New therapy and dosage for Aricept – severe Alzheimer

Aricept was approved last year for a higher dosage to 23mg – current dosage may be 5 to 10mg. We recently found this out from a friend who is in the medical profession and received samples. My mom was “diagnosed” with Alzheimer’s in 2004 and has been on Aricept since then. The new dosage sounds like it is okay for people who have already been on Aricept 10mg for at least 6 weeks. I was unable to find much of the study results, yet the following may help a little.

“The FDA has approved Eisai's Aricept (donepezil HCl tablets) in a 23mg dosage strength for the treatment of moderate-to-severe Alzheimer's disease. This approval was based on clinical data from a study conducted in 1,467 patients with moderate-to-severe Alzheimer's disease. The study demonstrated that Aricept 23mg significantly improved cognition compared to Aricept 10mg as measured by the Severe Impairment Battery (SIB) assessment, which measures cognition. The changes in total score in the SIB (higher scores are better) was 2.6±0.58 in the 23mg group compared to 0.4±0.66 in the 10mg group, a difference of 2.2 (p=0.0001).

Aricept 23mg is expected to be available in August 2010. Aricept is already available in 5mg and 10mg dosage strength tablets. Aricept ODT (donepezil HCl orally-disintegrating tablets) is available in 5mg and 10mg dosage strengths.” (source: www.empr.com/aricept-23mg-approved-for-alzheimers-disease/article/175367)

Contact your doctor (mom sees a Geriatric specialist) to see if Aricept 23mg is okay for your loved one. You may have to tell them about the new prescribing information as our doctor’s staff was unaware of the new dosage. We continually try to keep up on medications even though we are not sure they are improving her memory or stopping the progression of Alzheimer’s. Aricept seemed to work for mom and tapered off after about 2 years when we saw a significant decline. Mom also takes Namenda (www.namenda.com.) She stopped taking Aricept earlier this year only to participate in a clinical study for advanced Alzheimer’s patients for a drug called Dimebon. The Dimebon study was cancelled in May as the trials found Dimebon to be no better than placebo. (http://abcnews.go.com/Health/Alzheimers/pfizers-promising-alzheimers-drug-fails-study/story?id=9998774 )

There is always hope that new, better therapies will come. Since it is difficult to navigate our hope is that we can share practical information as we receive it.

Care Giving at Home for Advanced Alzheimer

My family has been dealing with the “loss” of our mother to Alzheimer’s for over 7 years now. I find it very difficult to decipher the medical, research, nonprofit, & governmental worlds – the information below may be useful.

My father who retired at 59, is mom’s primary caregiver. He is now 74 years old. My father is the type of person who could not find his own socks without the help of my mom. He now bathes, dresses and feeds her every day. My sisters and extended family help too, and we found a caregiver for my mom who comes 3 days a week, 8 hours a day.

Finding a caregiver is like finding a mate, yet, it costs a lot of money. We learned early on, that the middle class does not qualify for services – nor can you really afford it. We had COSA social workers at the house, called many different governmental agencies and didn’t get any help. We searched and found care givers on Craig’s list and went through about 5 people before we found our current, wonderful lady. The most important quality for us was that the person to help with mom's care had to be nice and patient, and provide some limited activity. We had problems with the first couple care givers who started off great, yet, became “lazy” and/or called out etc. Dad did not want to use the agencies that provide home aides although they are fully insured. Dad was afraid mom would not get consistent care. He pays his caregiver directly – saving a little.

Newly, we are also getting services through Medicare – this was more of a hassle than it may be worth for some people. Medicare only treats a “disease” that has a finite end. Alzheimer’s is progressive, and mom is not “trainable” to take care of herself. Unfortunately, she is at the point where she cannot do anything for herself.

A couple of years ago mom started seeing a gerontologist as her primary physician. She has other issues including a pace maker. The frustrating part is that doctors don’t do anything to “treat” Alzheimer’s. We kept asking about services from Medicare, especially when the government said it is a disability. Finally her physician got an agency to come and assess our needs within the home. You need a “prescription” for this “agency.” They send a social worker, and an occupational therapist/nurse. We asked for a physical therapist to help mom with walking and other physical strength. While this is active, we can have a home health aide come to the house a couple days a week and get mom up, bathe and dress her in the morning. It is not much and a lot of red tape to go through yet we were able to get some equipment too. Dad got raised toilet seats, a hospital bed, and is getting a lift installed for mom to go up the steps. We have to keep on top of the agency, and there are so many people involved, it is hard to get straight answers. We went through 2 agencies as the first one was far from the home – we didn’t know this at first.

If you are like my family, and want to have your love one stay home the following may help:
- Find a good primary care doctor, gerontologist, to handle all aspects of “healthcare” for mom
- Look on Craig’s list for home health aides, care givers etc. – Interview, spend time with them. Make sure they live close to the house etc. We posted an ad ourselves the last time and received many responses.
- Ask the doctor to refer an agency for Medicare services
- Don’t underestimate your needs. It may be a short time until your loved one is incapable of getting around on their own. Tell the “social worker” or occupational therapist if there are any issues with bathing, bathroom, eating, walking etc.
- Continue to lobby for services, this is terribly frustrating, yet needed to keep loved ones at home.

Aluminum and Alzheimer's Disease

The existence of a link between aluminum and Alzheimer’s disease is not a new proposal.  For over forty years, studies have tried to demonstrate the effects of aluminum on the human body. At present, aluminum and its physiological role remain an enigma. Aluminum exists in the air we breathe, food we eat and water we drink. But little of it is actually absorbed by a healthy body. Most is expelled by the kidneys. Despite this, there exists a great deal of ambiguity over aluminum as a cause of Alzheimer’s disease.

In 1993, the World Health Organization cited autopsies in a public health report that found high amounts of aluminum in individuals with Alzheimer’s disease. This led them to state, “There is a suspected link between Alzheimer’s disease and the toxicity of aluminum.”  Aerosol deodorants and antiperspirants have received a great deal of scrutiny because of the aluminum concentrations they contain and a potential neurotoxicity. Studies have suggested the inhaled aluminum compounds of these aerosol products could have a direct nasal-olfactory pathway to the brain.

The Food and Drug Administration (FDA) has not found sufficient evidence to make a determination that aerosol deodorants and antiperspirants cause Alzheimer’s disease. The Agency for Toxic Substances and Disease Registry presently state, “We do not know for certain whether aluminum causes Alzheimer’s disease.”  The Alzheimer Society questions the aluminum-Alzheimer’s relationship by referring to studies that have not found increased levels of aluminum in the brains of Alzheimer’s patients. They also mention the lack of increased Alzheimer’s disease in occupations with high aluminum exposure. Tea leaves, known to carry higher amounts of aluminum, have not been found to cause increased Alzheimer’s disease, especially in societies or cultures where tea is consumed regularly. Regarding a causal relationship between aluminum and Alzheimer’s disease, the Alzheimer’s Society state, “It has proved extremely difficult to devise studies to resolve this problem one way or another. Alzheimer's is a common disease with multiple causes, while aluminum is widespread in the environment, and there are no methods that allow us to measure an individual's 'body burden' or lifetime exposure to this element.”

References:

Alzheimer’s Society: Aluminum and Alzheimer’s Disease
Food and Drug Administration: Antiperspirant Drug Products For Over-the-Counter Human Use; Final Monograph
Agency for Toxic Substances & Disease Registry: ToxFAQs for Aluminum
Azheimer Society: Aluminum
Howard LeWine - Health Risks from Aluminum Pots or Deodorant?

Mercury Fillings and Alzheimer's

Dental fillings are commonly used in the process of tooth restoration. These fillings provide structure and integrity to a tooth that has suffered decay or damage. Fillings often use mercury as part of the amalgam or composite material. Much controversy has arisen over whether the mercury in dental amalgams is safe.

High levels of mercury are toxic and can seriously affect the brain and kidneys. People with mercury amalgam fillings have more mercury in their bodies. This added mercury is believed to put individuals at greater risk for mercury poisoning. As the mercury is absorbed by the body, it becomes neurotoxic when it enters the brain. This neurotoxicity is believed by some to be directly linked to Alzheimer’s disease. Studies have found elevated levels of mercury in the autopsies of Alzheimer’s individuals. It is believed mercury’s effects on other parts of the central nervous system may include amyotrophic lateral sclerosis, multiple sclerosis and Parkinson's disease.

In July of 2009, the Food and Drug Administration issued a final regulation on dental amalgams. In the release, the FDA said that the levels of mercury in dental amalgam fillings were not high enough to cause harm in patients. A 1999 study conducted autopsies on subjects with and without Alzheimer’s disease. The levels of mercury found between each group were no different. At this time the American Dental Association, the Centers for Disease Control, the U.S. Public Health Service and the World Health Organization have not found sufficient evidence to question the safety of mercury fillings.

References:
Department of Health and Human Services: Mercury
American Dental Association: Amalgam (Dental Filling Options)
Agency for Toxic Substances & Disease Registry: Public Health Statement for Mercury
Kip Sullivan: Evidence Implicating Amalgam in Alzheimer’s Disease
Michael J. Wahl, D.D.S.: Amalgam -- Resurrection and Redemption
Food and Drug Administration: FDA Issues Final Regulation on Dental Amalgam
Alzheimer’s Association: Alzheimer Myths

Exercise Your Brain Today To Keep It Sharp

Your brain is like a muscle and it can get better with use.  Research shows that mental exercises can grow your brain and enhance its performance.  This will help you stave off age related memory loss like Alzheimer’s disease later on in life.

Several large studies have found a less risk for developing Alzheimer’s disease in intellectually actively people compared with their mentally inactive peers.  And the mental activity can take many forms, such as reading, working jigsaw puzzles, woodworking, printing, knitting and playing board games.  Some studies have even found that people with mentally demanding jobs, professionals, managers, etc experience less memory decline as they age when compared with their counterparts who have less demanding jobs.

In a study with 500 elderly, they were asked how often they participated in leisure activities like dancing, playing chess, card games or doing crossword puzzles.  Over the years, the scientists kept records of those who developed mild memory loss or full-blown dementia.  They found that the people who were the most active mentally had a 63 percent lower risk of getting dementia compared with those who rarely played board games, read, or did similar activities.  The people who played the most had the most protection, doing crossword puzzles four days each week translated into 47 percent lower risk of dementia compared with once a week puzzle solvers.  For each day of the week that people exercised their minds, the researchers found nearly a 10 percent reduction in the risk for dementia.

Other studies indicate that mental activity earlier in life is beneficial as well.  The rate for developing Alzheimer’s disease was three times lower in people who had been intellectually active during their forties and fifties compared with those who had not.   Even mental activity as early as one’s twenties will mean better cognitive function late in life.  This means that college graduates have a lower risk for developing Alzheimer’s disease than those who never get beyond a high school education.

Experts believe that one reason solving puzzles and other forms of mental stimulation help lower the risk for dementia is that people develop a “cognitive reserve” that allows them to tolerate more damage from Alzheimer’s and other brain diseases.  A recent study  suggests that it’s not how much brain you have, but how you use it that makes the difference.  The investigators tested 19 people with a range of IQs from below to above average.  Participants performed memory tasks while the investigators measured their brain activity patterns during functional MRI scans.

The scans showed more activity in the frontal lobes of people with higher intelligence.  These same investigators also have demonstrated the brain-protective effects of education.  These findings show that more intelligent and better educated people use their brains differently than those without these benefits, and this may help explain why keeping the mind active helps protect against the onset of Alzheimer’s disease.

Mental calisthenics may not only keep our brain ells healthy, but they may also help them grow.  New research suggests that the brain can actually rewire itself and grow new cells, a process known as neurogenesis, believed impossible until the last few decades.  Research by the Princeton University has shown that laboratory animals continue to produce new brain cells in the hippocampus, that sea horse shaped formation beneath the temple.  Studies have shown that such neurogenesis can occur in humans as well.  Neurogenesis may be an important aspect of memory and learning.  In animal studies, they have found that enriched environments are associated with greater numbers of synapses or cell communication links in the brains memory centers.  And, when running through their mazes and completing other memory tests, the stimulated animals appear more intelligent.  These kinds of studies have led many researchers to believe that routine mental exercise
stimulates existing connections between neurons and leads to new neuronal connections in the brain.  This in turn will improve memory and brain performance.

Even in the face of this and other compelling evidence for the protective benefits of mental exercise, memory training and memorization techniques,  there are still skeptics who believe that mental activity has little or no effect on the rate at which our brains age.  However, even without absolute proof of cause and effect, the risks of staying mentally active are minimal, and the potential gains great.  In the words, remaining mentally active and practicing mental  exercises can’t hurt.  It can also enrich our lives.

Studies on mental exercises have shown that the tasks must involve an element of effort.  They can be diverse and can include any of a number of activities reading, working jigsaw puzzles, woodworking, painting, knitting, or playing board games.  You may prefer learning a language or reading a challenging novel or biography or learning a memorization technique as memory training  Evidence indicates that the “fun factor” keeps us coming back for more, and that is what you want – to sustain the activity over time.  Epidemiological studies suggest that we need to develop a regular habit  of mental calisthenics, and that years of activity may be needed to obtain optimum effect.

Tests for Alzheimer's – What Science Knows Now

More than 5 million Americans suffer from memory loss or dementia. While there are no definitive tests for Alzheimer’s, find out here what science knows now about this incurable disease.

There are more than 5 million people in the United States today who have Alzheimer's disease. In the over-65 population, 1 in 8 people has the disease. For those over 85, roughly 50% have Alzheimer's or some degree of dementia. And it’s estimated that 500,000 Americans under the age of 65 have already been diagnosed with Alzheimer’s

Imagine what will happen to these numbers when more than 72 million American baby boomers enter the senior population. But how is Alzheimer's disease diagnosed?

Unfortunately, there are no actual tests for Alzheimer's. It’s only diagnosed by the process of elimination. What science knows now is that there are a number of medical issues that can cause memory-related problems. These include thyroid disorders, small strokes, drug interaction, depression, and pernicious anemia. Science also knows that the earlier the diagnosis, the better chance for developing an appropriate treatment plan.

The diagnostic procedure begins with your health practitioner evaluating your medical history, as well as that of your parents, siblings and grandparents. Other possible causes of memory impairment are then ruled out. A physical examination and blood tests will help eliminate these possibilities.

A cognitive test may also be administered, in which the patient is asked to perform simple memory and processing tasks. The patient may then be referred for more complex medical screenings. Several types of brain imaging tests, such as CAT scans, MRIs and PET scans, are used to rule out strokes or tumors.

Dementia can be caused by a series of strokes so small as to be undetected. Depression can also cause memory lapses. Parkinson’s disease, a degenerative nerve disorder, can also be a cause of dementia. And some medications, especially in older patients, can cause fuzzy thinking and memory loss. Even a fever or a head injury
can result in memory problems, as can dehydration or malnutrition. Late-stage syphilis is yet another cause of dementia.

Blood tests can help eliminate these and other possible causes of memory loss, such as thyroid disorders or vitamin deficiencies.

More extensive neuropsychological testing may be given to the patient. These tests assess the patient’s memory, problem-solving abilities, attention span and skills involving numbers and language. Psychological tests can also be useful in diagnosing Alzheimer's disease.

A vaccine was developed that reduces the deposits in the brain associated with Alzheimer's. However, it was found to have dangerous side effects, and the clinical trial was abandoned.

Genetic testing for Alzheimer's is still in the beginning phase. Researchers have identified several genes that are associated with Alzheimer's disease. It must be mentioned here that recent studies have shown that only 30% of cognitive decline is the result of genetics. The remaining 70% is the result of lifestyle choices.

What science knows now is that Alzheimer's disease is not a normal part of the human aging process. There is always a cause. Although physicians have no definitive tests for Alzheimer's, you should not ignore any early symptoms of mental decline.

There are many other tests and screenings that can be used to eliminate possible causes of memory loss. Fortunately, there are drug therapies that can slow down the progression of this frightening disease.

Why Lipoic Acid Is Much More Than Just Another Anti-Oxidant

Lipoic acid is not only a highly potent anti-oxidant, but may also alleviate some symptoms of diabetes, multiple sclerosis and Alzheimer’s disease

Lipoic acid, also known as alpha-lipoic acid or thioctic acid, is a vitamin like compound produced naturally by the body in very limited quantities, but which may also be obtained from various dietary sources.

The lipoic acid produced in the body is closely bound to certain proteins and is essential to work in harmony with the B complex vitamins for the release of energy from food. No symptoms have ever been attributed to a deficiency of this type of lipoic acid, suggesting that the body is always able to manufacture a sufficient supply for this purpose. Research has focused, however, on the possible benefits of high dose supplementation with what is known as "free lipoic acid", which does not bind with proteins in the body.

Lipoic acid functions as an anti-oxidant, assisting in the destruction of the free radicals which may damage cell DNA and membranes. However, lipoic acid is found in tiny quantities when compared with other anti-oxidants such as vitamins C and E, and the enzyme, glutathione. Moreover, any increase in lipoic acid activity obtained through supplementation is likely to be short lived. The real anti-oxidant importance of lipoic acid, however, lies in its capacity to recharge and renew these other anti-oxidants, consequently enhancing their potency.

Lipoic acid has also been shown to stimulate the production of glutathione in the body, a particularly important consideration in the case of the elderly who commonly have difficulty synthesizing this enzyme and are consequently more vulnerable to the free radical attack which may damage cells and ultimately contribute to degenerate disease.

Research has suggested that high doses of lipoic acid may assist individuals with type 2 (non-insulin dependent) diabetes by improving glucose regulation and reducing the resistance to insulin which is characteristic of this form of the disease. Doses of 600 mg per day and more have been shown to enhance the action of insulin in type 2 diabetic individuals by as much as 25% after four weeks. It is much less clear, however, whether such courses of treatment will maintain similar benefits in the longer term.

There are also indications that lipoic acid may be effective in the alleviation of the pain and weakness commonly suffered by diabetic individuals as a result of peripheral nerve damage, particularly in the lower legs and feet. Close control of blood glucose levels has been found to be the best means of preventing this diabetic neuropathy, and although research suggests intravenous supplementation to be the most effective, both oral and intravenous supplements of lipoic acid are approved as treatments in Germany.

It has been suggested that lipoic acid's role in improving circulation and the general health of the vascular system may be responsible for its mitigation of the effects of diabetic neuropathy, but orthodox opinion is that more long term studies are required to establish this link. Supplementation in the case of diabetics should in any case only be undertaken under medical supervision.

But the possible benefits of lipoic acid don't end here. Lipoic acid is a valuable tonic for the liver, assisting its regeneration and recovery from hepatitis and toxic assaults such as drug, alcohol or fungal poisoning. A number of animal experiments have also appeared to show that supplements may restrict the activity of an enzyme associated with the progression of multiple sclerosis. As always, however, in the cautious world of orthodox medicine, it is argued that more long-term studies are needed before any definitive statements are made.

Likewise, although there have been some encouraging indications that lipoic acid may have a positive effect in slowing down memory loss, age-related cognitive decline and dementias, including Alzheimer's disease, larger long-term trials are needed before any definitive statements can be expected from the scientific community.

As always with supplementation, however, it is a question of weighing large potential benefits against the risks. As indicated above, lipoic acid is approved as a medical treatment in Germany and is freely available as a food supplement in the US and elsewhere. The few adverse reactions to oral supplements which have been recorded have been confined to relatively minor skin irritations and gastric upsets.

Moreover, good food sources are limited to the unpopular offal and dark green leafy vegetables, and even the best of these will provide only a tiny fraction of the bio-available lipoic acid that can be obtained from supplements. Indeed, because of the difficulty in absorbing lipoic acid in the presence of food, this is one of the very few cases where it's recommended that supplements should be taken on an empty stomach

It needs to be stressed again, however, that because of its potential effects on blood sugar regulation diabetics should not embark on a course of supplements without first seeking medical advice.