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Thursday, September 18, 2014

Technology to the Rescue

Guest post by Gregory A. Jicha, M.D, Ph.D
Professor of Neurology
University of Kentucky Alzheimer's Disease Center

Science fiction often portrays a future where intelligent robots take over menial tasks and make people’s lives easier. In yet another example of life imitating art, many researchers are studying artificial intelligence as a means to improve in home care for impaired elders and lessen the burden on their caregivers. Several groups are designing interactive talking devices or crude robots to guide cognitively impaired people through simple household tasks. Such machines are still in a primitive stage, nowhere near the level of sophistication of fictional movie androids. While the dream of caregiving robots is likely decades away from fruition, simple, readily available, technological tools exists today that can help avoid some of the major disasters memory loss can create every day and improve the quality of life for us all. Such devices include the common Blackberry or I-POD for those with only mild memory problems as well as “simple” phones and automated pill dispensers for the more severely impaired.

For those of us (like myself) that commonly forget appointments, the common smartphone can be a lifesaver. Keeping a calendar and providing alarms for taking medication and upcoming appointments can keep us functional, despite life’s daily distractions. Yet, even smartphones may pose challenges to those of us that find it hard to learn to use a new electronic device. Learning to use such a device
before the onset of memory problems can help maintain independence once a memory problem emerges, but such devices are essentially useless if adopted after the onset of memory problems.

Technological developments and good old American ingenuity have created a host of devices that are easy to use and can be mastered by even those in the early stages of Alzheimer’s disease or dementia. These include “simple” phones, originally designed for children that have a few simple programmable buttons, or even a single button to help them contact you when needed. These devices can be used by even those with moderate impairment that may struggle with the complexity of even the simplest cell phone designed for normal adults. These devices almost universally include a trackable GPS service that can help us find a lost or displaced loved one.

Programmable, alarmed pill dispensers can also be a lifesaver for those with memory decline. These devices can be programmed with dispensing times as frequent as four times daily and are preloaded weekly. Such devices can help ease the burden of daily medication oversight for those with dementia. While such devices could never replace a human caregiver/friend/family member, currently, they can be a valuable tool that lessens caregiver burden and helps those with memory problems remain as independent as possible for as long as humanly (or technologically) possible.
Author: Jeffree Itrich at 10:07 AM 0 Comments

Wednesday, September 03, 2014

Normal Brain Function Without Any Form of ApoE

Dear Readers,

As many of you will recall, ApoE is a protein that binds to and transports cholesterol throughout the body, including the brain. Since 1993, researchers in the Alzheimer’s field have known that one form of ApoE, called ApoE4 significantly increases the risk for developing AD and brings the disease on at an earlier age. People with one copy of ApoE4 are eight times more likely to develop AD, and those with two copies of ApoE4 are about 12 times more likely. About 20 percent of the general population has at least one copy of ApoE4.

The ApoE protein actually exists in three major forms (ApoE2, E3, E4) and the risk for getting AD differs with each form, E4>E3>E2. ApoE4 is thought to bind directly to beta-amyloid, forming a complex molecule. Work published a few years ago showed that the binding of ApoE4 to beta-amyloid shifts the removal of beta-amyloid out of the brain from a rapid export pathway, to a very slow pathway, resulting in poor beta-amyloid clearance from the brain, and hence, its accumulation within the brain. Furthermore, researchers showed that not only does ApoE4 lead to accumulation of beta-amyloid in the brain, but it also seems to be specifically routing beta-amyloid to synapses, connections between neurons, where it leads to additional injury. Other mechanisms exist in the brain to also remove beta-amyloid and are independent of this ApoE mechanism. Because of this, some treatments being developed for AD target ApoE and aim to alter its function.

Earlier this month, researchers at UC San Francisco reported on a 40 year old patient whose body produces no ApoE protein whatsoever. The condition, called dysbetalipoproteinemia is characterized by high blood levels of cholesterol as a consequence of poor clearance from the blood. The researchers conducted extensive neurological tests and found his cognition to be essentially normal. They performed MRI scans of the patient’s brain which revealed normal brain size, with no signs of the atrophy, or shrinkage in the hippocampus, a key finding that characterizes AD. They also measured levels of AD-related proteins such as beta-amyloid and Tau in his cerebrospinal fluid, which were also normal.

What do these results mean? Perhaps the most important take away message is that one can have normal brain function without any form of ApoE protein. Certainly other mechanisms are at work removing beta-amyloid out of the brain, and ApoE is just one component. But the notion that completely blocking ApoE, particularly in patients with ApoE4, to reduce the risk of AD may be worth examining further.

Thanks for reading,

Michael Rafii, MD, PhD
Director, Memory Disorders Clinic
Medical Core Director
Alzheimer’s Disease Cooperative Study
University of California San Diego
Author: Michael Rafii MD,PhD at 3:42 PM 0 Comments

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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.