A New Tool To Diagnose Alzheimer’s Disease

For nearly a century, Alzheimer's destructive path in the brain could be seen only by directly examining the tissue during an autopsy after the patient died. Consequently, a diagnosis of Alzheimer's disease has been, and continues to be, based on results from a comprehensive evaluation that typically includes a medical history, a mental status evaluation, a clinical examination and laboratory tests.

Last year, the U.S. Food and Drug Administration (FDA) approved a new radioactive dye (Florbetapir F 18 Injection, Amyvid) that, when used during positron emission tomography (PET), enables doctors to spot telltale signs of Alzheimer's while the patient is still alive. But spotting signs of Alzheimer's disease and making an accurate diagnosis are two different things. And while the Amyvid scan is a major step forward, researchers have yet to find the Holy Grail. In the meantime, here are answers to questions you may have about this important tool.

How is the test performed and what does it reveal?

Amyvid is a radioactive dye that is injected into a vein prior to a PET scan. From there, the dye travels through the bloodstream and into the brain, where it binds to amyloid plaques. These plaques are abnormal clumps of brain cells mixed with beta-amyloid protein - a type of protein that forms in some people, including individuals with Alzheimer's disease. The PET scanner produces three-dimensional images of the brain that show how much plaque is present and where it is located. The results of the scan are graded as positive or negative.

Should everyone suspected of having Alzheimer's have a scan?

No. While Amyvid is approved for use in adults who are being evaluated for Alzheimer's disease and other causes of cognitive decline, most of the time, the doctor can make an accurate diagnosis without the additional information provided by the scan. The test is likely to be most useful in difficult cases, such as in younger patients with dementia or in patients with dementia that is rapidly progressing.

A word of caution

A number of Alzheimer's disease experts have expressed concern that disreputable companies may begin offering Amyvid scans (or scans using other agents that may gain FDA approval in the future). Be wary of any providers claiming that they can diagnose Alzheimer's or predict one's risk of developing it or determine a person's prognosis based on scan results. Also, be sure that the radiologist who interprets the findings has successfully completed the Amyvid reader training program developed by the product's manufacturer, Avid Radiopharmaceuticals.

(Source:  John Hopkins Health Alerts, 27 May 2013)

Salk Scientists Develop Drug that Slows Alzheimer's

Marguerite Prior holds a vial of J147

The Salk Institute team used living neurons grown in laboratory dishes to test whether their new synthetic compounds, which are based upon natural products derived from plants, were effective at protecting brain cells against pathologies associated with brain aging.

Scientists at the Salk Institute for Biological Studies say they may have found a drug that not only stops Alzheimer's disease, but might also reverse the symptoms of the disease.

The current research findings were published in the Journal Alzheimer’s Research and Therapy.

"J147 is an exciting new compound because it really has strong potential to be an Alzheimer's disease therapeutic by slowing disease progression and reversing memory deficits following short-term treatment," says lead study author Marguerite Prior, a research associate in Salk's Cellular Neurobiology Laboratory.

Video ->  Salk Scientists develop Drug that slows Alzheimer's

The Gist

J147 was developed at Salk in the laboratory of David Schubert, a professor in the Cellular Neurobiology Laboratory.

He and his colleagues bucked the trend within the pharmaceutical industry, which has focused on the biological pathways involved in the formation of amyloid plaques, the dense deposits of protein that characterize the disease.

Instead, the Salk team used living neurons grown in laboratory dishes to test whether their new synthetic compounds, which are based upon natural products derived from plants, were effective at protecting brain cells against several pathologies associated with brain aging.

From the test results of each chemical iteration of the lead compound, they were able to alter their chemical structures to make them much more potent. Although J147 appears to be safe in mice, the next step will require clinical trials to determine whether the compound will prove safe and effective in humans.

Highlights

To test the efficacy of J147 in a much more rigorous preclinical Alzheimer's model, the Salk team treated mice using a therapeutic strategy that they say more accurately reflects the human symptomatic stage of Alzheimer's. Administered in the food of 20-month-old genetically engineered mice, at a stage when Alzheimer's pathology is advanced, J147 rescued severe memory loss, reduced soluble levels of amyloid, and increased neurotrophic factors essential for memory, after only three months of treatment.

In a different experiment, the scientists tested J147 directly against Aricept, generically known as donepezil, the most widely prescribed Alzheimer's drug, and found that it performed as well or better in several memory tests.

The researchers found that while both drugs (J147 and Aricept) improved short-term memory, only J147 improved spatial memory. They also found combining the drugs worked better than either alone.

The strategy of using mice with existing disease and the drug discovery process based upon aging are what make the study interesting and exciting. According to David Schubert, "this more closely resembles what happens in humans, who have advanced pathology when diagnosis occurs and treatment begins." Most studies test drugs before pathology is present, which is preventive rather than therapeutic and may be the reason drugs don't transfer from animal studies to humans.

The compound, derived from the curry spice component curcumin, has low toxicity and actually reverses damage in neurons associated with Alzheimer’s.

J147’s ability to reverse cellular damage and low toxicity puts it in a different class from all other Alzheimer drugs. The ability to repair neuronal damage may make J147 useful in treating other neurodegenerative diseases.

The Salk researchers say that J147, with its memory enhancing and neuroprotective properties, along with its safety and availability as an oral medication, would make an "ideal candidate" for Alzheimer's disease clinical trials. They are currently seeking funding for such a trial.

The work was supported by the Alzheimer's Drug Discovery Foundation, the Bundy Foundation, the Fritz Burns Foundation, the George E. Hewitt Foundation, the Alzheimer's Association, and the National Institutes of Health.

About the Salk Institute for Biological Studies

The Salk Institute for Biological Studies is one of the world's preeminent basic research institutions, where internationally renowned faculty probe fundamental life science questions in a unique, collaborative, and creative environment.

(Source:  Alzheimer's Reading Room, 14 May 2013)

SAT/8JUNE13 ADFM Public Seminar on "Person Centred Dementia Care"

ADFM National Caregivers Network in collaboration with Eisai Malaysia and The Faculty of Nursing, MAHSA University College is holding a One Day Seminar on: 

      

"PERSON CENTRED DEMENTIA CARE”                   

      

SPEAKERS:  
1.  Dr Ng Li-Ling, Senior Consultant Psychiatrist, Programme Director Community Psychogeriatric Programme, Changi General Hospital, Singapore.

2.  Dr Philip Yap Lin Kiat, Senior Consultant Geriatrician, Clinical Director, Geriatric Centre, Khoo Teck Puat Hospital, Singapore

DATE:              SATURDAY, 8 JUNE 2013

TIME:                9.00am – 4.30pm (Registration starts 8.00am)

VENUE:           LectureTheatre, Block A, 1st Floor, MAHSA UNIVERSITY COLLEGE

                           Jalan University Campus, Off Jalan University, 59100 Petaling Jaya    

Programme:

0800     Registration of Attendance

0900     Welcome Address by Chairperson

0905     Dementia – Chronic Disease of the 21^st Century (Dr Ng LI-LING)

1000     Understanding the Dementia Experience (video based learning) (Dr Philip Yap)

1100     Tea break

1130      A Primer on Person Centred Care (Dr Philip Yap)

1230      Lunch break

1330      Understanding Behaviours in Dementia (Dr Ng LL)

1430      Tea break

1500       Person Centred Care for Family Caregivers (Dr Philip Yap)

1600       Q & A

1630       End

OBJECTIVE:

Dementia is set to become the chronic disease of the 21st century. With 35million people with dementia in the world currently, the numbers will rise to 50million by 2020. Latest statistics in the United States show that one in 3 older persons die from dementia today. Indeed, as there is still no cure for dementia on the horizon, there is a pressing need to help persons with dementia (PWD) and their families live and cope better with the disease. 

In recent times, person centred care (PCC) has become synonymous with quality care for PWD. PCC values the person as a unique individual, adopts the perspective of the person and provides a supportive environment that understands his needs, upholds his autonomy and places the highest value on his well-being. Although it is true that brain pathology is often the dominant driver of dementia symptoms, PCC posits that an intimate knowledge of the person's unique past, comprising his biography and personality, coupled with insights into the environment he is subjected to, help us better understand and see the real person behind the facade of the disease. There is recent research to show that a supportive and enriched environment can help PWD. Therefore, it appears that beyond biological factors, quality of care impacts not just quality of life but also how dementia evolves.  Person centred care (PCC) is a call to care better for our elders with dementia and we should rise to the call.

SPEAKER’S PROFILE:

DR NG LI-LING, MBBS, MMED (Psych), FAMS, is a senior Consultant Psychiatrist in the Department of Psychological Medicine, Changi General Hospital Singapore. She chairs the National Dementia Network at the Ministry of Health, Heads the Community Psychogeriatric Programme and sits on the Board of Alzheimer's Disease International. She received specialist training in the field of psycho-geriatrics in UK in 1991.  Since 1993, she has been the Vice President of the Singapore Alzheimer’s Association and has had significant experience in the management of people with dementia and their families.  In addition, Dr Ng is actively involved in the planning of services for the elderly with mental illnesses and is a strong advocate for the greater awareness of the special needs of this sub-group.  

DR PHILIP YAP LIN KIAT is a Senior Consultant Geriatrician & Clinical Director of the Geriatric Centre, also leads the Memory and Dementia Care Service, in Khoo Teck Puat Hospital Singapore. He has a special interest in improving quality of care and quality of life for persons with dementia and their family caregivers.  He sits on the Committees of the National Dementia Network at the Ministry of Health, The Alzheimer’s Disease Association of Singapore, the Medical Advisory Board of Agency for Integrated Care and is also Chairperson of the Steering Committee for Person Centred Care and Dementia Care Mapping in Singapore.

WHO SHOULD ATTEND

Caregivers and families, Allied Health Workers & all those who directly or indirectly are involved in the care of persons with dementia.  

Certificate of Attendance will be awarded to participants from Allied Health Sector.   

To the Caregivers and their families, this is a seminar you should not miss it.  We look forward that all of you make it a point to register for the above seminar.   

COMPULSORY PRE-REGISTRATION :  First-Come-First-Served Basis:

1.  Email Registration Form to jenny@adfm.org.my or Fax to 03 7960 8482.

2.  SMS 016 608 2513 indicating full name, caregiver (Yes/No), and contacts if you do not have       email access.

3.  Email jenny@adfm.org.my or call 016 608 2513 / 03 7956 2008 for any clarifications.
4.  Closing date by 25 May 2013.

We look forward to welcoming all of you at the above seminar.