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BRAIN FACTS
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Clinical Research
Tremendous advances have been made in diagnosing, treating and preventing dementias such as Alzheimer’s disease
There will be three parts:
Diagnosis
People sometimes ask: “What is the difference between dementia and Alzheimer’s”? Here is the answer: “dementia” is a generic term and applies to all people who have cognitive and functional (daily activities) impairment. “Alzheimer’s” is a specific brain disease and is the most cause of dementia in the elderly.
A diagnosis of Alzheimer’s disease is made by your doctor. The evaluation would usually include:
On the basis of this information the doctor can usually make a diagnosis of the cause of dementia.
Care partners:
Alzheimer’s and other types of dementia produce a gradual loss of ability to do things and the patient becomes more dependent on a care partner, usually the husband or wife of the patient of one the sons or daughters. Caregiving is very stressful. The health of the care partner should be monitored just as the health of the patient is followed after a diagnosis is made.
More In-Depth Assessment:
Examining how the brain uses sugar can be done with a FDG PET scan. The patient receives in intravenous injection of sugar that has a tiny amount of radioactivity. The PET scan detects the radioactivity and produces a picture of the brain patterns of sugar use. In Alzheimer’s the use of sugar is typically decreased in the back part of the brain on the very inner and they out aspects. Other dementias produce other patterns – some dementias affect mostly the front part of the brain. In this way, the doctor can see if the metabolic pattern is supportive of a diagnosis of Alzheimer’s.
PET scans are commonly used for diagnosis of cancer and most large hospitals have a PET scanner. This same machine is use for FDG PET, amyloid PET, and tau PET (discussed below). Special training is needed to interpret the scans.
High-technology Assessment:
We live in a time when there are tremendous advances in medical technology. One of the most important advances for Alzheimer’s is the development of brain scans that can detect either the amyloid protein or the tau protein – the two key proteins that accumulate in the brain in Alzheimer’s.
Amyloid PET is a specialized brain scan that uses a tiny amount of radioactivity to detect the brain plaques of Alzheimer’s. A negative scan means that Alzheimer’s is not the cause of the memory loss. The FDA has approved several types of amyloid PET scans, and all give the same information. The scan is not paid for my Medicare and other types of insurance. It is expensive and is used mainly in research.
Tau PET detects the neurofibrillary tangles that accumulate in the brain in Alzheimer’s. The FDA has approved this type of scan to assess for the tangles of Alzheimer’s. The cost of this scan is not covered by Medicare or other insurances and is used mostly in research.
Tremendous advances have been made in diagnosing, treating and preventing dementias such as Alzheimer’s disease
There will be three parts:
- Diagnosis
- Treatment
- Prevention
Diagnosis
People sometimes ask: “What is the difference between dementia and Alzheimer’s”? Here is the answer: “dementia” is a generic term and applies to all people who have cognitive and functional (daily activities) impairment. “Alzheimer’s” is a specific brain disease and is the most cause of dementia in the elderly.
A diagnosis of Alzheimer’s disease is made by your doctor. The evaluation would usually include:
- Review of the changes the patient has exhibited such as repeating questions because the answer is not remembered
- Review of the patient’s history to see if there has been a stroke or brain injury that might contribute to memory loss
- Review of the patient’s medication to ensure that taking the wrong medication or in the wrong dose is not causing the memory loss
- Discussion of the health of your family members to see if there is any evidence that the memory loss is part of an inherited condition. A gene that increases the risk for Alzheimer’s known as ApoE4 in present in some families with Alzheimer’s
- Physical and neurological examination should be normal in Alzheimer’s. If there is parkinsonism, tremor, or weakness, the memory loss may be caused by some non-Alzheimer condition
- Blood tests are done to check on thyroid function and vitamin B12 levels; abnormalities in thyroid function or B12 availability in the body can cause or contribute to memory loss
- A CT or MRI brain scan is usually done to check for evidence of stroke, brain tumor, brain bleeding, or enlarged ventricles (hydrocephalus). The memory areas of the brain are examined on the scan and are usually shrunken in people with Alzheimer’s
- The doctor may decide to do a lumbar puncture to see if the specific pattern of chemicals in the spinal fluid confirms the presence of Alzheimer’s. This is a safe procedure done in the office. A small amount of fluid is removed from the sack holding the brain, spinal cord, and nerves by a needle placed in the lower part of the back. In Alzheimer’s, the level of one protein (amyloid) goes down, while the levels of other proteins (tau) go up. These changes are very specific to Alzheimer’s and provide very strong evidence for a diagnosis of Alzheimer’s if this pattern is present and against the diagnosis of Alzheimer’s if the pattern is absent.
On the basis of this information the doctor can usually make a diagnosis of the cause of dementia.
Care partners:
Alzheimer’s and other types of dementia produce a gradual loss of ability to do things and the patient becomes more dependent on a care partner, usually the husband or wife of the patient of one the sons or daughters. Caregiving is very stressful. The health of the care partner should be monitored just as the health of the patient is followed after a diagnosis is made.
More In-Depth Assessment:
Examining how the brain uses sugar can be done with a FDG PET scan. The patient receives in intravenous injection of sugar that has a tiny amount of radioactivity. The PET scan detects the radioactivity and produces a picture of the brain patterns of sugar use. In Alzheimer’s the use of sugar is typically decreased in the back part of the brain on the very inner and they out aspects. Other dementias produce other patterns – some dementias affect mostly the front part of the brain. In this way, the doctor can see if the metabolic pattern is supportive of a diagnosis of Alzheimer’s.
PET scans are commonly used for diagnosis of cancer and most large hospitals have a PET scanner. This same machine is use for FDG PET, amyloid PET, and tau PET (discussed below). Special training is needed to interpret the scans.
High-technology Assessment:
We live in a time when there are tremendous advances in medical technology. One of the most important advances for Alzheimer’s is the development of brain scans that can detect either the amyloid protein or the tau protein – the two key proteins that accumulate in the brain in Alzheimer’s.
Amyloid PET is a specialized brain scan that uses a tiny amount of radioactivity to detect the brain plaques of Alzheimer’s. A negative scan means that Alzheimer’s is not the cause of the memory loss. The FDA has approved several types of amyloid PET scans, and all give the same information. The scan is not paid for my Medicare and other types of insurance. It is expensive and is used mainly in research.
Tau PET detects the neurofibrillary tangles that accumulate in the brain in Alzheimer’s. The FDA has approved this type of scan to assess for the tangles of Alzheimer’s. The cost of this scan is not covered by Medicare or other insurances and is used mostly in research.
Treatment
Complex diseases such as Alzheimer’s require thorough evaluation and a personalized comprehensive treatment regimen. Medication is one of the many ways of helping people with Alzheimer’s and related brain conditions causing dementia.
There are six FDA approved drugs for treatment Alzheimer’s disease , the most recently approved drug is AduhelmÔ (aducanumab).
These drugs are available:
Drugs that block the enzymes that reduce the levels of a chemical critical to memory function. There are three available drugs in this class – donepezil (AriceptÔ), rivastigmine (Exelon PatchÔ), and galantamine (RazadyneÔ). All three of these drugs do the same thing in the brain and a patient should be on only one of them. They are prescribed for patients with dementia caused by Alzheimer’s. the main side effects are nausea, vomiting, and diarrhea that affect about 10% of people who take these drugs; the side effects stop when the treatment is stopped.
A second type of drug is commonly used with one of the enzyme-blocking drugs described above. This is memantine (NamendaÔ, EbixaÔ). Memantine affects another type of brain chemical different from the one affected by enzyme blockers. The main side effects are dizziness and sleepiness that occur in a small number of people and stop when the memantine is stopped.
AduhelmÔ is a very different type of treatment. Is it given every month by an intravenous infusion that takes about an hour to give. AduhelmÔ activates immune cells to remove the brain plaque that accumulates in Alzheimer’s. Getting rid of the plaque slows the progressive loss of memory of Alzheimer’s. AduhelmÔ does not improve the memory, it slows the future worsening of the memory. AduhelmÔ is associated with leaky brain vessels that can cause a syndrome called ARIA, and patients must be monitored with MRI to see if this is happening in the brain; if is detected the treatment can be stopped or the dose can be modified. Because AduhelmÔ is very specific therapy for the amyloid protein, an amyloid PET or measurement of spinal fluid amyloid is required before starting treatment with AduhelmÔ. AduhelmÔ is approved for use only in patients with mild memory loss caused by Alzheimer’s.
Treatment with drugs should be accompanied by recommendations for maintaining brain health. The main point of this website is to give you information about how to keep your brain healthy. [MOU1]
Dr. Kate and Jeff recommend the use of these drugs to treat Alzheimer’s in combination with a brain healthy lifestyle.
Dr. Kate and Jeff publish an annual report of all the drugs being studied for treatment of Alzheimer’s. [MOU2]
Prevention
There are no drugs approved for the prevention of Alzheimer’s, The proteins of Alzhemer’s accumulate in the brain before symptoms appear and it may be possible to remove the protein with drugs like AduhelmÔ and delay or prevent the memory loss of Alzheimer’s. this idea is currently being tested in clinical trials that include people who have the protein in the brain and do not have memory loss.
Reducing the risk of Alzheimer’s is possible, In fact, 30-40% of cases of Alzheimer’s could be avoided with brain healthy habits. Doing these things does not guarantee that you will not get Alzheimer’s, but the life changes can reduce the chance of getting it – and they’re easy to do!
Dr.Kate and Jeff review here the facts that show that brain healthy habits can delay the memory loss or slow the loss of memory function.
Finger study
[MOU1]Link here to brain health
[MOU2]Wheel of fortune
Complex diseases such as Alzheimer’s require thorough evaluation and a personalized comprehensive treatment regimen. Medication is one of the many ways of helping people with Alzheimer’s and related brain conditions causing dementia.
There are six FDA approved drugs for treatment Alzheimer’s disease , the most recently approved drug is AduhelmÔ (aducanumab).
These drugs are available:
Drugs that block the enzymes that reduce the levels of a chemical critical to memory function. There are three available drugs in this class – donepezil (AriceptÔ), rivastigmine (Exelon PatchÔ), and galantamine (RazadyneÔ). All three of these drugs do the same thing in the brain and a patient should be on only one of them. They are prescribed for patients with dementia caused by Alzheimer’s. the main side effects are nausea, vomiting, and diarrhea that affect about 10% of people who take these drugs; the side effects stop when the treatment is stopped.
A second type of drug is commonly used with one of the enzyme-blocking drugs described above. This is memantine (NamendaÔ, EbixaÔ). Memantine affects another type of brain chemical different from the one affected by enzyme blockers. The main side effects are dizziness and sleepiness that occur in a small number of people and stop when the memantine is stopped.
AduhelmÔ is a very different type of treatment. Is it given every month by an intravenous infusion that takes about an hour to give. AduhelmÔ activates immune cells to remove the brain plaque that accumulates in Alzheimer’s. Getting rid of the plaque slows the progressive loss of memory of Alzheimer’s. AduhelmÔ does not improve the memory, it slows the future worsening of the memory. AduhelmÔ is associated with leaky brain vessels that can cause a syndrome called ARIA, and patients must be monitored with MRI to see if this is happening in the brain; if is detected the treatment can be stopped or the dose can be modified. Because AduhelmÔ is very specific therapy for the amyloid protein, an amyloid PET or measurement of spinal fluid amyloid is required before starting treatment with AduhelmÔ. AduhelmÔ is approved for use only in patients with mild memory loss caused by Alzheimer’s.
Treatment with drugs should be accompanied by recommendations for maintaining brain health. The main point of this website is to give you information about how to keep your brain healthy. [MOU1]
Dr. Kate and Jeff recommend the use of these drugs to treat Alzheimer’s in combination with a brain healthy lifestyle.
Dr. Kate and Jeff publish an annual report of all the drugs being studied for treatment of Alzheimer’s. [MOU2]
Prevention
There are no drugs approved for the prevention of Alzheimer’s, The proteins of Alzhemer’s accumulate in the brain before symptoms appear and it may be possible to remove the protein with drugs like AduhelmÔ and delay or prevent the memory loss of Alzheimer’s. this idea is currently being tested in clinical trials that include people who have the protein in the brain and do not have memory loss.
Reducing the risk of Alzheimer’s is possible, In fact, 30-40% of cases of Alzheimer’s could be avoided with brain healthy habits. Doing these things does not guarantee that you will not get Alzheimer’s, but the life changes can reduce the chance of getting it – and they’re easy to do!
Dr.Kate and Jeff review here the facts that show that brain healthy habits can delay the memory loss or slow the loss of memory function.
Finger study
[MOU1]Link here to brain health
[MOU2]Wheel of fortune
Disclaimer: somewhere on the site it should say: “Dr. Kate and Jeff are not giving medical advice on this website. We are describing the elements of a brain-healthy lifestyle and how we have integrated them into our lives. Adopting any of the recommendations you read about on this site should be discussed with your doctor.”
I describe MRI, FDG, amyloid PET and tau PET. We could use images of any or all of these.
I describe MRI, FDG, amyloid PET and tau PET. We could use images of any or all of these.