Sign of the times: social media’s use in increasing interaction among patients with dementia. A researcher, part of a team, is busy at work on a web-based app based upon Facebook for utilization among cognitively impaired elders. She states:
“We have already carried out some practical testing of other web-based communications systems. Among other things, we have tested a “digital diary” and a “scrapbook” containing personal photos, newspaper cuttings and information found online.”
What is both curious and puzzling at the same time regarding this research is that it is being conducted in Norway, of all places. Why not here in the good ol’ U.S. of A? Innovation of this type began and germinated here. Social media’s global function of “keeping one in the loop”, including the elderly, can not be understated in its potential in non-pharmacologic dementia research. Here’s to hoping it gains ground on these shores.
Many physicians, including myself, who see a majority of elderly patients are always interested in ways we can educate patients and concerned family members of the wide spectrum of clinical presentations of cognitive decline. For many Boomers who are now just turning 65 (as the first and oldest cohort does this very year) the specter of that “senior moment” possibly belying something more ominous and progressive is a little more than just an afterthought that can be dismissed. When the moment came for a discussion with the patient and the family over the concern of cognitive impairment, it was always a delicate balance with respect to validating patient concerns with the real world possibility of subclinical disease.
New diagnostic indicators and guidelines for primary care providers and their patients as recommended and formulated by the National Institute on Aging are out to demystify the process, while making research more goal focused, tangible, and accessible with respect to discovering therapies that can actually reverse progressive dementia.
While laudable in these efforts, the three-stage set of guidelines for diagnosis and treatment insertion offered by the NIA and Alzheimer Association is just the beginning. It certainly complements what we geriatricians have been doing quite adeptly for a couple of decades now — informing and educating patients and their families while squelching myths that could delay or, worse, prevent treatment from ever occurring. Of course, the ability for researchers to recruit the most appropriate patients for targeted clinical trials doesn’t hurt, either.
Nobody said that it would be cheap. The Alzheimer Disease International (ADI) report projects worldwide costs of over $600 for 2010. It’s no coincidence that this news comes out today — on World Alzheimer’s Day. The ADI report combines the most recent global data on disease prevalence and research. ADI predicts that as populations age, dementia cases will almost double every 20 years to around 66 million in 2030 and 115 million in 2050 — much of the rise from disease incidence in poorer nations.
On these shores, it is known only too well that the costs of treating the symptoms, developing drugs to reverse the disease process itself, covering ancillary costs associated with caregiving, and the constant research in the race for a cure will add to the burden President Obama’s healthcare initiatives must overcome in the next 10 years. The main advocacy organization in the U.S. isn’t waiting; it has already begun pushing for the funding and implementation of a national “dementia plan”. | LINK [PDF]
Pharma company Eli Lilly recently scrapped further development of an anti-Alzheimer drug designed to fight the disease from the plaque mechanism; its compound would inhibit the enzyme responsible for catalyzing the process in forming the amyloid plaques pathognomonic for the disorder.
Their reasoning? That the enzyme also works on the formation of other proteins in the brain that have no consequence in the natural histopathological history of the disease. Scientists working on the R&D for this drug have also gone as far as to question this hypothesis as a valid point of research into anti-Alzheimer development. The implications of these second thoughts have yet to be fully realized, but there could be an immediate effect on other Pharma companies researching similar treatments for degenerative dementia should they decide to follow like concerns. | LINK
As Doctor Pundit has always reported in this space, the driver of current Alzheimer disease research has been via biomarkers — the naturally occurring by-products (in this case, abnormal proteins found as the disorder shows initial symptoms and develops) of the body’s normal physiological processes in any organ system. In this case, the system studied is the body’s omniscient powerhouse, the central nervous system. The latest game-changing news is what can be gleaned via the cerebrospinal fluid obtained from within the spinal cord.
Researchers report that a spinal fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease. [...] A lot of work lies ahead, researchers say — making sure the tests are reliable if they are used in doctors’ offices, making sure the research findings hold up in real-life situations, getting doctors and patients comfortable with the notion of spinal taps, the method used to get spinal fluid.
The invasive nature of the spinal tap is a barrier, but the overarching point here is that biomarker research is gaining ground and setting the stage for extremely targeted therapies. All of this talk — even in the past 2 to 3 years — has largely been conjecture. At least until now. Exciting news. | LINK
Research into better treatments and possible cures of Alzheimer dementia is one of the bright spots in the potential for better healthcare delivery in the decade of the 2010s. There are many signs that bode well for the approach to this disorder at the dawn of the second decade of the 21st century.
New research into alternate pathways of disease development is starting to generate excitement among primary care physicians and geriatricians (such as myself) as potential arenas for new classes of drugs to combat Alzheimer’s. Better care delivery models in long term care of the elderly as part of new initiatives in the Affordable Care Act are already starting to impact chronic disease care management strategies.
Perhaps most important, there is new evidence to suggest that earlier detection of this cognitive disorder can enhance those developments, and more. At an annual meeting of top dementia researchers, guidelines were proposed to expand on the research from the ’00s to diagnose the disorder earlier — a strategy that benefits more than just those potentially afflicted with Alzheimer’s.
If the guidelines are adopted in the fall, as expected, some experts predict a two- to threefold increase in the number of people with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it. The Alzheimer’s Association says 5.3 million Americans now have the disease.
Heavier use of newly discovered biomarkers for earlier detection of the pathology behind Alzheimer dementia will be a closely watched process by both physicians and health policy analysts alike. | LINK
Although the prevalence rate of dementia is higher overall in women over 65; this is due to a variety of factors — overall elderly age demographic prevalence, hormonal declines (circulating estrogens), and the presence of certain vascular related disorders, just to name a few. But what about the incidence of dementia in a male spouse as an association for the incidence of dementia in females — both of whom had no signs of the disorder initially?
A trial published in the latest Journal of the American Geriatrics Society shows that over 1000 patients (married couples in a single Utah county) were followed for a period of at least 12 years[1]. Initially without the diagnosis of Alzheimer dementia, those caregiving wives developed dementia along with their husbands in 30 cases. Although the study did not specifically examine wives as caregivers using explicit criteria, most lived in the same space as the male spouse at the time of diagnosis. An interesting result that should spur more study in the gerontological (social scientific) realm of dementia treatment and incidence in the community. | LINK
Perhaps the most salient aspect to the hubbub surrounding the reform bill (politics aside) is the tremendous amount of myth surrounding its individual provisions. Of course, no single lobby or advocacy group (mainstream media included) has the desire to read the entire thing — only the portions that benefit their needs, for whatever reason.[1] However, groups under the radar, such as those which lobby for the needs of the Alzheimer patient population, stand to benefit from the recently passed legislation. According to the VP of the Alzheimer’s Association’s Public Policy and Advocacy Division, Obama’s reform legislation would
[Establish] a Medicare pilot program to provide transitional care to seniors at a high risk, including those with cognitive impairment, of re-entering a hospital. Cognitive impairment due to Alzheimer’s and other causes increases the complexity of care transitions and post-acute care, resulting in increased risk for medication errors and hospital readmissions. Alzheimer families need assistance with planning and managing discharge and post-acute care, including arranging and monitoring in-home medical treatment and supportive services.
It is easy to see the mixture of hope, advocacy, and idealism in this organization’s comments on the possibilities inherent in the reform bill. It’s also apparent how difficult it will be to apply them in the face of other lobbies desirous of the same possibilities and resources Obama’s reform will bring. | LINK
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 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.
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.
Originating from Saint Paul, Minnesota, [doctorpundit.com] is a weblog about the policy of healthcare and where it intersects with politics and public opinion; it is edited by Michael Douglas, MD, MBA. Welcome, and please consider my take on what is Healthcare 2.0, complemented by a few of my thoughts on my personal avocations and guilty pleasures: music, prose, and writing. Follow Doctor Pundit via RSS above.
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DOCTOR PUNDIT @ ONE YEAR | An occasional DP series from 2010 highlighting healthcare policy trends over the period from 2009-2010 in a compare/contrast format.
