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The Village Landais Alzheimer – France’s New Care Facility

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A 17-acre elderly care village named Landais Alzheimer is currently being built near the city of Dax nestled in southwestern France. It may appear to be a senior living community like any other, but it’s unique in that it’s a village developed entirely for men and women suffering from Alzheimer’s disease (AD).

Henri Emmanuelli developed the idea after reading about a similarly established care facility for individuals with dementia in the Netherlands. Largely governmentally funded, the Village Landais Alzheimer is anticipated to cost around $36 million dollars once completed, with an expected daily resident cost of only $82 per day, which is comparable to the daily rate for traditional French nursing homes. Now-a-days, with increasing costs of care as we age, not everyone can attend a private care facility or maintain the ability to stay home despite help. The Village Landais Alzheimer is Henri’s solution.

The Village

The community is equipped with a salon, gym, restaurant, garden, 5-acre park, library, and even a small farm! Residents will maintain a sense of independence and normality by shopping in a small supermarket for their individual needs, and most importantly, in a safe space developed especially for them. The architecture will allow for residents to walk, navigate, and orient themselves within the community, something that can often prove challenging for individuals with AD.

The houses are arranged in four square-like districts that surround a central commons ground offering most amenities and an auditorium. Residents will share housing designed to respect various lifestyles and their independence and privacy, offering a familiar family way of life. Sixteen houses with 7-8 residents will reside in one of four neighborhoods. All attempts were made to make the village feel as if it’s a regular, every-day village. The neighborhoods are named after nearby towns found between Frances southwestern sea and forest, and are designed with styles to match. To help patients feel appropriately oriented the village used a more traditional and familiar look of a medieval fortified town, common in this region of France, rather than modern architecture.

Medical staff without any visible identifiers and in plain clothing will watch over residents as they go about their daily lives and may provide care if needed. Trained volunteers will be present for daily activities that sometimes consist of outside events, like sports games and plays. These volunteers, mostly from the surrounding community, will breathe life into the village and provide a link between the village and the ‘outside world’. The facility will not be an isolated village, but rather open to the town of Dax, which will help to introduce further culture. Trained dogs will also be available to prevent the psychosocial isolation often accompanied with aging and AD. 

Why create an entire community dedicated to people with AD?

It will allow individuals with AD to increase their freedom while also reducing anxiety, which is a side effect highly associated with AD. The facility is hoped to create a sense of normality, community, and continuity between pre and post AD diagnosis, with an emphasis on maintaining socialization. Advocates for the village expect residents to be happier with increased activity and less required medication when compared to traditional living facilities. The fact that a place exists specifically catered to caring for loved one’s with AD, without sacrificing quality of life, should also help to lessen the worry of friends and family.

Unlike the already established Dutch site in the Netherlands, 120 young researchers will cohabitate with the Alzheimer’s residents along with 100 live-in caretakers and 120 volunteers. The researchers will identify the impact of their residential approach on patients, caregivers, and medical staff with a comparative study with traditional nursing homes. The facility is expected to open at the end of 2019. Depending on the results of the associated research, it may change the way we currently view residential housing for individuals with AD.

The following video will take you on a tour of the village. Although it has not been translated into english, it provides a nice visual of its set up and accomodations.

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Sources: 
“France Builds First Alzheimer’s ‘Village’ in Pioneering Experiment.” BBC News, BBC, 5 June 2018, www.bbc.com/news/world-europe-44376247.
“La Maladie.” Village Alzheimer, villagealzheimer.landes.fr/la-maladie.
Samuel, Henry. “France Starts Work on Revolutionary ‘Alzheimer’s Village’ Where Patients Roam Almost Free.” The Telegraph, Telegraph Media Group, 4 June 2018, www.telegraph.co.uk/news/2018/06/04/france-starts-work-revolutionary-alzheimers-village-patients/.

Physical Activity Helps Delay AD Progression

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We have all been told how important it is for our health to lead an active lifestyle. Physical activity has many positive health benefits, but research is showing that it also has a protective effect on your brain!

According to a longitudinal study published in the July online edition of JAMA Neurology, physical activity and the management of other vascular risk factors – such as hypertension, diabetes, high cholesterol, atrial fibrillation and smoking – battle the progression of Alzheimer’s disease (AD).

Participants in this research were part of the Harvard Brain Study and were followed for up to 8 years. All of these individuals had positive amyloid PET scans and vascular risk at the beginning of the study. 

Physical activity was measured using pedometers that were worn around the waist, providing their mean steps per day. Participants also completed cognitive tests at baseline and throughout the study to monitor for decline. Amyloid levels were also monitored longitudinally for each participant.

Researchers found that modest regular physical activity (8,000-9,000 daily steps) was associated with slower brain volume loss over time and greater physical activity in those with high amyloid plaque burden protects against cognitive decline. 

The study also showed that the effect of physical activity on cognitive decline was independent of how well the subject’s vascular risk factors were being managed and controlled. These are two separate variables that have a profound influence on brain health that can be thoughtfully managed throughout life to promote brain health and longevity.

It is impossible to say exactly how much exercise is needed because every individual is different, but working to include modest regular activity into your daily routine will benefit you in the long run.

Not sure what to do for exercise? Keep it exciting! 

Rotate or have a good mix of resistance training, aerobic exercise, and mind-body exercises.

If you have not been engaging in any form of physical activity it’s not too late to begin! Just make sure to ease in to a routine and begin with gentle exercises to avoid injury. Over time you can increase the intensity of the activity or workout.

Here are some creative ways to get the body moving and get your steps in!

  • Find a walking buddy
  • Take a lunchtime walk
  • Park a little farther away at the store
  • Set an alarm to remind you when it’s time to walk or exercise
  • Look up walking exercise videos on YouTube
  • Take your dog on a walk
  • Take the stairs instead of elevators
  • Pace while watching your favorite TV shows, or take walk breaks during commercials
  • Dance!
  • Explore a new neighborhood/area with a friend or family member
  • Break it up, those small walks add up!
  • Walk in the mall 

What if I can’t walk?

There are still ways you can engage the body physically if you are unable to walk or have limited mobility. There are strength training and aerobic workouts that can be done in a chair. Great videos of these workouts can be found on YouTube that you can follow along and get your body moving!

Don’t forget that along with physical activity, you can also do other things to lower your risk of AD progression including stress reduction, proper nutrition, healthy sleep, social interaction, and maintaining stimulating hobbies/activities.

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Sources: 
Gomes-Osman J. What kinds of exercise are good for brain health? [Internet]. Harvard Health Blog. 2018 [cited 2019Sep24]. Available from: https://www.health.harvard.edu/blog/what-kinds-of-exercise-are-good-for-brain-health-2018050213762
Physical Activity Moderates Amyloid-Beta Burden in… : Neurology Today [Internet]. LWW. [cited 2019Sep24]. Available from: https://journals.lww.com/neurotodayonline/Fulltext/2019/08220/Physical_Activity_Moderates_Amyloid_Beta_Burden_in.6.aspx
Harvard Health Publishing. A Guide to Cognitive Fitness [Internet]. Harvard Health. [cited 2019Sep24]. Available from: https://www.health.harvard.edu/special-health-reports/a-guide-to-cognitive-fitness?utm_source=HHPBlog&utm_medium=link&utm_content=related-text&utm_campaign=referral
6 Pillars of Brain Health – Physical Exercise [Internet]. Healthy Brains by Cleveland Clinic. [cited 2019Sep24]. Available from: https://healthybrains.org/pillar-physical/

Intermittent Fasting, Could It Help Protect Your Brain While Aging?

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Why do people get Alzheimer’s disease (AD)?

The cause of this disease is still widely unknown, but after many years of studying AD caloric intake, neuroscience professor Mark Mattson suggests that it may have to do with our modern eating habits. Mattson is particularly focused on the timing and frequency of our meals and how this affects our brains. 

Intermittent fasting, also known as caloric restriction, may not just be a tool used to achieve weight loss goals. When you adopt intermittent fasting into your lifestyle, you are cycling through short periods of eating and longer periods of fasting.

Historically, humans would naturally fast in between periods of hunting and gathering foods, as food was not as accessible as it is today.  Stocked kitchens and pantries allow us easier access to food at any hour of the day, and early breakfasts and late-night snacking have made it harder for humans to achieve our natural fasting state. This hinders the body’s ability to metabolically switch from using glycogen to ketones for fuel.

Glycogen is derived from the glucose in carbohydrates that we eat and is used as fuel for up to 12 hours after we eat. If we don’t use all our glycogen between meals it is turned to fat. Ketones are derived from our fat reserves and take over after the glycogen is all used up. Fasting shifts our energy production from glycogen to ketones.

Both glycogen and ketones fuel our neurons, but higher ketone production has been linked to improvements in thinking, learning, and memory. 

Fasting is quickly showing strong potential for the treatment of AD as it has been shown to slow cognitive decline and improve AD symptoms in mice. In several studies, researchers used genetically altered mice displaying AD symptoms. The mice that were fed on an intermittent fasting diet were better off than those that were allowed to eat whenever they wanted. The fasting mice showed better cognitive functioning and had less plaque buildup in their brains. They also lived longer than the mice that were not fasting.

Fasting can also lower oxidative stress. Oxidative stress occurs when we breakdown the food we eat to utilize the energy from the sun.  Unfortunately, the very process that keeps us alive, accessing the sun’s energy from our food via free radical formation, damages our cellular function as we age and contributes to the development of Alzheimer’s disease and the aging process — the more we eat the more we rust! Fasting upregulates free radical scavengers and anti-oxidants.

Diets that are high in simple sugars are associated with an increased risk for developing AD, the worst being refined sugar. Currently there are several clinical trials studying the link between nutrition and neurodegenerative diseases as there is still much to be learned about caloric restriction as a form of treatment or prevention. 

Managing caloric intake reduces body fat mass and provides other age-related benefits such as supporting healthy weight loss which, in a recent clinical trial, was associated with cognitive improvement in elderly individuals with Mild Cognitive Impairment (MCI).

Does this mean you should immediately start fasting?

Until more is known about the effectiveness of intermittent fasting in the prevention of AD, the best thing to do is to reconsider those late night snacks and limit your eating to about 12 hours a day, making sure to fast for the other 12 hours. If this 12/12 regime is not unpleasant for you, attempt a 16/8 fasting regime in which you skip breakfast, having only tea or coffee without sugar, and stop eating dinner at 8:00pm.  A regimen such as this can help protect your brain as you age and make other positive contributions to your overall health. One of the worst things you can do is eat a large dinner and then go right to sleep, so make sure to stop taking in calories about 3 hours before bedtime. 

The following video features professor Mark Mattson discussing theories and findings related to intermittent fasting and the benefits it can have when adopted into your lifestyle.

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Sources:
The Growing Science Behind a Fasting Treatment for Alzheimer’s [Internet]. The Crux. 2019. Available from: http://blogs.discovermagazine.com/crux/2019/06/19/the-growing-science-behind-a-fasting-treatment-for-alzheimers/#.XUsdlfJKgdU
Markesbery WR. The Role of Oxidative Stress in Alzheimer Disease [Internet]. Archives of Neurology. American Medical Association; 1999. Available from: https://jamanetwork.com/journals/jamaneurology/fullarticle/775665

 

AFA’s New Online Memory Screen

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The Alzheimer’s Foundation of America (AFA) have added a new tool to their website in the form of an Online Screening Test that can help determine whether or not a visit to your doctor may be beneficial to you. This test only takes a few minutes to complete.

To begin the test, a prompt on the screen will provide you with instructions on how to correctly complete the test. The test itself is simple, presenting you with a series of images. When an exact repeat image appears on the screen, the spacebar is pressed on the keyboard. It is important to respond quickly because your reaction time is taken into account. When the test is completed you will be shown your results. These results tell you your percent correct, your mean reaction time, and a short test analysis. The test analysis section provides a range of how you performed on the test in terms of above average, average, or below average for your age group. If your score is interpreted as below average, it may suggest that you retake the test after reviewing the instructions. If your score does not improve the next time you take the test, a clinical evaluation may be a good idea.

How is this screening test helpful?

Executive dysfunction and impaired working memory are two early indicators of Alzheimer’s disease (AD). Alzheimer’s disease can begin causing executive dysfunction before any signs of memory loss begin to emerge.

Assessments, such as the AFA’s Online Memory Screen, that are targeted towards working memory, attention, and executive functioning help with the early detection of AD symptoms. As we have discussed in past blog postings, it is crucial to begin monitoring and addressing AD symptoms at the earliest sign possible in the hope of preventing progression to more severe AD symptoms for as long as possible.

Working memory is the brain’s ability to hold information in our minds for a brief time and work with it. A good example of this is if you try to prepare a Thanksgiving meal. There are many components to keep track of all at the same time, and you will need to recall the steps of the recipe that you have already completed. This online screening test is similar because it is asking you to assess images and hold them in your working memory, while also continuing to look at more images and sort through them.

What is encoding?

Encoding is when you initially learn information and is the first step in creating a new memory. This new information is then maintained over time, stored throughout the brain, and is available to be retrieved as it’s needed. Encoding is selective, as we are exposed to many stimuli throughout any given day of our lives and it is impossible to remember all of it. As more symptoms of Alzheimer’s disease begin to appear, the hippocampus starts to shrink and the brain’s ability to encode new information and form new memories becomes compromised. The hippocampus is also important for the retrieval of old memories.

It is important to remember that screening tests are not meant to diagnose AD or other conditions, but are to help with earlier diagnosis so that preventative and protective measures can be taken as early as possible.

Here is the link to access the online memory screen: AFA Online Memory Screen

*If you have any questions regarding your score on the Online Memory Screen, the AFA has a staffed National Toll Free Helpline available for you to call at 866-232-8484. The line is open from 9AM-9PM ET Mon-Fri, and 9AM-1PM ET Sat-Sun.

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Sources: 
Memory Encoding – Memory Processes – The Human Memory. [cited 2019Aug6]. Available from: http://www.human-memory.net/processes_encoding.html
Executive Functioning – Where is it Controlled and How Does it Develop? / Remediation Techniques for Deficits and Dysfunction [Internet]. Rainbow Rehabilitation Centers. 2017 [cited 2019Aug6]. Available from: https://www.rainbowrehab.com/executive-functioning/
Jahn H. Memory loss in Alzheimer’s disease [Internet]. Dialogues in clinical neuroscience. Les Laboratoires Servier; 2013 [cited 2019Aug6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3898682/
Heerema E. How Executive Functioning Is Affected by Dementia [Internet]. Verywell Health. Verywell Health; 2019 [cited 2019Aug6]. Available from: https://www.verywellhealth.com/executive-functioning-alzheimers-98596
Kirova, Anna-Mariya, B. R, Sarita. Working Memory and Executive Function Decline across Normal Aging, Mild Cognitive Impairment, and Alzheimer’s Disease [Internet]. BioMed Research International. Hindawi; 2015 [cited 2019Aug6]. Available from: https://www.hindawi.com/journals/bmri/2015/748212/
Memory (Encoding, Storage, Retrieval) [Internet]. Noba. [cited 2019Aug6]. Available from: https://nobaproject.com/modules/memory-encoding-storage-retrieval
Welcome to the Alzheimer’s Foundation of America’s Memory Screening Test [Internet]. AFA Online Memory Screening Test RSS. [cited 2019Aug6]. Available from: https://afamemorytest.com/
 

Benefits of Turmeric (Curcumin)

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Turmeric is a commonly used natural spice in South Asian cuisine such as curry. It is a common question whether or not turmeric and curcumin are the same thing. Turmeric is the plant itself, and curcumin is a compound found within turmeric.

Turmeric is used in traditional South Asian medicine to relieve wounds, gallstones, cramps, and Alzheimer’s disease (AD) symptoms. There is a growing amount of research being done regarding curcumin as an effective antioxidant and anti-inflammatory agent with the ability to improve cognitive functions in those with AD. Scientists report that Alzheimer’s disease for Indians aged 70-79 is four times lower than the rate in the United States. Several studies report turmeric(curcumin) to be equally as effective as donepezil(Aricept) in some cases. 

Top 10 documented uses of Turmeric and Curcumin

  • Memory Improvement
  • Heart Strengthener
  • Healthier Skin
  • Better Digestion
  • Less Dry Eye
  • Seasonal Allergy Relief
  • Artery Health
  • Diabetes
  • Better Liver Function
  • Arthritis Pain Relief

Reported benefits of turmeric include: anti-inflammatory properties, pain relief, improved liver function, reduced cancer risk, aids digestion, and immune health support.

How does Turmeric ( Curcumin) affect Alzheimer’s disease?

Both amyloid plaques and tau tangles are the basic pathologic markers of AD and initiate neuroinflammation causing more damage to thebrain because the immune system tries to clear these “foreign invaders”. These plaques and tangles accumulate, contributing to a decline in cognitive performance and memory loss. Research suggests that curcumin binds with the amyloid beta proteins, and due to its strong anti-inflammatory properties, prevents amyloid from resulting in further damage the brain.Curcumin decreases the level of oxidized proteins and isoprostanes in the brain while also suppressing Presenilin-1 activity (the BASE enzyme that make toxic AB-40/42), inhibiting further production of amyloid. Curcumin has also been found to have a high binding affinity for iron and copper; metals that can accelerate oxidative damage in the brain.

How much turmeric do I take?

The dosage of turmeric and curcumin extract vary depending on the form you are taking it in.

There are no official guidelines for the intake of turmeric, but the acceptable dietary intake is 1.4 mg per pound (3mg/kg) of body weight. This guideline was determined by The Joint FAO/WHO Expert Committee on Food Additives (JECFA).

If you are just taking curcumin extract, the dosage is unknown, but there are currently clinical trials being done to investigate a safe and effective dosage. 

Before deciding to add turmeric or curcumin extract into your daily routine, consult with your doctor. Be sure to consider the quality of the powder or supplement when deciding which one to purchase. Some powdered forms have additives or cheap fillers that may be hard to identify solely from the label. It is recommended to choose turmeric from a reputable agency, such as one that is USDA Certified Organic.

What if I don’t want to take the powdered form?

Turmeric can be added into your diet by getting creative in the kitchen and spicing up your recipes! For some inspiration check out some of these possible recipes from BBC Goodfood.

Are there side effects?

The most commonly reported side effect is stomach upset when taking turmeric. In some cases it also can cause a headache. A skin rash may occur when taking extremely high doses, although this is rare.

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Sources:
Adalier, Nur, and Heath Parker. “Vitamin E, Turmeric and Saffron in Treatment of Alzheimer’s Disease.” Antioxidants, vol. 5, no. 4, 2016, p. 40., doi:10.3390/antiox5040040.
Bhat, Abid, et al. “Benefits of Curcumin in Brain Disorders.” BioFactors (Oxford, England), 2019, doi:10.1002/biof.1533.
Tweed, Vera. “10 Benefits of Turmeric and Curcumin: The Popular Curry Spice and Its Active Ingredient (Curcumin) Offer a Wide Array of Uses for Health and Wellness.(Check OUT: GUIDE TO CUTTING-EDGE SUPPLEMENTS).” Better Nutrition, vol. 80, no. 5, 2018, p. 26.

Current Alzheimer’s Drugs and What They Do

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With so many advertisements claiming that certain medications treat Alzheimer’s disease, how can we tell which one’s are legitimate?

There are 4 FDA approved medications for the treatment of Alzheimer’s disease (AD) in the United States. These drugs are not cures for the disease, but rather, help better manage the symptoms that effect memory and thinking.

There are two types of medications that are FDA approved to treat the cognitive symptoms brought on by Alzheimer’s, cholinesterase inhibitors and memantine.

The three commonly prescribed cholinesterase inhibitors are Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Razadyne). These three medications are generally used during the mild to moderate stages of Alzheimer’s disease.

But what is a cholinesterase inhibitor?

Cholinesterase inhibitors work to prevent the breakdown of acetylcholine, which is a chemical in the brain that is part of the attention,  learning and memory circuits. Cholinesterase inhibitors have side effects mainly on the GI system. However, not everyone will get a response on these drugs; the effectiveness of these drugs varies from person to person. For people in later stages of AD, it may be harder to notice the assistance that these drugs can offer.

Memantine (Namenda) helps to regulate glutamate in the brain. Glutamate is a neurotransmitter in the brain that is responsible for sending signals between nerve cells. Memantine is typically used in the later, more severe stages of AD, but it can also be given to early stage patients to target anxiety and irritability.

New drugs are being tested to attempt to slow the progression of Alzheimer’s disease or even modify the disease process itself so that it does not have the opportunity to come to fruition as full blown Alzheimer’s disease. Common targets that experimental drugs are focusing on are Beta-amyloid, Beta-secretase, Tau protein, Inflammation, and the 5-HT2A receptor.

What about alternative treatments I’ve seen advertised?

There are many over-the-counter drugs and dietary supplements that claim to treat AD, delay AD, or enhance memory and thinking. However, these products have not been evaluated and approved by the Food and Drug Administration as safe or effective treatments for Alzheimer’s. In some cases, these products may negatively interact with prescribed medications already being taken in the course of treatment.

Always discuss any new herbal remedies, dietary supplements, or alternative treatments with a medical professional before adding any into your daily routine. If you see a new treatment available that interests you, make sure to do the research and bring information with you to discuss with your doctor.

The following video offers a visual explanation of cholinesterase inhibitors and memantine!

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Sources:
khanacademymedicine. Treatment of dementia and Alzheimer’s disease | Mental health | NCLEX-RN | Khan Academy [Internet]. YouTube. YouTube; 2015 [cited 2019Jul16]. Available from: https://www.youtube.com/watch?v=durV0mnzPo4
Medications for Memory [Internet]. Alzheimer’s Disease and Dementia. [cited 2019Jul16]. Available from: https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
Zhou Y, Danbolt NC. Glutamate as a neurotransmitter in the healthy brain [Internet]. Journal of neural transmission (Vienna, Austria : 1996). Springer Vienna; 2014 [cited 2019Jul16]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133642/

Our Stories

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Our Stories, by the Alzheimer’s Association, features the unique stories of 5 individuals with Alzheimer’s disease. These interactive stories help to notice changes in yourself or a loved one, and give tips on starting conversations about health concerns. It can be difficult to know what to do or say, but the stories of Cynthia, Mario, Julie, Theresa, and Tom are helpful guides in how to approach different situations.

It can be difficult to know what to say when you suspect someone important to you is experiencing memory problems, thinking problems, or behavior changes. Early detection of these problems offers significant benefits for an individual who is diagnosed with Alzheimer’s.  Benefits of early diagnosis include medical benefits, emotional and social benefits, more time to plan for the future, and cost savings. Further explanations of these benefits can be found here.

The biggest question is, How do you know when it’s time to have conversations like these? What if the concerns you have are part of normal aging?

Topics that can lead to a conversation about your concerns include:

  • challenges in planning
  • changes in mood
  • confusion with time and place
  • decreased judgment
  • difficulty completing tasks
  • memory loss
  • misplacing things
  • problems with words
  • trouble with visuals
  • social withdrawal

The Our Stories website also offers help by providing conversation starters with their 10 Steps To Approach Memory Concerns With A Loved One worksheet.

This 10 step guide is available to help you feel more confident and comfortable as you start to begin this discussion and take action. The steps navigate through three different categories:

  1. Assess The Situation
  2. Take Action Through Conversation
  3. Reach Out For Help

Each step is related to one of these three categories and suggests a course of action to be taken.

You can print out this guide and fill it out at your own pace and to meet your individual needs.

In some instances, you may be the one experiencing and noticing changes in your own memory or behavior. It can be hard to discuss concerns about your health with loved ones or trusted friends. There is also a version of the above guide that suggests what steps to take when you notice these changes in yourself, and how to begin conversations and seek support.

Find these amazing resources here at Our Stories!

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Sources: 
Our Stories. [cited 2019Jul9]. Available from: https://ourstories.alz.org/en/
Why Get Checked? [Internet]. Alzheimer’s Disease and Dementia. [cited 2019Jul9]. Available from: https://www.alz.org/alzheimers-dementia/diagnosis/why-get-checked

The Relationship Between Amyloid, Tau, and Cognition

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A recent article published on ALZFORUM discussed research from the first longitudinal study that conducted repeated scans on older adults for both amyloid and tau over several years, and correlate those PET scan results with cognitive changes.

Scans were analyzed from 60 men and women that took part in the Harvard Aging Brain Study who were cognitively healthy and between the ages of 65 and 85 years of age. In addition to the scans, the participants completed cognitive testing each year to monitor cognitive changes. Participants were divided into groups of high and low amyloid as measured from the initial scan.

Over the years of the study, amyloid and tau levels rose in both of the groups and cognitive scores decreased. Those with the faster rate of tau accumulation had the fastest cognitive decline. On average, this entire process was sped up in the group with higher levels of amyloid in the brain initially.

Amyloid is deposited in the brain years before symptoms of Alzheimer’s disease begin to appear. This makes amyloid PET scans the most useful tool in detecting early pathology of the disease.

The study mentioned above shows that a reduction of tau may help to preserve cognition in those with high amyloid accumulation.  

In brains without the presence of amyloid, the tau tangles stay confined to the medial temporal lobe as a part of normal aging. In brains where amyloid is present, the tau tangles invade the surrounding areas of the brain.

Studies support the theory that tau spreads through interconnected neurons, and that the spreading of tau depends of the presence of amyloid, as well as, the functional and structural connections between regions of the brain.

In addition to amyloid PET scans, tau PET scans are useful to track disease progression in clinical trials research. Currently, cognitive tests are helpful in tracking the progression, but take a long time to show any significant responses to clinical trials drugs.

Because amyloid may boost the accumulation of tau, people who accumulated amyloid at a fast rate throughout the study, experienced the most rapid increase of tau, and the largest cognitive decline.

Amyloid alone (without any presence of tau) has a weak affect on cognition, but as amyloid levels rise, it triggers a burst of tau production with ensuing cognition loss.

These findings help put the pieces in temportal order: amyloid, tau, and then cognitive decline. Tau PET biomarkers may get us closer to finding an effective disease modifying drug to combat Alzheimer’s disease. Larger studies will be needed to further evaluate this data and to fully understand the progression of this disease.

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Sources:
Serial PET Nails It: Preclinical AD Means Amyloid, Tau, then Cognitive Decline [Internet]. ALZFORUM. [cited 2019Jun19]. Available from: https://www.alzforum.org/news/research-news/serial-pet-nails-it-preclinical-ad-means-amyloid-tau-then-cognitive-decline

Early Changes In The Brain May Occur Decades Before The First Symptoms Of Alzheimer’s Disease Begin To Show.

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Does Alzheimer’s disease pathology accumulate in our brains in our younger years without making us symptomatic?

Typically, individuals don’t get evaluated for Alzheimer’s disease (AD) or Mild Cognitive Impairment (MCI) unless they begin to notice a change in their memory or start to have other concerning symptoms that cue them that something may be going on with their brain health.

Research indicates that a decade or more before symptoms of MCI or AD appear, the neuropathological mechanisms associated with the development of Alzheimer’s disease may have already begun.

A recent study was done to evaluate changepoints in a range of biomarkers during preclinical (non-symptomatic) Alzheimer’s disease. Four measures were evaluated in this study including cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), and cognitive testing. The study examined whether these measures had a significant change in relation to the onset of symptoms. The data was drawn from the BIOCARD study conducted at the National Institutes of Health (NIH) and Johns Hopkins University.

The study was made up of 306 cognitively normal individuals. A subset of these individuals progressed to the prodromal (symptomatic) phase of Alzheimer’s disease also called MCI. Approximately 75% of these participants had a first degree relative with AD.

The CSF measures analyzed the biomarkers  Abeta 42, the most toxic form of Abeta, total tau (t-tau), and phosphorylatedtau (p-tau, which make up the tangles in the brain). The MRI measures analyzed the entorhinal cortex, hippocampus, and the amygdala in the brain. The comprehensive neuropsychological battery tested all of the major cognitive domains including memory, executive function, language, visuospatial ability, attention, processing speed, and psychomotor speed. These were completed at baseline and at the onset of symptoms to examine the time association between performances.

Using a changepoint analysis determined whether any of the measures discussed above had a significant changepoint in relation to the onset of clinical AD or MCI symptoms.

Photo: Schematic representation of the changepoint model

All of the measures that were studied had significant changepoints, and all of them preceded the onset of symptoms. The changepoint for CSF t-tau occurred 34 years prior to symptom onset. Although this changepoint appears to be associated with the onset of Alzheimer’s disease symptoms, it does not necessarily correspond to an early effect. All of the cognitive tests had changepoints 10-15 years prior to symptom onset, as well as the remaining CSF measures. The timing of these changepoints varied.

The study results provide a credible indication that a change in the biomarker occurs some number of years before clinical onset. However, an accurate prediction of the timing cannot be made due to the variability between individual experiences. The image below shows the change in hippocampal volume on MRI, and function on PET scan,in a patient with MCI over just a year.

We can expect to see further research in this area in the future due to the fact that it is challenging to  identify biomarker changepoints during the preclinical phase of Alzheimer’s disease.

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Sources:
Younes L, Albert M, Moghekar A, Soldan A, Pettigrew C, Miller M. Identifying Changepoints in Biomarkers During the Preclinical Phase of AD. 2018;
Google Images. Google; [cited 2019Jun19]. Available from: https://images.google.com/

Thelma’s Place, Winner of the Brodsky Innovation Grant!

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Each year the Alzheimer’s Foundation of America awards a $25,000 grant to a nonprofit organization to help fund new programs or services within the community. To be considered for the Brodsky Innovation Grant the proposed program must seek to improve the lives of individuals living with Alzheimer’s disease and their families. It must also demonstrate creativity and uniqueness, fulfill a great need in the community, and demonstrate the potential to be replicated.

In 2018 Thelma’s Place in Canby, Oregon, received this grant to create The Garden of Life, an Intergenerational Sensory Garden. This garden has been designed to create an enriching, educational environment for both individuals with Alzheimer’s disease and pre-school aged children.

Gardens provide safe opportunities for interaction and relaxation between seniors and children. The intergenerational Sensory Garden at Thelma’s Place is an interactive experience that allows those with Alzheimer’s disease and children to stimulate their minds together, be creative and have fun. Having a space like this available allows individuals with Alzheimer’s disease to feel empowered, improve self-esteem and positively impact their overall well-being.

Those who visit the Sensory Garden can experience increased connectedness, renewed purpose for living, enhanced feelings of self worth, improved behaviors, an opportunity to laugh and the unconditional love with children who are in need of an enhanced sense of belonging, empathy and development.

The Garden of Life is comprised of different stations that are each intended to produce various results. Stations include a Sound Garden, Exploration Garden, Tasting Garden, and an Observation Garden. These stations allow for creative expression, stress release, imagination and much more.

Thelma’s place is a non-profit organization in the community that provides breaks for caregivers to re-energize while their loved one visits the day center to participate in daily activities that are specially designed for those with memory loss. Day trips and activities such as visiting places within the community and nearby areas are also planned for those who attend the day center. Whether a person has just been diagnosed with a memory condition, is coping with Alzheimer’ daily, or experiencing memory problems of any kind; all are welcome at Thelma’s Place.

Caregivers are able to take time for themselves and also attend support groups and education related to being a caregiver, while their loved ones participate and enjoy the daily activities that Thelma’s Place has to offer.

Here is a great video about Thelma’s Place!

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Sources: 
Alzheimer’s Foundation of America Chooses Thelma’s Place, of Canby, Oregon, as National Winner of its Brodsky Innovation Grant [Internet]. Alzheimer’s Foundation of America. 2018 [cited 2019Jun10]. Available from: https://alzfdn.org/alzheimers-foundation-america-chooses-thelmas-place-canby-oregon-national-winner-brodsky-innovation-grant/
Home [Internet]. Thelma’s Place. [cited 2019Jun10]. Available from: http://thelmasplace.org/
Rosen C. Thelma’s Place wins $25,000 innovation grant [Internet]. https://joomlakave.com. 2018 [cited 2019Jun10]. Available from: https://pamplinmedia.com/cby/147-news/401831-298212-thelmas-place-wins-25000-innovation-grant-