Tags Posts tagged with "Alzheimer’s"

Alzheimer’s

Above, a transmitter and wristband that can be obtained at the Suffolk County Sheriff’s Department. Photo courtesy of S.C. Sheriff's Dept.

When someone goes missing, it can be a terrifying experience for the person as well as family, friends and neighbors, especially when the individual has an impairment.

The Suffolk County Sheriff’s Department is reminding the public of its Project Lifesaver initiative after John Wile, a Stony Brook man with Alzheimer’s, was found dead Aug. 8 on the Research and Development Park property, also in Stony Brook, after leaving his home to jog two days earlier. The 10-year-old rapid-response program aids clients who may wander due to cognitive impairments or other afflictions, such as Alzheimer’s, dementia and autism.

Deputy Sheriff Sgt. Brian Weinfeld said those enrolled in the sheriff’s program wear a wristband with a transmitter that can be used on the wrist, ankle or as a necklace. The radio frequency transmitter and wristband come with a case, tester and battery. The battery and wristband have to be changed or charged every 30 to 60 days depending on the type.

He said caretakers are informed to call a special line with the Sheriff’s Department and 911 as soon as it’s discovered that someone with the transmitter is missing. The calls are received at the sheriff’s communication bureau and a text message is sent out to all Project Lifesaver responders, which is approximately 15 people within the department who are spread out from Montauk to Amityville. While all may not be working when an emergency occurs, Weinfeld said sometimes a responder will join the search on his or her day off.

Once the responders get a message that someone is missing they turn on their equipment and will receive a signal every one second transmitted from the person’s location device, Weinfeld said. The range of the signal depends on the terrain, and a responder’s antennae can pick up a signal approximately 3 miles on land and 5 in the air. The signal can be picked up by the antenna on a car or from a handheld antenna when searching on the ground. Using radio frequencies has its benefits.

“It’s not susceptible to satellites going down, cloudy weather or being in a basement,” he said. “That signal is going to be strong no matter what. Whereas with a GPS-type of device, you’re going to be relying on satellites and a clear path to the sky and that type of stuff.”

Weinfeld said responders start from where the person went missing and have an estimated range of how far the person could have wandered, which can be about 4 miles an hour. When a man in Brentwood went missing recently, a responder was near the Sagtikos State Parkway and the man was found within three minutes, according to the deputy sheriff sergeant. He said it’s critical when looking for someone who is lost that a caretaker calls the second he or she realizes, even before he or she searches for the person.

“Thankfully most of our searches end before we even get there,” he said. “Which is great. I tell all the clients, ‘Please, don’t hesitate to call us because we’re working, we’re on the road, we’re there. If you think your person is missing, just call us. We can start by sending someone to your area. Five minutes later we’re just pulling in and you found them, no big deal, we’ll just go back to work.’ I don’t want people to think they’re burdening us.”

Weinfeld said there are approximately 108 clients enrolled in the program, with roughly 50 percent being seniors with Alzheimer’s or dementia. The other 50 percent are children and adults with autism. He said there has been a 100 percent success rate out of the 3,000 reported searches in North America.

Those interested in the program can fill out a form with the Sheriff’s Department, and after a home visit and approval, can purchase the kit for approximately $300. Weinfeld said health insurance may cover the expense in some cases and others may be eligible to receive it for free.

According to the Alzheimer’s Association, a voluntary health organization in Alzheimer’s care, support and research, one in three seniors die with Alzheimer’s or other dementias, and it’s the sixth leading cause of death in the U.S. The association states 5.7 million Americans are currently living with the disease, and it’s projected that number will rise to about 14 million by 2050.

“The use of electronic tracking devices may be an appropriate part of a comprehensive safety plan which offers peace of mind for individuals with the disease and their caregivers,” said Douglas Davidson, executive director of the Alzheimer’s Association,  Long Island Chapter.”It should never be used as a replacement for needed supervision, and families should prepare for safety issues throughout the course of the disease.”

For more information on Project Lifesaver, visit www.suffolkcountysheriffsoffice.com/project-lifesaver. Also visit www.alz.org/longisland, for more information about Alzheimer’s and free programs and support available for patients in Suffolk and Nassau counties.

What do the signs tell us?

In Hawaii, numerous small earthquakes caused parts of Big Island to shake. Geologists, who monitor the islands regularly, warned of a pending volcanic eruption. They were right, clearing people away from lava flows.

How did they know?

It’s a combination of history and science. Researchers in the area point to specific signs that are reflections of patterns that have developed in past years. The small earthquakes, like the feel of the ground trembling as a herd of elephants is approaching in the Serengeti, suggest the movement of magma underneath the ground.

Higher volumes of lava flows could come later on, as in 1955 and 1960, say USGS scientists in the archipelago.

The science involves regular monitoring of events, looking for evidence of what’s going on below the surface. “Hopefully we’ll get smart enough that we can see [tremors] coming or at least be able to use that as a proxy for having people on the ground watching these things,” Tina Neal, scientist-in-charge at USGS Hawaiian Volcano Observatory, explained to KHON2 News in Honolulu.

People look for signs in everything they do, hoping to learn from history and to use whatever evidence is
available to make predictions and react accordingly.

Your doctor does it during your annual physical, monitoring your blood chemistry, checking your heart and lungs, and asking basic questions about your lifestyle.

Scientists around Long Island are involved in a broad range of studies. Geneticists, for example, try to see what the sequence of base pairs might mean for you. Their information, like the data the geologists gather in
Hawaii, doesn’t indicate exactly what will happen and when, but it can suggest developments that might affect you.

Cancer researchers at Cold Spring Harbor Laboratory and Stony Brook University are using tools like the gene editing system called CRISPR to see how changing the genetic code affects the course of development or the pathway for a disease. Gene editing can help localize the regions responsible for the equivalent of destructive events in our own bodies, showing where they are and what sequences cause progression.

Scientists, often working six or seven days a week, push the frontiers of our ability to make sense of
whatever signs they collect. Once they gather that information, they can use it to help create more accurate diagnoses and to develop therapies that have individualized benefits.

Indeed, not all breast cancers are the same, which means that not all treatments will have the same effect. Some cancers will respond to one type of therapy, while others will barely react to the same treatment.

Fundamental, or basic, research is critical to the understanding of translational challenges like treating
Alzheimer’s patients or curing potentially deadly fungal infections.

Indeed, most scientists who “discover” a treatment will recognize the seminal studies that helped them finish a job started years — and in some cases decades — before they developed cures. Treatments often start long before the clinical stages, when scientists want to know how or why something happens. The pursuit of knowledge for its own sake can lead to unexpected and important benefits.

Outside the realm of medicine, researchers on Long Island are working on areas like understanding the climate and weather, and the effect on energy production.

Numerous scientists at SBU and Brookhaven National Laboratory study the climate, hoping to understand how one of the most problematic parts of predicting the weather — clouds — affects what could happen tomorrow or in the next decade.

The research all these scientists do helps us live longer and better lives, offering us early warnings of
developing possibilities.

Scientists not only interpret what the signs tell us, but can also help us figure out the right signs to study.

In Europe, lipoic acid is classified as a drug, unlike in the United States, where it is a supplement.
Lipoic acid may have a significant effect on multiple chronic diseases

By David Dunaief, M.D.

Lipoic acid, also known as alpha lipoic acid and thioctic acid, is a noteworthy supplement. I am not a big believer in lots of supplements for several reasons: Diet contributes thousands more nutrients that work symbiotically; in the United States, supplements are not regulated by the FDA, thus there is no official oversight; and research tends to be scant and not well-controlled.

Dr. David Dunaief

So why would I write about lipoic acid? It is a supplement that has scientific data available from randomized controlled trials, which are the gold standard of studies. In Europe, lipoic acid is classified as a drug, unlike the United States, where it is a supplement (1).

Lipoic acid is an antioxidant, helping to prevent free radical damage to cells and tissues, but also is a chelating agent, potentially removing heavy metals from the body. Lipoic acid is involved in generating energy for cells; it is an important cofactor for the mitochondria, the cell’s powerhouse. It may also boost glutathione production, a powerful antioxidant in the liver (1). We produce small amounts of lipoic acid in our bodies naturally. Lipoic acid may be important in chronic diseases, including Alzheimer’s, multiple sclerosis and diabetic peripheral neuropathy. Let’s look at the evidence.

Diabetic peripheral neuropathy

Diabetic peripheral neuropathy, or diabetic neuropathy, involves oxidative stress and occurs in up to half the population with diabetes. One in five patients, when diagnosed, will already have peripheral neuropathy. The most common type is distal symmetric polyneuropathy — damage to nerves on both sides of the body in similar locations. It causes burning pain, numbness, weakness and pins and needles in the extremities (2).

The best studies with lipoic acid focus on peripheral neuropathy with diabetes. In a double-blinded, randomized controlled trial (SYDNEY I), results showed that the total treatment score had improved significantly more for those receiving 600 mg lipoic acid by intravenous therapy compared to the placebo group (3). Also, individual symptoms of numbness, burning pain and prickling significantly improved in the group treated with lipoic acid compared to placebo.

The study involved 120 diabetes patients with stage 2 neuropathy. Its weakness was its duration; it was a very short trial, about three weeks. The author concluded that this therapy would be a good adjunct for those suffering diabetic neuropathy.

In a follow-up to this study (SYDNEY II), the design and the results were the same (4). In other words, in a second double-blinded, placebo-controlled trial, the lipoic acid treatment group showed significantly better results than the placebo group. There were 180 patients with a similarly short duration of five weeks.

Why include this study? There were several important differences. One was that lipoic acid was given in oral supplements, rather than intravenously. Thus, this is a more practical approach. Another difference is that there were three doses tested for lipoic acid: 600, 1,200 and 1,800 mg. Interestingly, all of them had similar efficacy. However, the higher doses had more side effects of nausea, vomiting and vertigo, again without increased effectiveness. This suggests that an oral dose of 600 mg lipoic acid may help treat diabetic peripheral neuropathy.

Dementia and Alzheimer’s

In a recent randomized, placebo-controlled trial involving Alzheimer’s patients, results were significantly better for lipoic acid (600-mg oral dose) in combination with fish oil, compared to fish oil alone or to placebo (5). The amount of fish oil used was 3 grams daily containing 675 mg docosahexaenoic acid and 975 mg eicosapentaenoic acid of the triglyceride formulation.

The duration of this pilot study was 12 months with 39 patients, and the primary end point was a change in an oxidative stress biomarker, which did not show statistical significance. However, and very importantly, the secondary end point was significant: slowing the progression of cognitive and functional decline with the combination of fish oil and lipoic acid. Minimental status and instrumental activities of daily living declined less in the combination treatment group. This was encouraging, although we need larger trials.

However, another study showed 900 mg lipoic acid in combination with 800 IU daily of vitamin E (alpha tocopherol strain) and 500 mg vitamin C actually mildly reduced an oxidative stress biomarker but had a negative impact on Alzheimer’s disease by increasing cognitive decline on a minimental status exam (6). What we don’t know is whether the combination of supplements in this study produced the disappointing effects or if an individual supplement was the cause. It is unclear since the supplements were tested in combination. The study duration was 16 weeks and involved 78 moderate to severe Alzheimer’s patients.

Multiple sclerosis

In a study involving rats, giving them high doses of lipoic acid resulted in slowing of the progression of multiple sclerosis-type disease (7). The mechanism by which this may have occurred involved blocking the number of inflammatory white blood cells allowed to enter the cerebrospinal fluid in the brain and spinal cord by reducing the enzymatic activity of factors such as matrix metalloproteinases.

I know this sounds confusing, but the important point is that this may relate to a human trial with 30 patients that showed reduction in the enzyme MMP (8). Thus, it could potentially slow the progression of multiple sclerosis. This is purely connecting the dots. We need a large-scale trial that looks at clinical outcomes of progression in MS, not just enzyme levels. The oral dose used in this study was 1,200 to 2,400 mg lipoic acid per day.

Interestingly, the 1,200-mg dose used in the human trial was comparable to the high dose that showed slowed progression in the rat study (9). This only whets the appetite and suggests potential. So, we have lots of data. What do we know? In diabetic neuropathy, 600 mg oral lipoic acid may be beneficial. However, in Alzheimer’s the jury is still out, although 600 mg lipoic acid in combination with fish oil has potential to slow the cognitive decline in Alzheimer’s disease. It also may have a role in multiple sclerosis with an oral dose of 1,200 mg, though this is early data.

Always discuss the options with your physician before taking a supplement; in the wrong combinations and doses, supplements potentially may be harmful. The good news is that it has a relatively clean safety profile. If you do take lipoic acid, know that food interferes with its absorption, so it should be taken on an empty stomach (1).

References: (1) lpi.oregonstate.edu. (2) emedicine.medscape.com. (3) Diabetes Care. 2003;26:770-776. (4) Diabetes Care. 2006;29:2365-2370. (5) J Alzheimer’s Dis. 2014;38:111-120. (6) Arch Neurol. 2012;69:836-841. (7) J Neuroimmunol. 2002;131:104-114. (8) Mult Scler. 2005;11:159-165. (9) Mult Scler. 2010;16:387-397.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Dementia symptoms include impairments in thinking, communicating, and memory. Stock photo

By David Dunaief, M.D.

When you hear the word dementia, what is your reaction? Is it fear, anxiety or an association with a family member or friend? The majority of dementia is Alzheimer’s, which comprises about 60 to 80 percent of dementia incidence (1). There is also vascular dementia and Parkinson’s-induced dementia, as well as others. Then there are precursors to dementia, such as mild cognitive impairment, that have a high risk of leading to this disorder.

Dr. David Dunaief
Dr. David Dunaief

Encouraging data

There is good news! A recent study, the Health and Retirement Study (HRS), a prospective (forward-looking) observational study, suggested that dementia incidence has declined (2). This was a big surprise, since predictions were for significant growth. Dementia declined by 24 percent from 2000 to 2012. There were over 10,000 participants 65 years old and older at both the 2000 and 2012 comparison surveys. There was also a decrease in mild cognitive impairment that was statistically significant. However, the reason for the decline is not clear. The researchers can only point to more education as the predominant factor. They surmise that more treatment and prevention of risk factors for cardiovascular disease may have played a role.

So how is dementia defined?

According to the American Psychiatric Association’s DSM-5 (“Diagnostic and Statistical Manual of Mental Disorders,” Fifth Edition), dementia is a decline in cognition involving one or more cognitive domains. In addition to memory, these domains can include learning, executive function, language, social cognition, perceptual-motor and complex attention (3).

What can be done to further reduce dementia’s prevalence?

Knowing some of the factors that may increase and decrease dementia risk is a good start. Those that raise the risk of dementia include higher blood pressure (hypertension), higher heart rate, depression, calcium supplements in stroke patients and prostate cancer treatment with androgen deprivation therapy (ADT).

What abates risk?

This includes lifestyle modifications with diet and exercise. A diet shown to be effective in prevention and treatment of dementia is referred to as the MIND (Mediterranean–DASH intervention for neurodegenerative delay) diet, which is a combination of the Mediterranean-type and Dietary Approaches to Stop Hypertension (DASH) diets. Surprisingly, there is also a cocktail of supplements that may have beneficial effects.

How does medication to treat dementia, specifically Alzheimer’s, fit into this paradigm?

It is not that I was ignoring this issue. Our present medications are not effective enough to slow the disease progression by clinically significant outcomes. But what about the medications in the pipeline? The two hottest areas are focusing on tau tangles and amyloid plaques. Recently, drugs targeting tau tangles from TauRx Therapeutics and amyloid plaques from Eli Lilly failed to achieve their primary clinical end points during trials. There may be hope for these different classes of drugs, but don’t hold your breath. The plaques and tangles may be signs of Alzheimer’s dementia rather than causes. Several experts in the field are not surprised by the results.

Let’s look at the evidence.

The quandary that is blood pressure

If ever you needed a reason to control high blood pressure, the fact that it may contribute to dementia should be a motivator. In the recent Framingham Heart Study, Offspring Cohort, a prospective observational study, results showed that high blood pressure in midlife — looking specifically at systolic (top number) blood pressure (SBP) — increased the risk for dementia by 70 percent (4). Even worse, those who were controlled with blood pressure medications in midlife also had significant risk for dementia.

There were 1,440 patients involved in the study over a 16-year period with an examination every four years. Then, those patients who were free of dementia were examined for another eight years. Results showed a 107-patient incidence of dementia, of which half were on blood pressure medications. And when there was a rapid drop in SBP from midlife to late in life, there was a 62 percent increased risk, to boot. Thus, the moral of the story is that lifestyle changes to either prevent high blood pressure or to get off medications may be the most appropriate route to reducing this risk factor.

Prostate cancer inflates dementia risk

Actually, the title above does not do justice to prostate cancer. It is not the prostate cancer, but the treatment for prostate cancer, androgen deprivation therapy (ADT), that may increase the risk of dementia by greater than twofold (5). Treatment duration played a role: those who had a year or more of ADT were at higher risk. ADT suppresses production of the male hormones testosterone and dihydrotestosterone. The study involved over 9,000 men with a 3.4-year mean duration; however, it was a retrospective (backward-looking) analysis and requires a more rigorous prospective study design to confirm the results. Thus, though the results are only suggestive, they are intriguing.

Calcium supplements — not so good

In terms of dementia, the Prospective Population Study of Women and H70 Birth Cohort trial has shown that calcium supplements, especially when given to patients who have a history of stroke, increase the risk of dementia by greater than sixfold (6). Those who had white matter lesions in the brain also had an increased risk. The population involved 700 elderly women, with 98 given calcium supplements. How do we reduce this risk? Easy: Don’t give calcium supplements to those who have had a stroke. This brings more controversy to taking calcium supplements, especially for women. You are better off getting calcium from foods, especially plant-based foods.

The MIND diet to the rescue

In a recent study, results showed that the MIND diet reduced the risk of Alzheimer’s dementia by 53 percent in those who were adherent. It also showed a greater than one-third reduction in dementia risk in those who only partially followed the diet (7). There were over 900 participants between the ages of 58 and 98 in the study, which had a 4.5-year duration. When we talk about lifestyle modifications, the problem is that sometimes patients find diets too difficult to follow. The MIND diet was ranked one of the easiest to follow. It involves a very modest amount of predominantly plant-based foods, such as two servings of vegetables daily — one green leafy. If that is not enough, the MIND diet has shown the ability to slow the progression of cognitive decline in those individuals who do not have full-blown dementia (8).

Supplement cocktail

To whet your appetite, a recent study involving transgenic growth hormone mice (which have accelerated aging and demonstrate cognitive decline) showed a cocktail of supplements helped decrease the risk of brain deterioration and function usually seen with aging and in severe Alzheimer’s dementia (9). The cocktail contained vitamins, minerals and nutraceuticals, such as bioflavonoids, garlic, cod liver oil, beta carotene, green tea extract and flax seed. Each compound by itself is not considered to be significant, but taken together they seem to have beneficial effects for dementia prevention in mice.

The reasons for dementia may involve mitochondrial dysfunction, oxidative stress and inflammation that are potentially being modified by these supplements. Hopefully, there will be more to come on this subject. It comes down to the fact that lifestyle modifications, whether in terms of reducing risk or slowing the progression of the disease, trump current medications and those furthest along in the drug pipeline. There may also be a role for a supplement cocktail, though it’s too early to tell. The MIND diet has shown some impressive results that suggest powerful effects.

References: (1) uptodate.com. (2) JAMA Intern Med. online Nov. 21, 2016. (3) uptodate.com. (4) American Neurological Association (ANA) 2016 Annual Meeting. Abstract M148. (5) JAMA Oncol. online Oct. 13, 2016. (6) Neurology. online Aug. 17, 2016. (7) Alzheimers Dement. 2015;11:1007-1014. (8) Alzheimers Dement. 2015;11:1015-1022. (9) Environ Mol Mutagen. online May 20, 2016.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Reynaldo Macadaeg photo from SCPD

Update, 4.27.16, 9:42 a.m.: Police reported that Reynaldo Macadaeg has been found, unharmed.

An elderly man told his wife he wanted to go to the Philippines before disappearing on Monday, the Suffolk County Police Department said.

Reynaldo Macadaeg, a 77-year-old man with Alzheimer’s disease, was last seen at his home on Centereach’s Strathmore Village Drive around 3 p.m., according to police.

Authorities issued a Silver Alert for the missing man, who also has heart problems and did not bring any medication with him.

Macadaeg is described as Filipino, 5 feet 4 inches tall and about 160 pounds, police said. He has brown eyes and thinning white hair.

At the time he was last seen, when he told his wife about how he wanted to go to the Philippines, he was wearing navy blue slacks, a dark blue coat and black shoes.

Anyone with information on his whereabouts is asked to call detectives at 631-854-8652 or 911.

Annual Asharoken swim to benefit Alzheimer's disease research raises more than $6,000

By Talia Amorosano

On Tuesday morning, more than 20 kayakers and swimmers gathered for the 12th Annual Distant Memories Swim, an event created and organized by Bryan Proctor, a Harborfields physical education teacher, to raise awareness for Alzheimer’s disease, the most common form of dementia. Participants traveled two nautical miles from Asharoken Beach in Northport to Knollwood Beach in Huntington and were cheered on by family members and supporters who waited and watched the event from shore. This year’s event has raised more than $6,000 for the Alzheimer’s Disease Resource Center so far, and over the course of its existence, has raised over $100,000. Organizers hope that the money will eventually help researchers find a cure for this increasingly prevalent disease.

Participants paddle across Northport Bay in a previous Distant Memories Swim. File photo by Rohma Abbas

Alzheimer’s Disease Resource Center, Inc. announced that Bryan Proctor, a Huntington resident and a physical education teacher, will lead a team of swimmers in the 12th Annual Distant Memories Swim on Tuesday, July 28, to draw attention to the disease that impacts more than 60,000 families on Long Island.

In its lifetime, the swim has raised in excess of $100,000 for those with Alzheimer’s disease and their unpaid caregivers. Opening ceremonies are expected to begin at 9 a.m. Proctor and his teammates will take to the water at 9:15 a.m.

The swim will start at Asharoken Beach and move across Northport Bay to Knollwood Beach in Huntington — a distance just under three miles. The swim will also help raise funds for Alzheimer’s Disease Resource Center, Inc. The goal is to raise $20,000.

The issue is close to Proctor, as his grandfather and aunt died from the disease.

“Bryan is a champion for those with a diagnosis of Alzheimer’s disease,” said Mary Ann Malack-Ragona, executive director and CEO of Alzheimer’s Disease Resource Center, Inc. “He is a role model for the youth of our country.”

Over 5 million people in this country are currently living with Alzheimer’s.

“It is my hope that substantial funds will be raised to assist Alzheimer’s Disease Resource Center,” Proctor said.

For more information about this event, visit www.memoryswim.org. For more information about ADRC, please contact Malack-Ragona  at (631) 820-8068 or visit www.adrcinc.org.

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