Alzheimer’s Association Update

Article Outline

• Grant Recipients Share Progress at ETAC Symposium
• Early Detection, Comorbidities Highlighted at Dementia Congress
• Research Roundtable Presents Latest Findings in Early Risk Assessment for Alzheimer’s
• 2007 Grant Portfolio Available Online

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Grant Recipients Share Progress at ETAC Symposium 

Recipients of the Everyday Technologies in Alzheimer’s Care (ETAC) grants assembled October 15–16 in Chicago to update their colleagues on progress made and lend their own expertise to research challenges faced by their peers. ETAC is a research funding initiative established in 2003 by the Alzheimer’s Association and Intel Corporation. The consortium is committed to the development of new technologies that may compensate for functional impairments, enhance care and treatment strategies, foster independence, and improve the quality of life for people with dementia and their caregivers. Since 2004 ETAC has provided $3.2 million in research funding.

Maria C. Carrillo, Ph.D., director in the Medical and Scientific Relations Division of the Alzheimer’s Association, convened the gathering of researchers from around the world. Grant recipients traveled from as far as Singapore, Scotland, and Ireland to attend the annual symposium. While funding innovative technology-based research is the key aim of ETAC, the initiative goes beyond funding to building a strong sense of “community” among researchers, said Dr. Carrillo. Alzheimer’s Association Vice President for Medical and Scientific Relations William H. Thies, Ph.D., told the gathering that a “workforce mismatch” exists in care facilities, with fewer people entering careers in geriatric care while the geriatric population increases, and that the mismatch will only intensify with the aging of the baby boomer generation. Assistive devices such as those being developed by ETAC researchers have the potential to reduce the burden of Alzheimer’s disease by extending the productivity of caregivers and enabling those with dementia to live at home longer, commented Dr. Thies.

During the one-and-a-half–day symposium, progress was reported on 14 of the 17 ETAC grants awarded between 2004 and 2007. Grant recipients presented data on technology interventions ranging from interactive video exercise for cognitive rehabilitation and pocket PCs for improved quality of life to cell phone videostreaming to improve memory cues and a tactile way-finding belt to facilitate navigation.

Researcher Ronald Baecker, Ph.D., professor of computer science at the University of Toronto, described the development of “multimedia biographies” as a form of reminiscence therapy for those with Alzheimer’s disease or mild cognitive impairment. The DVD biographies, structured in a series of “acts” for each stage of the person’s life and shown once or twice a week, stimulated the remembering of places, names and scenes; facilitated interaction with family members; and reminded caregivers of the life history and identity that preceded the onset of dementia in patients.

Fellow ETAC awardee Diane Feeney Mahoney, Ph.D., G.N.P., Mohr Professor, Department of Gerontological Nursing Research, and director of gerontotechnology at Massachusetts General Hospital, described results of her study adapting wireless computational sensor technology for use in independent living facilities. Sensors were installed in residents’ units, and for each resident a series of events were identified that could be detected by the sensors, such as awaking at a certain time, eating meals, and taking medication. Data from the sensors were uploaded to a web site accessible to family and staff members. If the complete series of events was not detected, an alert was sent to the appropriate individual.

Margaret Morris, Ph.D., senior researcher at Intel, said that finding ways to bring technology to bear on the needs of those with dementia and their families was complex. “No one can take this on alone,” she remarked, emphasizing the need for partnerships.

The symposium concluded with a panel discussion on moving research products into the marketplace that featured Drs. Thies and Morris; Majd Alwan, Ph.D., director of the Center for Aging Services Technologies; and Jeff Kaye, Ph.D., chair of the Alzheimer’s Association’s Working Group on Technology. Panelists discussed what could be learned from the partnership model provided by the Oregon Center for Aging and Technology, which brings together clinicians, scientists and engineers to develop aging-related technologies. They also discussed technology transfer and commercialization, with a focus on potential purchasers and business models to maximize commercialization. The panelists went on to share ideas for developing successful relationships with venture capitalists and others in the business community, as well as strategies to make products geared toward an older population more appealing to businesses that often appear focused on a younger segment of the population.

The ETAC consortium welcomes new partners. For information on ETAC participation, contact Nancy Cullen, Corporate Initiatives, Alzheimer’s Association, at Nancy.Cullen@alz.org.

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Early Detection, Comorbidities Highlighted at Dementia Congress 

More than 600 physicians, nurse practitioners, and allied health care providers attended the Sixth Annual Dementia Congress held November 2–4 in Chicago. Program Chair David S. Geldmacher, M.D., medical director of the Memory Disorders Clinic at the University of Virginia Health System in Charlottesville, welcomed attendees to the free event, which offered up to 14.25 hours of American Medical Association category 1 continuing medical education credit through the Academy for Healthcare Education (AHE), Inc. The Congress is jointly sponsored by the Alzheimer’s Association, AHE, and UCLA Center on Aging and supported by an unrestricted educational grant from Eisai Inc. and Pfizer Inc.

Sixteen internationally recognized experts provided current information and opinion on the diagnosis, pathophysiology, treatment and social impact of Alzheimer’s disease (AD) and other dementias. Recurring areas of emphasis included the importance of detecting early-stage dementia and mild cognitive impairment (MCI); clinical approaches for distinguishing various forms of dementia; and the link between dementia and comorbidities such as cardiovascular disease and diabetes. Other topics included late-breaking news in clinical trials; depression and apathy in those with dementia; the interface between vascular and degenerative dementia; the role of cognitive reserve in detecting AD; and magnetic resonance imaging and cerebrospinal fluid biomarkers in early AD diagnosis.

The Congress kicked off with a Friday evening Hot Topics Panel, in which audience members used an interactive keypad to select their choices of topics from among several offered. The most popular topics, addressed by several panelists, were lifestyle factors as an approach for preventing or reducing the risk of dementia, whether antiamyloid therapies will prevent or cure AD, and if acetylcholinesterase inhibitors meaningfully alter behavioral problems in AD.

To bring both breadth and depth to the educational experience of the Congress, the event consisted of general sessions Saturday and Sunday morning, followed by track sessions geared toward primary care, psychiatry, and neurology. Keynote speaker Zaven S. Khachaturian, Ph.D., president of the Lou Ruvo Brain Institute, provided a historical perspective on AD research and a long-range view on prospects for preventing AD, which now affects up to 5 million Americans and costs the country more than $100 billion annually. Left unchecked, as many as 16 million Americans will have AD by mid-century.

In his presentation, “Fruit and Vegetable Supplementation in the Aging Brain: ‘Priming’ the Brain Against the Ravages of Time,” general session presenter James A. Joseph, Ph.D., described research suggesting that consumption of foods high in antioxidants, such as blueberries and walnuts, may decrease one’s vulnerability to oxidative stress with age. In rats fed a diet rich in antioxidants, the reduced oxidative stress was linked to improvements in motor and cognitive behavior. Director of the neuroscience laboratory at the USDA Human Nutrition Research Center on Aging at Tufts University, Dr. Joseph said the berries may increase neuronal communication and neurogenesis, enabling the brain to take advantage of its redundancy.

Reflecting the broad research and care continuum in dementia, Darryl S. Chutka, M.D., associate professor of medicine at the Mayo Clinic College of Medicine, followed Dr. Joseph’s empowering presentation on what patients can do to potentially reduce their risk of cognitive decline with a presentation on what physicians can do to help manage behavioral problems in those with dementia. Dr. Chutka emphasized the importance of considering each patient’s life history and experience when trying to unravel the origins of a behavioral problem instead of quickly resorting to pharmacological agents.

The final general session presentation of the Congress was also the most poignant. Daniel D. Christensen, M.D., clinical professor of psychiatry and neurology at the University of Utah School of Medicine’s Neuropsychiatric Institute, detailed a 20-year follow-up with the caregiver of a patient with Pick’s disease. Using the caregiver’s journal entries and videotaped interviews of both her and her husband, Dr. Christensen put a human face to the burden faced by caregivers, 75 percent of whom are women. Underscoring the role of gender in caregiving, he noted a revealing risk factor for early placement into a nursing home: not having a daughter.

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Research Roundtable Presents Latest Findings in Early Risk Assessment for Alzheimer’s 

Scientists from the pharmaceutical and biotech industries, academia, and federal regulatory agencies gathered in Washington, D.C., November 12–14 to learn the latest in diagnostic tools for early risk assessment of Alzheimer’s at the Alzheimer’s Association’s biannual Research Roundtable. Celebrating its fifth year, the mission of the Research Roundtable is “to facilitate the development and implementation of new treatments for Alzheimer’s disease [AD] by collectively addressing obstacles to research and development, clinical care, and public health education.” The Roundtable provides a unique forum for attendees to network and share expertise in a collegial environment.

The two-day scientific meeting featuring presentations by 25 leading researchers was preceded by a general meeting of representatives from the Roundtable’s 18 industry sponsors. Representatives selected clinical trial design for disease-modifying AD drugs as the topic for the fall 2008 Research Roundtable meeting, then heard updates on the Association’s Clinical Studies Initiative and Early Detection Initiative and opportunities for sponsors to play a role in developing those initiatives.

These discussions and others on topics such as the European AD Neuroimaging Initiative primed representatives for two full days of in-depth explorations into current and potential methods for early diagnosis. Day one included an overview of risk assessment, the role of epidemiology in risk assessment, known risk factors for AD, and genetic risk factors. From an epidemiological standpoint, AD is like many chronic diseases of older people in that the number and diversity of factors associated with it suggest a “web of causation.” Furthermore, the path from normalcy to disease is gradual, making it difficult to identify a precise point at which the condition begins. In a review of population studies in Italy, India, Austria, and the United States, between 15 percent and 24 percent of subjects (all subjects were age 65 or older) had mild cognitive impairment (MCI), and between 8.7 percent and 19.5 percent progressed to dementia. MCI is common and may be a transitional phase to AD, as well as a potential therapeutic target.

Therapeutic agents may also target genetic, cardiovascular, and metabolic AD risk factors. Suzanne Craft, Ph.D., professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, described insulin resistance and diabetes as risk factors for AD. Interventions that increase insulin signaling in the brain may have therapeutic value. The Study of Nasal Insulin to Fight Forgetfulness (SNIFF) showed that nasal insulin increased memory and retention while decreasing amyloid levels.

Day two of the Research Roundtable focused on early clinical diagnosis, regulatory issues in early risk assessment, and biomarkers and imaging for early detection of AD. Discussing psychometric challenges in assessment, Herman Buschke, M.D., professor of neurology at the Albert Einstein College of Medicine, said, “We need a new definition of memory impairment, because it catches people too late. We need to detect memory impairment when memory has decreased but is still in the normal range.” Dr. Buschke pointed to the importance of tests that detect presymptomatic memory impairment.

Biomarkers may provide another means for early detection, and cerebrospinal fluid (CSF) markers are of special interest. Amyloid production and clearance rates in CSF have been studied and “will tell us about the pathophysiology of AD,” said presenter Randall Bateman, M.D., of Washington University School of Medicine. Candidate CSF predictors of AD include the ratio of amyloid β(1–42) to amyloid β(1–40), levels of phosphorylated tau, and levels of the BACE 1 enzyme, but results of any early studies need to be confirmed in large multicenter studies. Magnetic resonance imaging (MRI), functional MRI, and fluorodeoxyglucose-positron emission tomography (FDG-PET) are among the imaging techniques under evaluation as tools for identifying AD biomarkers. MRI combined with CSF studies are better predictors of AD when used together than when used alone, said researcher Philip Scheltens, M.D., Ph.D., of Vrije Universiteit, the Netherlands.

The next Research Roundtable, focusing on scales as outcomes measures, will be held April 28–30 in Washington, D.C. The Roundtable welcomes new members. For more information, contact Jay Thompson, Corporate Initiatives, Alzheimer’s Association, at Jay.Thompson@alz.org.

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2007 Grant Portfolio Available Online 

In fiscal year 2006–07, the Alzheimer’s Association funded $21.6 million in research initiatives, including 109 awards through its annual grants competition. Grants were awarded in five categories: Zenith Fellows Awards, Everyday Technologies for Alzheimer’s Care Grants, Investigator-Initiated Research Grants, New Investigator Research Grants, and the Senator Mark Hatfield Award in Clinical Research. These grants fund research in areas ranging from the biology of disease-related molecules to social-behavioral factors of Alzheimer’s. Since 1982, the Association has awarded more than $220 million to support 1,500-plus grant proposals. For more information on the 2007 grant portfolio, visit www.alz.org/professionals_and_researchers_2007_research_grants.asp.