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Monday, April 11, 2016

Why AD Patients Cease Recognizing Loved Ones Faces

Dear Readers,

A recent study has demonstrated that, besides triggering memory lapses, Alzheimer’s disease also impairs visual face perception. Research conducted by the team of Dr. Sven Joubert, PhD, a researcher at the Centre de recherche de l’Institut universitaire de gériatrie de Montréal and a Professor with the Department of Psychology at Université de Montréal, was published today in the Journal of Alzheimer’s Disease.

Scientists know that face perception plays a primary role in human communication, and is why humans have become experts at quickly detecting and identifying faces. This ability is thought to depend on the capacity to perceive the entire face. Also known as “holistic perception,” this ability differs with the local and detailed analysis required to recognize individual facial features, such as the eyes, nose or mouth. Dr. Joubert’s study verified that Alzheimer’s disease impairs the holistic ability to perceive faces.

The Montreal team recruited people with Alzheimer’s along with healthy seniors to examine their capability at perceiving faces and cars in photos that were either upright or upside down. Dr. Joubert explains the team’s findings: “The results for people with Alzheimer’s were similar to those in the control group in terms of answer accuracy and the time to process the upside-down faces and cars. To perform these tasks, the brain must perform a local analysis of the various image components perceived by the eye. However, with the upright faces, people with Alzheimer’s were much slower and made more mistakes than the healthy individuals. This leads us to believe that holistic face recognition in particular becomes impaired. Subjects with Alzheimer’s disease also demonstrated normal recognition of the upright cars, a task that in theory does not require holistic processing. This suggests that Alzheimer’s leads to visual perception problems specifically with faces.” He noted that what was also surprising about this impairment is that it is observed in the early stages of the disease.

The study clarifies the mechanism involved when people with Alzheimer’s have trouble recognizing the faces of family members or celebrities. The fact that impaired facial recognition might stem from a holistic perception problem–and not just a general memory problem–opens the door to different strategies (such as the recognition of particular facial traits or voice recognition) to help patients recognize their loved ones for longer.

Full abstract:

Thanks for reading,

Jeffree Itrich, M.S.W., M.J.
Mgr, ADCS Communications
Author: Jeffree Itrich at 12:11 PM 0 Comments

Monday, April 04, 2016

Apathy: the Silent Wound of Alzheimer’s Bisease

Dear Readers,

While cognitive and functional decline are the hallmark of Alzheimer’s disease (AD), neuropsychiatric symptoms (NPS) also affect almost all patients. NPS can include agitation, hallucinations, depression, sleep disturbances, and various problem behaviors. These symptoms cause a significant strain on both patients and caregivers and often lead to a lower quality of life.

Apathy is one of the most prevalent NPS in AD patients, affecting as many as half. Patients suffering from apathy experience decreased motivation and rely heavily on caregivers to initiate and oversee daily activities. One study found that apathetic patients were 2.8 times more likely to struggle with at least one activity of daily living, such as dressing, bathing, or eating. This is further complicated by caregivers who lack an understanding of apathy and may perceive apathetic patients as insensitive or uncaring. Caregivers of apathetic AD patients report significant levels of distress and fewer positive experiences than those of non-apathetic patients. Greater caregiver distress is linked with increased service utilization and accelerated institutionalization, which, in turn, creates a significant financial burden. Therefore, the management of apathy should be a major priority in caring for patients with AD.

Despite the high prevalence and serious consequences of apathy in AD, there are no proven treatments for this condition. In the past, clinicians have preferred non-pharmacologic treatment strategies and the available data suggests reliable but limited effects. Recently, several pharmacologic options have been explored. Antidepressant medications have been considered, but some evidence suggests they could actually be detrimental in the treatment of apathy. Cholinesterase inhibitors have also been researched. While these studies have demonstrated a modest improvement in apathy, about half of the patients still showed no relief. Furthermore, these studies were not tailored specifically for apathy. In fact, some studies deliberately excluded apathetic patients since they tend to be less likely to participate and are less easily “engaged” while performing neuropsychological assessments.

The evaluation of dopaminergic (dopamine related, e.g. opiods and amphetamines) agents for the treatment of apathy is another potential approach. The rationale for their use is based on the strong tie between the dopaminergic reward system and the expression of motivated behaviors in brain damaged populations. Preliminary data in one study suggests that dopamine agonist methylphenidate is superior to placebo for the treatment of apathy in AD21. This study reported that the two patients who experienced serious adverse events during the study also experienced extreme AD symptoms (delusions, agitation, and more) prior to the treatment. This suggests methylphenidate might not be a viable option for patients with certain existing symptoms.

Unfortunately, there have been few randomized, placebo-controlled trials of dopamine agonists that address their efficacy for treatment of apathy in AD17. The few that do exist are showing promising results but are also identifying adverse events that will need to be considered as these treatments find their way to the clinic. Currently, a large study on methylphenidate is being conducted under the support of the National Institute of Aging. Data from this study is expected to help find the appropriate place for methylphenidate in the treatment of apathy in Alzheimer’s patients. Apathy is a silent wound of Alzheimer’s disease. Our job is to identify and treat it for the benefit of our patients and their caregivers.

Thanks for reading,

Jacobo Mintzer, M.D., Director, Roper St. Francis Clinical Biotechnology Research Institute, Charleston, S.C.

Jennifer Rowell, B.S., Research Administrative Assistant, Roper St. Francis Clinical Biotechnology Research Institute, Charleston, S.C.

Author: Guest at 1:44 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.