In the spring of 2011, the National Institute on Aging and the Alzheimer’s Association announced a new pre-clinical stage of Alzheimer’s Disease, marking the first change in the definition of the illness in 27 years. The announcement grows out of evidence that plaques and tangles characteristic of Alzheimer’s Disease begin to form in the brain years before the patient shows any symptoms. The new definition raises the tantalizing possibility of developing treatments that could delay or halt the progression of the illness before the brain is compromised. BeClose.com spoke with Dr. William Thies, chief medical and scientific officer for the Alzheimer’s Association, about the impact of this new definition both today and in the future.

Q: If there are no symptoms, why is it important to identify this very early phase of Alzheimer’s?

A: There is the feeling in the field that by the time someone has become demented, it’s too late to treat them. What we’re beginning to see is the evolution of a picture that is a lot like that of other diseases with a long onset. For example, at one time, people defined heart attack as the event that happened when the coronary artery was blocked. But the real success in treatment came when it was realized that the pathology for heart attack appeared many years before a heart attack occurred. We now know that if you treat the sclerosis that underlies the problem, you can prevent a heart attack from ever occurring.

Q: Can you get tested for pre-clinical Alzheimer’s at this point?

A: No, you can’t go to your local doc and say, I’d like to get this particular cerebro-spinal fluid test; it’s just not commercially available. That said, it may be possible that amyloid imaging, which is a way of using a PET scanner to take a picture of the amount of beta amyloid in an individual’s brain, will become publicly available in a relatively short period of time. A few months maybe. However, for consumers, there’s no point in doing the testing unless there are good treatment options.

Q: What are some of the most promising avenues of research into future treatments?

A: Many of the therapies being tested have the potential to limit the accumulation of beta amyloid. This is a polypeptide chain that exists naturally in the brain, but develops two extra amino acids as some people age. This substance starts to accumulate in the brain. We know from experiments that beta amyloid is toxic to brain cells. Many feel that if you could limit that accumulation of toxin, you could limit the course of Alzheimer’s Disease.

Q: How would a potential drug work?

A: You can either get the brain to make less amyloid or get rid of more. It’s not exactly rocket science. Two drugs are currently being tested at phase III level—these are the big trials necessary to get permission from the FDA to sell the drug. Being in phase III doesn’t mean that the drug is effective. Still, we can at least imagine a time when they might be available in your medicine cabinet. So that’s one promising area.

Q: Any others?

A: Some data says that if you drink more red wine you tend to have less Alzheimer’s Disease disease, so that track of epidemiological information has led us to resveratrol, an antioxidant found in grape skins. There’s also a blood product called IVIG (intravenous immunoglobin), which is being tested at phase III level. All of those are promising.

Q: But all this is far off. Without a cure, what’s the benefit of knowing you have this devastating illness in your future?

A: The Alzheimer’s Association has encouraged early diagnosis for years, not so much for the medical care you can receive, but rather for your ability to learn about the disease and prepare for the future. If you have a goal to travel around the world, for example, and if we have an effective biomarker that could let you know years in advance, you might want to take that trip a bit sooner while you’re still able. You’d certainly want to create powers of attorney so that your healthcare and estate planning would be handled as you wish.

Q: What about the impact for family members and potential caregivers?

A: It’s a chance for education. One of the things people don’t recognize is that people in early stage dementia get victimized by society. For example, they don’t remember they just bought a new car, so they go out and buy another one. Family members can help protect them from harm. Another benefit is understanding that Alzheimer’s changes peoples’ personality. This can be devastating to family members who mistakenly believe that mom or dad, in expressing hostility or anger, is revealing true opinions they’d been hiding for years. So the value of an early diagnosis will be able to stand on its own even with the limits of what we know today. And certainly knowing that better medications are coming, it takes on an even greater purpose.

–Steven Slon

Steven Slon is the Editorial Director for The Saturday Evening Post. He writes a regular column about aging and caregiving for http://www.BeClose.com, in which this article first appeared.

New Hope for an Alzheimer’s Cure The Saturday Evening Post

Imagine having a robot around the house that can lift a frail elder if they fall when you are not around. Now visualize automated dresser drawers that can literally talk and guide a dementia patient through the complex—and often stressful—act of getting dressed in the morning. You are seeing what could very well be the future of caregiving.

Diane F. Mahoney, PhD, Professor of Geriatric Nursing Research at MGH Institute and her team were among the first to study wireless monitoring technologies for caregiving. Frustrated with so-called “alert” bracelets  that patients frequently fail to activate, she became interested in high-tech devices that not only monitor patients in the home, but can provide an assist to the harried caregiver. Mahoney’s research is at the bleeding edge of caregiving technology. I spoke with her recently to find out what’s coming next.

Q: Robots in the home? What sparked this concept?

A: I got the idea when I heard that people are falling and not getting up, and they are not pushing the alert button on their alert bracelet or calling for an ambulance. I thought, wouldn’t it be nice if we had some kind of personal lifting device for elders?

Q: Is it feasible?

A: The concept already exists. The military has some neat robotic devices that they use to go into the battlefield and lift downed soldiers and remove them under fire. So I wound up getting involved as a consultant to a couple of robotic companies that are indeed working on devices that can move and lift a person. I am helping companies to develop a product for in-home use, for a future version when the technology becomes affordable.

Q: So, robots in the house? I guess, to appeal to baby boomers, you just put a BMW label on the thing.

A: [Laughs] Right!  I’m a baby-boomer and, I’ll tell you, 20 years from now, I’d like a little robot running around the house.

Q: Yes definitely, me too. So, will we start seeing robots soon?

A: iRobot already has the Roomba, a robotic vacuum device, and they are very entrepreneurial. There are also other companies around that are working on components of robotics for in-home use. So in the near future they could merge together, combine developments, and solve potential safety issues. I’m sure these companies will be able to overcome the technology challenges in the next decade. And wouldn’t that just be great?

Q: A lot of your work has focused not just on the patient, but on the caregiver’s need for respite, for just a small break during their 24-hour workday. Can you tell us a little about that?

A: After years spent listening to Alzheimer’s caregivers talk about their needs, one of the themes that kept coming up was, “if only I had 10 minutes to myself, if I could just breathe or go to the restroom without my husband or wife banging on the door!” So I designed an automated telephone call; I called it a respite call. To make it effective, we interviewed the caregiver for their patient’s favorite hobbies, foods, smells, songs, and so forth. The phone call was all computerized, and the caregiver could call in anytime and put their patient on the phone—even at two in the morning when they were being driven crazy. And by calling in and putting in the password the conversation would come up and the voice on the phone would say, “Oh, hello Harry. Oh, it’s so nice to talk with you now. You know, I understand you really like brownies…” And of course, for someone else, it could be chocolate candy.

Q: Would this keep them busy for the magic 10 minutes?

A: Actually I designed it to be 28 minutes long and it was able to repeat once. So we put it out there; I had no idea if this would work or not. Many people don’t let their person with dementia use the phone anymore. But others tried it and it gave people more than their 10-minute break. They got a 28-minute break. Some of them went around twice, for a total of 56 minutes.

Q: I bet caregivers were pleased with that.

A: Yes. One caregiver said to me, “The day is very long. And I need a tool box. And in my tool box I need a whole bunch of things to keep him occupied. This is a very important tool in the box.”

Q: What other tools have you developed?

A: I’m starting another project with a colleague who has been using motion sensor technology for children with autism. We just got funded a few months ago by the Alzheimer’s Association to build what I call DRESS – Development of a Responsive Emotive Sensing System—to help people with dementia get to a state of rest. The project grew out of our observation that, for people with dementia, getting dressed is often a trigger activity for becoming extremely upset. The person gets in the drawer and rummages and gets stuck and keeps on rummaging.

Q: What is the solution?

A: For the prototype we are going to put iPhones on each drawer. So if they get stuck in one drawer too long, the iPhone on the next drawer they should go to will turn green and flash, and if they open it, fine. If they don’t open it, the phone will speak, and actually say “Open this next.” It will continue with verbal cues until they perform the requested activity.

Q: This is not just to help them get dressed, right? Again, this is partly about caregiver respite.

A: Yes, even if we can’t get them fully dressed, the caregiver can use this as a safe activity. We might be able to convert what would have been an annoyance into a distracting respite activity for 20 or 30 minutes. Worst case, the caregiver gets a break; best case, the person actually gets dressed alone.

Q:  Either way, sounds like a victory.

A: Certainly! The respite part is central. Caregivers themselves are often so focused on their loved ones that they often don’t take the time to take care of themselves. I’m in this field because I really appreciate the role caregivers play. They make such a vital contribution that sometimes I don’t think our society fully appreciates.

Steve Slon is the editorial director for The Saturday Evening Post. This article was originally published by Beclose.com

“Help, Robot! I’ve fallen and I Need You to Pick Me Up” The Saturday Evening Post

For nearly 40 years, as a medical and nutritional writer concentrating on the predicament of aging, I have closely followed the research findings on Alzheimer’s and age-related memory loss.

Yes, we may face an epidemic as baby boomers age, and yes, there may also be a cure in our future. But the fact is our susceptibility to Alzheimer’s, like heart disease, cancer, and diabetes, though somewhat at the mercy of genes, is also partly influenced by factors within our control.

We all can do some things to help our brains negotiate the hazards of advancing age:

Overcome Depression

It is a risk factor for Alzheimer’s, not a symptom.

So you are feeling depressed, and your cognitive functioning is not what it used to be. Is this something to worry about? Yes, say experts. They know that depression is common among older people with mild cognitive impairment and Alzheimer’s.  But does depression bring on the disorder or is depression a subtle early sign of the underlying pathology of Alzheimer’s? Is it cause or consequence?

For ages, doctors thought depression emerged as a symptom after the disease had taken hold. Now, research suggests that the opposite is true—that depression is actually a risk factor that makes you more prone to develop Alzheimer’s in the first place. In short, warding off or treating depression may save you from impending brain disaster.

For example, UCLA researchers found that depressed people with mild memory problems were more likely to end up with Alzheimer’s than nondepressed people. The deeper the depression, the greater the probability.

In a French study, older women with mildly impaired mental agility who were also depressed were twice as likely to progress to Alzheimer’s. Moreover, if you are depressed, you are likely to develop Alzheimer’s at an earlier age, according to new University of Miami findings.

Robert S. Wilson, PhD, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago, theorizes that being depressed weakens the brain’s “neural reserve,” its ability to tolerate the pathology that comes with Alzheimer’s. In short, he says, depression changes the brain in distinctive ways that undermine its normal resistance to the disease.

The clear message: If you’re depressed, you are more apt to develop Alzheimer’s, and at an earlier age, especially if you already have age-related memory problems.

What to do? Do not let depression go untreated, especially if you already notice memory problems. Drugs, including antidepressants, and other therapies, such as exercise, can make a difference. UCLA investigators also found that Aricept (donepezil), an Alzheimer’s drug, significantly delayed the progression from mild memory problems to Alzheimer’s in depressed persons.

Find Good Information

The Alzheimer’s Association is a national nonprofit organization with local chapters and a website offering extensive information on the disease. Be sure to check out its excellent interactive tour of the brain, which shows how the brain works and how Alzheimer’s destroys it.  For the brain tour, click on “Alzheimer’s Disease,” then “Brain Tour.” It’s available in several different languages.

The Alzheimer Research Forum is a very lively and well-written website that post comments from both leading authorities on Alzheimer’s and the general public. It reports that the latest research, carries discussions among experts, and gives full exposure to innovate, controversial, and offbeat theories and ideas. It’s the place to go to find out the complete range of what top researchers in the field are thinking and doing.

Excerpted from the book 100 Simple Things You Can Do to Prevent Alzheimer’s and Age-Related Memory Loss by Jean Carper. Copyright © 2010 by Jean Carper. Reprinted with permission of Little, Brown and Company.

Outsmarting Alzheimer’s The Saturday Evening Post

Grandma Eileen and Grandpa Jim were in Indianapolis for the summer. I felt that Grandma needed to get out of the house for a little while, so I took her with me to run a few errands. Because her knees often hurt due to surgeries after falling off a horse in her youth, it was quite a battle getting her into my SUV. But after what seemed like hours of maneuvering and adjusting, we were buckled up and off to the bank.

To avoid the grueling process of getting in and out of the car, I decided to opt for drive-thru banking. As I was explaining my transaction to the teller, I heard the ding sound that signals a car door ajar. I looked over to my passenger, and yes, she was making a break for it! I inquired as to where she was going, and with an “isn’t it obvious” tone in her voice, Grandma replied: “I’m going to the bank.” Now, far be it from me to hold her back from doing her imaginary personal banking, as I’m pretty sure she did not hold an account at that banking institution, nor any other one for that matter. But I explained that I was working with the teller, and we didn’t even need to get out of the car; how convenient! She was delighted with the concept and closed the car door.

After the bank, I stopped to get a bagel and told Grandma that she could sit in the car while I went inside. I asked if she was hungry and she responded, “Sure.” Always so agreeable when it comes to food or drink, I thought. It must run in the family. But then I asked what kind of bagel she wanted. Blueberry? Salt? Plain? With light cream cheese? Butter? Or toasted? I waited for at least three minutes. Finally, she asked politely for “a round one.” As opposed to the ever popular, but far less tasty, triangular shaped bagels? I did hear that the octagonal bagel was making a comeback, and quite a treat, I thought. But she decided to stick with the original round bagel! You have to appreciate that kind of answer after so much consideration!

Have you ever been able to appreciate a light-hearted moment while coping with ongoing grief?

Running Errands … The Saturday Evening Post