loved ones more time to adjust to the news and make important decisions together before the disease advances, impacting the patients’ ability to interact and function.”

These survey results are particularly important given the rise of AD as the baby boomer population ages – up to 16 million are estimated to have the disease by 2050.2 The ADSDG encourages everyone with a loved one age 55 and over to visit http://www.seethesigns.com to learn more about the disease, its signs, and symptoms, and complete an online memory screener on behalf of a loved one if symptoms are suspected. Key differences between early signs of disease and normal aging include3:

Normal Aging                       Potential Signs of AD

Forgetting names of Forgetting the names of
people you rarely see people close to you

Briefly forgetting part Forgetting a recent
of an experience experience

Occasionally misplacing Not being able to
something find important things

Mood changes due to an Having unpredictable
appropriate cause mood changes

Changes in your interests Decreased interest in
outside activities



Original Content the Alzheimer’s Reading Room

About the Alzheimer’s Disease Screening Discussion Group (ADSDG)

The ADSDG is a multi-disciplinary panel of experts sponsored by Eisai/Pfizer Inc and first convened in November 2007 to debate the value of AD detection and routine screening. ADSDG members include:

* Dr. Paul R. Solomon, professor, department of psychology and program in neuroscience, Williams College, MA; clinical director, The Memory Clinic, Bennington, VT; and survey co-chair

* Dr. Richard Stefanacci, founding executive director, Geriatric Health Program, University of the Sciences in Philadelphia, survey co-chair

* Dr. Barry W. Rovner, director, clinical Alzheimer’s disease research at the Farber Institute for Neurosciences, and professor of psychiatry and neurology, Thomas Jefferson University, Philadelphia

* Dr. Yanira Cruz, president and CEO, National Hispanic Council on Aging
* Gail Hunt, president and CEO, National Alliance for Caregiving
* Janet Farr, Alzheimer’s disease Caregiver

About the Survey

This AD survey was conducted online within the United States by Harris Interactive on behalf of Eisai/Pfizer between May 12 and June 4, 2008, among 1,040 U.S. adults age 55 and over. No estimates of theoretical sampling error can be calculated; a full methodology is available.

 
Leave a comment

Posted by on September 29, 2008 in alzheimer's, health, science, study, survey

 

See the Signs of Alzheimer’s– Free Guide Available

This free guide is an excellent resource and should be especially interesting to baby boomers. The guide includes: information about Alzheimer’s disease, information about a prescription treatment option, a doctor discussion guide, and caregiving tips.

While you are on the website obtaining this free resource guide you can also select an option that allows a caregiving nurse to call you and discuss Alzheimer’s topics. The nurse can help you identify issues to discuss with your doctor, answer questions about Alzheimer’s, and provide you with important tips and resources in your area.

To obtain this free material go to See The Signs.

You can also visit these interesting areas while you are on the website.

Signs & Symptoms

Symptom Screener

Original content the Alzheimer’s Reading Room

Amazon.com Widgets

 

Combining Alzheimer’s drugs helps slow rate of decline in Alzheimer’s Patients

My mother is currently moving into the medium stage of Alzheimer’s so for us this is exciting news. I intend to send this information to our personal care physician and discuss it with him immediately.

I just finished reading a study published in the journal Alzheimer Disease and Associated Disorders that indicates combining two different kinds of Alzheimer’s drugs works better one. This unique research took place over a long time frame, 1990-2005. Typical clinical trials last about 6-9 months.

Those in earlier stages of Alzheimer’s disease are typically treated with cholinesterase inhibitors like Aricept, Razadyne, or Exelon. Those suffering from later stage Alzheimer’s disease are usually treated with Namenda (Memantine). The study found that people who took the combination of a cholinesterase inhibitor and Memantine showed a significantly slower rate of cognitve decline than those who took only a cholinesterase inhibitor or no drug.

While still in an early stage and needing follow-up this study indicates that the combination of drugs significantly slows the deterioration of cognitive function in Alzheimer’s patients.

“Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer’s treatment, but we really don’t know if that is happening or what the mechanism behind these effects might be,” Alireza Atri explains. “What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient’s symptoms get worse, that doesn’t mean the drug isn’t working, since the decline probably would have been much greater without therapy.”

John Growdon, MD, a senior author of the paper said, “The results of this study should change the way we treat patients with Alzheimer’s disease. Cholinesterase inhibitors are approved for use in mild to moderate dementia, while memantine has been approved for advanced dementia. But it looks like there is an advantage in prescribing both drugs as initial treatment.”


You can read more about the study by following the links:

Combining Alzheimer’s drugs helps, study says

Benefit Of Combination Therapy For Alzheimer’s Disease Confirmed

Combining Alzheimer’s drugs helps, study says

Drugs to treat Alzheimer’s disease have shown only modest success in easing symptoms of the incurable illness that robs people of their memory and makes them unable to lead normal lives. But a new study from Boston researchers offers a glimmer of hope that combining two kinds of drugs may help delay progression of the symptoms.

Researchers at the Massachusetts General Hospital Memory Disorders Unit report in the journal Alzheimer Disease and Associated Disorders that combining two types of Alzheimer’s drugs works better than giving none or one of the drugs alone to slow cognitive and functional decline. Previous clinical trials have compared the drugs with placebos in short studies of safety and effectiveness, but the MGH group says theirs is the first to look longer-term at patients in a real-world clinical setting. Their study was funded by the National Institute on Aging and the Massachusetts Alzehimer’s Disease Research Center.

Led by Dr. Alireza Atri, the researchers analyzed the records of 382 patients who were treated at the Boston clinic from 1990 to 2005. The earliest group of 144 patients did not receive any medication, the second group got a cholinesterase inhibitor approved by the Food and Drug Administration in the mid-1990s, and the third group took that drug plus memantine, a drug approved in 2003 that helps patients think more clearly. The patients were followed for an average of two and a half years and given tests to measure both their cognitive abilities and their capacity to carry out the activities of daily living.

People who took the combination of drugs showed a significantly smaller rate of decline than those who were taking only a cholinesterase inhibitor or no drug. Memantine was not studied alone because by the time it was available, cholinesterase inhibitors were widely used. The researchers accounted for differences among the groups, such as how early in the disease they were diagnosed and whether they had other illnesses, but the differences in how they scored on tests of cognition and function still held true.

The results raise the intriguing possibility that the drugs may be protecting the patients’ brains from further deterioration, the authors said.

“Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer’s treatment, but we really don’t know if that is happening or what the mechanism behind these effects might be,” Atri said in a statement. “What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient’s symptoms get worse, that doesn’t mean the drug isn’t working, since the decline probably would have been much greater without therapy.”

Original content the Alzheimer’s Reading Room

Amazon.com Widgets

 
 
%d bloggers like this: