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Wednesday, May 26, 2010

Spanish Study Looks at Alcohol Consumption and Smoking as Possible AD Risk Factors


Two of the key elements when taking a history from a patient include smoking tobacco and alcohol consumption. Both of these activities have been shown to affect general health. Now, in a recently published study from Barcelona, Spain, it appears that they may be important risk factors in Alzheimer’s disease (AD), but in a unique way.

Knowledge regarding environmental factors influencing the risk of AD is surprisingly scarce, despite substantial research in this area. In particular, the roles of smoking and alcohol consumption still remain controversial. A new study published this month in the Journal of Alzheimer's Disease suggests a protective effect of light alcohol consumption on the risk of Alzheimer's disease, particularly in women who do not smoke.

Researchers at the University of Valencia, the Generalitat Valenciana, and the Institut Municipal d'Investigació Mèdica, Barcelona, in Spain, carried out a study comparing personal and clinical antecedents of subjects affected with AD with healthy people, both groups were the same age and gender distribution. Women included in the study were mainly light or moderate alcohol consumers. The risk of Alzheimer's disease was unaffected by any measure of tobacco consumption, but a protective effect of light alcohol consumption was observed, this effect being more evident in women who are nonsmokers.

Certainly more work will be needed to compare these results across other lifestyle modifiers, and populations, in large prospective studies. This type of research is likely critical to better understanding the development of AD, as well as identifying the interplay of various risk factors, as it is undoubtedly a multi-factorial process.

*García, Ana M, Nieves Ramón-Bou, Miquel Porta. Isolated and Joint Effects of Tobacco and Alcohol Consumption on Risk of Alzheimer's Disease. J Alzheimers Dis 20:2 (May 2010), p 577-586.

Michael S. Rafii, M.D., Ph.D
Associate Medical Director
Alzheimier's Disease Cooperative Study

Author: Michael Rafii MD,PhD at 3:58 PM 0 Comments

Thursday, May 20, 2010

The Incalculable Cost of Alzheimer's

I wanted to share with you an update on the cost estimates of AD. These are, of course, in addition to the incalculable emotional losses caused by the disease, but are quite astonishing in themselves.

The tremendous physical and emotional cost of the disease to Alzheimer’s sufferers and their families has been known for decades. There is also, however, a financial cost of the disease. Finally, in 1998 and again in 2002, reports were commissioned by the Alzheimer’s Association on the costs to U.S. businesses. Both studies were shocking. “Alzheimer’s Disease: The Costs to U.S. Businesses,” authored by Ross Koppel, Ph.D., of the Social Research Corporation and the Department of Sociology at the University of Pennsylvania, found that the 2002 Alzheimer’s cost to U.S. businesses would be in excess of $61 billion.

To put that number into perspective, this amount is equal to the net profits of the top ten Fortune 500 companies and exactly double the amount that was calculated in the 1998 report. The costs to businesses to cover medical insurance and disability for workers with Alzheimer’s was $24.6 billion. The costs incurred because workers must take on the tremendous responsibilities as family caregivers was $36.5 billion due to absenteeism, productivity losses, and replacement costs.

Alzheimer's Disease will rack up more than $20 trillion in treatment costs over the next 40 years in the United States, according to a report today that calls on Congress to increase funding for drug research. The report issued by the Alzheimer's Association found that from 2010 to 2050, the cost of caring for Americans 65 and older with Alzheimer's disease will increase more than six times to $1.08 trillion per year. Currently, $172 billion a year is spent by the government, private insurance and individuals to care for people with the disease, the most common cause of dementia.

However, if by 2015 a drug was available to the public that slowed disease progression, it could cut the number of people in the severe stage of Alzheimer's disease in half to 1.1 million by 2020, and 1.2 million in 2050, down from the projections of 6.5 million. The fiscal imperative for finding a cure is now blindingly clear.

Michael S. Rafii, MD, PhD
Associate Medical Director, Alzheimer's Disease Cooperative Study
Author: Michael Rafii MD,PhD at 9:19 AM 0 Comments

Monday, May 10, 2010

MRI, PET, and PIB, oh my!


Rarely a day goes by when we do not see several news items about the role of neuro-imaging in detecting, treating, or monitoring the progression of Alzheimer's disease. Here are a few comments to bear in mind as you consume the daily press.

Magnetic Resonance Imaging (MRI) yields an image of brain structure and will reveal tumors, strokes, and (importantly for Alzheimer's disease) atrophy (or shrinkage) in particular parts of the brain that can be helpful in reaching an accurate diagnosis.

Positron Emission Tomography (PET) yields an image of brain metabolism and reveals where brain cells engage the healthy activities of their daily function. In some instances, this can reveal an earlier stage of a problem than MRI would reveal because cells may have stopped functioning but remained intact structurally.

Many news stories report on "tracers" or agents such as PIB (Pittsburgh Compound B) that, once injected into the blood, make their way to the brain and bind with beta amyloid, rendering it clearly visible in a PET scan. This technique of Amyloid Imaging is important because many in the field believe that beta amyloid accumulation is the cause of Alzheimer's disease.

While PIB studies are generally promising, public optimism should be tempered by the fact that the PIB compound has some significant practical shortcomings. It decays rapidly and must be injected very quickly after being manufactured. For that reason alone, the prospect of wide-spread use in a clinical setting is a distant one, but nonetheless, very exciting.

Michael S. Rafii, MD, PhD
Associate Medical Director
Author: Michael Rafii MD,PhD at 11:06 AM 0 Comments

Wednesday, May 05, 2010

NIA statement on Prevention of AD

Based on current evidence, the recent conclusion reached by a National Institute of Health panel of experts, is statistically sound. They concluded that we do not yet have proof that the progression of Alzheimer's disease pathology can be slowed by actively reducing known risk factors and by adopting certain lifestyle changes such as smoking cessation, intellectual stimulation, and physical exercise.

This is a case where I think it is worthwhile to translate the panel's conclusion.

Below is a quote from one of the panel experts; this was one of the direct comments that generated the nihilistic headlines in countless news outlets over the past week:

"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) can prevent Alzheimer's or age-related cognitive decline."

Now, let me state it in another way that would be equally acceptable to the independent and precision minded scientists on the panel:

"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) do not prevent Alzheimer's or age-related cognitive decline."

There is a great deal of work ahead of us in better understanding of the variables that can affect cognitive aging and the development of Alzheimer's disease. Well-planned, long-term, placebo-controlled studies are needed to definitively answer these questions. Until then, we continue our work towards this goal.

Michael S. Rafii, MD, PhD
Author: Michael Rafii MD,PhD at 4:22 PM 0 Comments

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About Us

The Alzheimer's Disease Cooperative Study (ADCS) was formed in 1991 as a cooperative agreement between the National Institute on Aging (NIA) and the University of California, San Diego. The ADCS is a major initiative for Alzheimer's disease (AD) clinical studies in the Federal government, addressing treatments for both cognitive and behavioral symptoms. This is part of the NIA Division of Neuroscience's effort to facilitate the discovery, development and testing of new drugs for the treatment of AD and also is part of the Alzheimer's Disease Prevention Initiative.

The ADCS was developed in response to a perceived need to advance research in the development of drugs that might be useful for treating patients with Alzheimer's disease (AD), particularly drugs that might not be developed by industry.