The Tangled Neuron

Flurizan, Lipitor and Alzhemed: Negative Study Results

On Monday, Myriad Genetics Inc. announced the failure of Flurizan in Phase III trials.  This news follows the results from the LEADe study showing the cholesterol drug Lipitor did not benefit Alzheimer's patients, and the failure of Alzhemed in Phase III trials last year.

With all this disappointing news, it seems more important than ever for professionals, with input from patients and their families, to talk about new approaches to Alzheimer's research and care.  Maybe implementing some of the ideas discussed at the National Institute on Aging 2006 conference would help.  I'll be at ICAD (the International Conference on Alzheimer's disease) in late July - it will be interesting to see whether new approaches are widely discussed.

Got Memory Loss? A Different Approach

So you have memory loss.  Maybe serious memory loss.  Of course you should pay attention to your health and make necessary arrangements.  But maybe the best thing you can do is pay attention to life.

While some scientists work to identify pharmaceutical treatments for memory loss, others are working to test whether activities such as painting, playing an instrument or dancing are beneficial.  Don Moyer, his wife Jenny Knaus (diagnosed with Alzheimer's) and Renee Beard, a geriatric sociologist, have collaborated to develop a database of the latter type of research.  The resulting information is available on Dancing Away Memory Blues, Don's blog.

On the blog, Don, Jenny and Renee list and summarize published studies on how activities in each of six categories (music, visual arts, drama, dance, mixed and other) can enhance the lives (and maybe improve the health) of people with memory loss.

If you need an excuse to learn to play the harmonica, or take up painting, this is it!

Grand Rounds is Up

Grand Rounds is up at Shrink Rap, with an interesting set of links wrapped into an iPhone theme!

The first two links are about using iPhones in medicine.  These posts are mostly for healthcare professionals, but it brings up a question for people with memory loss.  Would you use a phone or other small device for any of the following?  Do you already use your phone for some of these?

• Reminders for medicine, appointments or tasks
• Maps/navigation
• Store and display directions or notes
• Other?

Or, as some have said, do these devices (smart phones, PDAs, etc.) take too much work to program and use?

8 Practical Tips for Living with Memory Loss

I turned 50 last year.  Given my family history of dementia, I was not happy to read that as many as half of people my age and older have some memory loss. 

I've noticed my already poor navigation skills have declined lately, and I can't multitask the way I used to.  It's not just me - my friends complain about missing appointments, bouncing checks and forgetting words.  Even worse, they lose the calendars and smartphones that are supposed to keep them on track!

Modern medicine doesn't have a cure for memory loss, at least not yet.  Without a medical fix, are there things we can do to make living with memory loss easier?  I posed that question to some of my friends with more serious memory loss.  Here are some of their practical ideas that make sense to me:

1.  Experiment with a whiteboard for orientation and reminders. Use to record the date, where family members are, appointments, reminders, etc.

Surgery, Anesthesia and Memory Loss

Summary:  After surgery, many people experience short-term delirium and/or longer-term cognitive decline.  Scientists are still studying how to prevent these problems.

Doctors, families and patients report that surgery seems to cause short-term delirium and/or longer term memory loss in some people.

In a recent Duke University study of 1064 patients undergoing major surgery (but not heart surgery), neuropsychological tests showed the following rates of post-operative cognitive dysfunction or POCD:

Age range                  Leaving hospital      3 Months After Surgery

18-39 year olds                 37%                                 6%     

40-59 year olds                 30%                                 6%

60 or older                         41%                               13%

Zhongcong Xie, M.D., Ph.D.

Even higher rates of POCD have been reported after heart surgery, but scientists still don't agree on how to measure these problems, or on whether the heart patients also had memory loss before their surgeries.

Dr. Zhongcong Xie, Assistant Professor at Massachusetts General Hospital and Harvard Medical School, is working with his colleagues to determine what causes POCD.

POCD seems to be worse among the elderly, but "the reason why age is a risk factor for POCD remains to be determined," Dr. Xie says.  In his lab, he and his colleagues are researching

Ibuprofen, Naproxen and other NSAIDs for Alzheimer’s

Large observational studies have linked regular use of painkillers such as ibuprofen (Advil) and naproxen (Aleve) with lowered risk of Alzheimer’s, but clinical trials have not backed this up. The publication of the results of two new studies this month didn’t do much to resolve this issue. In the first study, Boston University researchers analyzed the medical records of hundreds of thousands of military veterans, and found long-term use of NSAIDs (non-steroidal anti-inflammatory drugs), particularly ibuprofen, was associated with a reduced risk of Alzheimer’s.

A detailed analysis of the results of the second study, ADAPT (Alzheimer's Disease Anti-inflammatory Prevention Trial), was published this month. It showed that neither naproxen nor another NSAID, celecoxib, improved thinking and memory in more than 2000 men and women 70 years and older who had a family history of Alzheimer’s. Naproxen actually seemed to worsen cognition. The trial was stopped early because scientists worried about the side effects of the two painkillers.

Differences in study design could explain these conflicting results.

Constantine Lyketsos, MD, MPH

The various studies tested different NSAIDs at different dosages in different populations for different lengths of time. It’s also possible that there were “confounding factors” in the population studies – maybe people who take NSAIDs had later onset of Alzheimer’s because they had higher education levels or better overall health, for example.

So, what DO we know about NSAIDs and memory loss? “After the onset of dementia, anti-inflammatory treatment does not seem to work,” says Dr. Constantine Lyketsos, one of the researchers involved in ADAPT. “The data are pretty strong.” Dr. Lyketsos is Director of the Memory and Alzheimer’s Treatment Center at Johns Hopkins University and Chairman of the Department of Psychiatry at Johns Hopkins Bayview Medical Center. 

If treatment with NSAIDs does not seem to be effective, what about prevention?

Aspirin: Good or Bad for your Memory?

Summary: Two recent studies do not show that aspirin helps memory loss. The painkiller may increase the risk of bleeding in the brain.

When my father first complained about his memory, his doctor told him to take a baby aspirin every day. After seeing headlines like “An aspirin a day to keep Alzheimer’s away?” I thought this was good advice.

Aspirin is one of several NSAIDs (non-steroidal anti-inflammatory drugs) that have been tested for prevention or treatment of memory loss. Results from two recent studies make it less likely your doctor will recommend the drug for memory loss.

Webcast: The Myth of Alzheimer's

If you want to congratulate Dr. Peter Whitehouse and Danny George for writing their book The Myth of Alzheimer’s, let them know how wrong you think they are, or are just plain curious, here’s your chance. They’ll be featured on a HealthTalk webcast tomorrow night (Wednesday, May 14th) at 7 PM eastern. Details are on the registration page at the HealthTalk site.

Chuck Jackson to Testify at U.S. Senate Hearing on Alzheimer’s

My friend Chuck Jackson, who along with many family members has early onset Alzheimer’s disease, will testify at a U.S. Senate hearing on Alzheimer’s tomorrow (Wednesday May 14th). The hearing starts at 10:30 AM eastern time. A link to the live webcast will be available at http://aging.senate.gov/.

Note:  you can now watch the webcast of the full hearing at any time, or read a transcript of Chuck's testimony.

Orien Reid Nix: Alzheimer’s Disease International and Baby Boomers at the Crossroads

Orien Reid Nix is a baby boomer with a family history of dementia. She is also Chair of Alzheimer’s Disease International.

Last week, she gave a keynote address at the Wisconsin State Conference on Alzheimer’s Disease and Related Disorders in Milwaukee. In her talk, she focused on the devastating effects of Alzheimer’s on baby boomers, both as they care for their elders and as they develop their own memory problems.

Orien Reid Nix and Corinne Reid Owens

Ms. Reid Nix was accompanied by her aunt, Corinne Reid Owens, a civil rights activist in Wisconsin. Ms. Owens is 95, and does not have Alzheimer’s. But several of Ms. Reid Nix’s family members, including her mother, had the disease. In her speech, she talked about the challenges of caring for her mother while still caring for her children – a common situation these days. Estimates of the number of Americans in the “sandwich generation” run as high as 20 million. There’s even a new term, “club sandwich generation,” to describe people who are caring for three generations.

Imaging with Pittsburgh Compound-B (PIB) – An Amyloid Surprise?

New imaging techniques have shown that many cognitively normal elders have as much amyloid protein (thought by some to cause Alzheimer’s) in their brains as do people diagnosed with Alzheimer’s. Does this mean that these cognitively normal elders are on the brink of developing Alzheimer’s, or does it mean that the amount of amyloid in the brain doesn’t always correlate to the amount of memory loss?

The Alzheimer Research Forum has now posted three parts of a four-part report from the Human Amyloid Imaging Conference. Their report covers the mixed results from studies using evidence Pittsburgh Compound-B (PIB) imaging of amyloid, and the potential effect on early diagnosis and clinical trials.

Does Depression Increase Your Risk of Memory Loss?

Summary: A new study provides more evidence that depression may be a risk factor for Alzheimer’s.

People with dementia often report they suffered from depression before they developed serious problems with memory and thinking. Study after study has shown a link between depression and memory loss. Researchers continue to debate whether depression increases the risk of developing serious memory loss or is simply a sign of brain changes underlying Alzheimer’s or other dementias.

Robert S. Wilson, Ph. D.

Dr. Robert Wilson, Professor of Neurological Sciences and Psychology at Rush University Medical Center, studies the neurobiology of the connection between depression and dementia. In an article in a recent issue of the Archives of General Psychiatry, he and his colleagues provide more evidence that depression may be a risk factor for Alzheimer’s.

"The Great Forgetting"

David Brooks’ April 11th New York Times opinion piece, “The Great Forgetting,” could have been a thoughtful look at the social consequences of memory loss and aging. Instead, his keen observations on "the memory haves and the memory have-nots" were followed by silly jokes.

He missed the opportunity for a more serious discussion about how our hyper-cognitive society measures a person's value by the speed and accuracy of his recall.

AAFP-ACP Guidelines for Drug Treatment of Dementia: What Do You Think Of The AAFP's Photo?

When my father was struggling with memory loss, his doctors prescribed both Aricept and Namenda. If they helped his memory and thinking, I couldn’t tell. For Dad, the side effects of these medicines didn’t seem to be worth any benefit.

Dad and my nephew Chris play the piano

But for other people with memory loss, these drugs seem to be very helpful, and the side effects are generally tolerable. This wide variety in benefits and side effects may be what the American Academy of Family Practitioners (AAFP) and the American College of Physicians (ACP) were trying to address when they published new guidelines about drug treatment of dementia last month.

CADASIL: Young Onset Dementia Caused by a Stroke Disorder

Summary: CADASIL is a type of stroke disorder that can cause young onset dementia. Two web sites have been developed by women whose families are affected by the disease.

Billie Duncan-Smith’s husband Steve’s first symptom came when he was 38. He woke up with an excruciating headache, and started vomiting because the pain was so bad. Over the next few years, he would suffer many such migraines, some lasting for several weeks. An MRI of his brain showed a high number of white matter lesions, but Steve’s doctors weren’t sure what was causing his headaches.

Billie and Steve in 2004

While Steve suffered, Billie searched the internet and contacted medical experts all over the world. She sent his records and test results to those who offered to help. Finally, someone at the U.S. National Institutes of Health called her to suggest Steve might have CADASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy), a type of stroke disorder.