New Cases Of Alzheimer's Dementia Continue Rise

The number of people with Alzheimer's and dementia – both new cases and total numbers with the disease – continues to rise among the very oldest segments of the population in contradiction of the conventional wisdom, according to research reported today at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna.

Previous epidemiological studies have suggested that the number of people with Alzheimer's and dementia begins to level off and perhaps even go down a bit in people age 90 and above, known as the "oldest old." This is the fastest growing segment of the population in western countries.

"The number of people affected by Alzheimer's and dementia is growing at an epidemic pace, and the skyrocketing financial and personal costs will devastate the world's economies and healthcare systems, and far too many families," says William Thies, chief medical & scientific Officer at the Alzheimer's Association. "We must make the fight against Alzheimer's a priority before it's too late."

"However there is hope. There are many drugs in late stage clinical trials for Alzheimer's that show promise to slow or stop the progression of the disease. This, combined with advancements in early detection, has the potential to change the landscape of Alzheimer's in our lifetimes. But we need more funding for research to see these possibilities through to completion," Thies says.

The research reported at ICAD 2009 includes a study of more than 2,100 individuals age 80 years or older in eight municipalities of Varese province, Italy, and a systematic review and collaborative analysis of studies reporting the prevalence of dementia in Europe.

The Monzino 80-plus Study – Dementia Risk Continues to Rise in the "Oldest Old"

Ugo Lucca, head of the Laboratory of Geriatric Neuropsychiatry at the Mario Negri Institute for Pharmacological Research in Milano, Italy, and colleagues conducted a prospective, door-to-door, population-based study of all people age 80 years or older in eight municipalities of Varese province, Italy, roughly 30 kilometers (20 miles) north of Milan (known as the Monzino 80-plus Study). Their goal was to estimate the prevalence (total number with the disease) and incidence (new cases of the disease) of dementia in this population.

The researchers were able to gather information and an initial dementia evaluation for 2,138 individuals. The mean age of the population at that first evaluation was 87.5 years; 74.1% were women. Mean education was 5.1 years, and mean MMSE score was 21.4. After an average follow-up period of three years, of the 1,085 survivors non-demented at baseline, 995 were re-evaluated for dementia.

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Simple Test Predicts 6-year Risk of Dementia

A simple test that can be given by any physician predicts a person’s risk for developing dementia within six years with 87 percent accuracy, according to a study led by researchers at San Francisco VA Medical Center (SFVAMC).

The test, developed in the study by the researchers, is a 14-point index combining medical history, cognitive testing, and physical examination. It requires no special equipment and can be given in a clinical setting such as a doctor’s office or at a patient’s bedside.

The new index is the “bedside” version of a longer, more technically comprehensive “best” test, also developed during the study, that is 88 percent accurate.

These are the first tools to accurately predict dementia, according to lead author Deborah Barnes, a mental health researcher at SFVAMC. Barnes described the tests in a presentation at the 2007 International Conference on Prevention of Dementia, in Washington, DC, sponsored by the Alzheimer’s Association.

“There are tests that accurately predict an individual’s chances of developing cardiovascular disease and other maladies, but, until now, no one has developed similar scales for dementia,” says Barnes, who also is an assistant professor of psychiatry at the University of California, San Francisco (UCSF).

As measured by the “bedside” index, the risk factors for developing dementia are an age of 70 or older, poor scores on two simple cognitive tests, slow physical functioning on everyday tasks such as buttoning a shirt or walking 15 feet, a history of coronary artery bypass surgery, a body mass index of less than 18, and current non-consumption of alcohol.

People who score 0 to 3 on the “bedside” test have a 6 percent chance of developing dementia within six years. A score of 4 to 6 indicates a 25 percent chance. People with a score of 7 or higher have a 54 percent chance of developing dementia within six years.

The 18-point comprehensive, or “best,” test measures for all “bedside” risk factors plus factors that would be more difficult to measure as part of a routine clinical visit. These include brain magnetic resonance imaging (MRI) findings of enlarged ventricles –– the fluid-filled cavities between brain tissue -- or diseased white matter –– the nerve cells that transmit signals between grey matter; thickening of the internal carotid artery, which brings blood to the head and neck; and the presence of one or two copies of the e4 allele, or subtype, of APO-E, the gene that codes for the protein known as Apolipoprotein. The presence of APO-E e4 alleles is a known risk factor for Alzheimer’s disease.


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Nursing Home Placement Associated with Accelerated Cognitive Decline in Alzheimer’s Disease

People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The study, published in the June issue of the American Journal of Psychiatry, finds that prior experience in adult day care may lessen this association.

The observational study involved 432 older persons with Alzheimer’s disease who were recruited from health care settings in the Chicago area. At baseline, they lived in the community and 196 participants were using day care services from two to six days a week for an overall mean of 1.7 days a week. At six month intervals for up to four years, they completed nine cognitive tests from which a composite measure of global cognition was derived.

On average, cognition declined at a gradually increasing rate for all participants. During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

Study participants who had previous adult day care experience fared better. As level of day care use at study onset increased, the association of nursing home placement with accelerated cognitive decline substantially decreased. Thus, people using day care 3 to 4 days a week at the beginning of the study showed no increase in cognitive decline upon nursing home placement.

“The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence,” says study author Robert Wilson, a neuropsychologist at the Rush Alzheimer’s Disease Center.

The study also found that a higher level of education was associated with accelerated cognitive decline upon nursing home placement. Yet, day care use markedly reduced the association of education with accelerated cognitive decline in the nursing home; further evidence that there is a robust association between day care experience and cognition during the transition to a nursing home.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

Alternatively, the increased cognitive decline upon placement may reflect difficulty adapting to an unfamiliar environment, consistent with clinical reports of increased confusion and behavior problems in those with dementia during acute hospitalization or trips away from home. Patients who had prior adult day care services may have been better able to adjust to the unfamiliar environment.

“The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living,” says Wilson.

The research was supported by grants from the National Institutes on Aging, which leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline.


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Common Pain Medications Do Not Prevent Alzheimer's

Over-the-counter pain medication naproxen and prescription pain reliever celecoxib do not prevent Alzheimer's disease, according to a study published April 25, in the online edition of Neurology, the scientific journal of the American Academy of Neurology. These findings appear to contradict earlier observational studies, which found sustained use of nonsteroidal anti-inflammatory drugs (NSAIDs) may have a protective effect against Alzheimer's disease.

The clinical trial, conducted at six dementia research clinics across the United States, involved more than 2,100 people over age 70 with no signs of dementia, but a family history of Alzheimer's disease. The participants were randomly assigned daily doses of naproxen, celecoxib, or placebo for up to four years, but most participants had received the treatments for less than two years.

The study found neither treatment was associated with a reduction in Alzheimer's disease or dementia.

"Although our study was conducted to test the hypothesis that celecoxib or naproxen would reduce the incidence of Alzheimer's disease, these results indicate no such effect, at least within the first few years after treatment begins," says study author Constantine Lyketsos, MD, MHS, with Johns Hopkins Bayview Hospital and Johns Hopkins School of Medicine in Baltimore, Maryland.

The findings appear to be inconsistent with other studies suggesting reduced risk of Alzheimer's disease among people who take NSAIDs over a long period of time. "One possible explanation for this inconsistency is that our findings relate specifically to celecoxib and naproxen, but not to other commonly used NSAIDs, such as ibuprofen. Or the drugs may not prevent the progression of disease in people who have advanced Alzheimer's pathology without symptoms – the very people most likely to develop symptoms within a year or two," says study author John Breitner, MD, with VA Puget Sound Health Care.

"While long-term follow-up of our study's participants is essential, for now we suggest celecoxib and naproxen not be taken to primarily prevent Alzheimer's disease," says Lyketsos.


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