A biomarker in the brain’s circulation system may be Alzheimer’s earliest warning

USC scientists say Alzheimer’s could be diagnosed earlier if scientists focus on an early warning within the brain’s circulation system.

That’s important because researchers believe that the earlier Alzheimer’s is spotted, the better chance there is to stop or slow the disease.

“Cognitive impairment, and accumulation in the brain of the abnormal proteins amyloid and tau, are what we currently rely upon to diagnose Alzheimer’s disease, but blood-brain barrier breakdown and cerebral blood flow changes can be seen much earlier,” said Berislav Zlokovic, the Mary Hayley and Selim Zilkha Chair in Alzheimer’s Disease Research at the Keck School of Medicine of USC. “This shows why healthy blood vessels are so important for normal brain functioning.”

In a new review article in the Sept. 24 issue of Nature Neuroscience, Zlokovic and his colleagues recommend that the blood-brain barrier, or BBB, be considered an important biomarker — and potential drug target — for Alzheimer’s disease. Because Alzheimer’s is irreversible, and not fully understood, understanding the first step in the disease process is a critical step in fighting it.

Full story at Science Daily

Epilepsy Affects People of All Ages, Including Seniors

IF YOU OR A LOVED ONE are experiencing epilepsy for the first time after age 65, you’re not alone. Among seniors, epilepsy is one of the top three most common neurological conditions. In fact, epilepsy starts more often in old age than in middle age, reflecting the parallel increase over time of some of its causes – such as stroke, Alzheimer’s disease and brain tumors.

Epilepsy poses special challenges for seniors. The first may be receiving the correct diagnosis. Gathering a clear description of the epileptic seizures may be difficult for seniors who live alone or in a residential care facility. Even if the seizures are witnessed or recorded on a smartphone, it may be difficult to recognize the signs, because seizures tend to look different in seniors than in younger people. They may be easily mistaken for other conditions that are common in seniors, such as stroke, dizziness and memory lapses. A neurologist can help uncover the problem and will likely perform an electroencephalogram, or EEG, and a brain MRI.

Once epilepsy is diagnosed, the next step is treatment with medication. For seniors, this also raises some special issues. As we age, our liver and kidneys become less efficient at eliminating drugs from the body, and we require lower and more frequent doses and more careful monitoring for side effects. Seniors with balance problems, fatigue, confusion, slow thinking or tremor may be especially sensitive to drug side effects. It’s important to communicate any concerns to your doctor so that the medication can be adjusted as needed to keep side effects at bay.

Full story at US News

Benzodiazepines are associated with increased risk of Alzheimer’s disease

The use of benzodiazepines and related drugs (Z drugs) is associated with a modestly increased risk of Alzheimer’s disease, according to a recent study from the University of Eastern Finland. The risk increase was similar with both benzodiazepines and Z drugs regardless of their half-life. The results were published in Acta Psychiatrica Scandinavica.

Even though the increased risk for Alzheimer’s disease was small in this study, the threshold for prescribing benzodiazepines and related drugs should be high enough due to their several adverse effects and events, such as falls. These medications are commonly used for sleep problems, but their effectiveness for this indication diminishes over weeks or months. However, the risk of adverse events remains in longer-term use.

Full story at Science Daily

Agitation in dementia: Are drugs the best treatment?

A common symptom among people with dementia is agitation, which can affect their and their carers’ well-being. Dementia experts conducted a new study and found the most effective means of addressing agitation.

In a paper that is now published in the journal International Psychogeriatrics, experts from several research institutions — including the University of Michigan in Ann Arbor, and Johns Hopkins University in Baltimore, MD — express their consensus on the best approaches to manage dementia-related behavioral and psychological symptoms.

More specifically, they speak of how to address states of agitation and psychosis in people with Alzheimer’s disease.

Full story at Science Daily

An Advance Directive for Patients With Dementia

I had hoped that by now most adults in this country would have completed an advance directive for medical care and assigned someone they trusted to represent their wishes if and when they are unable to speak for themselves. Alas, at last count, barely more than one-third have done so, with the rest of Americans leaving it up to the medical profession and ill-prepared family members to decide when and how to provide life-prolonging treatments.

But even the many who, like me, have done due diligence — completed the appropriate forms, selected a health care agent and expressed their wishes to whoever may have to make medical decisions for them — may not realize that the documents typically do not cover a likely scenario for one of the leading causes of death in this country: dementia. Missing in standard documents, for example, are specific instructions about providing food and drink by hand as opposed to through a tube.

Advanced dementia, including Alzheimer’s disease, is the sixth leading cause of death overall in the United States. It is the fifth leading cause for people over 65, and the third for those over 85. Yet once the disease approaches its terminal stages, patients are unable to communicate their desires for or against life-prolonging therapies, some of which can actually make their last days more painful and hasten their demise.

Full story at the New York Times

Dementia with Lewy bodies: Unique genetic profile identified

Dementia with Lewy bodies has a unique genetic profile, distinct from those of Alzheimer’s disease or Parkinson’s disease, according to the first large-scale genetic study of this common type of dementia.

The genome-wide association study, conducted by a UCL-led collaboration of 65 academics in 11 countries and funded by Alzheimer’s Society and the Lewy Body Society, is published in The Lancet Neurology.

“Dementia with Lewy bodies accounts for 10-15% of dementia cases, yet our understanding of it lags beyond the more well-known Alzheimer’s disease, partly because it’s commonly misdiagnosed. Our findings clarify the disease’s distinctive genetic signature, which should, in the future, help improve clinical trials, and lead to more targeted treatments,” said the study’s lead author, Dr Jose Bras (UCL Institute of Neurology and Alzheimer’s Society senior research fellow).

Full story at Science Daily

Alzheimer’s gene poses both risk and benefits

Scientists drilling down to the molecular roots of Alzheimer’s disease have encountered a good news/bad news scenario. A major player is a gene called TREM2, mutations of which can substantially raise a person’s risk of the disease. The bad news is that in the early stages of the disease, high-risk TREM2 variants can hobble the immune system’s ability to protect the brain from amyloid beta, a key protein associated with Alzheimer’s.

The good news, however, according to researchers at Washington University School of Medicine in St. Louis, is that later in the disease, when the brain is dotted with toxic tangles of another Alzheimer’s protein known as tau, the absence of TREM2 protein seems to protect the brain from damage. Mice without TREM2 suffer much less brain damage than those with it.

The findings potentially make targeting the TREM2 protein as a means of preventing or treating the devastating neurodegenerative disease a little more complicated, and suggest that doctors may want to activate TREM2 early in the disease and tamp it down later.

Full story at Science Daily

Being unaware of memory loss predicts Alzheimer’s disease, new study shows

While memory loss is an early symptom of Alzheimer’s disease, its presence doesn’t mean a person will develop dementia. A new study at the Centre for Addiction and Mental Health (CAMH) has found a clinically useful way to predict who won’t develop Alzheimer’s disease, based on patients’ awareness of their memory problems.

People who were unaware of their memory loss, a condition called anosognosia, were more likely to progress to Alzheimer’s disease, according to the study, published today in the Journal of Clinical Psychiatry. Those who were aware of memory problems were unlikely to develop dementia.

“If patients complain of memory problems, but their partner or caregiver isn’t overly concerned, it’s likely that the memory loss is due to other factors, possibly depression or anxiety,” says lead author Dr. Philip Gerretsen, Clinician Scientist in CAMH’s Geriatric Division and Campbell Family Mental Health Research Institute. “They can be reassured that they are unlikely to develop dementia, and the other causes of memory loss should be addressed.”

Full story at Science Daily

Staggering economic burden of dementia in younger people, study reveals

You may not have heard of it, but frontotemporal degeneration (FTD) accounts for 20 to 50 percent of dementia cases in people under the age of 65. FTD ravages an individual’s quality of life by dramatically altering their language, personality, behavior, cognition and motor function. But it doesn’t end there.

Research led by Florida Atlantic University, in collaboration with the Association for Frontotemporal Degeneration and Emory University, is the first to capture the economic burden of FTD in the United States and the results are staggering. The study, published in Neurology®, the medical journal of the American Academy of Neurology, reveals that costs associated with FTD are twice that of Alzheimer’s disease (AD). The researchers also found that costs for FTD were greater in the U.S. than in studies originating in other countries and the implications for patients and their caregivers are dire.

Full story at Science Daily

New mindset in the search for stroke therapies

UNSW researchers have identified a promising new avenue to explore in the search for stroke treatments, after translating findings from Alzheimer’s disease.

The study published in Nature Communications finds that mice deficient in tau, a protein within brain cells (neurons), are significantly protected from excitotoxic brain damage after experimental stroke.

Stroke is a major cause of death and disability, and there is only a short window for therapeutic intervention, aimed at restoring blood flow to the brain before neurons are irreversibly damaged.

Full story at Science Daily