ElderWeb

The following information was provided in a press release by the Alzheimer's Foundation of America:

MedicAlert ® and the Alzheimer's Foundation of America (AFA) have started marketing a new identification bracelet with a color-coded symbol specifically designed to symbolize Alzheimer's disease and related dementias in order to help individuals in emergency situations.

The new identification bracelet has a teal MedicAlert ® emblem to denote that an individual has Alzheimer's disease or a related dementia, marking the first time that MedicAlert ® is utilizing a colored emblem to symbolize a specific disease. In an emergency, the emblem alerts medical professionals or first responders to call MedicAlert ®'s 24-hour hotline to access electronic health records containing vital medical and contact information about each wearer.

Caregivers can easily obtain and update personal information in the system, including medication dosages, allergies, implanted devices, physician and family contacts, insurance information, organ donation specifications, and advance directives.

Membership in MedicAlert ®, which includes a bracelet with the teal emblem, a printed electronic health record summary, 24-hour emergency response service, patient identification, emergency contact and family notification service, and 24-hour customer service, costs $35 the first year and a $20 subscription each year thereafter. AFA and its member organizations will provide a special code that offers a $5 discount off the first year of membership.

PRESS RELEASE
New course will help people with dementia

The first nationally accredited training course aimed at improving the lives of people with dementia is being launched at the University of Sunderland.

The distance learning course for professionals will help further raise the level of care offered to thousands of people across the country living with dementia.

Sunderland has teamed up with the Alzheimer'™s society, BUPA care homes and the Joseph Rowntree Foundation to provide the new course, '˜an introduction to Dementia care'™.

Through open learning, the use of videos, group discussion and working with people with dementia, the course will encourage staff to view dementia care as a career choice and help in the understanding of the illness.

Vicki Lawson-Brown, senior lecturer in health studies at the university said: 'ÂœThis course recognises the attitude, expertise and knowledge needed to deliver successful dementia care.

'œIt'™s an exciting new development to provide a better quality of care for people who have dementia, treating them with the respect and dignity they deserve. We welcome the opportunity to recognise the work of care staff in this field.'

The new course is part of a range of Joseph Rowntree programmes awarded to the University of Sunderland by the trust two years ago.

Studies have shown that up to 75 per cent of people living in nursing and residential care homes have Alzheimer'™s or another form of dementia.

The Alzheimer'™s society hopes that all care providers will eventually use the course to help improve training for those working with people with dementia.

Daren Felgate, the Alzheimer'™s society'™s training and development manager, said: 'œWe hope this course will become the key introductory course for care workers helping people with dementia.

'œWorking with people with dementia is often seen as difficult and challenging, but with the right support many care staff will see it is the most rewarding work they have ever done.'

The course has already been piloted through four BUPA care homes and the Joseph Rowntree Foundation in York. It will be launched at the Royal Society in London on April 22, where speakers from BUPA and the Alzheimer'™s Society will be highlighting the importance of effective dementia care training.

More info is at http://www.sunderland.ac.uk/

The Alzheimers Association recently released a research report showing that the cost to the US government's Medicare and Medicaid programs for Alzheimers was $50 billion -- $32 billion for Medicare and $18 billion for Medicaid. They predict that the cost to the Medicare program alone for Alzheimers would reach $50 billion by 2010, along with a $33 billion cost to the Medicaid program and another $50 billion cost to beneficiaries, for a total cost in the US of about $133 billion.

The report points out several factors behind these high costs. For instance, patients with dementia are more likely to have preventable medical crises caused by their impaired judgment and inability to manage their own care. Alzheimers is also a significant cause of the burgeoning cost of the Medicaid program. Half of all nursing home residents have dementia, often with lengthy stays that are paid for by Medicaid.

The report was done by the Lewin Group, and was presented in a Senate hearing this week. The association urged Congress to double spending on Alzheimers research to $1 billion a year to prevent a situation which has the potential to bankrupt the Medicare and Medicaid programs. They warned Congress that these costs will sky-rocket even further in the future as baby-boomers age and start becoming eligible for Medicare in 2010.

UK's National Institute for Clinical Excellence (NICE) has issued guidance to local councils on the use of drugs for the treatment of Alzheimers Disease. Three drugs, Aricept, Exelon and Reminyl, have been approved for treatment of mild to moderate Alzheimers. NICE estimates that there are about 400,000 people in the UK with Alzheimers, and that about 250,000 of them have mild to moderate levels of the disease.

NICE reports that Donepezil is marketed by Pfizer/Eisai as Aricept, rivastigmine by Novartis as Exelon and galantamine by Shire Pharmaceuticals and Janssen Cilag as Reminyl. The annual cost in the UK of donepezil is 891 (5 mg)/1,248 (10 mg), taken in a single daily dose, for rivastigmine is £821 (all doses), taken twice per day, and for galantamine is £876 (16 mg)/1049 (24 mg) (allowing for an initial starting dose of 8 mg daily), taken as 8 mg or 12 mg twice per day.

NICE points out that it is difficult to estimate the total aggregate cost of using these medications, but that the cost may be offset by later entry to a nursing home. For example, a delay of 12 weeks at £370 per week would yield a cost saving of about £4,500.

The NICE website includes full guidance for local councils and leaflets for patients.

Researchers developing a vaccine against Alzheimer's disease have shown that it seems to stop mice with the condition from losing their memory, which boosts hopes that such vaccines could delay or prevent similar symptoms in humans. The vaccine also reduces the build-up of protein deposits in mouse brains - the other major indicator of Alzheimer's disease. The pharmaceutical company Elan, based in Dublin, Ireland, is poised to begin large-scale human clinical trials of a potential treatment based on the vaccine. But what works in mice does not always work in people and the vaccine will still have to prove its worth in a battery of further tests.

Peter St George-Hyslop of the University of Toronto in Canada and his colleagues and a second team led by Dave Morgan of the University of South Florida at Tampa showed that the vaccine reduces learning and memory loss as the mice age. Each group gave Alzheimer's mice learning and memory tests, in which the animals had to swim to a submerged platform. In one trial the platform was moved each day, testing short-term memory. The second trial investigated 'spatial-reference' memory by leaving the platform in one place and testing the mice once a month. Mice given the test vaccine developed fewer and smaller protein deposits in their brains and performed markedly better than unvaccinated animals in both types of memory test.

Whether the protein deposits actually cause dementia in people is unclear. Some researchers believe that preventing the deposits from forming should relieve the distressing mental symptoms, although others disagree. This research supports the hypothesis that the two are related, but other factors could still be involved.

A collection of research reports on this subject are included in the current issue of Nature Magazine.

Researchers report in the November issue of Archives of Neurology that aspirin and other anti-inflammatory drugs may help prevent Alzheimer's Disease (AD). Previous research has suggested that anti-inflammatory drugs such as aspirin and ibuprofen may cut Alzheimer's risk, but researchers were not sure how high a dose was necessary to produce the desired effects. Dr. G. Anthony Broe led a group of researchers at the University of Sydney who studied more than 600 men and women age 75 and older and found that even low doses of the drugs seemed to ward off Alzheimer's. The researchers are uncertain why aspirin and similar drugs might protect against Alzheimer's. The study's authors speculate that the drugs' heart benefits may offer an explanation, noting that low doses of aspirin are already known to help prevent heart disease. Aspirin and similar drugs improve blood flow to the heart and may improve the function of cells lining blood vessels.

People who care for the 4 million Americans suffering from Alzheimer's disease consider quality of life just as important as efforts to prolong the patient's life when choosing treatment options, according to researchers in a study reported in the October 10th issue of Neurology. Lead author Dr. Jason H. T. Karlawish, of the University of Pennsylvania Health System in Philadelphia, and his team interviewed 40 primary caregivers of Alzheimer's disease patients, none currently living in a nursing home. The caregivers were asked how their choice of treatment was affected by the potential to lengthen their charge's overall survival, to slow the progression of the disease, or to delay the transfer of the patient to a nursing home. The investigators also measured the caregivers' willingness to risk the development of negative side effects from a treatment in order to affect the overall course of the disease's progression.

Over 50% of caregivers said that improving the patient's quality of life was a more important treatment benefit than either lengthening survival time or delaying a move to a nursing home. Other benefits similarly valued included preserving the patient's memory; ability to communicate and recognize the family; improving the patient's mood; and improving the ability to manage basic daily physical activities. Karlawish and his colleagues also found that the caregivers' ability to assess quality-of-life issues was influenced by his or her own level of depression and burden--so that their judgment when choosing treatment might be affected by a desire to alleviate their own related stresses.

Overall, most caretakers were willing to risk possible side effects in order to delay the disease progression by 1 year--with the goal of delaying a move to a nursing home playing a major role in the caregivers' assessment of quality of life.

The Ontario provincial government is providing $6.3 million to expand and enhance adult day programs and respite services for people with Alzheimer Disease, Health and Long-Term Care Minister Elizabeth Witmer announced. The funding will be provided to 80 agencies across Ontario and now serve over 4,000 people, including 2,300 new clients.

A collaborative effort between the Alzheimer Society of Canada, AstraZeneca Canada Inc., AstraZeneca US and the Canadian Institutes of Health Research (CIHR) through its partnership with Canada's Research-Based Pharmaceutical Companies (Rx&D) will help generate new research into Alzheimer Disease. The Alzheimer Disease Research Grants Program is designed to stimulate individual Canadian investigators to undertake innovative research into the cause and cure of Alzheimer Disease. The Program offers up to four biomedical research grants focussed on the causes, diagnosis and treatment of Alzheimer Disease for each of two years. Researchers are invited to submit proposals designed to yield new insights into the prevention and treatment of Alzheimer Disease. Applications for up to $100,000/annum for projects of up to two years will be considered.

Some of the most common prescription and over-the-counter medicines can produce side-effects with symptoms similar to those of dementia, glaucoma, and other diseases of old age, according to Dr. Jacobo Mintzer of the Medical University of South Carolina in the September Journal of the Royal Society of Medicine. Some of the side-effects he noted were dementia-like symptoms of confusion, memory loss, and disorientation, and glaucoma-like blurred vision, dry mouth, constipation, urinary problems, dizziness, likelihood of falling, anxiety, rapid shallow breathing, and irregular or rapid heartbeat.

He said that illnesses like angina, diabetes, glaucoma, and dementia appear to be worsened by drugs with "anticholinergic activity". This includes many of the prescription drugs used in the treatment of Parkinson's disease, depression, allergies, migraine, and irritable bowel syndrome, as well as some pain relieving drugs. Non-prescription drugs of this type are also becoming increasingly available, including cold and flu medicines, indigestion tablets, sleeping pills and anti-diarrhoea treatments. The risk of side-effects from a dose of one of these might be very small, but many elderly patients take several kinds of medications at once, increasing the likelihood of "anticholinergic load".

Dr. Mintzer warns that elderly patients in nursing homes are most at risk, since some reports suggest that 60% of nursing home residents will have received drugs from the anticholinergic group in the past year, compared with only 23% of elderly people in the community. Doctors may assume that any side-effects are an inevitable part of the ageing process rather than something which could be avoided by altering existing medication regimes. The elderly are also more likely to be at risk from anticholinergic load because their metabolism is often less efficient, allowing drugs to stay longer in their system.

A study released by the National Academy on an Aging Society found that care for people with Alzheimers Disease can be very costly. The average cost for a person with Alzheimers who is still living at home is $12,572 a year, primarily for social services, like adult day care, homemaker services, and meal services. This cost is borne primarily by the patient or family, since most of these costs are not covered by Medicare, Medicaid, or insurance. The study also found that the lives of caregivers for Alzheimer's patients are more impacted by caregiving demands than those who care for people without dementia. Dementia caregivers were more likely to take time off of work (57% to 49%) and give up leisure activities (55% to 41%).

Researchers have found that people with a genetic high risk for Alzheimer's disease had to use more of their brains to perform memory tasks than those at normal risk. Thirty subjects aged 47 to 82 with normal age-appropriate memory performance were tested, and those with higher brain exertion demonstrated noticeable decline in their verbal recall abilities two years after initial testing. The results add to other evidence that physical changes to the brain begin years before dementia. The study was lead by Gary W. Small, director of the Center on Aging at the University of California at Los Angeles, and appears in the New England Journal of Medicine (NEJM).

The National Institutes of Health will increase funding for Alzheimers research by $50 million in the next five years. The National Alzheimers Association applauded the funding, but cautioned that it is still far short of the amount needed to significantly change Alzheimers treatment options. The association says $100 million should be allocated in the year 2001 alone.

PBS has posted on their web site streaming video and RealAudio files of their recent special on Alzheimers, along with a transcript of the program.

The current issue of the Journal of Clinical Oncology has a report from researchers who investigated complaints that breast cancer patients receiving chemotherapy have difficulty in their ability to remember, think, and concentrate. The research team was led by Dr. Ian F. Tannock of Princess Margaret Hospital in Toronto. Tannock's team found that, regardless of the women's mood, age and education, chemotherapy patients did show signs of mental impairment. They believe the cancer drugs may be acting on healthy brain cells, but that is still unclear. Tannock cautioned that this potential side effect should not scare away breast cancer patients, but that they should be fully aware of the possible adverse consequences of chemotherapy. He said, "As an oncologist, one thing that worries me is that some women might use this as an argument against a treatment that can help them."

The Journal of the American Medical Association (JAMA) has a report on a study into the potential benefits of estrogen replacement therapy on Alzheimers Disease. The researchers investigated whether this treatment was beneficial, in light of several reports from small clinical trials that indicated a potential benefit. They concluded that estrogen did not seem to be helpful in retarding the disease. They also said their study was inconclusive as to the benefit of estrogen in preventing or delaying Alzheimers, and recommended further study on that issue.

On March 13, the National Institute on Health Radio News Service will post an online audio clip from the National Institute on Aging. The clip will discuss a clinical trial being launched to determine whether treatment with certain non-steroidal anti-inflammatory drugs will slow cognitive and clinical decline in patients with Alzheimer's disease.

Ten key sessions at World Alzheimer Congress 2000, the largest international conference on Alzheimer's disease, will be broadcast over the Internet. Leaders in Alzheimer research, treatment and care from around the globe will gather in Washington D.C., from July 9 through July 18, to share the latest knowledge about research and care and identify strategies for eliminating Alzheimer's disease. Visit the congress web site at www.alzheimer200.org to get a schedule of viewable web casts.

Keeping active, either physically or mentally, in the midlife years may help prevent Alzheimer's disease, according to a study presented at the American Academy of Neurology's 52nd Annual Meeting. Robert Friedland, MD, a neurologist at Case Western Reserve University School of Medicine and University Hospitals of Cleveland, OH, was the primary author of the study.

This research found that participation in intellectual and physical activities had a significant impact on the likilhood of later development of Alzheimers Disease. Intellectual activities ranged from reading and painting to jigsaw puzzles, woodworking and knitting, whereas physical activity ran the gamut from gardening to racquet sports. The healthy participants had been more active between the ages of 40 and 60 than had the patients with Alzheimer's, even after the data was adjusted to take into account differences, such as age, income, gender and education.

The study's findings also suggest that it is never too late to get started - at least as far as intellectual activities are concerned. "A relative increase in the amount of time devoted to intellectual activities from early adulthood (ages 20 to 39) to mid-adulthood (ages 40 to 60) was associated with a significant decrease in the probability of having Alzheimer's disease later in life," said Friedland.

The research suggests that the brain stimulation associated with intellectual and physical activities works against the neurodegeneration of diseases such as Alzheimer's. Although scientists cannot rule out the possibility that lower activity levels are themselves symptoms of the disease in its very early stages, Friedland believes that to be unlikely, because the study looked at levels of activity from at least five years before the onset of dementia.

The Alzheimer's Association reported that the number of people who will be afflicted by Alzheimer's will increase by 350% by the middle of this century, if the disease continues to grow at current rates. The only way to avoid the epidemic is to accelerate the search for a way to delay, prevent or cure the disease.

"Large scale trials are expensive - $15 million to $20 million each - and they take at least five years to get results," said Dr. Steven DeKosky, chairman of the Medical and Scientific Advisory Council of the Alzheimer's Association. "Scientists now know that brain cells begin to change 10 years or more before the symptoms of Alzheimer's appear. We do not have enough time left to do these five-year trials one at a time. Scientists have many more good ideas for effective treatments than they can test with current funding. An estimated 14 million baby boomers are living with a sentence of Alzheimer's disease today."

The Alzheimer's Association reports that without a research breakthrough the Alzheimer's epidemic alone will cost enough to bankrupt Medicare. At present, annual per capita expenditures for Medicare beneficiaries with Alzheimer's disease are $7,682, almost 70 percent more than the average of $4,524 for other beneficiaries. And that's true even though Medicare pays for almost no long-term care.

"The best scientific minds have been brought into the race for the answers to Alzheimer's disease," said Alzheimer's Association Vice President Stephen McConnell. "A solid research infrastructure is in place. The paths for further investigation are clear. The missing ingredient is the money needed to realize the scientific opportunities before us."

Danish scientists reported at the World Alzheimer Congress 2000 that failing memory may be a symptom of a treatable and reversible condition and not always a sign of Alzheimer?s disease. Gunhild Waldemar, M.D., and her colleagues examined 785 patients with memory problems, and found that only 43% were diagnosed with Alzheimer?s disease or some other form of dementia. 6% of those they examined had Alzheimers, but their memory problems were a result not of Alzheimers disease but of some treatable and reversable medical condition. Overall, they found that 35% of the patients they saw had a potentially treatable concomitant condition that could influence cognitive function, most commonly depression, high blood pressure and thyroid disease. Researchers concluded that it is important for patients with memory problems to have them properly assessed and treated, and not to assume that they indicate a diagnosis of Alzheimers.

Scientists working for the Human Genome Project at the National Human Genome Research Institute in Bethesda Maryland announced they have deciphered the genetic code for chromosome 21, which includes genes involved in cancer, hardening of the arteries, arthritis, Alzheimer's disease and other diseases associated with aging. This is the second of the 23 human chromosomes to be fully mapped and sequenced. This research is expected to help researchers studying Alzheimers and other diseases affected by the chromosome, and may shorten the time it will take to develop treatments for the diseases. 62 scientists in the USA, Japan, Germany, France, Switzerland, and England have been involved in this research.

Novartis Pharmaceuticals' Exelon, has received approval by the Food and Drug Administration (FDA). Exelon, whose approval was announced Friday, works in the brain the same way as the other two Alzheimer's drugs, Aricept and Cognex. They inhibit the breakdown of acetylcholine, a brain chemical vital for nerve cells to communicate with each other. The longer acetylcholine remains in the brain, the longer those cells can call up memories.

The drugs offer modest relief for mild to moderate Alzheimer's symptoms. While the products have not been compared directly, Exelon's effectiveness is believed to be "pretty much in the same league" as Aricept and Cognex, said FDA official Dr. Russell Katz.

The results of a recent study indicate that the lack of human contact may play a role in the development of Alzheimers Disease. The Lancet medical journal has published results of research done by Dr Laura Fratiglioni of the Stockholm Gerontology Research Center. In this study, researchers worked with 1,200 Stockholm residents, who were all over 75 years old and free of Alzheimers at the initiation of the study. After three years, 176 had developed Alzheimers, and researchers analyzed the information they had collected about the health and social networks of the study participants. These results showed that a poor social network increased the risk of dementia by 60%. Dr. Fratiglioni said that the study results indicate how important it is that older people are not left isolated in their homes as they age, and to ensure that they are given opportunities for contact and interaction.

The "Nun Study" is a research project to determine the causes of Alzheimer disease, other brain diseases, and the mental and physical disability associated with old age. Researchers are from the University of Kentucky Sanders-Brown Center on Aging and participants are 678 American members of the School Sisters of Notre Dame religious congregation from 75 to 103 years of age. Each sister in the study agreed to participate in annual assessments of her cognitive and physical function, undergo a brief medical examination, have her blood drawn, allow investigators full access to her archival and medical records, and donate her brain at death for neuropathologic study.

Researchers just announced a finding from this study that low serum folate (folic acid) was strongly associated with atrophy of the cerebral cortex in women who had a significant number of Alzheimer lesions in the brain when they died a few years later. They postulate that folic acid may play an important role in maintaining the integrity of the brain in late life, although further research is necessary. Folic acid is present in leafy dark green vegetables, and in peas, beans, and legumes.

The Labor, Health and Human Services, and Education subcommittee of the Senate Appropriations committee held hearings on March 21 to discuss the need for $100 million in additional funding for Alzheimers research. The subcommittee is encouraging increased funding to the National Institutes of Health for such research, and held these hearings to identify issues to be considered. The witnesses included Maureen Reagan, daughter of ex-president and Alzheimers' victim Ronald Reagan.

The current issue of the Journal of the American Geriatrics Society reports there are significant delays between the first observation of symptoms and the final diagnosis of Alzheimers for many victims of the disease. The journal published results from a study done to determine how much time passes between the first observation of Alzheimer-like symptoms by caregivers and the time when a physician was consulted and a diagnosis was made. The study found that one to two or more years pass between the first time caregivers notice symptoms and the time they recognize there is a real problem. Caregivers then delayed another 10 months to a year or more before consulting a physician. There were further delays at that time, since caregivers reported that physicians correctly diagnosed the condition at the time of the initial consultation only 38% of the time.

A study published in the Journal of the American Medical Association found that there was a strong correlation between Alzheimers and levels of amyloid peptides Ax-40 and Ax-42. Levels of peptides were elevated early in dementia and were strongly correlated with cognitive decline. Of particular interest, peptide levels were elevated before the occurrence of significant tau pathology, which means they may be early indicators of the disease. Researchers concluded that these results support an important role for peptides in mediating initial pathogenic events in AD dementia and suggest that treatment strategies targeting the formation, accumulation, or cytotoxic effects of peptides should be further pursued.