Pfizer’s current research on a potential blockbuster anti-Alzheimer drug is currently back to drawing-board status. According to the pharma company

[T]he drug, called Dimebon, had shown virtually no effect after six months in treating the cognitive decline or behavioral problems associated with Alzheimer’s when compared with a placebo.

Apparently, Wall Street has been watching the results of this Phase I study; the verdict is still out on whether Pfizer will continue to fund the research for this agent — designed to work better and longer at inhibiting some of the most distressing symptoms related to the disease. | LINK

• The Wellpoint saga continues…as well as the blame game for significant premium hikes.
• Study: alcohol + energy drinks (like Red Bull) = recipe for disaster.
• Has the H1N1 pandemic peaked?
• The first study of the anti-CSF prototypes for treatment/reversal of Alzheimer dementia is underway.

The trial will measure in the cerebrospinal fluid (CSF) and blood plasma of amnestic mild cognitively impaired (MCI) patients the biochemical changes that are associated with AD and correlate them with the pharmacokinetics of the drug and its metabolites.

• For California, the bleeding never ends. Today, Gov. Schwarzenegger releases his spending plan for 2010-11 which details even deeper cuts to its Dept. of Human Services.

A nationwide clinical trial is underway to determine if a specialized drink is able to improve the neurocognitive deficits seen in Alzheimer dementia (AD). The tested concoction is being evaluated for its ability to provide improvement in the clinical domain of verbal recall. The trial is based upon a European study done in which 225 AD patients were randomized to take the nutritive drink or a placebo. Results were apparently encouraging^[1] enough to U.S. researchers to enroll patients at 40 sites across the U.S. in a double-blinded study. Should be interesting.

I guess you could call it a kind of Boost for dementia.

1. In that study, 225 patients with mild Alzheimer’s were divided into two groups. Some drank Souvenaid and the others sipped a non-medical drink every day for 12 weeks. Researchers found that the patients who drank Souvenaid improved in a delayed verbal recall task. [↩]

The major focus of research into the biochemical causes and manifestations of Alzheimer dementia (AD) has largely been characterized by a rather pinpoint and straightforward course. Relegated to the foundations of disease genesis within the cerebrospinal fluid and in cerebral neurons, discoveries in this facet of AD research have yielded much in the way of prior (development of cholinesterase inhibitors to treat AD symptoms) and future treatments (tau and beta amyloid protein modifiers, etc). The common theme with respect to those discoveries depended heavily on neurons already found to be diseased with the abnormal proteins and the like.

With the recent news of new research techniques involving the role of abnormal proteins in healthy cells, researchers hope to detect the onset of cellular changes responsible for initiating the AD cascade as it is happening, thus opening the potential for new mechanisms of disease and treatment. Although it is exciting to document the genesis of abnormal neuronal signals that may herald the early changes seen in asymptomatic AD patients, it is even more exciting to begin to search for the potential to turn off this mechanism completely. | LINK

In the upcoming NEJM, a large prospective study makes the case for the consideration of dementia as a certain cause of death for the mostly elderly patients who suffer from it. Ever since the disorder was first described by its namesake Alois Alzheimer, MD 102 years ago; it has always been thought of as an unfortunate comorbid “condition” of which advancing age itself was a risk factor. The complexity of the diagnosis made early attempts to formulate effective treatments virtually impossible. Toward the middle of the 20th century the focus of caring for the patient who suffered from dementia shifted to palliation and suppression of other comorbidities which could hasten its clinical effects.

At the end of the last century, breakthroughs in neurobiological research opened the doors to classes of drugs that have largely been successful for controlling debilitating symptoms — without, however, effecting retardation of the disease, or even a cure. Thus the stage was set for a redefinition of sorts for this illness. Authors of the study have delineated the course of dementia (not necessarily following Alzheimer patients, but studying the constellation of disorders that make up its syndrome — Parkinson’s, stroke related dementia, and other organic causes) as one of a terminal nature. They are sounding a clarion call for re-education of the public on what they call a termainal condition which requires effective palliation, at the very least.

At the moment, treatment (which may include some reversal of the pathology) of Alzheimer dementia is being heavily researched. Until the time comes for a certain cure for all causes of dementia, the importance of accurately diagnosing and crafting essential care plans for those who suffer from its horrible effects is the most effective treatment there is. Hopefully, by mid century, the estimated 17 million who will fall prey to dementia will have not only the treatments but also the resources to prevent its early mortality so prevalent in this population today. | LINK

It’s the sleeping giant. The expected increase in global Alzheimer dementia cases will do what everyone expects and acknowledges, but really refuses to do anything about. According to a report released within the past 24 hours from the Alzheimer’s Association, estimates are that 35 million people worldwide are living with Alzheimer’s and other forms of dementia. The figure is a 10% increase over 2005 numbers.

It’s no secret that research in the field for novel forms of treatment are going at a breakneck pace, with new agents expected to hit the market by 2011; the real hope is that these treatments will be widely available within the first year of availability. But the real fear is that the potential for the promise of these disease altering drugs will only be realized for a privileged few — those who can afford them. | LINK

• We’ve always known the prevalence of dementia increases with age. Here’s fresh evidence of its increasing incidence in the “oldest” old.
• Belly up to the bar? Moderate drinking may lower Alzheimer risk.
• New tests assessing brain volume may allow earlier Alzheimer detection.

In one study, Irish researchers found scans measuring brain volume and a combination of memory tests accurately identified nearly 95 percent of people who had progressed from mild cognitive impairment to early Alzheimer’s disease. In another study, U.S. researchers found that a type of brain scan that measures glucose combined with low scores on memory tests was a strong predictor of disease progression.

• Born and bred here in Minnesota: the birth of a new anti-Alzheimer drug.
• Omega-3 fatty acid supplements — a no-go in Alzheimer disease prevention.

Should patients with cognitive impairment be given caffeine supplements to stave off the typical short term cognitive deficits seen symptomatically with the disease? Well, while the jury is still out on that count, there’s no denying that for us coffee achievers on a Monday morning after a long holiday weekend, the news of this study is somewhat compelling.

Drinking five cups of coffee a day could reverse memory problems seen in Alzheimer’s disease, US scientists say. The Florida research, carried out on mice, also suggested caffeine hampered the production of the protein plaques which are the hallmark of the disease.

LINK

It’s pretty startling to think that one of this planet’s most significantly disabling disorders is essentially a diagnosis made on largely clinical gounds — Alzheimer dementia. Of course, the term “dementia” itself refers to a syndrome of sorts — a condition whose most salient features can also be present in a multitude of other disorders. No one ever said that medicine was a perfect science; that’s why it is “practiced”. It’s the road to perfection which marks its evolution, taking the society it benefits along the way for the journey.

As we get ready to move into the second decade of this new century of medical exploration, one thing is certain: the easier it is to identify the source of pathology, the more difficult it is to characterize it. New names of disorders, therefore, are rendered out of typical disease findings which have existed for decades. Medicine, in its evolution, now becomes more complex. Within the realm of neurodegenerative disease, the loss of cognition known as “dementia” may now not be as simple to characterize in the face of new diagnostic technologies being studied and constantly perfected, as a result. As we find out more about the origins of the pathology behind this disorder, we may be more perplexed, or … rather, vexed at the amount of overlap we have to muddle through on the journey toward a cure. | LINK

• NY principal with swine flu very ill.
• Obama names new CDC chief.

In a statement, Obama called [Thomas] Frieden “an expert in preparedness and response to health emergencies” who in seven years as New York City’s health commissioner has “been at the forefront of the fight against heart disease, cancer and obesity, infectious diseases such as tuberculosis and AIDS, and in the establishment of electronic health records.”

• CA: A Kaiser hospital is fined a cool quarter mil for a breach of patient confidentiality in “octomom” case.
• Researchers: Common heart abnormality shows increased risk of dementia.
• Pharma company offers free prescription meds for the unemployed.

     

    
   

   

It’s always interesting to see what the mainstream media “does” with a story such as this. Quite frequently, the sublime gives way to the sensational, and the true meaning of the story gets lost in all the hype. In the case of a research tool that has been studied by the researchers who have developed it, examiners who follow a point system which ranks the most common associative laboratory, imaging, and clinical findings in tested patients can “predict” with reasonable confidence the likelihood that those patients will develop a degenerative dementia.

Of course, like any discovery, its researchers warn of limited generalizability to the greater patient population, and that more research and instrument validation are needed before widespread adoption is recommended. (Excuse me while I yawn.) While this finding may have utility, its “availability” is virtually useless. Much, if not practially all, of the data used to come up with the indices for patient scoring and ranking were culled from existing data from other trials in which a diagnosis of cognitive impairment was already apparent or strongly clinically suggested. In other words, known associations with cognitive slowing in the aged had to be accounted for in the development of the index in a retrospective fashion.

At best, this measurement, even in its finished and validated form, should be used as a clinical treatment guide to what should be the ultimate diagnostic tool (short of a definitive finding at autopsy) — a well-taken history and an even better-performed physical examination. | LINK

When you think of the premium cable network HBO, such iconic and well-branded themes come to mind: The Sopranos, Chris Rock and George Carlin comedy specials, and unforgettable scores of revolutionary miniseries which have captivated the imagination while serving as the basis for a national discourse on a variety of topics. Building upon that last quality, the nation’s #1 premium cabler will debut tonight a four part series on Alzheimer disease. 

The Alzheimer’s Project debuts tonight with the film “The Memory Loss Tapes,” which features seven patients in various stages of the disease. A 63-year-old computer genius, blogs through the onset of Alzheimer’s disease, noting wryly that he helped invent DVDs and now gets lost in his own front yard; and a 75 year-old woman lives in a nursing home and befriends her own reflection, believing it to be a new resident named Ruth.

Previous forays into such socially gripping and affecting real life drama are not new territory for HBO, and this most recent installment is why the network is still at the top of its game. Compelling entertainment with a lesson for all of us … presented as an unforgettable series about forgetting. | LINK

Nothing, it seems, lends itself to the aphorism that if-one-doesn’t-like-the-results-of-some-medical-trial-just-wait-a-few-and-you’ll-be-rewarded than the hotly debated issue over whether the pathologic process behind the development of Alzheimer dementia is rooted in chronic inflammation. That day in which the pendulum of scientific thought has swung in the other direction is here — at least for now.

New data is out that supports the notion that not only anti-inflammatories such as naproxen and ibuprofen (two of the most popular) do not prevent the deveopment of dementia, they may also accelerate its course in “older” geriatric patients at the time of diagnosis. | LINK