Current Alzheimer’s Drugs and What They Do

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

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

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.

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!

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-

What Is The AFA and What Do They Do?

The Alzheimer’s Foundation of America is an organization that provides support and education to those living with Alzheimer’s disease, as well as, their caregivers and families. The AFA also helps to fund research on improved treatments in the hope of finding a cure for Alzheimer’s disease.

The AFA website offers a National Toll-Free Helpline. This resource is available 7 days a week and is staffed by licensed social workers. The neat thing about this help line is that, although they are based out of New York, they are also able to connect callers with local resources in their area throughout the United States. There are multiple ways to access this help line. You can call the number, 866-232-8484, or they offer Live Chat, Skype, and Email options as well.

Telephone Support Groups are also offered for caregivers and are led by licensed social workers. This option allows for those who can’t always make it to local in-person group meetings or those with busy schedules to receive the support they need.

Fact Sheets are available on the AFA website and cover a wide range of topics such as what to do after being diagnosed, sleep tips, tips for traveling, tips for talking about memory changes, incontinence, fall prevention, eating tips and much more.

Webinars are held frequently and discuss topics surrounding Alzheimer’s disease. These can be accessed later if you cannot attend during the scheduled time.

The Alzheimer’s Foundation of America also has a National Memory Screening Program. Memory screens are essential to early diagnosis of Alzheimer’s disease. They may also help diagnose other conditions that cause memory problems. Although we are still looking for a cure for Alzheimer’s disease, other conditions that cause memory problems may be treatable such as vitamin deficiencies or thyroid problems.

These free memory screens are provided across the United States. Screening sites near you can be found by clicking here. Your doctor may also provide memory screens, so be sure to ask them for more information.

The AFA is currently running their Educating America Tour and will be making a stop in Portland, OR on June 11th, 2019! This conference is free to attend and open to the public.

The conference will be held from 9:00am-1:30pm at the Oregon Museum of Science and Industry located at 1945 SE Water Avenue, Portland, OR 97214.

Center for Cognitive Health’s own Dr. Michael Mega is the keynote speaker at this event and will be giving a talk titled Unraveling Alzheimer’s. Dr. Mega will provide an overview of Alzheimer’s disease, an update on Alzheimer’s research and clinical trials, and what we can expect on the horizon.

The conference is offering additional workshops and free, confidential memory screens.

The other workshop topics include:

  • Preparing for and Understanding Long Term Care
  • Creating Innovative Intergenerational Programming and Therapeutics

The free memory screens done at this conference are a great resource that can provide insight on whether or not a follow-up is needed for further testing and evaluation. The earlier that memory changes can be identified, the better. Results from these screenings will be available for you to add to your medical records. There are 4 tests involved in the screenings and will be done in a private, one-on-one setting with trained test administrators. It is very important to remember that these tests are not used to diagnose any medical conditions. An official diagnosis needs to be given by your doctor.

If you are unsure whether or not you should have a memory screen, Here is a link to some questions that might help you decide. 

Hope to see you there!

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Sources:
Alzheimer’s Foundation of America [Internet]. Alzheimer’s Foundation of America. [cited 2019Jun4]. Available from: https://alzfdn.org/

Normal Aging vs. Early Alzheimer’s Disease

How can we tell the difference between normal age related memory symptoms and early Alzheimer’s disease symptoms?

It is important to note that not everyone will experience the same symptoms. What may be normal for one person may not be normal for another. Generally speaking, normal age-related cognitive decline is subtle and mostly affects thinking speed or the ability to pay attention. 

That being said, sometimes it’s hard to decide if you should be concerned about the memory changes you are experiencing.

The Alzheimer’s Association lists 10 warning signs and symptoms that you should be on the lookout for.

#1. Memory Loss

Normal Aging: This is the main complaint that aging individuals have. If you are experiencing normal aging you may still forget information such as someone’s name or what time you have an appointment, but you will eventually remember it later.

Early Symptom: If you are forgetting information and asking for that same information over and over, heavily relying on reminders from technology, family, or friends, you may be experiencing memory problems that are more severe than normal aging that could be a sign of Alzheimer’s. The main distinction to make here is whether or not your memory complaints are interfering with and disrupting your daily life.

#2. Changes in Problem Solving or Planning

Normal Aging: Making small mistakes from time to time, such as an error balancing your checkbook or forgetting an ingredient in a recipe while cooking is considered to be normal aging. Sometimes the ability to react or think things through will be a bit slower, and it may be easier to become distracted.

Early Symptom: If you have a harder time keeping track of monthly bills, following recipes from start to finish, working with numbers, counting change, calculating a tip, or creating and following plans, you may be experiencing early symptoms of Alzheimer’s disease. Here, the ability to concentrate will be very difficult.

#3. Difficulty With Tasks That Are Familiar At Work, Home, or Leisure

Normal Aging: During normal aging you may need help figuring out settings on appliances or understanding how to use newer technologies, but you are still able to complete your daily tasks despite these difficulties.

Early Symptom: If you are experiencing difficulties in these areas that keep you from completing your daily tasks, you may be experiencing early symptoms of Alzheimer’s. This could include forgetting how to get somewhere that you visit frequently, remembering the rules of a game you like to play, or having trouble completing your duties at work that you didn’t struggle with previously.

#4. Confusion With Time or Place

Normal Aging: Time Flies! It is normal to occasionally forget the date or day of the week, as long as you are able to remember it or figure it out later. It is also common to go into a room and forget the reason for going there, but remembering again shortly after.

Early Symptom: People who are developing Alzheimer’s typically forget dates and seasons and have a hard time recognizing the passage of time. If you are getting lost or don’t know where you are in a place that is familiar to you, this is a sign of something more severe than normal aging. There will also be a struggle with time-relationships when discussing life events. In this stage, the person is not likely to figure out the day of the week or what season it is later on because they don’t realize that they never knew it to begin with.

#5. Visuospatial Problems

Normal Aging: It is normal for your eyes to age along with the rest of your body. Things like cataracts, misty or cloudy vision, or changes in your eyesight strength contribute to the way you see images or perceive spatial relationships. These would be considered normal aging events.

Early Symptom: It is not normal when you are experiencing difficulties interpreting visual information such as reading, driving, and judging distances between things. These may be indications that something more concerning is going on.

#6. Trouble Speaking or Writing Words

Normal Aging: It is normal to struggle to find the right word sometimes. We all do it. As we age we may also have more difficulty keeping up with a conversation and find that we need to concentrate harder in order to participate. If too many people are speaking at once, it may be easy to lose track of the conversation.

Early Symptom: If you notice a change in your ability to hold a conversation with someone, finding the correct word for something, or forgetting what you’re talking about in the middle of speaking, this may be a sign that you’re developing early symptoms of Alzheimer’s.

#7. Losing Items and Not Being Able To Find Them

Normal Aging: In normal aging we may set something down and forget later where we left the item, but we have the ability to think back and retrace our steps to find the lost item.

Early Symptom: In early Alzheimer’s you may lose something, but not be able to find it again. You may even start leaving things in unusual places that they don’t necessary belong. Over time this will start to occur more frequently.

#8. Changes in Judgment

Normal Aging: We all make bad choices from time to time throughout life. We learn from these mistakes and recognize that it may not have been the best choice or action.

Early Symptom: When your ability to make appropriate decisions or assess risks begins to decrease, you may be showing early signs of Alzheimer’s. Making bad choices frequently such as giving large sums of money to telemarketers or getting involved in pyramid schemes are common examples of changes in judgment.

#9. Abandoning Social Activities or Work

Normal Aging: Hesitating before going to a social gathering or function is to be expected. As you get older, social engagements can be tiring.

Early Symptom: A person who is experiencing early symptoms of Alzheimer’s will start to abandon, lose interest or withdraw from hobbies, work responsibilities, or social gatherings altogether. This could be due to the changes they are experiencing, or they may be forgetting that they enjoy the activity.

#10. Mood and Personality Changes

Normal Aging: Being irritated when someone or something disrupts your daily routine is common. Normally, you are irritated briefly, work through it and move on. It is also normal aging to feel a bit anxious or weary about social or family obligations.

Early Symptom: If you are having early Alzheimer’s symptoms, you may have drastic changes in feeling suspicious, confused, angry, sad, anxious and uncomfortable. Typically, you may easily become upset over little things. You may pace or wander away from an unfamiliar situation, and odd behaviors will begin to emerge.

*Make sure not to try and self diagnose after reading through these symptoms. If you have concerns that you may be showing early signs of Alzheimer’s disease, discuss what you are experiencing and feeling with your doctor.

Being aware of these 10 warning signs and symptoms will help you, or your loved one, be proactive with care related to Alzheimer’s disease.

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Sources: 
10 Early Signs and Symptoms of Alzheimer’s [Internet]. Alzheimer’s Disease and Dementia. [cited 2019May29]. Available from: https://www.alz.org/alzheimers-dementia/10_signs
Healthy Aging [Internet]. Memory and Aging Center. [cited 2019May29]. Available from: https://memory.ucsf.edu/symptoms/healthy-aging
Normal ageing vs dementia [Internet]. Alzheimer’s Society. [cited 2019May29]. Available from: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/normal-ageing-vs-dementia
 

Sleep and Alzheimer’s Disease

Sleep problems and disorders are relatively common among seniors. Many individuals with a neurodegenerative disease complain of experiencing  insomnia, excessive daytime sleepiness, or abnormal motor activity while they are sleeping. [3]

Research shows that adults should be sleeping 7 or more hours per night on a regular basis, give or take an hour depending on the individual. The sleeping brain uses almost as much energy as the awake brain. Certain hormones are only secreted while we sleep, problems can be solved during sleep, and memories are consolidated. [1] Although people find ways and excuses for functioning on less sleep, there is really no substitute for sleep itself. The brain needs this time to clear neurotoxins and maintain optimal health

Neurodegenerative diseases such as Alzheimer’s and Parkinson’s disease can damage the regions of the brain that control sleep, making insomnia and disrupted sleep two prominent features of these disorders. [2] Sleep disruptions can also be a side effect of medications.  

Circadian rhythm disorders can also contribute to sleep disruption and the development of sleep disorders. People with Alzheimer’s disease and circadian rhythm disorders tend to have prolonged wakefulness at night and sleepiness and naps during the day. [2] Bright light therapy can be used to help synchronize the person’s internal clock to help improve sleep patterns and quality.

REM sleep behavior disorder is often diagnosed in those with Alzheimer’s, Parkinson’s, and Lewy Body disease. Normally when we enter REM sleep, dreaming begins and the body is paralyzed so that we do not act out our dreams.  For those who have REM sleep behavior disorder, dreaming is disrupted, and paralysis does not occur so they act out their dreams.  Safety Precautions should be implemented if someone is experiencing REM sleep behavior disorder because they may get out of bed, walk around, thrash or flail their limbs; some people even eat in their sleep. [3] Here are some safely precautions to consider when dealing with REM sleep behavior disorder. [2]

  • Remove furniture with sharp edges and other sharp objects from the sleeping area
  • Remove any weapons that may be stored in or near the sleeping area
  • Move the bed away from windows
  • Use heavy curtains or drapes
  • Place the mattress on the floor of the bedroom
  • Put soft padding on any hard surfaces near the bed
  • Sleep in separate beds to avoid injury
  • Consider adding a bed alarm to wake up the person or partner

Caring for someone with sleep disruptions or disorders affects the quality and quantity of sleep that the caregiver is getting nightly. If caregivers do not get enough sleep there is a high chance of burnout and health decline.

Remember these basic tips to promote healthy sleep hygiene habits!

  • Pick a schedule and stick to it
  • Stay active during the day
  • Get some Vitamin D
  • Don’t drink anything right before bed
  • Take a bath before bed
  • Convert your bedroom into a sleep sanctuary

Sweet Dreams! 

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Sources:
[1] Basner M. Sleep and Neurocognitive Performance . Practical Neurology. 2019;57–9.
[2] Malhotra RK. Sleep and Neurodegenerative Disease. Practical Neurology. 2019;37–40.
[3] Sleep and Aging – Senior Sleep Guide [Internet]. Tuck Sleep. [cited 2019May16]. Available from: https://www.tuck.com/sleep-aging/

Does Periodontal Bacteria Cause Alzheimer’s Disease?

We have been taught the importance of brushing our teeth since childhood, but could maintaining healthy oral hygiene protect us from getting Alzheimer’s disease? The human mouth is home to at least six billion bacteria! [2]

A recent study published in Science Advances claims that the oral pathogen Porphyromonas gingivalis can travel from the mouth to the brain, where it may instigate Alzheimer’s disease. They have found that people with Alzheimer’s disease have higher levels of the bacterial protease gingipain in their brain tissue, which is produced by the bacterium P. gingivalis. They also found that the brains of people with Alzheimer’s disease contain traces of gum bacteria that may initiate or aggravate Alzheimer’s disease pathology. [1] See the full publication here.

The study suggests that once in the brain, the P. gingivalis bacteria releases toxic proteins, gingipains, that have been shown to destroy neurons and cause other signature signs of Alzheimer’s disease in the brain in animal studies. Once the brain is infected, the brain’s natural defenses gather around the infected cells causing the inflammation and buildup of plaques associated with Alzheimer’s disease.[4]

What is Porphyromonas gingivalis?

P. gingivalis is most commonly associated with degenerative gum disease. In the U.S., periodontal disease affects one-half of the population over 30 years of age and is the major cause of tooth loss among adults. [6] Studies show that older people with periodontal disease have an increased risk of Alzheimer’s disease and cognitive decline, however, it remains unclear whether poor hygiene and gum disease lead to dementia. [1]

How do I improve my oral health?

It has been noted that establishing and maintaining good oral health habits throughout life is imperative. The damage of the P.gingivalis bacterium is done over a lifetime, not just in later life or after the onset of Alzheimer’s disease. Paying extra attention to your oral health can protect you, not only from Alzheimer’s disease, but from other health conditions including diabetes, coronary artery disease, heart attack, and stroke. Below you will find some basic oral health tips to improve or maintain your oral health! 

More research in this area?

Since the publishing of the initial research findings in January 2019, The GAIN Trial, a phase 2/3 trial sponsored by Cortexyme Inc, is just being put into motion. The trial began in April 2019, and is looking to treat more than 500 participants diagnosed with mild to moderate Alzheimer’s disease. Treatment with the study drug will last for one year. P.gingivalis levels will be measured in these participants before starting treatment, as well as, after treatment. Participants cognitive abilities will also be measured before, throughout, and after the study. More information about Cortexyme can be found here. The GAIN Trial website can be found here

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Sources: 
[1] An Antimicrobial Approach to Treating Alzheimer’s? [Internet]. ALZFORUM. [cited 2019May14]. Available from: https://www.alzforum.org/news/research-news/antimicrobial-approach-treating-alzheimers
[2] Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors [Internet]. Science Advances. Available from: https://advances.sciencemag.org/content/advances/5/1/eaau3333.full.pdf
[3] Cortexyme, Inc [Internet]. Cortexyme, Inc. [cited 2019May14]. Available from: https://www.cortexyme.com/
[4] GAIN Alzheimer’s Clinical Trial [Internet]. GAIN Study. [cited 2019May14]. Available from: https://gaintrial.com/
[5] Photo :Top 10 Dental Hygiene Tips [Internet]. Oswal Dental Clinic. 2016 [cited 2019May14]. Available from: http://www.oswaldentalclinic.com/top-10-dental-hygiene-tips/
[6] How KY, Song KP, Chan KG. Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line. Frontiers in Microbiology. 2016;7.

Clinical Trial Myths vs Facts

Clinical trials tend to have a cloud of negative talk hovering over them. Participating in something that involves your health can be daunting and scary, and unfortunately, this fear has led to some misconceptions about participating in clinical research trials.

Here are some of the common Myths/Facts surrounding clinical trial participation:

Myth: Clinical trials are dangerous.

Fact: There will always be risks associated with medical research when testing new and unproven treatment options. Uncomfortable side effects may occur. However, clinical trials are federally regulated and there are ethical and legal codes that apply to each study. If you are considering participating it is important to discuss risks and benefits with your doctor. All studies are voluntary and participants can withdraw at any time.

Myth: The quality of care is not as good as the care I currently receive with my doctor.

Fact: Clinical trial participants receive a high level of care and are highly monitored for any side effects that may occur. All participants are able to discuss any areas of concern with the study staff, and the participants primary care provider may also be involved. For some living with Alzheimer’s disease, research shows that they do better while participating in clinical trials.

Myth: Clinical trials will not accept me as a participant because I have another disease or condition.

Fact: Other chronic medical conditions may be present along with Alzheimer’s disease, and some clinical trials may be designed to accommodate this. Each study has its own inclusion and exclusion criteria. When discussing participation during the informed consent process, be sure to let the study team know of any medical conditions that are present. 

Myth: If clinical trials are so important, my doctor will encourage me to participate.

Fact: There are hundreds of clinical research studies being done across the country. Your physician may not be aware of which of these studies are in your area, or which studies you may be eligible to participate in. Be sure to discuss any clinical trial opportunities you find with your doctor.

Myth: Clinical trials are not confidential.

Fact: When you enroll in a study there are pieces of personal information that will need to be collected and shared with the study team and study sponsor. This generally includes date of birth, medical history, any results collected throughout the study etc. This information is kept confidential to an extent which means that it is given a blinded number to protect your identity throughout the study. Although your information is shared with the study sponsor and FDA, it is our highest priority to maintain our participants information and dignity.

Myth: The study site/team knows who is actually getting the drug.

Fact: In randomized clinical trials there is a group receiving a placebo and a group receiving the study drug. Neither participants nor study team is aware of which participant is receiving a placebo or not. This information is not released until the closing of each study. Make sure that you are okay with the potential chance of getting a placebo when considering participation in a clinical trial.

Myth: The drugs being tested in clinical trials haven’t been tested on humans yet, I’d just be a “guinea pig.”

Fact: The drugs tested in clinical trials have been researched and evaluated multiple times before they can be used in a clinical trial.

Myth: Clinical Trials don’t work.

Fact: Clinical trials are needed to find safe and effective new treatments for various medical conditions. Some trials show more success than others, but not all trials are failures.

Here are two videos that may be helpful when considering a clinical trial. Clinical Trials.gov also has a helpful page with Questions To Ask, and the Alzheimer’s Association has a page discussing How Clinical Trials Work.

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Sources: 
10 Misconceptions About Clinical Trials Debunked [Internet]. Rox Medical. 2018 [cited 2019Apr29]. Available from: https://www.roxmedical.com/news/10-clinical-trial-misconceptions/
Clinical Trials: Myths vs. Facts [Internet]. Alzheimer’s Disease and Dementia. [cited 2019Apr29]. Available from: https://www.alz.org/alzheimers-dementia/research_progress/clinical-trials/myths-vs-facts
How Clinical Trials Work [Internet]. Alzheimer’s Disease and Dementia. [cited 2019Apr29]. Available from: https://www.alz.org/alzheimers-dementia/research_progress/clinical-trials/how-trials-work
Learn About Clinical Studies [Internet]. ClinicalTrials.gov. [cited 2019Apr29]. Available from: https://clinicaltrials.gov/ct2/about-studies/learn