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The Future Of Alzheimer Disease

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Last Updated: 16 October 2020

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General | Latest Info

Finding out if you or your loved one has Alzheimer's Disease can be difficult, confusing and scary. Fortunately, future is looking brighter as researchers and organizations like the Alzheimers Association work towards finding a cure. Learn more about disease, what preventative measures you can take, and current therapies being study. First discovered by Dr. Alois Alzheimer in 1906, Alzheimer's Disease is a type of dementia that causes issues with memory, thinking and behavior. Typically, symptoms develop and worsen over time, eventually becoming severe enough to interfere with daily tasks. There is not one single cause of Alzheimers, but risk factors include: age - people tend to develop Alzheimers at age 65 and older. Family history - if you have an immediate family member with a disease, youre more likely to develop it yourself. Genetics - Certain genes, like apolipoprotein E, are linked to Alzheimer's Disease. While there is currently no known cure for Alzheimer's Disease, there are medications or other treatments doctors can recommend in order to help ease symptoms and delay progression of the disease. At present, there are five Alzheimer's drugs approved by the US Food and Drug Administration to treat symptoms of the disease, but they do not treat its cause or progression. There are no known methods of preventing disease. However, researchers have focused on overall healthy lifestyle choices as a way to prevent decline, including: quitting smoking Regular exercise Cognitive training exercise Plant - base diet Consume antioxidants Interact socially we use Life Stations at Edgewood to help our residents spark old memories and create activities that encourage interest, movement and interaction. Make up of old gardening supplies, baby dolls and other items, these stations help residents revisit and retain memories while also inspiring new moments of joy. The next generation of drug therapies is under research, and they give some hope for the future of preventing and curing Alzheimer's Disease. The following are examples of medications being analyze:

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

The hope for future drugs

Adopting multiple healthy lifestyle habits can help when it comes to Alzheimer's Disease, according to New Research. 2019 was banner year for research offering new hopes for Alzheimer's Disease prevention and possibly new hopes for future treatment for AD, said Curtis P. Schreiber, MD, medical director of Missouri Memory Center at Citizens Memorial Hospital in Bolivar. Dr. Schreiber says that many people have concerns that they are at risk of developing Alzheimer's Disease. New Research presented at the July 2019 Alzheimers Association International Conference in Los Angeles reveals for the first time that lifestyle factors do matter and that addressing these items long before the onset of memory loss can reduce the risk of developing Alzheimer's Disease in future. Researchers evaluated more than 2 000 people and checked to see how five lifestyle factors would change their chances of developing AD. The results find that the risk of AD was 60% lower for those who adopt four or five lifestyle factors, when compared with those who do not follow any or only one of the lifestyle factors. Researchers find that those who adopt just one more lifestyle factor, whatever their current number of factors, their risk of Alzheimer's Dementia decrease by an additional 22%. Five lifestyle factors study include a healthy diet, moderate to vigorous physical activity at least 150 minutes a week, not smoking, light to moderate alcohol intake, and engaging in cognitively stimulating activities. Dr. Schreiber says that this study is great news for people who are interested in reducing their risk of Alzheimer's Disease. This study gives scientific proof that these simple, common - sense lifestyle choices can make a difference. All of the US can benefit, not only for our brain health, but also for the rest of our bodies by working on these five lifestyle factors, says Dr. Schreiber. While five lifestyle factors may help prevent AD, ultimate goal of research would be to find treatment to treat disease more effectively for people who already have Alzheimers. Scientists call this disease modifying treatment. Although there are medications currently available to help treat symptoms of AD, there are currently no available disease modifying treatments, says Dr. Schreiber. In October 2019, new possible treatment for AD was submitted to the Food and Drug Administration for possible approval to treat AD. This drug, aducanumab, had its clinical trials halt earlier in 2019 due to early analysis indicating low chance of the drug working. However, when longer duration effects were later review, much more encouraging findings were see. Although it remains to be seen if all scientific information is sufficient for FDA to approve this drug, it is exciting in the field of AD treatment to see this development, said Dr. Schreiber. Missouri Memory Center at CMH in Bolivar participates in Alzheimers Disease Research. Here at Missouri Memory Center, we offer large investigational clinical studies for interested patients to participate in AD Research in Bolivar, add Dr. Schreiber.

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* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Alzheimer's prevention trials

Forty years of intensifying research have brought an explosion of new knowledge about Alzheimer's Disease. Studies in genetics; basic biology; drug discovery; and translational, clinical, behavioral, and social science research have helped redefine disease and clarify ways to approach study of treatments and prevention. 1 Yet despite significant progress in understanding disease, there is still no effective treatment or cure for Alzheimers. The progress of research to date is not only the product of a cadre of dedicated scientists. In large part, it comes from thousands of volunteers who participate in epidemiological and clinical studies, taking part in neuropsychological tests of memory and cognitive function; contributing DNA, blood, and cerebrospinal fluid samples; and undergoing brain scans. These study participants are why we know what we know about Alzheimer's Disease. The relationship between Alzheimers researchers and the public is at a critical juncture. More than 150 clinical trials and studies in the United States, sponsored by government, private industry, and research foundations, seek at least 70 000 participants to enroll. 2 Using the conservative rule of thumb of ten people screened for each enrolled participant, researchers will need to screen upward of 700 000 potential volunteers to help investigate promising therapies emerging from discovery of newer targets and risk factors. Pharmaceutical Research and Manufacturers of America, in Its report on Alzheimers Drug development, notes that recruiting and retaining clinical trial participants is currently the greatest obstacle to developing new Alzheimers treatments. 3 number of factors relating to research recruitment generally and to Alzheimers trials specifically must be addrest in the near future if obstacles to recruitment are to be overcome. Furthermore, upcoming trials to test interventions at presymptomatic stage of disease, when it is thought treatment will be more effective, will seek new cohort of participants who are cognitively healthy but at risk for developing Alzheimers. The National Plan to Address Alzheimer's Disease, introduced by the Department of Health and Human Services in 2012, directs the United States to increase enrollment in Clinical trials and other Clinical Research through community, National, and International outreach, including step - up enrollment of racial and ethnic minorities in Alzheimer Studies. 4 We outline some of the challenges to increase enrollment and offer specific solutions to enhance awareness and facilitate participation at all stages of disease in the urgent search for cure.


DISCUSSION

Most studies to date were performed in mild and moderate AD patients, with neuronal damage already present to a considerable extent. At this stage, disease progression path and rate are uncertain and show individual variability in part due to variability in dementia rating and patient populations. In mild and moderate AD patient populations, it has become apparent that use of amyloid and tau modulation agents to inhibit generation and / or increase clearance may not compensate for neuronal damage that is already present, thus challenging clinical trials ' odds of success. Some published results show no or very slow cognitive decline in their placebo group, strongly suggesting failure in clinical trial design. Other trials have suffered from lack of sensitivity of standard measures of cognitive performance at early and prodromal stages of disease. In addition, widely used CDR - SB scale, while clinically meaningful, was not designed to be used in traditional statistical analysis of efficacy of treatment. Because evaluation is subjective, additional variability may be introduced in multicenter trials, further hampering success. When used as measure of disease progression in evaluation of primary endpoints, unequal size of change between stabilization and / or improvement in the treatment group as compared to disease progression in the placebo group. Since the typical annual change in CDR - SB report for early AD patients is between 1 - 2 points, changes are small and require a large number of subjects to reach statistical significance, even in cases when drug is clinically effective in stabilizing cognitive decline. As mentioned previously, to overcome issues with measuring cognitive change early in AD progression, Phase II clinical trial of BAN2401 uses combination measures, ADCOMS, which at 18 months show statistically significant changes compared to placebo. However, changes in CDR - SB were not statistically significant, which could be, in part, attributed to select patient population and disease staging in trial. In prevention trials, time to diagnosis of dementia has been used as an endpoint and it is likely to show similar variability. Further, multiple trials have attempted to conduct subgroup analysis after failures to report clinical benefit. These attempts have been criticized for providing inaccurate information as subgroups are often not properly randomized and do not have significant sample size.

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* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Success Will Bring New Challenges

Progress against Alzheimer's Disease and related dementia remains slow. Currently, estimate 5. 8 million Americans are living with Alzheimers or dementia, or one in 10 people aged 65 and older. By 2050, that statistic is expected to climb to 14 million Americans. Alzheimer's Disease is rapidly overwhelming our older population, their caregivers and families, and the entire healthcare systemyet even as the crisis worsens, no new treatments have entered the global market since 2003. Give these trends, it is increasingly imperative that innovative and effective Alzheimer's treatments are develop. Even modest delays in progression of Alzheimer's Disease could dramatically alter current trajectory and generate large health benefits. Just a one - year delay in onset of Alzheimer's Disease could generate 219 billion in savings in medical and caregiving costs by 2050. Randomize clinical trials are the cornerstone of the drug - development process, but clinical trialswhich account for the vast majority of costs and time in any drug development processesare especially tall hurdle for Alzheimers drug development. In fact, Alzheimers trials are slower to enroll participants, take longeryears, not monthsto complete, and are more expensive than trials in other therapeutic areas. Screening procedures are expensive and time - consuming, and a large share of potential participants fail screening criteria due to necessary restrictive eligibility criteria. Naturally, slow progression of Alzheimer's Disease also contributes to long timelines, as well as limited consensus on measures of effectiveness required to demonstrate treatments ability to prevent or slow disease progression. Currently, approximately 99% of potential participants are never referred to or considered to participate in Alzheimers clinical trials that might bring the US closer to effectively preventing or treating the disease. To be effective, new approaches to Alzheimer's trials must surmount barriers to participation and bring as many people as possible into the Alzheimer's clinical - trial ecosystem. To understand these barriers and develop a strategy for surmounting them, our colleagues surveyed and interviewed nearly 900 Alzheimer's Disease stakeholders, including clinical trial personnel, patients, caregivers, and physicians. The new Schaeffer Center White paper outlines barriers to accelerating Alzheimers Disease clinical trials. Researchers identify several broad challenges, including limited physician and patient awareness of early stages of Alzheimer's Disease; fear of Alzheimers diagnosis; overstretch healthcare systems; lack of effective treatment options; lack of fast, inexpensive diagnostics; and lack of physician and patient awareness of clinical trials. In essence, main barriers to more efficient Alzheimer's Disease trials are those which keep participants from ever reaching trials in the first place. Along the Alzheimers Disease continuum, distinct approaches to improving participant identification, recruitment, enrollment and retention could be used. Innovations with the greatest potential to funnel as many people as possible toward Alzheimers clinical trials would increase awareness of diseaseespecially, early Alzheimersamong public, equip healthcare providers and researchers with effective and efficient biomarkers and Cognitive assessment tools, and facilitate participant awareness of, referral to, and retention in clinical trials. The lack of diverse representation of participants with regards to varied race, ethnicities, sex, or educational backgrounds further limits Alzheimer's clinical trials.

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* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Tau Protein

In the wake of recent disappointments over Clinical Trials targeting amyloid plaque build - up in Alzheimers Disease, researchers are focusing more attention on misfolded Tau Protein, another culprit in brain diseases that cause Dementia. New research published in Science Translational Medicine finds that targeting abnormal Tau through suppression of a gene called MSUT2 shows promise. Tau, like amyloid Protein, is another substance that builds up in Alzheimer's Disease and damages brain cells. However, Clinical Trials targeting Tau have been far less numerous in PART because Tau - target drugs have been hard to find. In this study, researchers conclude that suppressing MSUT2 might protect people from Alzheimer's Disease as long as RNA Binding Protein PolyA Binding Protein Nuclear 1 is not deplete. Msut2 and PABPNI normally work together closely to regulate the biology of Tau in the Brain. If you inhibit MSUT2 and do affect PABN1, that protects against the effects of Tau pathology, say senior author Brian Kraemer, Research associate Professor of Medicine in Division of Gerontology and Geriatric Medicine at University of Washington School of Medicine. He is also a scientist at Veterans Affairs Puget Sound Health Care System. Kraemer said his team see their role as people kicking the ball down field to provide other researchers and drug companies opportunity to move the ball towards the ultimate goal: treatment or cure for Alzheimer's Disease. Pharmaceutical companies have heavily invested in going after amyloid but so far these efforts haven't moved needle on Dementia treatments, he say. I think the field needs to think about targeting amyloid and tau together because both amyloid and tau act together to kill neurons in Alzheimer's Disease. Senior author Jeanna Wheeler, Research scientist at Seattle Institute For Biomedical and Clinical Research and VA, said what novel about the study is the discovery of the role of the MSUT2 gene. We discovered MSUT2 originally in a completely unbiased way by looking for anything that could make worms resistant to pathological Tau Protein. Now we have shown that this gene can also affect Tau toxicity in mice, and also that there are differences in MSUT2 in human Alzheimer's patients, she say. If we can use MSUT2 in future as a drug target, this would be a completely novel approach for treating Alzheimer's and other related disorders. Study also bring more attention to the role of Tau pathology in Alzheimer's Disease. A healthy human brain contains tens of billions of specialized cells or neurons that process and transmit information. By disrupting communication among these cells, Alzheimer's Disease results in loss of neuron function and cell death. Previous studies have shown that abnormal Tau burden correlates strongly with cognitive decline in Alzheimer's Disease patients, but amyloid does not. Some Dementia disorders, such as frontotemporal lobar degeneration, may have only abnormal Tau with NO amyloid deposits. If you could protect the brain from Tau alone, you may provide substantial benefit for people with Alzheimer's Disease, Kraemer say.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

The Alzheimers Prevention Initiative (API)

The Alzheimers Prevention Initiative has ignited a new era of Alzheimers Research focusing on Prevention. Champion and led by Banner Alzheimers Institute, API is an international collaborative form to launch a new era of Alzheimers Prevention Research by evaluating the most promising therapies in cognitively normal people who - based on age and genetic background - are at highest risk of developing Alzheimer's Disease symptoms as quickly as possible. The goal of API is to identify pre - symptomatic treatments or interventions that will postpone, slow or prevent disease progression. Apis scientists, researchers and physicians collaborate with partners throughout the world and with Arizona Alzheimers Consortium and Collaboration for Alzheimers Prevention on: Prevention trials Biomarker studies Registries


Introduction

Alzheimer's disease is the most common cause of dementia. Only therapies available for patients with AD, such as cholinesterase inhibitors and memantine, target symptoms of disease, but these treatments do not slow disease progression. There is a high unmet need for treatments that target underlying disease pathophysiology at early stages, with the goal of slowing progression, delaying, or even preventing onset of clinical symptoms due to AD. Substantial evidence from genetically at - risk groups and otherwise cognitively unimpaired individuals suggests progressive biomarker changes before cognitive impairment,. One critical change is slow accumulation of pathological amyloid beta species in the brain, which starts a decade or more before symptoms occur. Investigational treatments targeting AD pathogenic cascade include those that interfere with production, accumulation, or toxic sequelae. Base on nonclinical studies and lack of benefit in recent clinical trials targeting symptomatic stages of disease, current hypothesis is that - lowering therapies might only be effective in preventing or slowing progression of AD when initiated in preclinical stages of disease,. Although some recent trials confirm that antiamyloid drugs could induce measurable reduction, this reduction generally does not correlate with improvements in cognition in early or mild AD stages. One explanation for these failures is that deposition is an early - stage process, and antiamyloid therapies may have little clinical effect in patients who are at clinical stages. As understanding of AD has advance, biomarkers may be used to enrich study population based on genetics and factors underlying AD pathophysiology, and trials can enroll cognitively unimpaired participants at earlier stages of disease. Without genetic or biomarker enrichment strategy, very large number of cognitively unimpaired persons studied over many years would be required to conduct Prevention trials,. The Alzheimer's Prevention Initiative was established in 2010 to help accelerate evaluation of promising AD Prevention therapies,. Aims of API include conducting potentially label - enabling trials in cognitively unimpaired persons at high risk for development of AD using novel composite clinical endpoints, thereby providing better tests of amyloid hypothesis than trials that have recently failed in clinical stages of disease,. An initial trial was launched in members of the world's largest autosomal dominant AD kindred in Colombia, with the intention of following on with trials described here. Trials are also designed to assess the relationship between biomarker status and clinical benefits of treatment to support development of surrogate endpoints for predicting clinical benefits in future Prevention trials. Finally, API was designed as a series of public - private partnerships that would identify large numbers of interested research participants who might enroll in a range of studies, and that would share baseline and post - trial data, to help find effective AD Prevention therapies as soon as possible.

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JAX innovations

Indianapolis and Bar Harbor, Maine With the goal of breaking a bottleneck in developing new drugs to treat Alzheimer's Disease, National Institute of Aging will provide 25 million over five years to establish and Fund Alzheimers Disease Precision Models Center at Indiana University School of Medicine and Jackson Laboratory. The center will be jointly led by Drs. Bruce Lamb and Paul Territo at IU School of Medicine and Drs. Gareth Howell and Greg Carter at JAX. Age - Related neurodegenerative Disease, Alzheimers Disease, is the leading cause of Dementia among people aged 65 and older. An estimated 5 million Americans have the disease, and it ranks among the top six causes of death. Center will focus on creating dozens of New Models of Alzheimer's Disease; studying their physiology, behavior and genomes for disease relevance; and discovering and testing potential Alzheimer's Disease treatments. To date, success rates in clinical trials of Alzheimer's Disease drugs after testing in animal models have been disappointing. Howell note, existing mouse models for Alzheimer's Disease have provided important insights into aspects of Alzheimers Disease Biology, but have not been great preclinical models as they do not sufficiently MODEL Disease. The Combination of new gene editing technologies such as CRISPR / Cas9, large - scale genomic data resources, and advanced computational methods is enabling rapid and precise development of mouse Models of Disease, even in complex diseases such as Alzheimers Disease that involve multiple gene mutations. Our aim is to develop animal models that more closely mimic human Alzheimer's Disease and a preclinical testing pipeline through which novel therapies can be tested to greatly accelerate the process by which therapies are successfully moved forward to human Alzheimer's Disease clinical trials, Howell say. Bruce Lamb, PhD, executive director of Stark Neurosciences Research Institute at IU School of Medicine, notes that in the past decade, researchers have identified many genetic variants that appear to be linked to Alzheimer's Disease but whose roles are unknown. I would argue that those results indicate that we do not, even today, have a very good understanding of the biology of late - onset Alzheimers Disease, says Dr. Lamb, Roberts Family Professor of Alzheimers Disease Research. Developing these new animal models will be key to ultimately translating those research discoveries into new Alzheimers therapies, Dr. Lamb say. The goal of this partnership is to create animal models that will, on national level, accelerate development of effective therapies for Alzheimer's Disease, say Jay L. Hess, MD, PhD, MHSA, dean of IU School of Medicine and Vice President for University clinical affairs. Alzheimers Disease Precision Models Center will build on the unique expertise of both institutions. Ius strengths in neurodegenerative Research include 25 years as home to NIA - Support Indiana Alzheimer Disease Center, expertise in clinical drug testing and leadership role in the National Alzheimers Disease Neuroimaging Initiative. Jax, which has NIA - Support Nathan.

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Most trials target brain pathologies

The Cholinergic hypothesis was proposed by Peter Davies and. J. F. Maloney in 1976 31. They study and compare the activities of key enzymes involved in synthesis of neurotransmitters, including acetylcholine, - aminobutyric acid, dopamine, noradrenaline, and 5 - hydroxytryptamine, in 20 regions of AD and Control brains. Activity of choline acetyltransferase in AD brains was greatly reduced in the amygdala, hippocampus, and cortex, in which concentration of acetylcholine was decreased at synapses. 50 51 52 activity of glutamic acid decarboxylase, tyrosine hydroxylase, aromatic amino acid decarboxylase, dopamine - hydroxylase, and monoamine oxidase in all areas of AD brain study appear to be well within normal range. Choline acetyltransferase is a key enzyme in the synthesis of acetylcholine, and its catalytic activity requires these substrates: choline, acetyl - CoA, and adenosine triphosphate. This was the first time that the concept of AD was noted as cholinergic system failure. 31 53 This finding has also been reported in other neurological and psychiatric disorders, such as Parkinson's Disease and depression. 54 55 AChEIs can alleviate Cognitive Impairment in AD patients by inhibiting degradation of acetylcholine. 56 57 58 59 Therefore, AChEIs have been in used for more than 20 years since FDA approved Tacrine, first Drug for Treatment of AD, in 1995. 60 Tacrine is reversible AChEI. Because of its liver toxicity, number of Tacrine prescriptions dropped after other AChEIs were introduce, and usage of Tacrine has been largely discontinue. Second generations of AChEI drugs that are widely used at present include donepezil, rivastigmine, and galantamine. 61 62 these drugs show fewer side effects and higher central selectivity and improve cognition level of patients with Mild to moderate AD. The daily living ability and overall function of patients treated with rivastigmine and galantamine are better than those treated with donepezil. 61 62 63 According to the latest meta - analysis on the efficacy of AChEIs for treating Cognitive symptoms of Dementia, AChEIs have modest effects on Dementia in AD, 64 but the effect is not continuous. 65 66 in conclusion, current clinical drugs used for treatment of AD improve the quality of life of AD patients, but have NO significant effect on occurrence or progression of AD. In 2012, French Pharmacoeconomic Committee assessed the medical benefit of these drugs and downgraded its rating of medical benefit provided by AChEIs in AD from major to low. 67 Amyloid hypothesis was first proposed in 1991 by John Hardy and David Allsop. 32 33 They find pathogenic mutation in precursor protein gene on chromosome 21, which suggests that APP mismetabolism and deposition were primary events in AD. They think that pathological cascades in AD were deposition, Tau phosphorylation, NFT formation, and neuronal death. The Presence of deposits in APP mutant Transgenic model supports this hypothesis and further contributes to shifting the Amyloid hypothesis from descriptive to mechanistic hypothesis.


Introduction

Alzheimer's Disease is an irreversible progressive neurological disorder that is characterized by memory loss, retardation of thinking and reasoning, and changes in personality and behaviors. 1 2 AD seriously endanger the physical and mental health of the elderly. Aging is the biggest risk factor for disease, incidence of which doubles every 5 years after the age of 65. 3 Approximately 40 million people over the age of 60 worldwide suffer from AD, and the number of patients is increasing, doubling every 20 years. 4 5 6 7 in 1906, Alois Alzheimer presented his first signature case and pathological features of the disease at the 37 convention of Southwestern German Psychiatrists. Later, in 1910, his coworker Emil Kraepelin named Disease in honor of his achievements. In following years, researchers and physicians did not pay much attention to disease until Robert Terry and Michael Kidd revived interest by performing electron microscopy of neuropathological lesions in 1963. Electron microscopy analysis showed that neurofibrillary tangles were present in brain biopsies of two patients with advanced AD. 8 9 Since then, studies on pathological features and mechanisms of AD and drug treatments for disease have been conducted for more than half a century. 10 clinically, AD is divided into sporadic AD and familial AD. Fd accounts for 1 - 5% of all AD cases. 11 12 13 14 15 in early 1990s, linkage Analyses of Early - Onset FD determined that mutations in three genes, namely, amyloid - beta A4 precursor protein, presenilin 1, and presenilin 2, are involved in FD. Psen1 mutations account for ~81% of FD cases, APP accounts for ~14%, and PSEN2 accounts for ~6%. 11 in addition to these three genes, more than 20 genetic risk loci for AD have been identify. 16 17 strongest genetic risk factor for AD is 4 alleles of apolipoprotein E. 18 19 20 21 APOE is a class of proteins involved in lipid metabolism and is immunochemically colocalized to senile plaques, vascular amyloid deposits, and NFTs in AD. The APOE gene is located on chromosome 19q13. 2 and is associated with late - onset FD. The APOE gene has three alleles, namely, 2, 3, and 4, with frequencies of 8. 4%, 77. 9%, and 13. 7%, respectively. Differences in APOE2, APOE3, and APOE4 are limited to amino acid residues 112 and 158. 22 23 24 25 Analyses of frequencies of these APOE alleles among human populations have revealed that there is a significant association between APOE4 and late - Onset FD, suggesting that APOE4 may be an important susceptibility factor for etiopathology of AD. 25 26 27 Moreover, APOE4 can increase neurotoxicity of - amyloid and promote filament formation. 28 APOE4 genotype influences timing and amount of amyloid deposition in the human brain. 29 Reelin signaling protects synapses against toxic through APOE receptors, which suggests that APOE is a potential target for AD therapy. 30 incidence of SAD accounts for more than 95% of all AD cases.

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Public Policy

Table

National Plan 2019 Update 2019 HTML 2019 PDFNational Plan 2018 Update 2018 HTML 2018 PDFNational Plan 2017 Update 2017 HTML 2017 PDFNational Plan 2016 Update 2016 HTML 2016 PDF
National Plan 2015 Update 2015 HTML 2015 PDF 2015 Press Release 2015 Fact SheetNational Plan 2014 Update 2014 HTML 2014 PDF 2014 Press ReleaseNational Plan 2013 Update 2013 HTML 2013 PDF 2013 Press ReleaseNational Plan 2012 Update 2012 HTML 2012 PDF 2012 Press Release

State governments have begun to make some headway in the Alzheimers Disease arena. Thirty - three states have developed and updated Alzheimer's Disease Plans over the past decade. Plans reflect the need to coordinate across service systems including health, aging, social services, transportation, and others, as well as to identify gaps in service and opportunities. Plans developed by early - adopter states such as New York and California contain elements considered by many in the field to represent best practices. These elements were developed with significant input from people in early stages of disease, family members, caregivers, researchers, among many other stakeholders. They feature several common focal points that have since been reflected in both the Healthy Brain Initiative Roadmap For State and National Partnerships and, importantly, National Plans. 8 For example, Plan From New York and California includes sections on Public Awareness, acknowledging the role and needs of caregivers, and a growing body of work on Brain Health or promotion of lifestyle interventions that maintain or improve Brain Health and typical comorbid conditions. The Plans also include recommendations to address gaps and obstacles. In addition, these State Plans recognize lack of solid information and widespread availability of misinformation, both of which are obstructions to good policy. Many State Plans call for and highlight the value of earlier detection of Alzheimer's Disease. For example, exercising autonomy while he or she retains the capacity to do so helps not only the patient, but the family and provider. Having the opportunity to plan for predictable challenges in health care, housing, safety, custodial care, and other key aspects of life can reduce stress on caregivers and also relieve patients of common I dont want to be burden issue. These State Plans typically call for care coordination activity to ensure quality of life and of care. The population of people with Alzheimer's Disease is coincident with the population at highest risk for other chronic conditions. It is essential in addressing Alzheimers that health promotion regarding these other conditions be consider. Good nutrition, regular physical activity, and disease management should all be thought of when policy decisions are being consider. Health Care System quality and capacity have become components of most current state Alzheimers Disease Plans. Waiting times for appointments, obstacles to access, including transportation, and the importance of early detection have become common elements of these plansevidence that we are moving in the right direction. The ability of Health Care systems to reach into community - base Services and of community - base Services to link with Health Care systems is another essential component of these State Plans, referred to as clinical - community linkages. Quality is yet another component, and the National Plan calls for development of high - quality dementia care guidelines across care settings. One quality indicator addrest in some plans is that of Care transition. For those with Alzheimers, care transition, such as moving from home to hospital, has been shown in some cases to cause reduction in cognitive ability and thus can be considered a risk factor for complications.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

New York State Initiative

Meghan Fadel, Director of Evaluation and Collaborative Projects Bureau of Community Integration and Alzheimers Disease Division of Long Term Care New York State Department of Health Alzheimers Disease Caregiver Support Initiative is a 5 - year grant Initiative funded by the New York State Department of Health and designed to support caregivers and people With Dementia in Community using evidence - base strategies. Adcsi takes a two - pronged, systems approach to investmentboth, focusing on Community Support while also equipping Medical Systems to provide early diagnoses, quality care management, and linkages to Community Services. This webcast will profile New York State Alzheimers Disease Caregiver Support Initiative, including information on how to access services or refer to service providers in any area of the State. Speakers will share details on emerging findings from multi - level Evaluation being carried out by the University at Albany School of Public Health in collaboration with the New York State Department of Health. The webcast will include discussion of what Evaluation findings mean for New York State and the future of Alzheimer's Disease programs and policy. Learning Outcome As result of this activity, learners will be able to enhance their knowledge and competence on preliminary findings of the Evaluation of New York State Alzheimers Disease Caregiver Support Initiative and programmatic and policy implications of themes emerging from Evaluation. Learning Objectives After viewing the webcast, participants will be able to: Describe NYSDOH Caregiver Support Initiative List emerging findings From Evaluation of NYSDOH Caregiver Support Initiative Discuss policies relevant to Alzheimer's Disease and caregiving in New York State Target Audience Physicians, Physician assistants, Nurses, Nurse practitioners, local Health Department staff, Community Health Workers, pharmacists, Social Workers and others that Work With Families providing Care For people With Alzheimers Disease. To Obtain Continuing Education Credits Each participant interested in CE Credits must complete Evaluation and Post - test, which is available above Under Evaluation, Post - test & Credits. A Score of 80% and above on Post - test will generate a certificate indicating request credits. Please note: CPHCE cannot recreate lost certificates. Carefully enter your E - mail Address in the system to have your certificate sent to you. Planners, moderator, and presenters have disclosed no financial arrangements or affiliations with any commercial entities whose products, research or services may be Discuss in this activity. No commercial funding has been accepted for this activity. Continuing Medical Education Credits School of Public Health, University at Albany is accredited by the Medical Society of State of New York to provide Continuing Medical Education For Physicians. School of Public Health, University at Albany designates this enduring material for maximum of 1. 0 AMA PRA Category 1 Credits TM. Physicians should only claim only credit commensurate with the extent of their participation in activity. Continuing Medical Education Credits are offer until February 28 2022.


3 PREVALENCE

More women than men have Alzheimer's or other dementias. Almost twothirds of Americans with Alzheimer's are women. 7 62 Of 5. 8 million people aged 65 and older with Alzheimer's in the United States, 3. 6 million are women and 2. 2 million are men. 7 62 based on estimates from ADAMS, among people aged 71 and older, 16% of women have Alzheimer's or other dementias compared with 11% of men. 187 prevailing reason that has been stated for higher prevalence of Alzheimer's and other dementias in women is that women live longer than men on average, and older age is the greatest Risk Factor for Alzheimer's. 211 - 213 But when it comes to differences in actual risk of developing Alzheimer's or other dementias for men and women of the same age, findings have been mix. Most studies of incidence in the United States have found no significant difference between men and women in the proportion who develop Alzheimer's or other dementias at any given age. 71 210 213 - 215. However, some European studies have reported higher incidence among women at older ages, 216 217 and one study from the United Kingdom reported higher incidence for men. 218 Differences in risk of dementia between men and women may therefore depend on age and / or geographic region. 219 220 If there is a difference in risk of Alzheimer's or other dementias between men and women, there are a number of potential biological and social explanations. 219 221 One explanation may be differences in distribution of or even effect of risk factors for dementia between men and women. If women's risk for Alzheimer's or other dementias is higher, it is possible that lower educational attainment in women than in men born in the first half of the 20th century could account for some of the elevated risk, as limited formal education is a Risk Factor for dementia. 222 This explanation requires more research, but there is evidence that an increase in educational attainment over time in the United States, which has been more substantial for women than men, has led to a decreased risk of dementia. 223 Interestingly, European studies have found that the relationship of lower education with dementia outcomes may actually be stronger in women than in men. 224 225 Some studies have attributed observed difference in risk for dementia between men and women to differences in health factors. A study using Framingham Heart Study data suggests that men in the study appear to have lower risk for dementia due to survival bias, in which men who survived beyond age 65 and were included in the study were ones with a healthier cardiovascular risk profile and thus lower risk for dementia. 212 More research is needed to support this interpretation. Other research is assessing whether the risk of Alzheimer's could actually be higher for women at any given age due to genetic differences or different susceptibility to Alzheimer's pathology.


4 MORTALITY AND MORBIDITY

As shown in Figure 7, rate of deaths due to Alzheimer's has risen substantially since 2000. 281 Table 6 shows that the rate of death from Alzheimer's increases dramatically with age, especially after age 65. The 11 281 increase in Alzheimer's Death rate over time has disproportionately affected the oldestold. 294 Between 2000 and 2018, death rate from Alzheimer's increased 32% for people aged 65 to 74, but increased 53% for people aged 75 to 84 and 84% for people aged 85 and older. 281 report by CDC determines that even after adjusting for differences in age distributions over time, annual Alzheimer's Death rate in the United States increased substantially between 1999 and 2014. 295 Therefore, growing proportion of older adults in the country is not the only explanation for the increase in Alzheimer's Death rates. Other possible reasons include fewer deaths from other common causes of death in old age such as heart disease and stroke; increased diagnosis of Alzheimer's dementia; and increased reporting of Alzheimer's as a cause of Death by physicians and others who fill out death certificates.


5 CAREGIVING

Caregiving refers to attending to another person's health needs and wellbeing. Caregiving often includes assistance with one or more activities of daily living, including bathing and dressing, as well as multiple instrumental activities of daily living, such as paying bills, shopping and using transportation. 306 307 Caregivers also provide emotional support to people with Alzheimer's as well as many other forms of help. In addition to providing descriptive information about Caregivers Of People with Alzheimer's or other dementias, this section compares Caregivers Of People with dementia to either caregivers of people with other medical conditions or, if that comparison is not available, to noncaregivers.


Health care

Table 10 reports average annual perperson payments for health care and longterm care services for Medicare beneficiaries aged 65 and older with and without Alzheimer's or other dementias. Total perperson health care and longterm care payments in 2019 from all sources for Medicare beneficiaries with Alzheimer's or other dementias were over three times as great as payments for other Medicare beneficiaries in the same age group. 18 207 Twentyseven percent of older individuals with Alzheimer's or other dementias who have Medicare also have Medicaid coverage, compared with 11% of individuals without dementia. 207 Medicaid pays for nursing home and other longterm care services for some people with very low income and low assets, and high use of these services by people with dementia translates into high costs to Medicaid. Average Annual Medicaid payments per person for Medicare beneficiaries with Alzheimer's or other dementias were 23 times as great as average Medicaid payments for Medicare beneficiaries without Alzheimer's or other dementias. 207. Despite these and other sources of financial assistance, individuals with Alzheimer's or other dementias still incur high outofpocket costs. These costs are for Medicare, other health insurance premiums, deductibles, copayments and services not covered by Medicare, Medicaid or additional sources of support. On average, Medicare beneficiaries aged 65 and older with Alzheimer's or other dementias pay 11 068 out of pocket annually for health care and longterm care services not covered by other sources. 207 researchers have evaluated additional or incremental health care, residential longterm care and family caregiving costs of dementia. 312 520 - 522 in recent systematic review of studies of older adults with Alzheimer's and other dementias enrol in private Medicare managed care plans, researchers find a wide range of incremental costs attributable to Alzheimer's and other dementias. 523 One group of researchers found that incremental health care and nursing home costs for those with dementia were 28 501 per person per year in 2010 dollars. 19 520 Another group of researchers found that the incremental lifetime cost of Alzheimer's dementia was substantially higher for women than men, due to a greater lifetime risk of developing Alzheimer's dementia. 524 Additionally, because women are more likely to be widows and live in poverty, incremental Medicaid costs associated with Alzheimer's dementia were 70% higher for women than men. A third group of researchers found that the lifetime cost of care, including outofpocket costs, Medicare and Medicaid expenditures, and value of informal caregiving, was 321 780 per person with Alzheimer's dementia in 2015 dollars. 312 lifetime cost of care for individuals with Alzheimer's dementia was more than twice the amount incurred by individuals without Alzheimer's dementia, translating into an incremental lifetime cost of Alzheimer's dementia of 184 500. Several groups of researchers have examined additional outofpocket costs borne by individuals with Alzheimer's or other dementias. In a recent analysis of the lifetime incremental cost of dementia, researchers found that individuals with dementia spend 38 540 more outofpocket between age 65 and death, due to nursing home care.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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