Newly Discovered Antibody May Be Body's Natural Defense Against Alzheimer's (Gammagard)

In what could prove to be an important development in the search for a treatment of Alzheimer's disease, NewYork-Presbyterian Hospital/Weill Cornell Medical Center physician-scientists say the results of an initial (Phase I) clinical study provide encouraging evidence that antibodies derived from human plasma can capture the beta-amyloid protein in blood and exert positive effects on patients' thinking abilities.


Read more at the Alzheimer's Reading Room: Newly Discovered Antibody May Be Body's Natural Defense Against Alzheimer's (Gammagard)

Many Alzheimer's caregivers seek help in God

About a third of those who take care of loved ones with the disease feel 'more religious' because of their experiences, a new national study says.


You can read this article at The CareGiver Weblog

Caring for the CareGivers

Group meetings help those coping with dementia in a loved one.



Caring for the Caregivers


By Elizabeth Cooney
TELEGRAM & GAZETTE
ecooney@telegram.com

WORCESTER— You came to the right place, the group told the silver-haired woman who had just joined them.

She took her seat on one of the 14 armchairs fanning out from the fireplace at Dodge Park Rest Home. Twice a month, people caring for loved ones with Alzheimer’s disease meet to share supper, stories, strategies and support. Across the hall, their relatives can have a meal and take part in an activity while the two-hour session unfolds.

The new arrival, who didn’t want her name used in the newspaper, told the group why she came.


“I don’t think I know how to handle the situation with dementia,” she said about her husband’s disease, diagnosed 10 years ago. “I lose my temper a lot and I get exasperated. I know I’m not handling things well, not for him and not for myself.”

Everyone in the room struggles with anger, frustration, fear and sorrow, said Deanne Weissflog, who was sitting next to her. While the men and women were all caring for relatives in different stages of dementia or Alzheimer’s, they all know the difficult road they are traveling.

And that includes Nafie Saba-Shapazian, executive director of Dodge Park and its Day Club, and Don Kemp, who helps her lead the sessions for caregivers.

Ms. Saba-Shapazian, a registered nurse, is responsible for Dodge Park’s 60 residents. Mr. Kemp, a rehabilitation counselor, took care of his father when he had Alzheimer’s.

They all know dementia and Alzheimer’s are insidious diseases, stealing up on people and their families. Only after the fact do bizarre behaviors and odd lapses make sense, sometimes after working lives and financial security are in a shambles. Alzheimer’s affects about 4.5 million Americans. There are some medications that stall the chronic, progressive disease, but there is no cure.

At the meeting, Betty Belevick read from an article in a business magazine about drugs in the pipeline. It might be too late for their loved ones in the grips of Alzheimer’s, but maybe it could help their children, Donna Haran said. There has been progress, not just in medications, Jeanette Rosa-Brady, support group coordinator of the Alzheimer’s Association’s Massachusetts chapter, said in an interview. She is not involved with the Dodge Park group.When she started training support group leaders in 1992, not as much was known about the disease, she said.

“People are able to access information much more readily now with the Internet,” she said. “That wasn’t there when I started. There weren’t medications to treat Alzheimer’s and there wasn’t a lot we knew from research about how to manage home safety or understand what someone with Alzheimer’s perceives.”

The Dodge Park group members talked about how to stay in the moment with the patients. For Ms. Haran, that meant not fighting with her husband when he headed for the snow blower at the first flake. Instead, she told him it was out of gas.

Distraction can work, as can humor.

The worst can be those moments of lucidity when Alzheimer’s patients recognize their plight.

Barbara Gould said her husband retired when he couldn’t face going to work once he knew he wasn’t doing it properly.

“All of a sudden he couldn’t count the money in his pocket,” she said. “That was humiliating for such a proud man. He was quick with numbers, like a calculator.”

One woman who, like many in the room, is caring for not one but two relatives — a parent and a spouse — with Alzheimer’s, said putting her husband in a nursing home was harder for her to get through than his death. Another woman said she had promised her aunt to keep her at home as long a she possibly could. Because her relatives disagree with her vow, she said, they don’t help her with the care.

Some of the people the caregivers spoke about were elderly, but some were just in their 50s when they began to fail. Many of the caregivers in the group are still working full time, fraying when demands tear them apart.

Russ Varney said he hasn’t taken a vacation in the three years since his mother became ill. He lives in Boston, works in Wellesley and takes care of his mother in Worcester. He’s exhausted pretty much all the time.

At 89, she is in perfect health — except for her dementia. She attends a day program most weekdays, as did other relatives of group members. He was cleaning her bathroom one recent weekend when he realized he couldn’t recall the last time he did the bathroom in his own house.

He recommended respite care, just to recharge.

That sounds good, but it’s not so easily done. First, the caregivers have to get over the guilt they feel when they turn their attention to themselves for a change, said Ms. Rosa-Brady of the Alzheimer’s Association. They feel guilt that they didn’t notice the disease sooner, or that they still enjoy things they used to do together, or that they get angry.

“People feel guilty that they are not doing a better job,” she said. “Any support group can dispel that right away. There’s no such thing as a perfect caregiver. You’re a human being.”

And human beings need rest. Ms. Saba-Shapazian tells them they can’t give good care if they don’t take care of themselves.

There’s even a study from the National Institutes of Health published in November that showed caregivers significantly improved their own quality of life and their loved ones’ when they were visited by people trained in stress management and problem-solving techniques and had support groups to call on.

While the Dodge Park group members talked about their trials, they never forgot the patients, saying how painful it must be for them, both in the early stages when they know they are declining and later when they are afraid and can’t be calmed.

Ms. Haran’s husband asked her one morning, when he didn’t know if he should get up, “What life is this, when I don’t know if it’s morning or night?”

Deanne’s mother was frightened, asking her, “What’s going to happen to me?”

Heads nodded as she said that.

“The strength from the people in this room is very encouraging,” Ms. Haran said.

Ms. Rosa-Brady said that’s the constant in support groups.

“You can read about Alzheimer’s on the Internet all you want. You will find information that is useful but all of us need to sit down and talk to other people who are doing the same thing you are,” she said. “You can read all you want, but that’s not going to dispel the feeling that you are the only person in the world this is happening to.”

That’s what the newcomer heard.

“It’s not easy being the ones who are left, trying to keep your head afloat. But here there’s camaraderie, compassion and understanding,” June Shack told her. “This is the right place to be.”

Comment on this story at www.telegram.com. Send an e-mail to Elizabeth Cooney at ecooney@telegram.com.






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Huperzine A in Alzheimer's Disease--Phase Two Clinical Trial

The Huperzine A in Alzheimer's Disease clinical trial is currently open and recruiting patients. This is a Phase II clinical trial.



Huperzine A in Alzheimer's Disease-The Clinical Trial

See the trial specification at Clinical Trials.gov

Study Type: Interventional

Study Design: Treatment, Randomized, Double-Blind, Placebo Control, Parallel Assignment, Safety/Efficacy Study

Official Title: A Multi-Center, Double-Blind, Placebo-Controlled Therapeutic Trial to Determine Whether Natural Huperzine A Improves Cognitive Function

Further study details as provided by National Institute on Aging (NIA).

Huperzine A is a natural cholinesterase inhibitor derived from the Chinese herb Huperzia serrata. There is evidence that huperzine A may compare favorably in symptomatic efficacy to cholinesterase inhibitors currently in use. In addition, huperzine A has antioxidant and neuroprotective properties that suggest that it may be useful as a disease-modifying treatment for Alzheimer's disease (AD). The drug is currently available as a nutraceutical in this country, and is being used by some U.S. clinicians to treat AD. However, there have been no controlled clinical trials outside China assessing its toxicity and efficacy. The present study will evaluate huperzine A in the treatment of AD in a randomized controlled trial of its effect on cognitive function.

The primary aim of this multicenter, double-blind, placebo-controlled therapeutic Phase II trial is to determine whether treatment with huperzine A 200µg twice a day improves cognitive function in individuals with AD. Secondary aims of this study are to: a) determine whether treatment with huperzine A 400µg twice a day improves cognitive function in individuals with AD; b) determine the effect of huperzine A treatment on global clinical status, activities of daily living, and behavior in AD; c) evaluate the tolerability of huperzine A treatment at dosages of 200µg twice a day and 400µg twice a day in AD; and d) determine the relationship between blood cholinesterase activity and cognitive function in individuals with AD treated with huperzine A. A total of 150 participants will be randomly assigned to three groups of equal size. This will allow a comparison of huperzine A 200µg twice a day, huperzine A 400µg twice a day, and placebo. The primary outcome measures will be the change in score on the ADAScog at the 16 week visit. Secondary outcome measures include the ADCS clinical global impression of change (CGIC) (Schneider et al 1997) and activities of daily living (ADL) (Galasko et al 1997) scales, and the Neuropsychiatric Inventory (Cummings 1997). Volunteers must be able to participate in the study for 24 weeks and make 9 visits to the trial site.

At the end of the double-blind study, participants will be invited to continue huperzine A treatment for 6 months in an open-label extension phase. Participants will receive 200µg of huperzine A twice a day for six consecutive months, and will be assessed at 3-month intervals (months 6, 9, and 12, with month 6 assessments coinciding with the final visit of the double-blind phase).

Eligibility

Ages Eligible for Study: 55 Years and above, Genders Eligible for Study: Both CriteriaThe selection process is designed to allow enrollment of all people with AD who are likely to be testable at the conclusion of the study period, and who do not have concurrent medical conditions or medications that might influence cognitive testing or that would increase the risk of treatment. Women and members of minority groups are encouraged to volunteer.

Inclusion Criteria:

NINDS/ADRDA criteria for probable AD.
Mini Mental State Examination between 10 and 24, inclusive.
Stable medical condition for 3 months prior to screening.
Supervision available for administration of study medications.
Study partner to accompany participant to all scheduled visits.
Fluent in English or Spanish.
Age 55 years or older.
Modified Hachinski score equal to or less than 4.
CT or MRI since onset of memory impairment demonstrating absence of clinically significant focal lesion.
Able to complete baseline assessments.
6 years of education, or work history sufficient to exclude mental retardation.
Able to ingest oral medication.
Stable doses of medications for 4 weeks prior to screening.
Physically acceptable for this study as confirmed by medical history, physical exam, neurological exam and clinical tests.


Exclusion Criteria:

History of active peptic ulcer disease within 1 year of screening.
Clinically significant cardiac arrhythmia.
Resting pulse less than 50.
Active neoplastic (cancer) disease (skin tumors other than melanoma are not excluded; participants with stable prostate cancer may be included at the discretion of the Project Director).
Use of another investigational agent within 2 months of screening.
History of clinically significant stroke.
Current evidence or history in the past 2 years of epilepsy, focal brain lesion, head injury with loss of consciousness and/or immediate confusion after the injury, or DSM-IV criteria for any major psychiatric disorder including psychosis, major depression, bipolar disorder, alcohol or substance abuse.
Blindness, deafness, language difficulties or any other disability which may prevent the participant from participating or cooperating in the protocol.
Residence in a skilled nursing facility; but patients in an assisted living facility are acceptable.


Excluded Medications:

Use of cholinesterase inhibitors (galantamine, rivastigmine, donepezil, and tacrine) within 2 months of screening.
Regular use of narcotic analgesics (>2 doses per week) within 4 weeks of screening.
Use of medications with significant central nervous system anticholinergic activity within 2 months of screening (e.g. tricyclic antidepressants, diphenhydramine).
Use of anti-Parkinsonian medications (including Sinemet, amantadine, bromocriptine, pergolide, selegiline) within 2 months of screening.
Participation in any other investigational drug study within 2 months of screening (individuals may not participate in any other drug study while participating in this protocol).
Use of estrogen is allowed if the dose has been stable for 3 months prior to screening.
Use of vitamin E is allowed if the dose has been stable for 3 months prior to screening.
Use of memantine is allowed if the dose has been stable for 3 months prior to screening.

To see a list of availale locations go to Location and Contact Information

New Gene Linked to Alzheimer's

"It fits into what we believe is the main mechanism of Alzheimer's already," Gandy said. "This reinforces the idea that we're on the right track with therapies already in the pipeline, while also suggesting a totally new strategy that could be used to target entirely new classes of drugs."

To read the article in its entirety go to the The Alzheimer's Reading Room.

Dementia

I ran across this factsheet on Dementia from the Milton S Hershey Medical Center. The section entitled, What are the Symptoms, is particularly interesting.

Source Milton S Hershey Medical Center

Dementia

What is it?

Dementia is the gradual deterioration of mental functioning, such as concentration, memory, and judgment, which affects a person’s ability to perform normal daily activities.

Who gets it?

Dementia occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process.

What causes it?

Dementia is caused by the death of brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer’s disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Lewy body dementia is another common cause attributed to changes in brain tissue. Other causes can include AIDS, high fever, dehydration, hydrocephalus, systemic lupus erythematosus, Lyme disease, long-term drug or alcohol abuse, vitamin deficiencies/poor nutrition, hypothyroidism or hypercalcemia, multiple sclerosis, brain tumor, or diseases such as Pick’s, Parkinson's, Creutzfeldt-Jakob, or Huntington's. Dementia can also result from a head injury that causes hemorrhaging in the brain or a reaction to a medication.

What are the symptoms?

In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. Dementia is often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others.

How is it diagnosed?

Dementia is diagnosed through a study of the patient’s medical history and a complete physical and neurological exam. The doctor will speak with those close to the patient to document a pattern of behavior. He or she will also evaluate the patient’s mental functioning with tests of mental status, such as those that require the patient to recall words, lists of objects, names of objects, and recent events. Diagnostic tests, such as blood tests, x-rays, or magnetic resonance imaging (MRI), positron emission tomography (PET), or computed tomography (CT) scans, can help determine the cause of the dementia.

What is the treatment?

In some instances, treating the cause of dementia may successfully reverse some or all of the symptoms. This is the case when the cause is related to a vitamin/nutritional deficiency, tumor, alcohol or drug abuse, reaction to a medication, or hormonal disorder. When dementia is related to an irreversible destruction of brain tissue, such as with Alzheimer’s disease, Lewy body dementia, or multiple strokes, treatment involves improving the patient’s quality of life as much as possible. This includes maintaining a stable, safe, supportive environment and providing constant supervision. While this may be done in the home, people in the advanced stages of dementia may require round-the-clock care in a long-term healthcare facility. It is important to provide the patient with structured activities and avoid disruptions to his or her daily routine. Many patients enjoy therapeutic activities, such as crafts or games, designed specifically for people with dementia. Some medications, such as donepezil and tacrine, have been effective in improving the mental functions of those in the beginning stages of dementia. Patients with hallucinations and delusions may also be treated with antipsychotic drugs, while antidepressant medications are used to treat depression.

Self-care tips

There is currently no known way to prevent dementia associated with Alzheimer's disease. You can decrease your risk of dementia associated with stroke by maintaining a healthy lifestyle, following a heart-healthy diet, and controlling high blood pressure and high cholesterol. Healthy lifestyles, including not smoking and not abusing drugs and alcohol, go a long way in keeping most people in good health. Caring for a person with dementia is stressful. It is important to learn all you can about the disease, seek the help of support groups, and find a responsible caregiver who can give you a break when needed. There are daycare programs specifically designed for patients with dementia that are good for the patient and the family.


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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.




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