28th December 2010 by Christian Elliott
With the first of 70 Million boomers in the United States turning 65 next year, the topic of memory screening tests for Alzheimer’s and other forms of cognitive impairment is becoming more commonplace. An added push also comes from new Medicare rules for an “Annual Wellness Visit” that (in theory) includes screenings for cognitive impairment.
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The combination of a huge demographic flow into late middle age, and national policy shifts to support screening for memory impairment brings up some interesting questions:
1. How will cognitive screening for 70+ Million people be accomplished? Given the large number of annual screenings, the logical choice is in the physician’s office or other primary point of care. Is the typical doctor’s office prepared to offer a simple cognitive screening test? What type of equipment and skills do they need to make this happen?
2. Is there a common test standard and common reporting standard for cognitive screening? There are literally dozens of computer based and paper based cognitive screening tools in use today, all with different subtests for cognitive domains (episodic memory, executive function, reaction time, etc), and all with different scoring methods. What are the benefits and drawbacks to using a standardized test battery vs. a “pick and choose” approach?
3. Is there agreement in the health care community on what a cognitive screening test result means? If the intent of a screening test is a quick “red light/yellow light/green light” result, are clinicians in agreement on the red light definition for example? What are the ethical considerations in communicating screening test results to patients?
Enabling a national test standard for cognitive screening will obviously take some time to work out, but a consensus on cognitive screening should happen sooner rather than later. Recent data from the Alzheimer’s Association points out that the total Alzheimer’s care burden could reach $1 Trillion annually by 2050, and that a modest five year delayed onset of AD could save Medicare (and US taxpayers) $360 Billion a year by 2050. Routine cognitive screening to catch early signs of Alzheimer’s will be necessary to achieve the goal of delayed AD onset.
15th December 2010 by Christian Elliott
This New York Times article provides a good synopsis on new research efforts to find a method for curing Alzheimer’s, or at least radically slowing down the disease progression. The new research avenues fall into into two main categories:
1. Slow beta amyloid clearance in older brains. The historical research focus on overproduction of amyloid proteins as a culprit in Alzheimer’s may be shifting to a view that impaired natural clearance of this brain protein is a more likely scenario. This presents some interesting avenues for drug discovery that can speed amyloid clearance, in addition to drugs that slow production of the protein.
2. Default network vulnerability. The default network in the human brain includes the hippocampus and parts associated with sense of self and personality. A consistent finding is that amyloid protein accumulates first in the default network, which is why memory impairments and sometimes major changes in behavior are hallmarks of Alzheimer’s. Sleep deprivation overtaxes the default network and doesn’t allow the necessary time to clear amyloid protein from the hippocampus, for example. Getting a solid eight hours of sleep is a good idea for this and many other brain health goals.
The story also mentions that early detection of Alzheimer’s is crucial, with the comment that “The trick in Alzheimer’s, though, might be to start treatment before too much damage is done.” This is a prime reason why memory screening in the doctor’s office needs to become routine, in order to catch early signs of Alzheimer’s and other forms of dementia.
5th December 2010 by Christian Elliott
Last night NBC aired the first Together for Care telethon for Alzheimer’s Disease. The Alzheimer’s Foundation of America (AFA) conceived and launched this effort, which helps raise awareness of Alzheimer’s at a national level. Celebrity appearances and performances by Ellen DeGeneres, Morgan Freeman, Naomi Judd, Mario Lopez, Kirk Morrison, Donald Trump, Kris Allen, Brett Eldridge, Shontelle, Wilson Phillips, and Al Roker were interspersed with compelling stories on the struggles family members face in providing care for loved ones afflicted with Alzheimer’s.
The AFA also sponsors a National Memory Screening Day, which is an annual event to promote memory health screening as a way to catch signs of early cognitive impairment that can lead to Alzheimer’s. This annual event also serves the purpose of educating consumers and health care providers on the benefits of preventive memory health screening.
I think the next (big) step is to move from a “special event” memory screening day concept to the routine, every day availability of cognitive screening in the physician’s office or community health clinic. If blood tests and other simple diagnostic screens are already routine in primary care settings, then adding cognitive screening is a logical step.
There are some hurdles to get over to make this happen, however, including a lack of adequate cognitive testing standards. The use of computerized cognitive screening tests is probably the best solution to this problem, but this will most likely take a few years before the US health care system moves ahead on widespread implementation.
In the meantime, readers can download two paper-based memory health screening tests that have strong scientific validation, and can also be administered at home by a family member or friend. (Be sure to read the test instructions carefully!)
24th November 2010 by Christian Elliott
A common theme I heard at the Society for Neuroscience conference last week was the easy availability of preventive steps that can be taken now to reduce the rate of new Alzheimer’s cases. Two of these preventive steps that have strong research evidence are lifestyle choices:
1. Moderate aerobic exercise (30 minutes) a few times a week sharply upregulates a protein called BDNF, which encourages new neuron growth, especially in the hippocampal and frontal cortex areas which are vital to learning and memory.
2. Antioxidents, from both food sources and Vitamin C tablets, have strong neuroprotective properties. (My personal favorite source of antioxidents is red wine.)
Another preventive measure is routine cognitive health screening in a doctor’s office or health clinic. Computer based memory screening tools are now sensitive enough to pick up early signs of memory impairment that older paper tests might miss.
As Americans dig into their turkey feast tomorrow, it would be a good idea to schedule preventive step # 1 above during the weekend!
15th November 2010 by Christian Elliott
The Society for Neuroscience is conveniently holding its annual conference here in my hometown of San Diego this week. Earlier this afternoon, US Representative Patrick Kennedy gave a very honest and personal speech on how brain illnesses have affected his family, including his father’s (Senator Ted Kennedy) death from brain cancer, his own struggles with Bipolar disorder, and family members who have succumbed to Alzheimer’s Disease.
Rep. Kennedy is also very passionate about the struggles many US military service members face with traumatic brain injuries (TBI). He accurately notes that there really isn’t a national organized effort on solving major brain disorders like Alzheimer’s and TBI, and that ‘political science’ and neuroscience need to work together on a national plan that has political backing.
It will be interesting to see how Patrick Kennedy’s new brain advocacy endeavor, www.moonshot.org, evolves over the next year.