Thursday, 29 December 2011

iPods Can Help People With Alzheimer's Remember

It's a diagnosis that we dread, both for our loved ones and ourselves: Alzheimer's disease. Although at first glance, it may seem that the disease has robbed a person of their sense of self, this is not always the case. Not all people with Alzheimer's and other forms of dementia entirely lose their sense of self. The feelings, emotions and memories of experiences that make them who they are may still reside inside of them. It's their ability to access this sense of self that now becomes the challenge.

Scientists at research organizations, such as the Institute for Music and Neurologic Function (IMNF), have been studying the effects of music on the human condition for more than 30 years. And results have been promising. Now, technology is playing a key role in helping people with Alzheimer's disease and other forms of dementia reconnect to their memories and their loved ones, if only for immediate and short periods of time.

As MP3 players such as the iPod have become more mainstream, they are being used as part of music therapy. A new program, called "Well-Tuned: Music Players for Health," is helping people who suffer from Alzheimer's disease ... and it is music to caregivers' ears.

Professionals from IMNF will work with caregivers to develop a play list of music that is emotionally significant to the person with dementia. The play list is customized based on the elder's life experiences, cultural backgrounds and frame of reference. As with lovers who grow sentimental when "their song" is played on the radio, the right music stimulates the personal associations that it is connected with, sparking memory and renewed "presence." It is best to select music that is familiar, enjoyable and meaningful to the elder with dementia.

How iPod music helps Alzheimer's patients with memory

Caregivers can also enhance the impact of the music with meaningful photos of family, friends or by telling family stories and talking about past events. Often, the music can spark memories that were thought to be long gone, or stimulate recognition of a loved one that moments earlier was no more than a blank face. Music may also help a person with dementia transition more easily throughout the day. Playing lively, upbeat music can be used as a stimulus to help motivate an elder to take a walk or participate in an activity. Alternatively, slower, more calming music will help relax an elder when they are agitated or help them wind down as bedtime approaches. The science behind music therapy has to do with the emotional connections we make to music throughout our life and where in the brain those connections live. Music stimulates the areas of the brain that are involved in emotion, association and long-term memory processes for people with Alzheimer's disease and other forms of dementia. As a result, musical selections that are linked to emotions and personal experiences can unlock memories and associations. Senior residential facilities, adult day care centers, and assisted living centers are now using music therapy as part of the residents' routine. For caregivers, seeing the light of recognition in a loved one's eyes is priceless.

(Source: By Dr. Concetta M. Tomaino,

How to Plan Meaningful Activities for Someone with Alzheimer's

A multitude of research studies have come out over the years, touting the benefits of keeping seniors with memory disorders physically and mentally active. But, coming up with activities to keep a person with Alzheimer's busy and engaged with life can be a tricky task for a caregiver.

There are a few things that you should keep in mind when considering various pastimes: First, as your loved one begins to forget who they are, it's all the more important that you remember, and try to present them with meaningful activities that echo their previous interests and talents.

It's also important to remember that, for many people with Alzheimer's and other memory-altering diseases, their desire to accomplish things doesn't vanish. Activities that can give an elderly loved one a sense of accomplishment may help stave off anxiety and depression.

Here are a few examples of easily-modifiable activities that may be good for seniors with Alzheimer's:

1. Stick to Simple Pleasures-Keeping things simple and straightforward is often the best course of action when coming up with activities for people with Alzheimer's. Going to a local park to feed the birds and fish is an easy task that may be very fun for a person with Alzheimer's. You can also take turns reading a favorite book aloud. This can be an easy way to encourage a senior to exercise their mind while giving them the pleasure of reading a beloved book.

2. Listen to Music-Research has shown that listening to music can help a person with Alzheimer's remember events, people, and places from their past. Additionally, music can be a way to get a senior moving through dance or song.

3. Cook and Clean-You can turn mundane, daily tasks into activities that a person with Alzheimer's can help with. Even if they just help with measuring ingredients, having a senior help you cook a family recipe can be a fun way for both of you to spend some time together. An elderly loved one might also be able to help you do things around the house like dusting or folding laundry.

4. Work Up A Sweat-Exercise provides countess benefits to all seniors, regardless of whether or not they have Alzheimer's. Workouts can consist of everything from talking a walk around the block to taking a yoga-for-seniors class.

5. Play A Game-While you probably don't want to start a game of Risk with your elderly loved one, it's possible to make an entertaining, personal game out of things lying around the house. Sorting through old family photos is a good way to help an elderly loved one remember special events and people from their past. You can even turn a routine trip to the grocery store into a scavenger hunt where you and your loved one search for particular items on a list.

6. Volunteer-Devoting time to helping other people can provide immense satisfaction to both you and your elderly loved one. Volunteering can involve something as simple as collecting things like school supplies, toys, canned goods, etc., and taking them to a local shelter or food bank. Seniors who can't leave the house could help by sorting, wrapping, or taking inventory of collected goods.

These activities will require varying levels of patience on the part of the caregiver. A loved one with Alzheimer's will not be able to perform tasks perfectly, if at all, and seniors are likely to get frustrated is an activity is too difficult. It will take constant trial and error to create and modify activities to meet an elder's shifting capabilities.

The Community for Family Caregivers is an online forum created to Support Caregivers of Elderly and Aging Parents. The material of this web site is provided for informational purposes only. does not provide medical advice, diagnosis or treatment; or legal, financial or any other professional services advice.

(Source: By Anne-Marie Botek, 14 December 2011,

New Research Focuses on Lowering Levels of Beta Amyloid

Mounting evidence suggests that beta amyloid accumulation in the brain is an early biomarker and a critical event in the early progression of Alzheimer's. Researchers are targeting amyloid-based therapies to be given in earlier stages of the disease, perhaps even before symptoms emerge. While more research is needed, some scientists believe these therapies could reduce the risk of, and possibly prevent, cognitive impairment and dementia.

Researchers Look to Disease-Modifying Therapy to Ward Off, Possibly Prevent Alzheimer’s Disease

Just as statins help lower high cholesterol levels to reduce the risk of heart attacks, researchers are seeking a comparable approach for people with large amounts of beta amyloid, an abnormal protein in the brain commonly found in Alzheimer’s disease patients. Medicines would clear those proteins before any signs of memory loss or other early symptoms of Alzheimer’s appear.

Could amyloid-based drugs given at much earlier stages of Alzheimer’s-even before any clinical symptoms begin-reduce the risk and possibly prevent the emergence of cognitive impairment and dementia?

That is the central question of a provocative commentary in the Nov. 30 issue of Science Translational Medicine, written by a trio of researchers who cite how Alzheimer’s, which affects more than one out of every 10 individuals over the age of 65, is the only leading cause of death for which no disease modifying therapy exists.

Currently, most proposed Alzheimer’s drugs are tested in patients in the later stages of the disease, because no reliable medical test, brain imaging or other method currently exists to accurately detect the disease before initial symptoms appear. Recent clinical trial failures at the dementia stage have raised multiple questions about the current development of disease-modifying therapies, prompting a strategy to begin developing and testing drugs aimed at the initial stages of the disease rather than at the end stage of the illness.

Mounting evidence, the authors note, from natural history studies supports amyloid beta accumulation in the brain as an early biomarker and a critical event in the early progression of Alzheimer’s. Already, some studies have shown that a person’s brain may be damaged at least a decade prior to the first signs of Alzeimer’s symptoms. More than 50% of certain brain cells are already lost by the time a patient shows even the mildest cognitive impairment.

However, it remains unclear whether the buildup of amyloid beta protein (which accumulates in the areas of the brain responsible for learning and creating, retaining and extracting memories) is an early symptom or a cause of the disease. Several small monoclonal antibody studies that reduced the amyloid plaque burden have not shown any clear benefit in the limited number of patients treated at stages of mild to moderate dementia.

Titled “Testing the Right Target and Right Drug at the Right Stage,” the authors suggest specific amyloid-based therapies be directed at much earlier stages of Alzheimer’s-perhaps even before the emergence of clinical symptoms. “Furthermore, we argue that the field has sufficient tools to being secondary prevention trials—those conducted after the disease process has begun in hopes of preventing the emergence of symptoms—in asymptomatic individuals who are at risk for the progression of cognitive impairment and AD dementia.”

Still, one-third of the nation’s aging baby boomers show no signs of Alzheimer’s despite an amyloid burden, prompting the researchers to ask, “How do older individuals spend years with a ‘head full of amyloid’ and remain apparently healthy? Is amyloid ‘necessary but not sufficient’ to result in cognitive impairment?”

Clinical trials to test whether specific drugs can head off the disease at various stages of Alzheimer’s, and thinking about the disease in terms of primary, secondary and tertiary prevention, rather than lumping together all disease modifying treatments, is a first step.

The article’s lead author, Reisa Sperling, M.D., an Alzheimer’s specialist at Brigham and Women’s Hospital in Boston, said she hopes to launch a three-year study of an amyloid clearing medication in 1,000 patients age 70 or older who have no Alzheimer’s symptoms but have amyloid plaque in their brains. The clinical trial also would be a milestone as the first known anti-amyloid drug given to people without Alzheimer’s symptoms.

Dr. Sperling’s plan, which requires major government and industry funding, is among a trio of academic plans to pursue comparable research in populations not diagnosed with dementia, with a goal of launching studies next year, according to Maria Carrillo, M.D., senior director of medical and scientific relations for the Alzheimer’s Association.

"Although nothing is programmed or funded yet, we are having discussions with federal regulators, the National Institutes of Health and various experts, and I think in 2012 we may see the first clinical trials,” said Carrillo, adding that both the FDA and the EMA are involved in the discussions of pre-dementia clinical studies.

She also is optimistic that by next June the FDA could approve a brain imaging product for early amyloid plaque detection that possibly could rule out Alzheimer’s in those with no signs of the amyloid protein in their brain scans.

“The analogy with statins, where you are treating populations with no symptoms early on, is a good one,” said Carrillo, “because we can change the course of Alzheimer’s disease to where it can be delayed, detected early, understanding changes without cognitive impairment—even avoided altogether.”

(Source: By Ronald Rosenberg, 19 December 2011, Alzheimer’s Association)

Tuesday, 27 December 2011

Early Detection May Delay Alzheimer's Development Among Patients

A Researcher has found A New Way To Approach Early Detection of Alzheimer's Disease.

The researcher at the University of the Basque Country (UPV/EHU) Xabier Elcoroaristizabal is looking for complementary genetic factors.

One of our genes is apolipoprotein E (APOE), which often appears with a variation which nobody would want to have: APOEe4, the main genetic risk factor for sporadic Alzheimer's disease (the most common form in which this disorder manifests itself and which is caused by a combination of hereditary and environmental factors).

It is estimated that at least 40 percent of the sporadic patients affected by this disease are carriers of APOEe4, but this also means that much more still remains to be studied.

Elcoroaristizabal has opened up a channel for making a start by analysing candidate genes, which always in combination with APOEe4, could help to explain more cases.

The long-term aim is to contribute towards the early detection of Alzheimer's disease by identifying signs that could be detectable in the very early phases. And, as Elcoroaristizabal explains, while there is no cure for this disorder, the alternative is to get ahead of it and delay its development.

"Certain preventive measures involving cognitive stimulation delay its appearance. There are even new drugs that could start to be used earlier. Today there is no solution, but the more we maintain a person's correct cognitive state, the better," he said.

The individuals who develop Alzheimer's go through a transition period first of all, and this could be the key moment for the effective application of preventive measures. This is mild cognitive impairment (MCI), in which slight cognitive alterations take place but do not affect everyday activities.

Among the different types of MCI, one affects memory almost exclusively (amnestic MCI), and those people who suffer from it have a high probability of developing the disorder. The difficult and interesting part is knowing which genetic components are linked to this impairment and also in determining by what percentage the risk of developing the disease increases, a task which Elcoroaristizabal has set himself.

"If we can identify which genes are involved and what susceptibility factors there are, preventive measures could be taken," he said.

So a contrast study has been carried out among a sample of patients with MCI, ones with Alzheimer's and healthy people. This can be used to observe the changes and narrow down the field for the zones to be studied, so that candidate genes can be sought there.

Elcoroaristizabal himself notes one example among the many others identified.

"It has been observed that the brain's capacity to control cholesterol levels seems to play a key role throughout the illness. So, protein encoding genes linked to this control have been analysed," he claimed.

In this quest for candidate genes, Elcoroaristizabal has confirmed that the APOEe4 genetic variation is, in fact, the main risk factor for developing Alzheimer's disease. But it does not end there; he has identified several genes which, as long as they are manifested in combination with APOEe4, could take us one step further towards the early detection of this disorder.

"Genes that in some way are connected with neurotransmission channels, oxidative stress or the effectiveness of oestrogens seem to be linked to a greater risk for APOEe4 carriers," he explains. Specifically, the candidate genes are as follows: COMT (neurotransmission), SOD2 (oxidative stress elimination) and ESR1 and ESR2 (oestrogen action facilitators).

His thesis is entitled 'Molecular markers in mild amnestic cognitive impairment and Alzheimer's disease' (Marcadores moleculares en deterioro cognitivo leve tipo amn sico y enfermedad de Alzheimer). An initial article on this can be read in the Journal BMC Neuroscience.

The study has been published in the Journal BMC Neuroscience (ANI).

(Source: ANI, 24 December 2011)

Alzheimer's Association® Successfully Advocates on Behalf of Constituents to Secure Funding for Alzheimer's Research and Programs

Funding includes dollars for innovative Alzheimer's research and successful public private partnerships with the government to provide care and support to families

As the world's leading voluntary health organization advocating for Alzheimer's care, support and research, the Alzheimer's Association is pleased that Congress and President Obama have responded to calls by the Alzheimer's Association on behalf of people with Alzheimer's disease, caregivers, health professionals and researchers, to provide federal funding for several programs critical to the Alzheimer's community.

The Fiscal Year 2012 Omnibus Appropriations bill, that was passed last week and signed by President Obama today, includes funding for the National Alzheimer's Project Act (NAPA) Advisory Council on Alzheimer's Research, Care, and Services. NAPA mandates the development of the first-ever national plan to address the rapidly escalating Alzheimer's crisis and coordination of Alzheimer's disease efforts across the federal government. One year after enactment of NAPA, the Association is delighted that Congressional Appropriators supported the intent of Congress for robust implementation of the statute by providing $250,000 in funding for the Advisory Council. Leadership and foresight by Senate Labor, Health and Human Services, and Education Appropriations Subcommittee Chairman Tom Harkin (D-IA), Ranking Member Richard Shelby (R-AL), House Labor, Health and Human Services, and Education Appropriations Subcommittee Chairman Rep. Denny Rehberg (R-MT) and Ranking Member Rosa DeLauro (D-CT) is appreciated by the Alzheimer's Association and the millions impacted by this fatal disease.

"It is clear that the Alzheimer's Association's efforts on behalf of people living with Alzheimer's disease, families and health professionals, are being heard. We urgently need funding that will provide us with a greater understanding of Alzheimer's as well as provide care and support to those currently impacted," said Robert Egge, Vice President of Public Policy for the Alzheimer's Association. "Our hope is that the priority placed on Alzheimer's disease by the federal government will continue to increase to a level that is proportionate to the human and financial toll of this disease."

Continuing to set an example for successful programs, Congress intends to fund the National Alzheimer's Call Center, which is a helpline run by the Alzheimer's Association that is available 24-hours a day, 7 days a week to provide crisis counseling, care consultation, and information and referral services in 140 different languages for people with the disease, caregivers, families and professionals and all those impacted. Historically, federal funding for the National Alzheimer's Call Center has been included in the annual appropriations bill at $1 million. This productive private-public partnership has included a matching investment by the Alzheimer's Association to ensure effective support for people impacted by Alzheimer's disease. The Association is pleased that the program was included in the Administration on Aging (AoA) Aging Network Support Activities program for Fiscal Year 2012. While the specific funding level was not enumerated in the Omnibus bill, the intent of Congress is to continue this successful program.

Critical to changing the trajectory of Alzheimer's disease is research, and because of the Alzheimer's Association's advocacy efforts, an additional $12 million was directed to the Department of Defense (DoD) Peer-reviewed Alzheimer's Research Program. Established eight months ago with $15 million, the program focuses on innovative and outcome-oriented research that is relevant to military personnel and the Alzheimer's community. As a result, the well-designed and results-oriented program received strong support from House Defense Subcommittee Chairman C.W. Bill Young (R-FL) and Ranking Member Norm Dicks (D-WA), Congressman Jim Moran (D-VA) and Congressman Steve Israel (D-NY) helping to drive the added investment to continue this important program for Fiscal Year 2012. Their thoughtful leadership is valued by the Alzheimer's Association and our constituents.

In addition, on the research front, extensive advocacy by the Alzheimer's Association was successful in ensuring that biomedical research remains a priority. The National Institutes of Health (NIH) saw an additional $299 million added to their budget, bringing the total to $30.6 billion. The bill also established for the first time the new National Center for Advancing Translational Sciences (NCATS). As part of the funding directed to the NIH through the Omnibus spending bill, $10 million was designated for a new program within NCATS – the Cures Acceleration Network (CAN). NCATS and CAN will provide vital new approaches to moving high need medical cures through the drug development pipeline faster. Given the estimated 5.4 million Americans living with Alzheimer's disease and 16 million people projected to have the disease by mid-century, according to the Alzheimer's Association's 2011 Alzheimer's Disease Facts and Figures report, these innovative processes are an important opportunity for Alzheimer's biomarker and early detection research. The funding commitment to the NIH, along with the Agriculture Appropriations bill passage in November, that provided the Food and Drug Administration (FDA) funding at $2.5 billion (a $50 million increase over FY11), will support critical FDA responsibilities, including the review of potential breakthrough therapies and diagnostics for those with Alzheimer's disease.

"Hope of changing the trajectory of Alzheimer's lies in the discovery of effective treatments and identifying Alzheimer's at an early pathology point," said William Thies, chief medical and scientific officer of the Alzheimer's Association. "NIH, FDA and DoD funding for Alzheimer's must increase as a national priority so that we can advance medical progress, improve the lives of people with Alzheimer's and reduce cost incurred by the federal government in the future."

Funded at the same level as the previous year, the Healthy Brain Initiative at the Centers for Disease Control and prevention (CDC) is another example of successful public-private partnership between the Alzheimer's Association and the federal government. Created by Congress in fiscal year 2005, the partnership between the CDC and the Alzheimer's Association educates both the public and health professionals about ways to reduce the risk of developing Alzheimer's by maintaining a healthy lifestyle.

The Alzheimer's community also saw a significant decrease in State grants to support community programs for the coming year, with only $4.018 million being designated for the Alzheimer's Disease Demonstration Program at the AoA. The Alzheimer's Association is disappointed to see a 65 percent cut to a program that helps develop innovative and evidence based approaches to helping people with the disease and their families.

Alzheimer's Association
The Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. For more information, visit

(Source: Washington, 23 December 2011 - PRNewswire-USNewswire.)

Friday, 23 December 2011

Thinner Brains Could Signal Alzheimer's, Study Suggests

New research suggests that the outer edges of the brain are thinner in older people who may be destined to develop Alzheimer's disease, but there's currently no way to use the information to help people fend off dementia.

Still, the findings could help researchers test Alzheimer's medications by allowing them to track the progression of the disease, said study co-author Dr. Brad Dickerson, an associate professor of neurology at Harvard Medical School.

Alzheimer's disease is the sixth leading cause of death in the United States, according to the Alzheimer's Association, and the number of deaths has risen in recent years. There's no cure for the disease.

In the new study, researchers focused on the thickness of the edges of the brain, known as the cortex. "We're looking at the parts of the cortex that are particularly vulnerable to Alzheimer's disease, parts that are important for memory, problem-solving skills and higher-language functions," Dickerson said.

Previous research found that several areas of the cortex were smaller in people with dementia from Alzheimer's. "It's like an orange that's shriveling. The thickness of the outer skin might get thinner as it dries out," Dickerson said.

In the new study, researchers examined the MRI brain scans of 159 people with an average age of 76; about half were men. Three years later, the participants took tests designed to measure how their brains were functioning.

The findings appear in the 21 December 2011 online issue of the Journal Neurology.

The 15 percent of participants with the thinnest brain areas performed the worst on the tests: About one in five of them experienced cognitive decline. They also showed increases in signs of abnormal spinal fluid, a possible sign of developing Alzheimer's disease.

"That suggests they may be developing symptoms," Dickerson said.

A lower number - 7 percent - of the participants in the middle range of brain thinness experienced cognitive decline. None of the people with the least thin brain areas developed problems.

So are the scans appropriate as tools to figure out whether patients are on the road to Alzheimer's?

Cost doesn't appear to be a major challenge at this point. It's not clear how much the MRI scans might cost at doctor's offices, Dickerson said. However, they're only a few hundred dollars each in the research world.

Also, many older people already receive MRI scans of the brain for other reasons, said Dr. Raj Shah, medical director of the Rush Memory Clinic, in Chicago.

But with no cure for Alzheimer's, the best use for the scans will be to help researchers figure out if medications work, Dickerson said.

Cathy Roe, an Assistant Professor of Neurology at the Knight Alzheimer's Disease Research Center at Washington University School of Medicine, in St. Louis, said the findings could have value down the line. "Right now, there is not much we can do to delay the progression of dementia," said Roe, who's familiar with the findings. "But once effective treatments are identified, this research could help to identify which patients should receive that treatment and when they should receive it."

(Source: HealthDayNews, 21 December 2011)

Wednesday, 14 December 2011

ADI Newsletter "Global Perspective" December 2011 Issue, Vol. 21 No. 4

Dear Caregivers/Members,

The December 2011 Newsletter "Global Perspective" from the Alzheimer's Disease International (ADI) is now available online, click at:
Global Perspective, December 2011 Vol. 21 No. 4

This issue includes:
* World Alzheimer's Day 2011
* Launch of the World Alzheimer Report 2011
* Antipsychotic drug treatment for dementia symptoms


Monday, 12 December 2011

Alzheimer's Australia, Bupa Health Launch Brain Health App in the UK

The Bupa Health Foundation and Alzheimer's Australia have announced the UK launch of a world-first brain health app, the latest digital tool to help in the fight against dementia.

Based on latest research that links brain health and a reduced risk of dementia, to a healthy heart and cardiovascular system, 'BrainyApp' is the first dementia risk reduction iPhone app designed to help people monitor and improve their brain-heart health.

The new app, which was designed by Alzheimer's Australia and Bupa Health Foundation, has already knocked Facebook off the number one spot in the Australia and New Zealand Top Free Apps list and has clocked up more than 130,000 downloads down under.

Now available to people in the UK, 'BrainyApp' helps users monitor and improve the physical, mental, dietary and social aspects of their lifestyle.

There are currently 750,000 people living with dementia in the UK and this is predicted to rise to over a million by 2021. Delaying the onset of dementia by just five years would reduce deaths directly attributable to dementia by 30,000 a year.

Jeremy Hughes, Chief Executive, Alzheimer's Society, said: "Most people know how to reduce their risk of heart disease, diabetes and stroke but they don't realise that the same healthy lifestyle choices may also lower the risk of developing Alzheimer's disease and other kinds of dementia. The idea is that what is good for the heart is also good for the brain."

'BrainyApp' allows users to take a brain-heart health survey about their diet, exercise patterns and lifestyle. It then provides suggestions and ideas about how to make improvements to each. It also includes all-new brain games, and encourages users to build brain-heart points by staying physically and mentally active, socialising with friends and family, and sharing their progress on Facebook.

One of the brain games - 'Word Tennis' - requires players to unscramble anagrams in order to move a paddle and hit a ball back to their opponent.

Director of Dementia Care for Bupa Care Services, Dr Graham Stokes, said: "There is evidence to show that keeping the mind exercised can stave off the onset of dementia but 'BrainyApp' highlights that good physical health also has a part to play. Best of all it's good fun."

'BrainyApp' is available as a free download for users of iPhone, iPod and iPad devices from the App Store. There are plans to develop an Android version in early 2012.


App Features:

1. Brain health survey – see what your brain health score is and receive personalised recommendations on what you can do to improve your brain health.
2. Brain games – give your brain a work out with interesting and challenging games.
3. Activities – add to your brain health points with a range of activities including exercise, eating well, getting health checks, keeping your mind active and managing your smoking and alcohol intake.
4. Monitor your Brain Health Points and track your progress over time.
5. Get a daily fact sent to you from BrainyApp.
6. Share facts and your brain health scores with friends and family.

Watch Video : Alzheimer's Australia-2011 BrainyApp Info

(Source: Bupa Health Foundation, Published on December 6, 2011)

Friday, 9 December 2011

The Latest Brain Discoveries From Alzheimer's to Autism to Stroke

The brains of the mice that Bradley Hyman keeps in his sprawling lab at an old naval base in Boston offer a window, literally and figuratively, into the mysterious damage that causes Alzheimer's disease. When each mouse reaches a few months of age, one of the lab workers carefully creates an opening in its skull and places a tiny glass window over the hole. Day after day, week after week, a powerful microscope is trained on the brain, searching for ugly clumps of sticky protein fragments like those that litter the brains of elderly people who have died of Alzheimer's. "It's like time-lapse photography," says Hyman, director of the Massachusetts Alzheimer's Disease Research Center at Harvard Medical School. When the ugly plaques appear—and they always do, as the mice carry genes engineered to produce them—nearby brain cells begin to wither and die, interrupting the flow of information. Next, waves of cells die off.

Hyman's microscope is one of several new technologies that promise to revolutionize the struggle to understand and beat Alzheimer's, which now afflicts more than 5 million Americans. Worldwide, a staggering 1 percent of all economic output is spent caring for and treating people with it and other types of dementia, according to Alzheimer's Disease International, the umbrella group of Alzheimer's associations around the globe. Meanwhile, just four drugs have been approved by the Food and Drug Administration to battle the disease, and all address symptoms only, not the poorly understood causes. Over the past decade, billions of dollars have been poured into researching drug after initially-promising drug, and nearly all have been disappointing in large clinical trials.

"When you can watch the brain over time, we see now, we didn't have the details right," says Hyman, who holds out great hope that his microscope studies will help correct that. One assumption has been that the plaques themselves, accretions of a protein fragment called beta amyloid, harm the brain. Instead, it appears that the individual sticky strands that eventually form the plaques damage neurons, and that the plaques are a sign of a brain long under siege.

For years, researchers have debated whether the brains of people who develop Alzheimer's produce excess beta amyloid or they're simply bad at clearing it. In December, researchers at Washington University School of Medicine in St. Louis provided strong evidence for the latter theory. They measured radioactively labeled beta amyloid visible in the spinal fluid of healthy older adults and people with Alzheimer's. Both groups appeared to produce the same amount, but the ill individuals cleared the substance from their brains into their spinal fluid at a rate about 30 percent slower. Moreover, since autopsy studies find that some people with no cognitive symptoms of Alzheimer's carry a substantial plaque load, the body may possess a varying capacity to withstand beta amyloid's assault.

Following on the success of periodic cholesterol testing, which has revolutionized heart care, researchers are experimenting with measuring beta amyloid via brain scans, spinal taps, and blood tests. Early results offer hope that, someday, physicians will be able to screen the middle-aged for the hallmarks of pre-Alzheimer's. "It's critical to identify people at risk," says Reisa Sperling, who is using brain PET scans of beta amyloid at Brigham and Women's Hospital in Boston to study the impact in people who are not showing symptoms. She's concerned that right now drug treatment starts five or 10 years too late. An FDA advisory committee recommended in January that the agency approve a PET scan that could be helpful in diagnosing people who already have the plaques.

Of course, without effective drugs, early detection offers little solace. Most of the recently failed drugs aimed to interrupt production of beta amyloid by blocking the enzyme that produces it. However, researchers have opened a new front in the battle, targeting the synapses between neurons, which new research shows may be the first structures to deteriorate. Another approach, based on the theory that the body must have natural defenses if most people don't get Alzheimer's, seeks to train the immune system to attack beta amyloid. But all of the new drugs have been given to patients who already show cognitive symptoms. Adrian Ivinson, director of the Harvard NeuroDiscovery Center, which focuses on degenerative brain diseases, thinks some of the failed drugs should be retested in asymptomatic individuals who show beta amyloid on brain scans or in spinal fluid tests. "The implication of all this work is we have to get [the drugs] into people before they're patients," he says. "They have a silent disease."

What about prevention? There is accumulating evidence that exercise, eating fish or other sources of omega-3 fatty acids, and remaining intellectually and socially engaged throughout life reduce the risk of Alzheimer's. But last year a panel assembled by the National Institutes of Health concluded that the evidence on lifestyle interventions is inconsistent and inconclusive, pretty much across the board. "There are suggestions that some things might be effective, but there isn't strong, high-grade evidence for any of them," says Neil Buckholtz, chief of the dementias of aging branch of the National Institute on Aging. The NIA is now running several large studies to see if exercise, diet, or social or intellectual engagement will reduce risk.

Having had a stroke substantially raises the odds of Alzheimer's, as does having diabetes. But the biggest known risk factor is one people can do nothing about: a family history of the disease. People carrying one copy of variations in a gene called APOE are at about a threefold risk, while those carrying two copies have a whopping 12-fold risk. But it appears possible now that many genes, perhaps even a hundred, may each confer a tiny increased risk of developing Alzheimer's. Still, Rudy Tanzi, an Alzheimer's geneticist at Harvard Medical School, is hopeful that by 2020, a screen of a person's genome will reliably estimate his or her risk of developing the disease. Ideally, the people at highest risk will then have scans or spinal fluid or blood tests regularly to detect accumulating beta amyloid. Once it is seen, they'll begin taking the equivalent of a "statin for the brain" to reduce the load. And Alzheimer's will become as preventable as heart disease is today.

(Source: US News & World Report, By Brian Vastag, Kathryn Roethel, Angela Haupt, Donna Banks, Keith Sinzinger, December 7, 2011)

Breakthrough Closer for Alzheimer's Treatment After Vaccine Success

AUSTRALIAN researchers have proved that an Alzheimer's vaccine could halt the disease – and even see the return of some losses – well after the symptoms first appear.

Lars Ittner from the Alzheimer's and Parkinson's disease laboratory at Sydney University said it was the first time researchers had proved a vaccine targeting the tau protein in mice could be effective after the disease had set in.

Tau proteins stabilise microtubules, which help maintain cell structure. When defective, they can result in dementias such as Alzheimer's disease.

Professor Ittner said targeting the tau protein in younger animals before the onset of the disease was a different approach, as most researchers worked with animals after the onset of Alzheimer's.

"What we tried to do was to work with older mice with a lot of damage," he said. "Because in people, by the time they realise their symptoms are Alzheimer's, a lot of the damage has already been done."

In a paper in the scientific journal PLoS ONE today, the research team says the novel approach worked, producing some of the most improved results recorded in mice with advanced dementia.

"The older group with the very advanced Alzheimer's actually benefited the most," Professor Ittner said.

While human trials are at least five years away, he said such positive results from the animal trials were a surprise.

Three groups of mice were used in the study. Each group was formed according to age – six months, 12 months and 18 months. The older the group, the more advanced the the stage of Alzheimer's disease.

The mice were treated for 10 months and assessed at the end of that period. Professor Ittner said there were also signs the animals had regained some losses such as weight loss and activity levels.

"But this was limited as, when there's damage to a neuron, it's gone. It doesn't regenerate," he said.

The team, which is already collaborating with the US pharmaceutical industry in the quest to develop a vaccine, aims to create a monthly injection which would become part of a broader treatment of the disease.

According to Alzheimer's Australia about 269,000 Australians live with dementia. Without a significant medical breakthrough, it is forecast about 981,000 Australians will be living with dementia by 2050.

Dementia is used to describe a large group of illnesses which cause a progressive decline, including a loss of memory, intellect, rationality, social skills and physical functioning. Alzheimer's disease is the most common form of dementia, accounting for up to 70 per cent of cases.

Also read -> Alzheimer's vaccine cures memory of mice

(Source: Bridie Smith, Sydney Morning Herald, December 9, 2011)

Wednesday, 7 December 2011

Latest Study : Risk for Dementia Rises When Diabetes, Depression Meet

When people with type 2 diabetes also struggle with depression, their odds for a third worrisome condition - dementia- goes up markedly, a new study suggests.

Specifically, patients with type 2 diabetes are twice as likely to develop dementia three to five years after being diagnosed with depression compared to nondepressed people with diabetes, researchers found.

"We've known for years that diabetes is a risk factor for dementia," explained study lead author Dr. Wayne Katon, a professor and vice chair of the department of psychiatry and behavioral sciences at the University of Washington's School of Public Health in Seattle. "In fact, having diabetes itself probably doubles the risk for dementia," Katon added.

"We've also known that a very common accompanying condition with diabetes is depression," Katon said. "Some 20 percent of diabetics have depression. And now our data suggests that if you do have depression in addition to diabetes, it actually doubles again the already increased risk for dementia that diabetic patients face."

However, the study authors noted that the absolute risk of dementia for any one person with depression and diabetes remains relatively small - about one in 50.

Katon and his colleagues published their research, which was supported by the U.S. National Institutes of Health-funded Diabetes & Aging Study and the Diabetes Study of Northern California, in the Dec. 5 online edition of Archives of General Psychiatry.

The authors noted that depression and diabetes are among the most prevalent health issues facing American seniors.

What's more, each of the two conditions seem to independently raise the risk for developing the other: Being diabetic bumps up the likelihood of becoming depressed, while being depressed boosts the risk for developing diabetes.

In the new study, the researchers focused on more than 19,000 California residents with diabetes between the ages of 30 and 75.

Nearly one in five of the patients were also deemed to be experiencing "clinically significant" depression, the authors noted.

After monitoring for the onset of dementia over a three- to five-year period, the research team found that just over 2 percent of those who had both diabetes and depression went on to develop one or more forms of dementia, including Alzheimer's disease.

By contrast, just 1 percent of patients who had diabetes alone ended up developing dementia during that period.

But the authors also noted that many of the things that can boost the odds for depression among diabetic patients, such as eating a poor diet, maintaining a sedentary lifestyle and/or smoking, are modifiable behaviors. This means that patients and physicians alike have some clear targets for interventions to lower depression risk, and possibly dementia risk as well.

"So the important thing to focus on here is that there are very effective treatments for depression," said Katon. "And so if you're a diabetic who does have depression it's very important to get it attended to. Just as important as getting your diabetes itself treated."

Dr. Robert Friedland, chair of neurology at the University of Louisville School of Medicine in Louisville, Ky., agreed.

"It is not surprising that they should find a relationship between depression in diabetics and a higher risk for dementia," he said. "But I would point out that although both diabetes and dementia have genetic influences, there are also clear things people can do to lower their risk for both. For example, avoiding obesity by eating a relatively low-fat diet and engaging in regular physical exercise can help to prevent both diabetes and depression. And, therefore, dementia as well."

There's more on the diabetes-depression link at the American Diabetes Association.

(Source: HealthDay News, 5 December 2011)

Tuesday, 6 December 2011

How to Respond to Wandering Attempts in Alzheimer's

What should you say or do if someone with Alzheimer's or another dementia is trying to wander away? For example, imagine that your father with dementia, who is living with you in your home, starts to pace around and try to go outside. Here are some practical approaches you may utilize in response.

5 Strategies to Employ:

1. Ask Him Questions In A Non-Threatening Manner
Ask him how you can help and where he's going. Perhaps he's just a bit restless and unsettled. Maybe he'll respond with an answer that will give you insight into what he's looking for or where he wants to go.

2. Don't Argue
It's almost universally not helpful to argue with someone with dementia who is intent on doing something. Arguing will likely increase his agitation because in his reality, what you're saying doesn't make any sense. Rather, just talk with him and validate3 his feelings. For example, if he is talking about needing to go to work, ask him about his job. You can ask him what he liked the most about his job, or talk about the benefits of retirement.

3. Remember Your Non-Verbals
If you're standing there with your hands on your hips and a frustrated look on your face, you'll have less success in persuading your loved one to do anything. The words that you speak may or may not make sense to him, but your body language will send clear messages to him. Speak in a calm tone of voice and smile. Be gentle, and if physical touch is something your dad is used to, a little pat on the shoulder or holding of his hand may reassure h

4. Distract
Distraction is often very effective. You can ask him to eat a bite of dinner before he leaves, for example. You could also let him know that he may need to return to his room to grab his sweater or jacket before he leaves. Perhaps there's a football game on tv you can flip on when he returns with his sweater. Or, you can remind him that his friend Joe may be stopping by to chat with him so he may want to stay home for his visit.

5. Walk With Him
If it's a nice day, take a break from what you're doing and go with him. I realize that the timing may not always be ideal, but perhaps he simply needs to go for a walk. Take your cell phone with you before you leave in case he's unwilling to come back home with you or is too tired to walk any further.

What if it's cold or raining out and your father still is agitated and determined to go outside?
Grab a jacket for both of you, go outside and walk with him. I've seen many people with Alzheimer's walk for a brief time outside, turn to their loved one who came out with them and say, "Let's go inside. It's cold out here!" Again, take your cell phone or notify someone that you're going for a walk with him.

(Sources: By Esther Heerema, Guide, Updated December 01, 2011)

Monday, 5 December 2011

How To Control Alzheimer's Wandering

Alzheimer's disease causes sufferers to become disoriented, confused and afraid. The disease can erase memories of once-familiar surroundings, and as a result, Alzheimer's patients often wander away from home. In fact, the Alzheimer's Association estimates that 60% of Alzheimer's patients wander away from home. The stress can weigh heavily on caregivers and family.

It is not possible to completely prevent wandering in people with Alzheimer's and dementia, but caregivers can minimize the risk.

Here are some techniques to try:

1. Install Wandering-Prevention Locks
Install locks and escape prevention devices on doors, windows and gate. These products require complex maneuvers to open doors, thus making it difficult for Alzheimer's and dementia patients to leave. For example, if your loved one tends to unlock doors, install sliding bolt locks out of your loved one's line of sight.

2. Install Alarms
There are many wandering prevention alarms on the market that can alert you that your loved one is trying to get out. These devices include motion detectors, pressure-sensitive alarm mats at the door, and warning bells on doors.

3. Disguise Escape Routes
Camouflaging doors and windows inhibits the Alzheimer patient's ability to find a way out. Paint doors the same color as walls, or hang curtains on windows that match the color of walls, so they blend in with surroundings, and make them less visible.

4. Provide A Safe Place To Wander
Provide a safe place in your home or yard for walking or exploration — such as a path through the rooms of your house or a circular trail through a fenced backyard.

5. Use Visual Cues
People who have Alzheimer's often forget where they are, even inside their own homes. Visual reminders provide clues and trigger memories. For example, post descriptive photos on the doors to various rooms, such as the bathroom, and kitchen. Even Stop signs at doors have been reported to help.

6. Look for Triggers and Plan Distractions
Many people with Alzheimer's disease have a pattern to their behaviors. Watch for triggers, such as a certain time of day. (Many people with Alzheimer's become agitated or fear just before or after sundown, known as Sundowner's syndrome) If your loved one tends to wander at the same time every day, a planned activity at that hour could stem the wandering.

7. Hide keys
In addition to wandering on foot, people with Alzheimer's might attempt to drive. Store and hide keys to cars and doors. Also, keep coats and shoes out of sight.

8. Warn Neighbors and Authorities
Caregivers often don't know their loved ones are missing before someone finds them. If neighbors are made aware of the situation, they can be on the look-out. Notify neighbors and police and make sure they have your contact information.

9. Use A Tracking Device
If your loved one wanders, a GPS or radio frequency device can help emergency personnel, find him or her quickly. The Alzheimer's patient wears a bracelet or ankle tracking device - a personal transmitter that tracks the person's location. Many communities have a program called Project Lifesaver, (link to Project Lifesaver article) to track and locate wanderers. Check with your police station to find out if a program is available in your area.

10. ID Bracelets
The Alzheimer's Association operates a nationwide identification system called Safe Return . The person with Alzheimer's wears an engraved ID bracelet or necklace with a phone number to call if they're found. Their name is entered into a national database, where anyone can call 24 hours a day.

11. Prepare for A Search
Keep a recent photo and detailed physical description of the person readily available. Also have medical and health information, and vehicle information on hand.

(Source: By Marlo Sollitto,

How-To Take the Stress Out of Getting Dressed with Dementia

Alzheimer's can turn even the simplest of tasks into great trials. In the middle and later stages of the disease, many people have difficulty dressing themselves.

Here are a few pointers to help simplify the task of helping a person with Alzheimer's get dressed.

1. Shop Together
If at all possible you should take the person with Alzheimer's disease when you shop for their clothes. Letting them select some of their favorite items will make the new clothes seem familiar and they will be more likely to wear them.

2. Buy Duplicates
If your parent often insists on wearing that "favorite outfit" constantly, consider buying several identical sets.

3. Look for Simplicity
Choose clothing that is easy to get on and off. Elastic waists and Velcro enclosures minimize struggles with buttons and zippers.

4. Give Them Choices
This can be tricky because a person with dementia can have trouble making decisions if there are too many options present. To avoid frustration and potential tantrums, give them a few choices, preferably no more than three. Lay out the clothes on a bed or dresser so the person with Alzheimer's can easily see them.

5. Give Them Time
Depending on how advanced the person's dementia is, it may take longer than normal for them to select their outfit and dress themselves. Be patient, and schedule enough time so that delays in the dressing process don't interfere with other plans.

6. Establish Order
Arrange the clothes in the order they are to be put on to help the person move through the process.

7. Be Positive and Open
Encouragement and compliments go a long way to helping a person with Alzheimer's disease feel content with their clothing choices. This includes supporting decisions that you may not necessarily agree with. As long as it doesn't endanger the elderly person, let them wear a dress to bed or a sweatshirt in warm weather.

(Source: By Anne-Marie Botek, 16 November 2011,

Thursday, 1 December 2011

As Alzheimer's Advances, Couple Finds Acceptance

Former Pilot Alan Romatowski Faces Increased Obstacles

When diagnosed with Alzheimer's disease at age 56, airline pilot Alan Romatowski was determined to remain productive, even if people could no longer depend on him to shepherd them across the country in Boeing 737s.

The Middlesex, Butler County, resident threw himself into volunteer work like he'd never done before. He made speaking appearances for the Alzheimer's Association in front of hundreds of people. He took whatever part-time work he could to help replace his US Airways income for his wife and children.

But as Alan passes through his fifth holiday season since being grounded by the devastating disease in the prime of his career, the productive work and most of the volunteering is gone. Stripped of his driver's license, he's alone much of the time in a home surrounded by woods, watching CNN for hours while playing with cats.

The good news is his memory is intact and he can often carry on a conversation well. Alzheimer's has eroded the 60-year-old's functioning more slowly than is the case for many patients -- he knows who everyone is, recalls what happened yesterday, is aware of his condition.

But that lucidity increasingly competes with fog. Alan strives to be the jovial joke-teller he's always been, but he stammers more than ever, forgetting obvious words. Simple tasks such as washing dishes and bagging groceries can confuse him. He becomes restless, and wife Josie finds it harder all the time to keep him contentedly occupied.

But if in some ways 2011 has been the toughest year for the Romatowskis since Alzheimer's settled into their spacious, suburban household, it has also brought a more mature understanding of how to live with the affliction.

After spending a year angrily denying that dementia symptoms had robbed him of his ability to drive his pickup truck safely or ride his beloved motorcycle, Alan now acknowledges that giving up his keys -- an action forced by his doctors -- was probably best for everyone.

Most all family responsibilities, from earning income from her Route 8 gift shop to doing chores, have fallen to Josie, his wife of 23 years. That's in addition to the burden of serving as a caregiver.

Not long ago, that all felt like too much to her. The onetime flight attendant, who fell in the 1980s for the Alan she knew as a smooth, confident pilot, would sometimes leave the house just so she could cry alone in her car in frustration. But after so many days of struggling through, then seeing she could make it to day's end and do it again and still keep her family, business and sanity intact, she realized she didn't have to feel defeated.

"I guess the big word is acceptance," she said in describing a recent awakening to how to live with a spouse's Alzheimer's. "I find I can get through the day without becoming overly emotional or overly frustrated. ... You find pleasures where you can."

Alan is not the normal Alzheimer's patient. An estimated 5.4 million Americans have the disease, but only a few hundred thousand are under age 65 and have his "younger-onset" version. The most prominent of those, highly successful University of Tennessee women's basketball coach Pat Summitt, received her diagnosis this year and is a year younger than Alan.

From the time his illness was confirmed at the University of Pittsburgh's Alzheimer Disease Research Center in September 2007, Alan became committed to raising Alzheimer's awareness. For the Alzheimer's Association, he served on a national advisory committee made up of people in early stages of the disease.

He also sought to enlighten the public about the disease by sharing his progress and struggle with it through the Pittsburgh Post-Gazette since 2008. It's become a less comfortable story for him.

Sitting next to his wife on a sofa in Glade Run United Presbyterian Church, the hub of a Meals on Wheels program in which he still volunteers once a week, Alan's arms were folded or fingertips tapping together as he described more recent experiences.

"I can still hold a conversation, but I get these senior moments more and more where the words don't come out," he said quietly while looking down.

His words flowed fine at that moment, but he also confessed it's become hard to read and retain anything. A task like raking leaves around their 5-acre property overwhelms him. He sees himself as a burden to his wife and stepdaughter, who lives with them, because he relies on them to drive him everywhere.

"I say I'm resigned to it, but that doesn't mean it's easy," he says, referring to his loss of driving, but it's just as applicable to the rest of what he's given up.

Earlier this year, he was both volunteering and doing part-time paid kitchen work at St. John Specialty Care Center, a nursing home in Mars. Those positions have ended, as has part-time work he enjoyed for nearly two years interacting with customers by providing food samples at the Costco in Cranberry.

When Alan started working at Costco, using his gift of gab and easy smile, it was hard for others to notice he had dementia, said his supervisor, Maria Jarvis of Club Demonstration Services. Once co-workers were aware of the disease, they helped look out for him. In recent months, they could no longer cover for his fogginess.

"One day he would seem 'with it,' like he was focused, and then another he would come in and it almost seemed like he was lost, like he didn't know where he was," Ms. Jarvis explained. She told Josie recently that giving Alan hours to work was no longer feasible, although Ms. Jarvis didn't want to tell him that directly.

While he can't drive for Meals on Wheels, Josie drops him off at the church every Wednesday morning to handle food deliveries. He rides alongside a driver in his 90s. Even there, he's not as sharp as he used to be, occasionally needing reminders from the older man of what to do with the meals, but the staff admire him and aim to help him remain a contributor as long as possible.

The Alzheimer's Association estimates there are some 15 million unpaid caregivers like Josie Romatowski for people with dementia. It is said that the disease is harder on them than on those it afflicts, especially as patients lose track of what's going on.

Among other difficulties in the past year, Josie has watched her husband get lost in supermarkets; curse at the microwave when it didn't do what he wanted; and shred documents she needed when Alan mixed them up with worthless papers she gave him to destroy to keep him busy. He's tried to repair things around the house, as he once did, only to make them worse. When confused or frustrated, he has lashed out, swearing and blaming others.

To relieve the frustration, Josie sometimes swaps stories about such incidents with other members of a local Alzheimer's Association support group, all of them wives who can relate. She even feels fortunate after such discussions, when hearing from others that their husbands can no longer carry on a conversation.

For four-plus years, she's watched how hard her husband has battled the disease, feeling admiration at his persistence while at the same time becoming more exasperated by Alan's behavior -- as though she had an adult-size 4-year-old child.

"He's kind of at an odd point," she said several months ago. "He really can't do too much, but he's not at the point yet where that doesn't bother him."

As a commercial airline pilot, Alan had to function mentally at such a high level for nearly three decades that his doctors believe it's given him more protection from the disease than is often the case. Alzheimer's affects everyone differently, in both pace and symptoms, and he's staved off the worst symptoms better than many.

"It's been a remarkably slow progression up to now, but this year is a little bit of a turning point for him," said Lori Macedonia, clinical coordinator of Pitt's Alzheimer Disease Research Center, where Alan receives an annual evaluation.

While Josie is increasingly worried about maintaining her gift store as Alan declines, Ms. Macedonia said a caregiver's ability to have her own outlet away from the disease has importance of its own. That sense of occasional freedom and use of a support group with whom to share struggles can be the biggest assets for someone like Josie.

"It's nice to know we're all in it together," Josie agrees.

When Alan was called upon as more of a public spokesman for Alzheimer's, the disease would more often make its way into conversations at home. It's most likely to come up now when the Romatowskis drive to the ADRC in Oakland, where in addition to evaluations, Alan receives a transfusion every 13 weeks of an experimental drug.

He reclines while Bapineuzumab is pumped into his system as part of an international study of its effectiveness. Preliminary results on use of the drug showed it could reduce the amyloid plaque in the brain that has been linked to Alzheimer's, though there's yet to be evidence that doing so restores individuals' mental abilities.

Alan had an earlier role in the study in which he received either the drug or a placebo, and he still doesn't know which. He and Josie are glad to know he's getting the real thing now, though they have no illusion of miracles.

"It's not something that's going to be an overnight fix," he says, sounding cautious like an academic researcher. "I'm not looking around the corner to see if there's going to be a major change in my cognition."

He also takes a couple of daily pills, Razadyne and Namenda, that can slow symptoms, though there's no guarantee.

Josie is agnostic about all these efforts, though there's nothing to do but try.

"People ask me 'Do the medicines work?' and I really don't know how to respond," she explains. "I don't know if he wasn't taking the medicine, if it would be worse. I don't know if the infusion is staving off progression. ... I do know he's declining."

But unlike before, she believes it's a decline she can live with. The couple still enjoy going out for meals. They were able to spend a summer week relaxing alone at their Edinboro Lake cottage, forgetting troubles. Old friends of Alan's occasionally visit him at home, though some have stopped, apparently because they're uncomfortable around him.

The disease has also robbed Alan of the relationship he wishes he had with his son, Yuri, a college freshman. In addition, he regrets that there's little he can do now to assist the family's income.

Josie worries about finances too, but also feels a sense of relief from that once all-consuming weight of Alzheimer's. She remembers feeling swallowed "in a black hole" by the fear of the future. But it is often preached that the key to battling the disease is dealing with it day to day.

She's succeeded in that, finally, by the repetition of assisting her husband and doing what she needs for herself without drowning.

"Now the days have piled up behind us, while two years ago there were days where I didn't think I could get through that day," she says. "Before, you didn't know if there was life after Alzheimer's, but there is ... for both of us."

(Source: -By Gary Rotstein, Pittsburgh Post-Gazette, Sunday, November 27, 2011.)