Archive for May, 2010

In my last post, I talked about a handy booklet available for caregivers at the Alzheimer’s Family Day Center. I just finished reading another valuable resource, a book by Frank Fuerst, published in 2007, Alzheimer’s Care with Dignity. This is definitely a handbook worth owning for anyone caring for someone with Alzheimer’s disease. Frank Fuerst shares his 17 years of experience caring for this wife. In his Preface, he says:

After doctors diagnosed June Fuerst with early onset Alzheimer’s disease (AD), her husband attended lectures and read every available book and article on the subject. He followed most advice and found what worked, and what did not. He kept daily notes. As the disease progressed, he found himself in uncharted territory and relied on his own creativity and a process of trial and error. He realized that some information he needed was not available from any source.

Alzheimer’s Care with Dignity is not a big book — just over 200 pages — but loaded with helpful information. It’s an amazing book to read, but more importantly, it’s an essential handbook to have at your finger tips. Caregiving for an Alzheimer’s patient is an extremely challenging and daunting task, particularly in the later stages and unfortunately, everyone is different so that the suggestions he makes may not work in your situation. Facetiously, he says of the job:

  • On call — 24 hours each day
  • Regular pay — None
  • Overtime pay — None
  • Holidays — None
  • Sick time — None at night, weekends or holidays
  • Time off — None without a paid replacement
  • Ambidexterity — Mandatory
  • Needing more than two hands — Mandatory

I will introduce other chapters in future posts. If you cannot afford to buy the book, check to see if it’s in your local library.

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Caregiving at a Glance

The Alzheimer’s Family Day Center has a wonderful booklet for Alzheimer’s disease caregivers called Caregiving at a Glance. It’s designed with tabs that you can simply slip your finger under and get to the information you need. Sample topics covered include:

  • Sleeping
  • Bathing
  • Car and Home Safety
  • Activities … What to do Between Meals
  • Hostility and Aggression

On the topic of “Wandering,” for example, they suggest you register your loved one with the Safe Return program sponsored by the Alzheimer’s Association. You can call them toll-free at 1.888.572.8566 or on the Web at www.alz.org/safereturn.

“Troublesome Behaviors” is another section of this booklet. This covers a wide gamut, but they talk about things like screaming, repetitive phrases, or picking at clothes, tearing paper into tiny shreds, and other behaviors that develop in the middle to the late stages of the disease.

This wonderful resource is available at the Alzheimer’s Family Day Center by calling 703.204.4664 or e-mailing them at AFDC@alzheimersfdc@org.  The booklet is free – one copy per person. It was published with the permission of the Alzheimer’s Association. The project was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services, Washington, DC, 20201.

In this, the third of our series of breakthrough tests for Alzheimer’s disease, scientists at the University of California San Diego (UCSD), have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). This study promises to improve diagnosis and monitoring of Alzheimer’s disease (AD).

The techniques were applied to the dataset of the multi-institution Alzhiemer’s Disease Neuroimaging Initiative (ADNI). What the scientists at UCSD were able to demonstrate was that the sub-regional brain volume measurements outperform available measures for tracking the severity of AD, including widely used cognitive testing and measures of global brain-volume loss.

According to insciences.org, the new research shows that changes in the brain’s memory regions, in particular a region of the entorhinal cortex, offer sensitive measures of the early stages of the disease. According to Anders M. Dale, PhD, professor of neurosciences and radiology at the UC San Diego School of Medicine, who led the study, “Loss of volume in the hippocampus is a consistent finding when using MRI, and is a reliable predictor of cognitive decline. However, we have now developed and validated imaging biomarkers to not only track brain atrophy, but distinguish the early stages of Alzheimer’s disease from changes related to normal aging.”

The study’s co-author, James Brewer, MD, PhD, a neurologist and assistant professor in the Departments of Radiology and Neurosciences at UCSD adds that, “The technique is extremely powerful, because it allows a researcher to examine exactly how much brain-volume loss has occurred in each region of the brain, including cortical regions, where we know the bad proteins of Alzheimer’s disease build up.”

If a picture is worth a thousand words, here are serial MRI brain scans, taken six months apart, that show progression from mild cognitive impairment to Alzheimer’s disease with significant atrophy (blue) and ventricle enlargement (orange/red).

For more information, see “Analyzing Structural Brain Changes in Alzheimer’s Disease” at insciences.org.

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UCLA Ronald Reagan Medical Center

As stated in the previous post, today there are no reliable tests to determine conclusively if a person has Alzheimer’s disease (AD). However, there are several breakthrough tests on the horizon that have us hopeful that soon we may have an accurate test to diagnose Alzheimer’s disease. In the last post, I covered what’s happening at the Blanchette Rockefeller Neurosciences Institute (BRNI) at West Virginia University and Inverness Medical Innovations. In this post I will report on the breakthrough test for Alzheimer’s disease at the University of California at Los Angeles (UCLA).

At UCLA, researchers have developed a blood test that would measure the amount of amyloid beta that is being absorbed by immune cells in the blood. If the immune system isn’t adequately clearing amyloid beta, it may indicate Alzheimer’s risk. According to Gen News, the UCLA scientists took blood samples and isolated monocytes including amyloid beta. The monocytes were incubated overnight with amyloid beta, which was labeled with a fluorescent marker. Using flow cytometry, the investigators then measured the amount of amyloid beta ingested by the immune cells.

The 18 Alzheimer’s disease patients in the study showed the least uptake of amyloid beta. The healthy control group, which consisted of 14 university professors, had the highest uptake.

The method was able to distinguish the Alzheimer’s disease patients with adequate sensitivity and specificity and the results were found to be positive in 94% of patients and negative for the entire control group. Additionally, the data was positive in 60% of participants who suffered from mild cognitive impairment.

Milan Fiala, M.D., is the lead author of the UCLA study, which appeared in the May 2009 issue of the Journal of Neuroimmunology.

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