Alzheimer’s Disease Today & Tomorrow
Brain
Posted on: Aug 16
Brain
Posted on: Aug 16
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Tags: neurology, brain, alzheimers, memory, article

Alzheimer’s Disease Today & Tomorrow

Inability to balance a checkbook, problems driving, poor decision-making, inappropriate word choice, becoming lost on familiar routes…these are just some of the symptoms of early Alzheimer’s disease. Alzheimer’s disease is the most common neurodegenerative disorder to cause impaired cognition. By the time a person reaches the age of 85, he or she has a 50 percent chance of developing Alzheimer’s. (1) Although current treatments cannot halt the progression of Alzheimer’s, early diagnosis and treatment can help patients and their families stabilize the symptoms over a longer period of time.

Diagnosing Alzheimer's disease

Alzheimer’s generally affects a person’s short-term memory first. Thus, doctors often begin the diagnostic process with neuropsychological testing to look for disruption in the person’s everyday activities. Doctors often rely on the input of someone close to the person, such as a family member or caretaker, who can help determine if a marked change in the person’s cognitive ability has occurred. People with Alzheimer’s lack insight into their disease and behavior, so the caretaker’s insight helps doctors more accurately pinpoint when the cognitive decline began.

If the physician suspects the cognitive decline is due to Alzheimer’s, he or she will order neuroimaging via magnetic resonance imaging (MRI) and computed tomography (CT). These tests gather information about the shape and position of brain tissue, as well as help rule out other diseases that have the same symptoms as Alzheimer’s, but require different interventions.

Once Alzheimer’s is diagnosed, first-line therapy includes medicine to prevent the breakdown of acetylcholine, a chemical messenger in the brain. Although these medications (known as cholinesterase inhibitors) may slow progression of the disease, they will not cure it. As the symptoms worsen, doctors may prescribe a medication called memantine to work alongside the cholinesterase inhibitors. In later stages, antipsychotics may be used to treat depression and to manage difficult behaviors that can present challenges for the patient, as well as their caregivers and physicians.

Early detection may allow a person to be involved in his or her own health care decisions.

Advantages of early detection

There currently is no cure for Alzheimer’s disease. However, early detection can be beneficial in the long run, and physicians urge families to consult a doctor before a family crisis occurs. Traffic accidents, wandering, or even loss of family finances due to poor decision-making are just some examples of problems that involve the entire family. Using proper medication early to control mild cognitive symptoms such as these may prevent a family crisis. Early detection may also allow the person to be involved in his or her own care decisions before severe cognitive decline sets in.

Studies indicate that aerobic physical exercise may be beneficial in reducing the risk of Alzheimer’s disease.

Preventing Alzheimer’s disease

It is not known whether Alzheimer’s can be prevented; however, research has shown that controlling cardiovascular health factors such as blood pressure, blood sugar, and cholesterol may play a role in the risk of developing Alzheimer’s.

Many people believe that cognitive exercises are important in warding off Alzheimer’s. However, it is difficult to design trials to measure cognitive benefit. New trials indicate that aerobic physical exercise may be more effective than cognitive exercises. In fact, studies have shown that physical exercise, including activities such as daily chores, reduces the risk of Alzheimer’s even in older individuals. (2)

Neuroimaging studies and genetic research remain essential in understanding the cause of Alzheimer’s disease.

The horizon of Alzheimer's disease

Because of the devastating effect of this disease, the push is on for research to better understand the underlying cause of Alzheimer’s. Neuroimaging studies remains essential in understanding the changes in brain structure before a noticeable decline in cognition occurs. The Alzheimer’s Disease Neuroimaging Initiative (ADNI) involves 60 centers across the US and follows individuals with mild cognitive impairment using neuroimaging studies. This initiative also tests for biomarkers that may allow for earlier detection and increased understanding about the disease. 

Dominantly Inherited Alzheimer Network

The Dominantly Inherited Alzheimer Network (DIAN) is a research partnership funded by the National Institute on Aging to study the gene mutations involved in early-onset Alzheimer’s. Although not as common as late-onset Alzheimer’s, people born with this gene mutation have a 50 percent chance of passing the gene on to their children. (3) Understanding the genetics behind early-onset Alzheimer’s will allow doctors to move forward in developing therapies to seriously delay outward symptoms of both types of the disease. The Indiana University School of Medicine is a participant in DIAN in support of the long term goal of improving Alzheimer’s treatments and quality of life for patients suffering from the disease.

Participants in DIAN

  • Indiana University
  • Washington University in St. Louis
  • Columbia University
  • University of California, Los Angeles
  • Brigham & Women's Hospital
  • Brown University
  • University of Pittsburgh
  • University College London
  • Neuroscience Research Australia
  • University of Melbourne
  • Edith Cowan University 

National Cell Repository for Alzheimer's Disease

Housed at the Indiana University Medical Center, the National Cell Repository for Alzheimer’s Disease (NCRAD) collects and distributes cells from people with Alzheimer’s. Since 1991, NCRAD has collected more than 12,000 samples that have been used worldwide in genetic research of Alzheimer’s disease. (4) Findings from this research have helped to understand the genetics of both the early and late onset forms of the disease.

Alzheimer’s is a devastating disease not only for the person experiencing cognitive decline, but for the families as well. Early detection and treatment can help lessen the burden. Further research in prevention and treatment of the disease continues in an attempt to better understand the changes in the brain that causes such devastating cognitive impairment.

References

1. http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf, accessed June 18, 2012.
2. Buchman AS, Boyle PA, Yu L, et al. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012; 78:1323-1329.
3. http://www.dian-info.org/faq.htm, accessed May 2, 2012.
4. http://ncrad.iu.edu/About/dna.asp, accessed May 2, 2012.

Tags: neurology, brain, alzheimers, memory, article
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Alzheimer’s Disease Today & Tomorrow

Inability to balance a checkbook, problems driving, poor decision-making, inappropriate word choice, becoming lost on familiar routes…these are just some of the symptoms of early Alzheimer’s disease. Alzheimer’s disease is the most common neurodegenerative disorder to cause impaired cognition. By the time a person reaches the age of 85, he or she has a 50 percent chance of developing Alzheimer’s. (1) Although current treatments cannot halt the progression of Alzheimer’s, early diagnosis and treatment can help patients and their families stabilize the symptoms over a longer period of time.

Diagnosing Alzheimer's disease

Alzheimer’s generally affects a person’s short-term memory first. Thus, doctors often begin the diagnostic process with neuropsychological testing to look for disruption in the person’s everyday activities. Doctors often rely on the input of someone close to the person, such as a family member or caretaker, who can help determine if a marked change in the person’s cognitive ability has occurred. People with Alzheimer’s lack insight into their disease and behavior, so the caretaker’s insight helps doctors more accurately pinpoint when the cognitive decline began.

If the physician suspects the cognitive decline is due to Alzheimer’s, he or she will order neuroimaging via magnetic resonance imaging (MRI) and computed tomography (CT). These tests gather information about the shape and position of brain tissue, as well as help rule out other diseases that have the same symptoms as Alzheimer’s, but require different interventions.

Once Alzheimer’s is diagnosed, first-line therapy includes medicine to prevent the breakdown of acetylcholine, a chemical messenger in the brain. Although these medications (known as cholinesterase inhibitors) may slow progression of the disease, they will not cure it. As the symptoms worsen, doctors may prescribe a medication called memantine to work alongside the cholinesterase inhibitors. In later stages, antipsychotics may be used to treat depression and to manage difficult behaviors that can present challenges for the patient, as well as their caregivers and physicians.

Early detection may allow a person to be involved in his or her own health care decisions.

Advantages of early detection

There currently is no cure for Alzheimer’s disease. However, early detection can be beneficial in the long run, and physicians urge families to consult a doctor before a family crisis occurs. Traffic accidents, wandering, or even loss of family finances due to poor decision-making are just some examples of problems that involve the entire family. Using proper medication early to control mild cognitive symptoms such as these may prevent a family crisis. Early detection may also allow the person to be involved in his or her own care decisions before severe cognitive decline sets in.

Studies indicate that aerobic physical exercise may be beneficial in reducing the risk of Alzheimer’s disease.

Preventing Alzheimer’s disease

It is not known whether Alzheimer’s can be prevented; however, research has shown that controlling cardiovascular health factors such as blood pressure, blood sugar, and cholesterol may play a role in the risk of developing Alzheimer’s.

Many people believe that cognitive exercises are important in warding off Alzheimer’s. However, it is difficult to design trials to measure cognitive benefit. New trials indicate that aerobic physical exercise may be more effective than cognitive exercises. In fact, studies have shown that physical exercise, including activities such as daily chores, reduces the risk of Alzheimer’s even in older individuals. (2)

Neuroimaging studies and genetic research remain essential in understanding the cause of Alzheimer’s disease.

The horizon of Alzheimer's disease

Because of the devastating effect of this disease, the push is on for research to better understand the underlying cause of Alzheimer’s. Neuroimaging studies remains essential in understanding the changes in brain structure before a noticeable decline in cognition occurs. The Alzheimer’s Disease Neuroimaging Initiative (ADNI) involves 60 centers across the US and follows individuals with mild cognitive impairment using neuroimaging studies. This initiative also tests for biomarkers that may allow for earlier detection and increased understanding about the disease. 

Dominantly Inherited Alzheimer Network

The Dominantly Inherited Alzheimer Network (DIAN) is a research partnership funded by the National Institute on Aging to study the gene mutations involved in early-onset Alzheimer’s. Although not as common as late-onset Alzheimer’s, people born with this gene mutation have a 50 percent chance of passing the gene on to their children. (3) Understanding the genetics behind early-onset Alzheimer’s will allow doctors to move forward in developing therapies to seriously delay outward symptoms of both types of the disease. The Indiana University School of Medicine is a participant in DIAN in support of the long term goal of improving Alzheimer’s treatments and quality of life for patients suffering from the disease.

Participants in DIAN

  • Indiana University
  • Washington University in St. Louis
  • Columbia University
  • University of California, Los Angeles
  • Brigham & Women's Hospital
  • Brown University
  • University of Pittsburgh
  • University College London
  • Neuroscience Research Australia
  • University of Melbourne
  • Edith Cowan University 

National Cell Repository for Alzheimer's Disease

Housed at the Indiana University Medical Center, the National Cell Repository for Alzheimer’s Disease (NCRAD) collects and distributes cells from people with Alzheimer’s. Since 1991, NCRAD has collected more than 12,000 samples that have been used worldwide in genetic research of Alzheimer’s disease. (4) Findings from this research have helped to understand the genetics of both the early and late onset forms of the disease.

Alzheimer’s is a devastating disease not only for the person experiencing cognitive decline, but for the families as well. Early detection and treatment can help lessen the burden. Further research in prevention and treatment of the disease continues in an attempt to better understand the changes in the brain that causes such devastating cognitive impairment.

References

1. http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf, accessed June 18, 2012.
2. Buchman AS, Boyle PA, Yu L, et al. Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology. 2012; 78:1323-1329.
3. http://www.dian-info.org/faq.htm, accessed May 2, 2012.
4. http://ncrad.iu.edu/About/dna.asp, accessed May 2, 2012.

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