Researchers Have Identified A New Type Of Dementia
In May, an international team of researchers identified a brain disorder known as LATE. It has similar symptoms to Alzheimers disease but appears to be caused by the build up of the toxic protein TDP-43.
Our researchers were able to delve into this particular protein by studying human brain tissue through our initiative Brains for Dementia Research.
The finding will help us distinguish between different brain disorders and develop precise and personalised treatments.
The Rise Of Treatable Neurology
In October 2019, another patient was admitted to the John Radcliffe hospital.Pippa Carter, aged 19, had just begun an English literature degree at the University of Leeds when she noticed that her vision seemed to be strangely distorted.
I would be in lectures and I was really struggling to focus with my eyesight and with concentration in general, she says. I was trying to audition for a university play, and I had to stop because I couldnt really read at all. Initially, I thought it was just nerves because I was starting a new chapter in life.
Within weeks, she found herself unable to get her words out properly, before she was taken to hospital after suffering a large seizure. Just like Abraham, it was the speed of her decline which alerted doctors to a potential autoimmune cause. Within a week she was hallucinating, shouting things, remembers Irani. In her hospital room, which she was in for several weeks, she drew these bizarre childlike pictures on the wall, like the sorts of things a four-year-old would draw. It was like something was causing her to regress in her behaviour.
Carter was suffering from a neuropsychiatric syndrome caused by an autoantibody binding to the brains NMDA receptors, proteins which play a key role in learning and memory formation. Soon after she began treatment, first with steroids, and then an immunotherapy called rituximab, she began to improve. Now more than a year on, she is hoping to resume her university studies soon.
Fda Protects Consumers From Companies Selling Unapproved New Drugs
The FDA takes action against companies marketing unapproved new drugs that claim to prevent, diagnose, treat or cure Alzheimers disease and a number of other diseases and health conditions.
The FDA issues warning letters to advise the companies to change or remove claims about their products that render the products misbranded or otherwise illegally marketed, and if the companies dont comply, the FDA may take further legal action to prevent the products from reaching consumers.
If you know of a product or supplement being advertised or sold as treatment for Alzheimers or other diseases, you can report it on FDAs website.
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But Behavioural Changes Can Reduce The Risk Of Developing It
PERFORMING HIS autopsy on Auguste Deter in 1906, Alois Alzheimer noticed three unusual features of her brain. It was at least a third smaller than normal. Many neurons, the nerve cells, had vanished. He also saw abnormal deposits inside the remaining cells, especially in the cerebral cortex, the thin outer layer of grey matter. Between a third and a quarter had been invaded by dense knotty bundles, now known as neurofibrillary tangles, caused by a build-up of a protein called tau. And across the cortex were deposits of another protein, since identified as beta-amyloid, which collect between neurons and disrupt their functioning.
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Despite decades of research, Alzheimers still has no vaccine and no cure. Some fear that the covid-19 crisis will now squeeze the financial and scientific resources available for dementia research. In the pandemic, research has anyway suffered because clinical trials became difficult. Miia Kivipelto, a Finnish neuroscientist who led a study showing how changes in ways of life could slow or arrest cognitive decline, had to suspend her follow-up research. And many people have become wary of seeking diagnosis or help, for fear of infection, or of laying claim to health-care resources needed elsewhere.
How Is Alzheimer’s Disease Treated
Alzheimers disease is complex, and it is therefore unlikely that any one drug or other intervention will ever successfully treat it in all people living with the disease. Still, in recent years, scientists have made tremendous progress in better understanding Alzheimers and in developing and testing new treatments, including several medications that are in late-stage clinical trials.
Several prescription drugs are already approved by the U.S. Food and Drug Administration to help manage symptoms in people with Alzheimers disease. And, on June 7, 2021, FDA provided accelerated approval for the newest medication, aducanumab, which helps to reduce amyloid deposits in the brain and may help slow the progression of Alzheimers, although it 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. However, it is important to understand that none of the medications available at this time will cure Alzheimers.
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Treatment For Mild To Moderate Alzheimers
Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.
Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.
An Unprecedented Study Could Lead To A More Precise Diagnosis Of Alzheimer’s As Well As New Treatments For The Disease
Scientists have discovered an additional 42 genes connected to the development of Alzheimer’s disease, according to a landmark study that is the result of 30 years of work.
Professor Julie Williams, Centre Director at the UK Dementia Research Institute in Cardiff, said in a statement that genetics has and will continue to help us identify specific disease mechanisms which we can target therapeutically. This piece of work is a major leap forward in our mission to understand Alzheimers, and ultimately produce several treatments needed to delay or prevent the disease.
The highly collaborative, international project was carried out in research centres in eight partner countries including the UK, US, Australia and across Europe.
The study provides compelling evidence to support the role of inflammation and the immune system in the disease. It also confirmed previous findings implicating the proteins amyloid-beta and tau, that build up in and around nerve cells as Alzheimers disease progresses.
The study involved researchers analysing the genomes of more than 100,326 people with Alzheimers disease and comparing them with over 600,000 healthy individuals to look for differences in their genetic makeup.
This study more than doubles the number of identified genes influencing risk for the more common form of Alzheimers disease, said Dr Rebecca Sims, a Senior Research Fellow at Cardiff University and co-leader of the study.
Why is Alzheimers complex?
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Will We Ever Cure Dementia
As with cancer, there is currently no cure for dementia
If there is one dreaded word uttered by doctors to rival cancer, it’s dementia. Patients the world over fear its impacts: the lack of independence the higher likelihood of ending up in a nursing home. As with cancer, there is currently no cure for dementia.
But the prognosis is not entirely bleak. It’s now becoming more apparent we may be able to prevent or delay the onset of dementia symptoms by living more healthily in our earlier years.
An often forgotten and more pressing need is how do we care for people living with dementia? Doing so will require investment both now and into the future.
Meanwhile, a large section of the scientific community is squarely focused on the search for effective treatments. Millions of dollars have been invested over the last three decades in search of a holy grail.
This despite the reality that dementia is a complex condition, an enigma to researchers.
For two important reasons, dementia cannot be fixed quickly and with great effectiveness – like a heart attack or angina is with a stent, or like some cancers can be with surgery.
First, it’s a cumulative condition with multiple causes that impact on the brain at various times during a person’s life span. Second, dementia creeps up on a person with changes in the brain beginning decades before a person actually starts to show symptoms.
A logical question that follows is, what can be done about reducing the burden of dementia?
Where We Are Now
In brief, these Harvard researchers have a viable hypothesis to explain why this woman has been highly resistant to developing Alzheimers disease dementia. Moreover, their work suggests a possible path to a treatment that could be beneficial for all forms of Alzheimers disease.
We are still years away from a human treatment. The next step will be to try to treat laboratory models of Alzheimers disease in rodents, and then clinical trials in people with the disease after that. But in my view, this paper has provided the scientific community with a clue that may lead us to an eventual cure for Alzheimers disease.
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Can You Die From Dementia And How Does It Kill You
Many people worry about developing dementia one day. However, experts say there are things you can do to by more than 30 percent. In this article, we’ll cover some of the easy lifestyle changes you can make to improve your odds of staying healthy.
If you have dementia, you may be wondering what it might mean for your long-term health. Know that it’s not the type of disorder that can shorten your life expectancy, but it may make you more susceptible to contracting certain illnesses. We’ll talk about that in more detail later on, and we’ll share some suggestions to ease your fears and worries.
What Will Cause Death?
For many, dementia is unfathomable. It’s scary to think about losing memories and the ability to function normally. If you have been diagnosed with dementia, know someone who has, or are just curious about the subject, you may wonder how a person with dementia dies.
It’s possible that you could die from complications of dementia, but you’re unlikely to die from the disease itself. For example, dementia could damage your brain over time to the point that you lose the ability to breathe and therefore die. However, for many patients, this is not the case.
Even though there are around 50 million people worldwide who have dementia, you’re not destined to get it. There are billions of people who don’t have it and who will never get it.
Promising Steps In The Right Direction
Currently available medications such as those which block the actions of an enzyme that destroys an important chemical messenger in the brain for memory or blocks the toxic effects of another messenger, glutamate temporarily manage symptoms. But new treatments are focused on slowing or reversing the disease process itself, by targeting the underlying biology.
One approach, called immunotherapy, involves creating antibodies that bind to abnormal developments in the brain , and mark them for destruction by a range of mechanisms. Immunotherapy is experiencing a surge of interest and a number of clinical trials targeting both amyloid- and tau are currently underway.
Aducanumab, an antibody targeting amyloid-, has shown promise in clinical trials and phase 3 trials are currently ongoing, as are several tau-based strategies. If any are successful, we would have a vaccine for Alzheimers.
Its estimated only 0.1% of antibodies circulating in the bloodstream enter the brain this also includes the therapeutic antibodies currently used in clinical trials. An approach my team is taking is to use ultrasound to temporarily open the blood-brain barrier, which increases the uptake of Alzheimers drugs or antibody fragments.
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There Is No Alzheimers Cure So Whats The Point
The answer to this question is significant and important for anyone suffering or at risk from Alzheimers disease. And its particularly critical for care partners and families that will ultimately be responsible for the journey of care that an Alzheimers patient must take in life. The fact is that there is a very strong and relevant point: Alzheimers disease is not a normal part of aging and just because there is no cure, there are still steps to take that can slow the progression of the disease. Information is power, and with the right information patients and families can plan a strategy to make the most of the days, months or years ahead and provide someone with Alzheimers disease the best quality of life possible.
Alzheimers Medication Currently Available
While there is no drug to cure Alzheimers, there are medications available as an Alzheimers treatment to impede the progression of the disease. As the condition advances, brain cells die and connections among these cells are broken, causing cognitive symptoms to increase. Current medications are available to help lessen or stabilize symptoms by impacting certain chemicals that carry messages between the nerve cells of the brain. While this effect is limited in its duration, it still can provide extra time for a patient to be mentally present with their friends and family.
Alzheimers Medications for Early-to-Moderate Stages
Moderate-to-Late Stage Alzheimers Medication
Other Alzheimers Treatments
The Dementia That Can Be Cured
There are more than 200 subtypes of dementia. And researchers have found that in one, confusion and memory loss can be treated. But the trick is to spot it
When John Abraham began to lose his mind in late 2019, his family immediately feared the worst. Abraham had enjoyed robust health throughout retirement, but now at 80 he suddenly found himself struggling to finish sentences.
I would be talking to people, and all of a sudden the final word wouldnt come to mind, he remembers. I assumed this was simply a feature of ageing, and I was finding ways of getting around it.
But within weeks, further erratic behaviours started to develop. Abrahams family recall him often falling asleep mid-conversation, he would sometimes shout out bizarre comments in public, and during the night he would wake up every 15 minutes, sometimes hallucinating.
Patients can go from being in a nursing home, unable to communicate, to returning to work
To his son Steve, the diagnosis seemed inevitable, one which all families dread. I was convinced my dad had dementia, he says. What I couldnt believe was the speed at which it was all happening. It was like dementia on steroids.
A lot of patients over 60 are misdiagnosed, says Flanagan. Thats a concern because if you miss these cases, youre committing them to a presumed neurodegenerative course when they could respond to immunotherapy, and their symptoms resolve.
More Research Is Being Done Than Ever Before And We Already Understand A Lot More About Dementia Than We Used To
More research is being done than ever before, and we already understand a lot more about dementia than we used to. Some people who are living with dementia help with this, by taking part in research projects.
Sometimes the media reports on research that is still at a very early stage. Promising results in the laboratory are always good news, but it can take a long time to turn them into a treatment that can be used to help people.
At the moment, there is no way to halt or reverse the brain changes that cause dementia. Its hard to know exactly when there will be new treatments for the different types of dementia, but research is already helping doctors to find the best ways to care for people with dementia.
Research has also helped to develop medicines that can relieve some of the symptoms that people with dementia experience, such as depression. There are also medicines that may help to keep a persons symptoms stable for longer. Everyone is different, but for some people these medicines can make a real difference.
This information was updated in November 2019 and is due for review in November 2021. Please contact us if you would like a version with references.
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Q: If Drugs Against Amyloid Arent The Answer What Is
Back in the 80s and 90s, genetic tools weren’t quite developed enough to address the real question we had: What genes are involved in most cases of Alzheimers disease?
Techniques have advanced and we can now answer this question. New studiesmany led by Richard Mayeux, MD have been pointing to other processes in the brain. We also have better biological tools that can reveal the basic problem inside neurons.
Based on this research, the new consensus in the field is that there are two other pathways that cause the disease.
One involves protein trafficking, which is how proteins are shipped to different sites within a single cell. The health of neurons, more so than other cells, depends on protein trafficking in and out of one particular site: the endosome.
In Alzheimers, the flow of proteins out of the endosome is blocked, and we think that causes the other problems we see in the disease: the amyloid, the tau tangles also common in the Alzheimers brain, and the neurodegeneration. Essentially it’s a plumbing problem.
Our research here at Columbia provided some early evidence for an endosomal trafficking problem in Alzheimers. And genetic studiesincluding those led by Dr. Mayeuxhave now found that some endosomal genes are linked to Alzheimers, which provides more support.
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