Icipating In Alzheimer’s Disease Clinical Trials
Everybody those with Alzheimers disease or MCI as well as healthy volunteers with or without a family history of Alzheimers may be able to take part in clinical trials and studies. Participants in Alzheimers clinical research help scientists learn how the brain changes in healthy aging and in Alzheimers. Currently, at least 270,000 volunteers are needed to participate in more than 250 active clinical trials and studies that are testing ways to understand, diagnose, treat, and prevent Alzheimers disease.
Volunteering for a clinical trial is one way to help in the fight against Alzheimers. Studies need participants of different ages, sexes, races, and ethnicities to ensure that results are meaningful for many people.
NIA leads the federal governments research efforts on Alzheimers. NIA-supported Alzheimers Disease Research Centers throughout the U.S. conduct a wide range of research, including studies of the causes, diagnosis, and management of the disease. NIA also sponsors the Alzheimers Clinical Trials Consortium, which is designed to accelerate and expand studies and therapies in Alzheimers and related dementias.
To learn more about Alzheimers clinical trials and studies:
- Talk to your health care provider about local studies that may be right for you.
Watch videos of participants in Alzheimers disease clinical trials talking about their experiences.
Medications To Maintain Mental Function In Alzheimer’s Disease
Several medications are approved by the U.S. Food and Drug Administration to treat symptoms of Alzheimers. Donepezil, rivastigmine, and galantamine are used to treat the symptoms of mild to moderate Alzheimers. Donepezil, memantine, the rivastigmine patch, and a combination medication of memantine and donepezil are used to treat moderate to severe Alzheimers symptoms. All of these drugs work by regulating neurotransmitters, the chemicals that transmit messages between neurons. They may help reduce symptoms and help with certain behavioral problems. However, these drugs dont change the underlying disease process. They are effective for some but not all people and may help only for a limited time.
Causes Of Alzheimer Disease
What causes Alzheimer disease is unknown, but genetic factors play a role: About 5 to 15% of cases run in families. Several specific gene abnormalities may be involved. Some of these abnormalities can be inherited when only one parent has the abnormal gene. That is, the abnormal gene is dominant. An affected parent has a 50% chance of passing on the abnormal gene to each child. About half of these children develop Alzheimer disease before age 65.
One gene abnormality affects apolipoprotein E the protein part of certain lipoproteins, which transport cholesterol through the bloodstream. There are three types of apo E:
Epsilon-4: People with the epsilon-4 type develop Alzheimer disease more commonly and at an earlier age than other people.
Epsilon-2: In contrast, people with the epsilon-2 type seem to be protected against Alzheimer disease.
Epsilon-3: People with the epsilon-3 type are neither protected nor more likely to develop the disease.
However, genetic testing for apo E type cannot determine whether a specific person will develop Alzheimer disease. Therefore, this testing is not routinely recommended.
Risk factors, such as high blood pressure, diabetes, high cholesterol levels, and smoking, can increase the risk of Alzheimer disease. Treating these risk factors as early as midlife can reduce the risk of mental decline in older age.
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Prevention Of Alzheimer Disease
Some research tentatively suggests certain measures that may help prevent Alzheimer disease:
Controlling cholesterol levels: Some evidence suggests that having high cholesterol levels may be related to developing Alzheimer disease. Thus, people may benefit from a diet low in saturated fats and, if needed, drugs to lower cholesterol and other fats .
Controlling high blood pressure: High blood pressure may damage blood vessels that carry blood to the brain and thus reduce the brains oxygen supply, possibly disrupting connections between nerve cells.
Exercising: Exercising helps the heart function better and, for unclear reasons, may help the brain function better.
Keeping mentally active: People are encouraged to continue doing activities that challenge the mind, such as learning new skills, doing crossword puzzles, and reading the newspaper. These activities may promote the growth of new connections between nerve cells and thus help delay dementia.
Drinking alcohol in modest amounts: In modest amounts , alcohol may help lower cholesterol and maintain blood flow. Alcohol may even help with thinking and memory by stimulating the release of acetylcholine and causing other changes in nerve cells in the brain. However, there is no convincing evidence that people who do not drink alcohol should start drinking to prevent Alzheimer disease. Once dementia develops, abstaining from alcohol is usually best because it can make symptoms of dementia worse.
Vascular Contributions To Alzheimers Disease
People with dementia seldom have only Alzheimers-related changes in their brains. Any number of vascular issuesproblems that affect blood vessels, such as beta-amyloid deposits in brain arteries, atherosclerosis , and mini-strokesmay also be at play.
Vascular problems may lead to reduced blood flow and oxygen to the brain, as well as a breakdown of the blood-brain barrier, which usually protects the brain from harmful agents while allowing in glucose and other necessary factors. In a person with Alzheimers, a faulty blood-brain barrier prevents glucose from reaching the brain and prevents the clearing away of toxic beta-amyloid and tau proteins. This results in inflammation, which adds to vascular problems in the brain. Because it appears that Alzheimers is both a cause and consequence of vascular problems in the brain, researchers are seeking interventions to disrupt this complicated and destructive cycle.
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Treatment Of Alzheimer Disease
Safety and supportive measures
Drugs that may improve mental function
Treatment of Alzheimer disease involves general measures to provide safety and support, as for all dementias. Also, certain drugs can help for a while. The person with Alzheimer disease, family members, other caregivers, and the health care practitioners involved should discuss and decide on the best strategy for that person.
Pain and any other disorders or health problems are treated. Such treatment may help maintain function in people with dementia.
Later In Alzheimer Disease
As Alzheimer disease progresses, people have trouble remembering events in the past. They start to forget the names of friends and relatives. They may require help with eating, dressing, bathing, and going to the toilet. All sense of time and place is lost: People with Alzheimer disease may even get lost on their way to the bathroom at home. Their increasing confusion puts them at risk of wandering and falling.
Disruptive or inappropriate behavior, such as wandering, agitation, irritability, hostility, and physical aggression, is common.
Eventually, people with Alzheimer disease cannot walk or take care of their personal needs. They may be incontinent and unable to swallow, eat, or speak. These changes put them at risk of undernutrition, pneumonia, and pressure sores . Memory is completely lost.
Ultimately, coma and death, often due to infections, result.
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How Is Alzheimer’s Disease Diagnosed And Evaluated
No single test can determine whether a person has Alzheimer’s disease. A diagnosis is made by determining the presence of certain symptoms and ruling out other causes of dementia. This involves a careful medical evaluation, including a thorough medical history, mental status testing, a physical and neurological exam, blood tests and brain imaging exams, including:
Causes Of Alzheimers Disease
Scientists dont yet fully understand what causes Alzheimers disease in most people. In people with early-onset Alzheimers, a genetic mutation is usually the cause. Late-onset Alzheimers arises from a complex series of brain changes that occur over decades. The causes probably include a combination of genetic, environmental, and lifestyle factors. The importance of any one of these factors in increasing or decreasing the risk of developing Alzheimers may differ from person to person.
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Alzheimer’s Disease: Brain Changes Symptoms And Treatment
ByCari Nierenberg19 June 2019
Alzheimer’s disease is a progressive brain disorder that causes problems with memory, thinking and behavior in older adults. The disorder affects an estimated 5.7 million Americans, and is the fifth-leading cause of death in people ages 65 and older, according to the Centers for Disease Control and Prevention .
Alzheimer’s disease is often used as a synonym for dementia, which is a devastating loss of memory and cognitive function in older people, said Dr. Brad Hyman, a neurologist and director of the Massachusetts Disease Research Center at Massachusetts General Hospital in Boston. Dementia is an umbrella term for impaired memory thinking skills, and Alzheimer’s is a specific form of dementia. Alzheimer’s disease is responsible for 50-70% of all dementia cases, according to Alzheimers.net.
The first case of Alzheimer’s was described in 1906 by Dr. Alois Alzheimer, a German neurologist. Alzheimer identified two of the disease’s key physical traits when he examined a woman’s brain tissue under a microscope after her death: He found abnormal protein clumps and tangled bundles of nerve fibers .
A Coordinated Push For Better Diagnosis And New Treatments
We heard from Dr Jennifer Whitwell from the Mayo Clinic in the US whose research into brain imaging in FTD is identifying new ways to distinguish between the different types of FTD. On average, people with FTD can wait up to five years for an accurate diagnosis, and reports suggest that almost three quarters of people are initially misdiagnosed. So advances in this area are vital for families affected, as well as helping researchers to improve their approach to studying the disease.
Brain imaging is also a central theme in the Genetic Frontotemporal Dementia Initiative , outlined today by Dr Jonathan Rohrer from UCL. This collaborative programme is following hundreds of people whose families are affected by inherited forms of FTD. Using brain scans, the team has already identified particular networks of nerve cells in the brain that are affected differently in FTD caused by different faulty genes.
The study is now entering a second phase with the ultimate aim to map what changes happen in brain, blood and spinal fluid in FTD and when. This will be vital for helping to guide future clinical trials of new treatments in the disease.
As the Alzheimers Research UK Drug Discovery Institutes are kick-starting new drug discovery programmes and a Dementia Consortium drug discovery project already focusing on FTD, its vital these kinds of initiatives run hand-in-hand.
- Weve already funded over £11m into FTD, donate to help us fund more.
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What Happens In Alzheimer Disease
You probably know that your brain works by sending signals. Chemical messengers, called neurotransmitters , allow brain cells to talk to each other. But a person with Alzheimer disease has lower amounts of neurotransmitters.
People with Alzheimer disease also develop deposits of stuff that prevent the cells from working properly. When this happens, the cells can’t send the right signals to other parts of the brain. Over time, brain cells affected by Alzheimer disease also begin to shrink and die.
How Alzheimer’s Disease Impacts The Brain
November 26, 2019Neurology
One condition becoming all too common today is Alzheimers disease, a brain condition that is the 6th leading cause of death in the United States. The Alzheimers Association defines the disease as a type of dementia that causes problems with memory, thinking, and behavior.
Alzheimers doesnt happen all at once. In fact, the symptoms may at first be dismissed as simply getting older, if doctors and family members arent vigilant. Early symptoms include relatively small issues like trouble learning new things or remembering details. Eventually, the symptoms grow to the point of inability to care for oneself or understand ones surroundings. So, where does the brain with Alzheimers disease go wrong?
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How Is Alzheimer’s Different From Other Forms Of Dementia
Alzheimer’s disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination during autopsy. Brains affected by Alzheimer’s disease often show presence of the following:
Fiber tangles within nerve cells
Clusters of degenerating nerve endings
Another characteristic of Alzheimer’s disease is the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin, and somatostatin.
How Is Alzheimers Disease Treated
Alzheimers is complex, and it is therefore unlikely that any one drug or other intervention will successfully treat it in all people living with the disease.
Scientists are exploring many avenues to delay or prevent the disease as well as to treat its symptoms. In ongoing clinical trials, scientists are developing and testing several possible interventions. Under study are drug therapies aimed at a variety of disease interventions, as well as nondrug approaches such as physical activity, diet, cognitive training, and combinations of these. Just as we have many treatments for heart disease and cancer, we will likely need many options for treating Alzheimers. Precision medicine getting the right treatment to the right person at the right time will likely play a major role.
Current approaches to treating Alzheimers focus on helping people maintain mental function, treating the underlying disease process, and managing behavioral symptoms.
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Tangles And Cell Death
In normal brain tissue, a protein called tau stabilizes microtubules. Microtubules are key parts of cell structure.
In a diseased brain, protein strands, or threads, become tangled. As a result, the brain system of transporting cell nutrients along parallel structures which can be compared to railroad tracks falls apart.
Without these critical nutrients, brain cells die.
Memory and thinking depend on the transmission of signals across 100 billion neurons in the brain.
AD interferes with this cell signal transmission. It also affects the activity of brain chemicals called neurotransmitters.
The scrambled chemistry produces flawed signaling, so the brains messages are lost. This impacts the ability to learn, remember, and communicate.
Microglia are a type of cell that initiate immune responses in the brain and spinal cord. When AD is present, microglia interpret the beta-amyloid plaque as cell injury.
The microglia go into overdrive, stimulating inflammation that further damages brain cells.
Some AD research focuses on how this inflammatory response can be reduced or controlled.
How Alzheimer’s Disease Affects The Hippocampus
Research has found that one of the first areas in the brain affected by Alzheimer’s disease is the hippocampus. Scientists have correlated atrophy of the hippocampal areas with the presence of Alzheimer’s disease. Atrophy in this area of the brain helps explain why one of the early symptoms of Alzheimer’s disease is often impairment of memory, especially the formation of new memories.
Hippocampus atrophy has also been correlated with the presence of tau protein that builds up as Alzheimer’s disease progresses.
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Symptoms Of Alzheimer Disease
Problems doing usual daily tasks
Disruptive or inappropriate behavior
However, Alzheimer disease also differs from other dementias. For example, recent memory is typically affected much more than other mental functions.
Although when symptoms occur varies, categorizing them as early, intermediate, or late symptoms helps affected people, family members, and other caregivers have some idea of what to expect. Personality changes and disruptive behavior may develop early or late in Alzheimer disease.
Behavior Disorders In Alzheimer Disease
Because people are less capable of controlling their behavior, they sometimes act inappropriately or disruptively . These actions are called behavior disorders.
Several effects of Alzheimer disease contribute to this behavior:
Because people with Alzheimer disease have forgotten the rules of proper behavior, they may act in socially inappropriate ways. When hot, they may undress in public. When they have sexual impulses, they may masturbate in public, use off-color or lewd language, or make sexual demands.
Because they have difficulty understanding what they see and hear, they may misinterpret an offer of help as a threat and may lash out. For example, when someone tries to help them undress, they may interpret it as an attack and try to protect themselves, sometimes by hitting.
Because their short-term memory is impaired, they cannot remember what they are told or have done. They repeat questions and conversations, demand constant attention, or ask for things they have already received. They may become agitated and upset when they do not get what they ask for.
Because they cannot express their needs clearly or at all, they may yell when in pain or wander when lonely or frightened. They may wander, yell, or call out when they cannot sleep.
Whether a particular behavior is considered disruptive depends on many factors, including how tolerant the caregiver is and what sort of situation the person with Alzheimer disease is living in.
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Early In Alzheimer Disease
Symptoms develop gradually, so for a while, many people continue to enjoy much of what they enjoyed before developing Alzheimer disease.
Symptoms usually begin subtly. People whose disease develops while they are still employed may not do as well in their jobs. In people who are retired and not very active, the changes may not be as noticeable.
The first and most noticeable symptom may be
Forgetting recent events because forming new memories is difficult
Sometimes changes in personality
Early in the disease, people become less able to use good judgment and think abstractly. Speech patterns may change slightly. People may use simpler words, a general word or many words rather than a specific word, or use words incorrectly. They may be unable to find the right word.
People with Alzheimer disease have difficulty interpreting visual and audio cues. Thus, they may become disoriented and confused. Such disorientation may make driving a car difficult. They may get lost on their way to the store. People may be able to function socially but may behave unusually. For example, they may forget the name of a recent visitor, and their emotions may change unpredictably and rapidly.
Many people with Alzheimer disease often have insomnia. They have trouble falling or staying asleep. Some people become confused about day and night.
At some point, psychotic behavior develops in many people with Alzheimer disease.