Telegraph.co.uk, April 26, 2011  —   A vaccine that could reverse the stages of Alzheimer’s may be available within two years.

Although the jab is not a cure it has been found to be able to halt the disease and even reverse the damage caused in some cases.

It is regarded as one of the biggest potential breakthroughs in the research for the disease.

The vaccine is now being tested on more than 10,000 patients around the world, including hundreds in the UK. Only two vaccines for the incurable condition have reached the final phase of testing, known as stage three.

The bapineuzumab jab prevents, and in some cases can reverse, the build up of amyloid, the toxic protein which can build up in the brain of dementia sufferers and is thought to be linked to the onset of symptoms such as memory loss and mental impairment.

The development of tests which detect Alzheimer’s early on would allow the vaccine to be administered as early as possible.

The vaccine could slow the progression of the disease in sufferers saving thousands from the most devastating effects which leaves sufferers unable to walk, talk and swallow.

Dr David Wilkinson, from Southampton University’s Memory Assessment and Research Centre, was involved in some of the earliest research into Alzheimer’s vaccines in the 1990s.

He told the Daily Mail: “Hopefully the vaccine will make a big difference to Alzheimer’s treatment. If we can give it early – before major brain impairment is seen – it may have an important part to play.

“If it can clear amyloid plaques from the brain and we can give it very early in the disease process, it may prevent some of the damage.”

Around £17billion is spent on Alzheimer’s treatment in Britain each year.

http://www.telegraph.co.uk/health/healthnews/8469346/Alzheimers-vaccine-could-be-available-in-two-years.html

 

 

 

 

Anatomy of the Brain

 

© 2000 – 2011 American Health Assistance Foundation

The image on the left is a side view of the outside of the brain, showing the major lobes (frontal, parietal, temporal and occipital) and the brain stem structures (pons, medulla oblongata and cerebellum).

The image on the right is a side view showing the location of the limbic system inside the brain. The limbic system consists of a number of structures, including the fornix, hippocampus, cingulate gyrus, amygdala, the parahippocampal gyrus and parts of the thalamus. The hippocampus is one of the first areas affected by Alzheimer’s disease. As the disease progresses, damage extends throughout the lobes.

 

 

 

Glossary of Terms for an Anatomy of the Brain

Amygdala – limbic structure involved in many brain functions, including emotion, learning and memory. It is part of a system that processes “reflexive” emotions like fear and anxiety.

Cerebellum – governs movement.

Cingulate gyrus – plays a role in processing conscious emotional experience.

Fornix – an arch-like structure that connects the hippocampus to other parts of the limbic system.

Frontal lobe – helps control skilled muscle movements, mood, planning for the future, setting goals and judging priorities.

Hippocampus – plays a significant role in the formation of long-term memories.

Medulla oblongata – contains centers for the control of vital processes such as heart rate, respiration, blood pressure, and swallowing.

Limbic system – a group of interconnected structures that mediate emotions, learning and memory.

Occipital lobe – helps process visual information.

Parahippocampal gyrus – an important connecting pathway of the limbic system.

Parietal lobe – receives and processes information about temperature, taste, touch, and movement coming from the rest of the body. Reading and arithmetic are also processed in this region.

Pons – contains centers for the control of vital processes, including respiration and cardiovascular functions. It also is involved in the coordination of eye movements and balance.

Temporal lobe – processes hearing, memory and language functions.

Thalamus – a major relay station between the senses and the cortex (the outer layer of the brain consisting of the parietal, occipital, frontal and temporal lobes).

 

 

 

 

 

Brain With Alzheimer’s Disease

 

These images represent a cross-section of the brain as seen from the front. The cross-section on the left represents a normal brain and the one on the right represents a brain with Alzheimer’s disease.

 

 

In Alzheimer’s disease, there is an overall shrinkage of brain tissue. The grooves or furrows in the brain, called sulci (plural of sulcus), are noticeably widened and there is shrinkage of the gyri (plural of gyrus), the well-developed folds of the brain’s outer layer. In addition, the ventricles, or chambers within the brain that contain cerebrospinal fluid, are noticeably enlarged. In the early stages of Alzheimer’s disease, short-term memory begins to fade (see box labeled ‘memory’) when the cells in the hippocampus, which is part of the limbic system, degenerate. The ability to perform routine tasks also declines. As Alzheimer’s disease spreads through the cerebral cortex (the outer layer of the brain), judgment declines, emotional outbursts may occur and language is impaired. As the disease progresses, more nerve cells die, leading to changes in behavior, such as wandering and agitation. In the final stages of the disease, people may lose the ability to recognize faces and communicate; they normally cannot control bodily functions and require constant care. On average, the disease lasts for 8 to 10 years, but individuals with Alzheimer’s can live for up to 20 years.

 

How the Brain and Nerve Cells Change During Alzheimer’s Disease

 

 

Illustration by Bob Morreale, provided courtesy of the American Health Assistance Foundation.

 

 

 

One of the hallmarks of Alzheimer’s disease is the accumulation of amyloid plaques between nerve cells (neurons) in the brain. Amyloid is a general term for protein fragments that the body produces normally. Beta amyloid is a fragment of a protein snipped from another protein called amyloid precursor protein (APP). In a healthy brain, these protein fragments would break down and be eliminated. In Alzheimer’s disease, the fragments accumulate to form hard, insoluble plaques.

Neurofibrillary tangles are insoluble twisted fibers found inside the brain’s nerve cells. They primarily consist of a protein called tau, which forms part of a structure called a microtubule. The microtubule helps transport nutrients and other important substances from one part of the nerve cell to another. Axons are long threadlike extensions that conduct nerve impulses away from the nerve cell; dendrites are short branched threadlike extensions that conduct nerve impulses towards the nerve cell body. In Alzheimer’s disease the tau protein is abnormal and the microtubule structures collapse.

As Alzheimer’s disease progresses, brain tissue shrinks. However, the ventricles, chambers within the brain that contain cerebrospinal fluid, are noticeably enlarged. In the early stages of Alzheimer’s disease, short-term memory begins to decline when the cells in the hippocampus degenerate. Those with the disease lose the ability to perform routine tasks. As Alzheimer’s disease spreads through the cerebral cortex (the outer layer of the brain), judgment worsens, emotional outbursts may occur and language is impaired. Advancement of the disease leads to the death of more nerve cells and subsequent changes in behavior, such as wandering and agitation. In the final stages, people may lose the ability to feed themselves, speak, recognize people and control bodily functions. Memory worsens and may become almost non-existent. Constant care is typically necessary. On average, those with Alzheimer’s live for 8 to 10 years after diagnosis, but this terminal disease can last for as long as 20 years.

 

 

 

 

Plaques and Tangles

© 2000 – 2011 American Health Assistance Foundation

The formation of amyloid plaques and neurofibrillary tangles are thought to contribute to the degradation of the neurons (nerve cells) in the brain and the subsequent symptoms of Alzheimer’s disease.

Amyloid Plaques

One of the hallmarks of Alzheimer’s disease is the accumulation of amyloid plaques between nerve cells (neurons) in the brain. Amyloid is a general term for protein fragments that the body produces normally. Beta amyloid is a protein fragment snipped from an amyloid precursor protein (APP). In a healthy brain, these protein fragments are broken down and eliminated. In Alzheimer’s disease, the fragments accumulate to form hard, insoluble plaques.

Neurofibrillary Tangles

Neurofibrillary tangles are insoluble twisted fibers found inside the brain’s cells. These tangles consist primarily of a protein called tau, which forms part of a structure called a microtubule. The microtubule helps transport nutrients and other important substances from one part of the nerve cell to another. In Alzheimer’s disease, however, the tau protein is abnormal and the microtubule structures collapse.

 

 

 

What Has Genetics Taught Us About Alzheimer’s Disease, Harvard Medicial School

 

 

 

Alzheimer’s Disease Photo Essay

 

 

 

Preventing Alzheimer’s Disease

 

 

 

 

Dementia Prevention: Brain Exercise

Medical Author: William C. Shiel, Jr., FACP, FACR
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

Dementia is significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. Dementia is reported in as many as 1% of adults 60 years of age. Moreover, it has been estimated that the frequency of dementia doubles every five years after 60 years of age. So, dementia is clearly related to aging.

Alzheimer’s disease is the most common form of dementia. Among other causes are medical conditions (thyroid disease, drug toxicity, thiamine deficiency with alcoholism, and others), brain injury, strokes, multiple sclerosis, infection of the brain (such as meningitis and syphilis), HIV infection, hydrocephalus, Pick’s disease, and brain tumors.

Dr. Joe Verghese and others at the Albert Einstein College of Medicine in collaboration with Syracuse University studied 469 subjects older than 75 years of age who lived in the community setting. They recorded the frequency of participation in leisure activities for the subjects. They documented their thinking and physical abilities and recorded them in activity-days per week.

The results of the study were recently published in the New England Journal of Medicine (N Engl J Med 2003;348:2508-16). The researchers found that over an average period of 5.4 years, dementia developed in 124 subjects (Alzheimer’s disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). They also found that among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia!

The authors of the study concluded that participation in leisure activities is associated with a reduced risk of dementia. They suggested that further studies be done to determine the power of the “protective” effect of leisure activities that involve thinking on the risk of dementia.

In an accompanying editorial, Dr. Joseph T. Coyle from Harvard Medical School noted that while more studies are needed to clarify the relative roles of genes vs. environmental factors, such as effortful mental activities, “seniors should be encouraged to read, play board games, and go ballroom dancing, because these activities, at the very least, enhance their quality of life, and they just might do more than that.” This editor cannot agree more. So, to the elderly, “dance on!”

REFERENCE: J. Verghese, R. Lipton, M. Katz, C. Hall, C. Drby, G. Kuslansky, A. Ambrose, M. Sliwinski, H. Buschle. “Leisure Activities and the Risk of Dementia in the Elderly,” New England Journal of Medicine; 2003;348:2508-16

 

 

 

The New York Times, April 26, 2011, by Natasha Singer  —  Before pharmaceutical company marketers call on a doctor, they do their homework. These salespeople typically pore over electronic profiles bought from data brokers, dossiers that detail the brands and amounts of drugs a particular doctor has prescribed. It is a marketing practice that some health care professionals have come to hate.

“It’s very powerful data and it’s easy to understand why drug companies want it,” said Dr. Norman S. Ward, a family physician in Burlington, Vt. “If they know the prescribing patterns of physicians, it could be very powerful information in trying to sway their behavior — like, why are you prescribing a lot of my competitor’s drug and not mine?”

Marketing to doctors using prescription records bearing their names is an increasingly contentious practice, with three states, Maine, New Hampshire and Vermont, in the vanguard of enacting laws to limit the uses of a doctor’s prescription records for marketing.

On Tuesday, the Supreme Court will hear arguments in a case, Sorrell v. IMS Health, that tests whether Vermont’s prescription confidentiality law violates the free speech protections of the First Amendment.

The case is being closely watched not only by drug makers and data collection firms, but also by health regulators, doctors and consumer advocates who say the decision will have profound implications for doctors’ control over their prescription histories, and for information privacy, medical decision-making and health care costs.

Vermont’s attorney general, William H. Sorrell, petitioned the court to review the case after three leading data collection firms including IMS Health, a health information company, and the Pharmaceutical Research and Manufacturers of America, a drug industry trade group, challenged the state statute. Although the federal district court in Vermont originally upheld the law, an appellate court reversed the decision last November.

The federal government, the attorneys general of several dozen states, AARP, professional medical associations, privacy groups and the New England Journal of Medicine have filed briefs in support of Vermont’s law. The National Association of Chain Drugstores, the Association of National Advertisers and news organizations like Bloomberg and The Associated Press have filed briefs aligning themselves with the data firms.

The concern over marketing based on doctor-specific prescription records revolves around the argument that it makes commercial use of private health treatment decisions — initiated in nonpublic consultations between doctor and patient, and completed in government-regulated transactions with pharmacists.

The data has become more available because pharmacies, which are required by law to collect and maintain detailed files about each prescription filled, can sell records containing a doctor’s name and address, along with the amount of the drug prescribed, to data brokers. (The records are shorn of patient names and certain other personal details covered by the Health Insurance Portability and Accountability Act, known as H.I.P.A.A., the federal legislation governing a patient’s privacy.) Data brokers in turn aggregate the records for use in medical research and marketing.

Drug makers spent about $6.3 billion on marketing visits to doctors in 2009, the last year that such figures were available, according to IMS Health. Access to a doctor’s prescription history, drug makers say, helps ensure that information about the latest prescription drug options quickly reaches specialists who treat particular conditions.

But some federal regulators and medical societies argue that drug makers are simply mining the data to identify and go after the doctors who would be most likely to prescribe the latest, most expensive brand-name medicines — driving up health care costs and exposing patients to newer drugs whose side effects may not yet be fully known.

Vermont enacted its prescription confidentiality law with the idea that drug makers do not have an inherent right to a doctor’s identifiable prescription information for use in marketing because the data originated in highly government-regulated, nonpublic health care transactions, said Mr. Sorrell, the Vermont attorney general.

“Does ‘Ajax Incorporated’ have a constitutional unfettered right to the data for commercial purposes,” Mr. Sorrell said, “or is it legitimate to give the doctor who is writing the prescription a say over whether that information should be used for marketing?”

Although the state law does not inhibit pharmaceutical sales representatives from marketing to doctors in their offices, he said, it does give doctors the right to consent before their prescribing information may be sold and used for marketing. If a doctor does not agree, he said, pharmacies must remove or encrypt the doctor’s name, just as they do for patients, before they sell this type of record for promotional use.

Even if the Supreme Court were to find that the law infringes on free speech, Mr. Sorrell added, the justices could still uphold the law on the grounds that the state has a legitimate interest in containing the higher medical costs and safety risks that can be associated with the newest drugs.

But industry representatives contend that Vermont should not be allowed to cherry-pick certain approved uses for the records in question while restricting those that conflict with what the law’s opponents say is the state’s apparent agenda: promoting less expensive generic drugs in an effort to lower health care costs.

Vermont allows those records to be used in research and by law enforcement, said Thomas C. Goldstein, a lawyer representing IMS Health. Moreover, he said, drug makers are allowed to buy the very same records so they can identify doctors whose patients might be good candidates for clinical trials or communicate drug safety updates.

“The one exception is that drug companies cannot use the data to combat the insurers’ and the state’s messages about their products,” Mr. Goldstein argued.

He added that pharmacies obtain the information through business transactions that are no different than any other, making the physician records no more private than stock quotes or commodity prices.

“It’s all data,” he said, “and it’s all protected by the First Amendment.”

Moreover, such laws reduce the ability of drug makers to quickly communicate with specialists about new drugs for rare diseases, a situation that could make it prohibitive for, say, a small biotechnology company with a tiny sales force to market a breakthrough medication, said Randy Frankel, the vice president for external affairs at IMS Health.

“Without the data, you might visit 1,000 physicians to identify the 10 whose patients might most benefit,” Mr. Frankel said. “With the data, you would go to the 10.”

But some consumer advocates say the real issue in the case is the confidentiality of information that people submit in government-regulated transactions that they would not otherwise make public.

“If the court is not going to protect personal and confidential health records,” said Wells Wilkinson, a staff lawyer at Community Catalyst, a nonprofit group that filed a brief in support of Vermont, “how could any consumer transaction be protected?”