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How Is Alzheimers Diagnosed And Treated

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Doctors may ask questions about health, conduct cognitive tests, and carry out standard medical tests to determine whether to diagnose a person with Alzheimers disease. If a doctor thinks a person may have Alzheimers, they may refer the person to a specialist, such as a neurologist, for further assessment. Specialists may conduct additional tests, such as brain scans or lab tests of spinal fluid, to help make a diagnosis. These tests measure signs of the disease, such as changes in brain size or levels of certain proteins.

There is currently no cure for Alzheimers, though there are several medicines approved by the U.S. Food and Drug Administration that can help manage some symptoms of the disease along with coping strategies to manage behavioral symptoms. In 2021, FDA provided accelerated approval for a new medication, aducanumab, that targets the protein beta-amyloid, which accumulates abnormally in the brains of people with Alzheimers. The new medication helps to reduce amyloid deposits, but has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.

Most medicines work best for people in the early or middle stages of Alzheimers. Researchers are exploring other drug therapies and nondrug interventions to delay or prevent the disease as well as treat its symptoms.

Can I Reduce My Risk Of Developing Alzheimers Disease

While there are some risk factors for Alzheimers you cant change, like age and genetics, you may be able to manage other factors to help reduce your risk.

Risk factors for Alzheimers disease include:

Research shows that having a healthy lifestyle helps protect your brain from cognitive decline. The following strategies may help decrease your risk of developing Alzheimers disease:

  • Stay mentally active: Play board games, read, do crossword puzzles, play a musical instrument or do other hobbies that require brain power.
  • Get physically active: Exercise increases blood flow and oxygen to your brain, which may affect brain cell health. Wear protective headgear if youre participating in activities that increase your risk of a head injury.
  • Stay socially active: Regularly talk with friends and family and join in on group activities, such as religious services, exercise classes, book clubs or community volunteer work.
  • Eat healthily: Follow the Mediterranean or DASH diet or another healthy diet that includes antioxidants. Consume alcoholic beverages in moderation.

Talk to your healthcare provider if youre concerned about your risk of developing Alzheimers disease.

Causes And Risk Factors Of Alzheimers Disease

What causes Alzheimers? That is the billion-dollar question of dementia research. Scientists have made progress in understanding what happens in the brain as the disease progresses, but they still dont know just what kicks off these changes.

Researchers believe that the vast majority of Alzheimers cases are due to some combination of genetics, lifestyle, and environment. Risk factors include:

  • Age Alzheimers disease is not a normal part of aging, with many people entering their nineties with their cognitive abilities intact. But age increases risk: Most people with the disease are 65 and older. After 65, risk doubles every five years. Nearly one-third of people who are 85 and older have Alzheimers.
  • Family History Having a first-degree relative such as a parent or sibling with the disease is a strong risk factor. This may reflect shared genetics, environmental factors, or both.
  • Genetics Scientists have identified over 20 genes involved with Alzheimers, although only one gene variant, called APOE-e4, appears to significantly raise risk. Still, some people with the APOE-e4 gene never develop Alzheimers, while others who develop Alzheimers dont have the gene.

Risk factors for Alzheimers that may be somewhat under a persons control include:

Learn More About Causes of Alzheimers Disease: Common Risk Factors, Genetics, and More

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What Are The Stages Of Alzheimers

Alzheimers disease slowly gets worse over time. People with this disease progress at different rates and in several stages. Symptoms may get worse and then improve, but until an effective treatment for the disease itself is found, the persons ability will continue to decline over the course of the disease.

Early-stage Alzheimers is when a person begins to experience memory loss and other cognitive difficulties, though the symptoms appear gradual to the person and their family. Alzheimers disease is often diagnosed at this stage.

During middle-stage Alzheimers, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. People at this stage may have more confusion and trouble recognizing family and friends.

In late-stage Alzheimers, a person cannot communicate, is completely dependent on others for care, and may be in bed most or all the time as the body shuts down.

How long a person can live with Alzheimers disease varies. A person may live as few as three or four years if he or she is older than 80 when diagnosed, to as long as 10 or more years if the person is younger. Older adults with Alzheimers disease need to know their end-of-life care options and express their wishes to caregivers as early as possible after a diagnosis, before their thinking and speaking abilities fail.

Where The Prospects Are

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Still, biotech executives are enthused about their scientific prospects in 2023. The genetic medicine theme features companies like Moderna and BioNTech , which hope to shift the mRNA focus from Covid to new use cases like personalized cancer vaccines.

Crispr Therapeutics , with partner Vertex Pharmaceuticals , could snag the first approval for a gene-editing drug using CRISPR technology.

Among other biotech stocks outside of genetic medicine, Biogen and Eli Lilly will vie for the upper hand in treating Alzheimer’s disease, and the obesity treatment landscape will evolve with a likely second approval from Lilly.

Some analysts also see a revival in the nonalcoholic steatohepatitis space riding on Madrigal Pharmaceuticals‘ coattails. Known as NASH, nonalcoholic steatohepatitis is liver inflammation caused by excess fat cells.

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Coping Strategies For Alzheimer’s Disease Caregivers

If you are a caregiver for someone suffering from Alzheimer’s disease , you may face difficult challenges as you try to provide care and understand the behavior changes of the person you are caring for. Understanding the behavior of a person with AD can help lessen these difficulties.

People with AD may exhibit the following behaviors:

  • Extreme anxiety about daily life, which may be exhibited by asking questions and repeating information about once familiar events and/or people, preparing for appointments/day care well ahead of time and using notes and reminders endlessly.
  • Apathy or a lack of initiative about tasks that used to be routine, though now feel overwhelming. For example, the person who always enjoyed puzzles but no longer does them because they are too overwhelming and require skills he/she no longer possesses.
  • Frequent agitation may occur as people become less able to interpret their environment and control or express their feelings. For example, a person with AD may strike out at a caregiver.

Apoe4 Or The Alzheimers Gene

Leqembis drugmakers have highlighted that carrying two copies of the APOE4 gene does confer an especially high risk of life-threatening brain hemorrhage.

According to Madhav Thambisetty, neurologist and senior clinical investigator at the National Institute of Aging, experts are watching the data for Leqembi closely to better understand specific risks for patients.

Thambisetty believes that if the drug does receive FDA approval, physicians must account for risk factors like APOE4 before prescribing the drug.

Other researchers and clinicals Being Patient interviewed took an even stronger stance, saying that the risks are too great to justify the drugs use: Karl Herrup, an Alzheimers researcher at the University of Pittsburgh, expressed concern about the long-term impact of ARIA for patients taking monoclonal antibody drugs for Alzheimers. I would say to a patient group that I recommend against it, Herrup told Being Patient.

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Women Might Be At Higher Risk

Age is the major risk factor for Alzheimers disease, and women on average live longer than men.

However, longevity alone does not fully explain why two-thirds of Alzheimers patients are women. Even after taking into account the difference in longevity, some studies have suggested that women are still at a higher risk.

Amyloid Related Imaging Abnormalities

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Looking closely at people on the drug within the first of 14 weeks. Risk of ARIA is higher for people with two copies of APOE4. If a patient experiences symptoms suggestive of ARIA, clinical evaluation should be performed, including MRI scanning if indicated. Consider testing for ApoE 4 status to inform the risk of developing ARIA when deciding to initiate treatment with LEQEMBI. Later in the booklet, it says that you should tell parents theres an APOE4 test available if patients want.

Amyloid-related imaging abnormalities are small brain bleeds and swelling that occur as a side effect of anti-amyloid drugs. These reactions occurred most often in participants who carried two copies of the APOE4 gene, a genetic variant linked to Alzheimers risk.

In the aducanumab trials leading up to Aduhelms FDA approval for Alzheimers treatment in the summer of 2021, ARIA occurred in more than one third of patients receiving the high dose of the drug.

Comparatively, Leqembi appears safer: One in five people who received Leqembi experienced ARIA. Among these cases only 3.5 percent were symptomatic.

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Can I Get Alzheimers Disease If Im Younger Than 65

Even though Alzheimers disease most commonly affects people older than 65, it can develop and cause symptoms in younger people.

When that happens, its referred to as early-onset Alzheimers disease or younger-onset Alzheimers disease. This condition can strike when someone is even in their 40s and 50s, which can make getting an accurate diagnosis difficult as we mainly think of the disease happening in someone older.

Hrt May Help Prevent Alzheimers Disease In At

Alzheimers affects an estimated one in 14 people over the age of 65 and one in every six people over the age of 80.

Hormone replacement therapy may help prevent Alzheimers disease in women at risk of developing the condition, researchers have suggested.

A team said the use of HRT, which helps control symptoms of the menopause, is associated with better memory, cognitive function and larger brain volumes in later life in women carrying a gene called APOE4.

About a quarter of women in the UK are thought to carry the APOE4 gene and Alzheimers is more common in women than men.

APOE4 is the strongest risk factor gene for Alzheimers disease, although inheriting APOE4 does not mean someone will definitely develop the condition.

In a new study, researchers found that HRT was most effective when given during perimenopause where symptoms build up months or years before periods actually stop and could lead to brains that appear several years younger.

Professor Anne-Marie Minihane, from UEAs Norwich Medical School, who led the study with Professor Craig Ritchie at the University of Edinburgh, said: We know that 25% of women in the UK are carriers of the APOE4 gene and that almost two thirds of Alzheimers patients are women.

In addition to living longer, the reason behind the higher female prevalence is thought to be related to the effects of menopause and the impact of the APOE4 genetic risk factor being greater in women.

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Cope With Changes In Communication

As your loved ones Alzheimers or dementia progresses, youll notice changes in how they communicate. They may have trouble finding words, substitute one word for another, repeat the same things over and over, or become easily confused. Increased hand gestures, losing their train of thought, and even inappropriate outbursts are all common as well.

Even if your loved one has trouble maintaining a conversationor less interest in starting oneits important to encourage social interaction. Making them feel safe rather than stressed will make communication easier, so try to manage your own frustration levels.

Be patient. If your loved one has difficulty recalling a word, for example, allow them time. Getting anxious or impatient will only inhibit their recall. Gently supply the word or tell the person that you can come back to it later.

Be aware of your body language. Your loved one responds to your facial expression, tone of voice, and nonverbal cues as much as the words you choose. Make eye contact, stay calm, and keep a relaxed, open posture.

Speak slowly and clearly. Give one direction or ask one question at a time, use short sentences, and give your loved one more time to process whats being said. Find a simpler way to say the same thing if it wasnt understood the first time.

Maintain respect. Dont use patronizing language, baby talk, or sarcasm. It can cause hurt or confusion.

What Are The Latest Findings In Alzheimer’s Disease Research

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The Wisconsin Alzheimer’s Disease Research Center is committed to educating the community about the latest updates in Alzheimer’s disease research through our outreach events, newsletters, podcast and direct discussion with our research participants. Information on research advances can also be found at Alzforum and Being Patient, both news sources for dementia and brain health research news. In addition to clinical trials conducted in partnership with the Wisconsin Alzheimer’s Disease Research Center, information on clinical trials for people both with and without memory problems can be obtained by visiting the following websites: Alzheimer’s Disease Education and Referral Center Clinical Trials, the Alzheimer’s Association TrialMatch, and ClinicalTrials.gov.

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Drug Patent Expirations Loom

Biotech stock investors should also keep an eye on the macro when it comes to patent expirations. That phenomenon is due to rock companies like Pfizer , , Merck, Eli Lilly and Bristol Myers Squibb . Companies may scramble to replace revenue with new acquisitions.

Olema’s Bohen says he went through this at AstraZeneca , where he was previously the chief medical officer.

“The challenge for those companies is the doesn’t get pushed away very effectively,” he said. “There are some forecasts that Big Pharma is going to lose some $200 billion in revenue by 2030. That’s a lot of money. And even if it’s a slight overestimate and its $100 billion, you’re not talking chump change when you get there. So, the need is there.”

But there aren’t too many assets that can create an inflection in that time period, he says. Yocca, of BioXcel, says Big Pharma has to be strategic with what it buys. Small biotech companies with midstage assets are in the sweet spot. Still, just because Big Pharma is buying doesn’t mean biotech companies are selling.

“What’s in some of the media, they’re saying, ‘Prices are low , pharma is going to go on a buying spree,’ ” Yocca said. “Yes, but the has a say in this too, and many of the companies will say no.”

Follow Allison Gatlin on Twitter at @IBD_AGatlin.

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New Uses For Mrna Technology

The Covid pandemic offered a paradigm shift for companies using mRNA technology. Among those de facto leaders, Moderna, is now turning its sights back to cancer. In a recent study, Moderna added its personalized cancer vaccine to Merck‘s blockbuster cancer drug, Keytruda. The combination reduced the risk of relapse or death by 44% in patients with melanoma.

In cancer, the way tumor cells mutate is highly individualized. So, Moderna is creating bespoke cancer vaccines targeted to each patient’s own tumor mutations. The vaccine prompts the immune system to create T cells capable of taking on those specific mutated tumor cells. If they return, the body’s defense system is ready.

BioNTech, meanwhile, just started a Phase 1 study to test a vaccine that would prevent herpes. The study will enroll 100 healthy volunteers, ages 18-55, in the U.S. It’s being developed with the University of Pennsylvania.

Anzalone, Arrowhead’s CEO, is more skeptical of mRNA.

“I don’t think we’ll see more interesting uses of it next year,” he said. “It’s a powerful technology and I’ve always thought that the low-hanging fruit with mRNA is vaccines. That makes total sense to me. I think we still are a breakthrough or two away from applying this to other disease states.”

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Biotech Stocks Focus On Genetics

The deep focus on genetic medicines has undeniable ties to the pandemic, which thrust a technology discovered decades ago to the forefront. Now, biotech stock investors are watching to see whether the messenger RNA companies can put on a second act.

“I think the pandemic really shows the versatility, the scalability and the programmability of these approaches,” said Michael Severino, CEO of privately held Tessera Therapeutics and a CEO-partner at Flagship Pioneering.

Severino left his role as vice chairman and president at AbbVie to take a leading spot at Flagship, the venture capital firm behind Moderna, Tessera and other biotech names. Tessera has a gene-writing platform.

“The success of the mRNA vaccines shows how rapidly that can progress,” Severino told IBD. “I don’t think there are many people who, before this pandemic, would have been able to comprehend going from identification of the pathogen, sequence in hand to vaccine to administration to something approaching a billion people around the planet in the very rapid time frame we’ve all seen.”

What Are The Warning Signs Of Alzheimers Disease

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Alzheimers disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimers disease and related dementias.

In addition to memory problems, someone with symptoms of Alzheimers disease may experience one or more of the following:

  • Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
  • Trouble handling money and paying bills.
  • Difficulty completing familiar tasks at home, at work or at leisure.
  • Misplacing things and being unable to retrace steps to find them.
  • Changes in mood, personality, or behavior.

Even if you or someone you know has several or even most of these signs, it doesnt mean its Alzheimers disease. Know the 10 warning signs .

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