Namenda Treatment for Moderate to Severe Alzheimer’s

About Namenda

A medication known as Namenda (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer’s disease. This drug’s main effect is to delay progression of some of the symptoms of moderate to severe Alzheimer’s. It may allow patients to maintain certain daily functions a little longer than they would without the medication. For example, Namenda may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers.

Namenda is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

Namenda was approved in October 2003 by the Food and Drug Administration for the treatment of moderate to severe Alzheimer's disease. The approval was based partly on a rigorous 28-week study of 252 people who were randomly chosen to receive the drug or a placebo. The results, published in the prestigious New England Journal of Medicine in the spring of 2003, showed that the drug could slow the downward spiral of the disease.

Therapeutic Effect

Namenda is proven to help treat the symptoms of moderate to severe Alzheimer's disease. That is important because the longer symptoms are treated, the more quality time you may have to spend with the person with Alzheimer's disease who you are caring for.

In a 28-week study, mentioned earlier, published in the New England Journal of Medicine patients suffering from moderate to severe Alzheimer's disease received either 20 mg of Namenda per day or a placebo (sugar pill). The study found that compared to patients taking placebo:

• Patients taking Namenda experienced a slower rate of decline in thinking over time.
• Namenda treated patients had significantly greater ability to perform daily activities, including doing household tasks such as taking out the garbage or clearing the table after dinner, as well as conversing.

Namenda in combination with donepezil may do more to treat the symptoms of moderate to severe Alzheimer's disease then donepezil alone.

Since so far there is no cure for Alzheimer's disease, the goal of treatment with Namenda, as with all Alzheimer's disease medications, is to treat the symptoms of Alzheimer's disease. Once treatment is started, you may wonder how long it will take for Namenda to have an effect. Some patients have seen an improvement within twelve weeks of starting therapy, although individual results may vary.

Please keep in mind that either no change in Alzheimer's disease symptoms or a slower rate of progression of symptoms are positive results compared to the more rapid decline a person with Alzheimer's disease might experience without treatment. It is important to understand that every day symptom progression is delayed may allow the person with Alzheimer's disease to spend more quality time with his or her loved ones.

How it works?

Namenda works in a unique way and is different from other prescription medications approved to treat Alzheimer's disease. As the only NMDA receptor antagonist, Namenda targets a brain chemical known as glutamate. Nerve cells rely on a variety of chemical messengers to transmit messages from one cell to the next. One of those chemical messengers is glutamate.

Glutamate is a chemical in the brain that has been associated with learning and memory. Abnormal glutamatergic activity in the brain may lead to Alzheimer's disease symptoms. Namenda may help block abnormal glutamatergic activity to improve symptoms.

Other Alzheimer's disease medications, known as AChEIs (acetylcholinesterase inhibitors), such as Aricept (donepezil), work by targeting a different brain chemical called acetylcholine. When there is too little acetylcholine in the brain of a person with Alzheimer's disease, memory and learning can be affected. AChEIs work by addressing that problem.

Taking Namenda alone or in combination with donepezil may help improve quality of life for people with Alzheimer's disease and their caregivers. There is no evidence that Namenda prevents or slows neurodegeneration in patients with Alzheimer's disease.

Taking Namenda

Getting Started

Therapy begins at a low dose (5 mg per day) and is gradually increased until the recommended target dose (10 mg, twice daily) is reached. A common dosing schedule for beginning Namenda therapy is provided below:

Recommended Namenda dosing schedule

1. Week 1: Start on Day 1

Take one 5 mg tablet in the morning, each day.

2. Week 2: Start on Day 8

Take one 5 mg tablet in the morning and one 5 mg tablet at night, each day.

3. Week 3: Start on Day 15

Take one 10 mg tablet in the morning and one 5 mg tablet at night, each day.

4. Week 4: Start on Day 22

Take one 10 mg tablet in the morning and one 10 mg tablet at night, each day.

5. Once the recommended target dose (10 mg, twice daily) has been reached, people taking Namenda can continue with that daily regimen unless instructed otherwise by their doctors (For patients with severe renal impairment, 5 mg twice daily is the recommended dose).

Side Effects

Although generally well-tolerated, the most common side effects are dizziness, headache, constipation, and confusion. Unlike cholinesterase inhibitors such as Aricept, Exelon, and Razadyne, those taking Namenda have a low risk of gastrointestinal side effects.

Potential Interactions

Namenda has a low potential for drug interactions. However, other NMDA antagonist medications, which include some cold and flu medications (like dextromethorphan), should be used with caution while taking Namenda. Sometimes, doctors prescribe Namenda along with a cholinesterase inhibitor to treat moderate Alzheimer's disease, as some studies have shown additional benefit from combining these medications.

Sources and Additional Information:

http://www.nia.nih.gov/Alzheimers/Publications/medicationsfs.htm

http://www.namenda.com/

http://alzheimers.about.com/od/treatmentofalzheimers/p/namenda.htm

http://www.healthyplace.com/alzheimers/medications/memantine-namenda-for-treating-alzheimers/menu-id-72/

http://www.medicalnewstoday.com/articles/35952.php

Niacinamide (Vitamin B3) May Prevent Alzheimer’s Memory Loss

All conservative official sources claim that Alzheimer’s Disease is one-directional, and you cannot turn it back. While it is true as of today, and most of the efforts are placed to slow down the disease development and smooth negative symptoms effects, there is always hope that one day it will be found the distinctive cure, if not a complete cure, but any way to fight efficiently the dementia development. One of the promising directions, for example, is related to use of medical marijuana based products.

Today, we will review one more nutrient, which gives positive signals of being a remedy for Alzheimer’s patients. It is Nicotinamide (vitamin B3, nicotinic acid), an over-the-counter vitamin.

What is Nicotinamide?

Niacin (also known as vitamin B₃, nicotinic acid and vitamin PP) is an organic compound with the formula C₅H₄NCO₂H and, depending on the definition used, one of the between forty to eighty essential human nutrients.

Note that in spite of the common similarity Nicotinamide is not exactly the same as Niacin. Niacin is converted to Nicotinamide in vivo, and, though the two are identical in their vitamin functions, nicotinamide does not have the same pharmacologic and toxic effects of niacin, which occur incidental to niacin's conversion. And vice versa, nicotinamide has the some positive health effects, not linked with niacin.

Nicotinamide(Niacinamide) and Alzheimer’s

As an Alzheimer's treatment, large doses of nicotinamide, a form of vitamin B3, "cured" Alzheimers disease in mice, reports health researcher/reporter Dr. David Williams. (Again, note: Niacinamide is NOT the same as Niacin. Do not confuse the two.) "Rarely do you hear researchers using the word ‘cured,’ but that’s exactly what happened," says Dr. Williams. "At the end of the Alzheimer's research study, the diseased mice that were treated with niacinamide performed just as well in memory tests as healthy mice. The niacinamide not only protected their brains from further memory loss, it also restored lost memory function."

The study of this treatment for Alzheimer's disease, headed by Dr. Kim Green at the University of California at Irvine, involved four months of Alzheimer's treatment with the human dose equivalent of 2000 to 3000 milligrams of niacinamide. "Cognitively, they were cured," said Dr. Green. "The vitamin completely prevented cognitive decline associated with the disease, bringing them back to the level they’d be at if they didn’t have the pathology." Niacinamide also improved memory in mice without Alzheimer’s.

The late Dr. William Kaufman did extensive research on niacinamide in the 1930s. Dr. Kaufman found that niacinamide moves in and out of the body quickly, so that smaller doses throughout the day are most effective, with 250 milligrams being the most the body could utilize at one time.

Dr. Kaufman and his wife took 250 milligrams of niacinamide every three waking hours (six doses) for at least 55 years, believing, as a result of his studies, that it helps prevent many of the physical and mental problems associated with aging, including arthritis, fatigue, muscle strength, loss of balance, depression, and cancer.

Niacinamide has been widely used for a variety of purposes for more than 60 years, and its safety is well known, says Jonathan Wright, M.D. In one of Dr. Kaufman's books, Kaufman described symptoms of niacinamide deficiency:

• Impaired memory, can't concentrate, easily distracted, slow thought, mental fog.
• Anxiety for no reason, resistant to making decisions and taking responsibility, lacks initiative, starts projects but never finishes, uncooperative.
• Quarrelsome, mean, intolerant, opinionated, unreasonable, unhappy, little things annoy, can't take a joke.

Dr. Kaufman found that these symptoms and more went away or improved a lot with the use of niacinamide, says Dr. Wright. Arthritis symptoms also improve or disappear with niacinamide, says Dr. Wright, but it's not a cure; the arthritis symptoms return if patients stop taking it.

Based on Dr. Kaufman’s work, Dr. Williams estimates that Alzheimer’s patients "would achieve the best results if they took 250 mg every 1Ѕ hours (a total of 12 doses)" for Alzheimer's treatment. Dr. Wright recommends higher doses at less frequent intervals, which can cause side effects in a small number of people. For more info on Dr. Wrights regimen, read his newsletter.

Keep in mind that this Alzheimer's cure only works for mice so far. Given the outstanding results in mice, human trials for Alzheimer's treatment are proceeding in Southern California and in England. In humans, taking 2000 to 3000 milligrams a day is "totally harmless," says Dr. Williams. The toxic dose would be nearly a pound of niacinamide daily, and there has never been a death reported from niacinamide supplementation.

Where does the positive effect come from?

While the niacinamide didn't have any effect on the most common marker of Alzheimer's, beta-amyloid, it did cause a 60 percent decrease in another marker, called "tau protein" (one specifically referred to as "Thr231-phospho-tau").

Niacinamide was also associated with an increase in "microtubules," which carry information inside brain cells. "Microtubules are like highways inside cells. What we're doing with [niacinamide] is making a wider, more stable highway," one of the researchers said. "In Alzheimer's disease, this highway breaks down. We are preventing that from happening."

On the road to healing

Researchers found that most people are able to take 1,000 milligrams of niacinamide three times daily indefinitely with no adverse effects. Nearly everyone reported that their arthritis symptoms started to improve in just three to four weeks. And after three to four months they'd most often disappear completely-and stay away as long as the person kept taking the vitamin. However, if they stopped taking it, the symptoms it had relieved would start to return (or worsen) just as quickly as they gone away-and come back as bad as ever in within four months.

Occasionally someone would experience nausea taking the full amount of niacinamide. Whenever this occurred, it is recommended that the dose be cut in half, to 500 milligrams three times daily.

According to news reports, clinical trials in humans with Alzheimer's are set to begin in 2010 in both England and Southern California. But, again, there's no need for you to wait for the outcome of these clinical trials to try niacinamide for a family member who has Alzheimer's already. Its exceptional safety, affordability, and availability make it worth trying right now. And when it's Alzheimer's, the sooner naicinamide is started, the better the chances are for it to work, before the accumulation of "intracellular garbage" has done irreversible damage. Of course it's best to work with a physician skilled and knowledgeable in nutritional and natural medicine, in case you have any questions.

Niacinamide is available in 500 and 1,000 milligram capsules and tablets. It can be found at nearly any natural food store and pharmacy.

Side Effects of Niacinamide

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Niacinamide:

• ·         Diarrhea;
• ·         dizziness;
• ·         headache;
• ·         itching; nausea;
• ·         stomach upset;
• ·         temporary feeling of warmth or flushing of the skin.

Seek medical attention right away if any of these SEVERE side effects occur when using Niacinamide:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry, or bloody stools; changes in vision; dark urine; decreased urination; fast or irregular heartbeat; loss of appetite; muscle pain or weakness; numbness or persistent tingling of the skin; persistent nausea, vomiting, or general "unwell" feeling; severe or prolonged flushing of the skin; stomach pain; swelling of the hands, legs, or feet; vomit that looks like coffee grounds; yellowing of the skin or eyes.

Sources and Additional Information:

http://en.wikipedia.org/wiki/Niacin

http://en.wikipedia.org/wiki/Niacinamide

http://www.mayoclinic.com/health/niacin/NS_patient-niacin

http://www.alternative-medicine-digest.com/alzheimers-treatment.html

http://ahha.org/Alzheimers.htm

http://www.drugs.com/sfx/niacinamide-side-effects.html

Curry as potential Alzheimer's weapon

A dietary staple of India, where Alzheimer's disease rates are reportedly among the World's lowest, holds potential as a weapon in the fight against the disease.

The UCLA-Veterans Affairs study in 2004, involving genetically altered mice suggested that curcumin, the yellow pigment in curry spice, inhibits the accumulation of destructive beta amyloids in the brains of Alzheimer's patients and also breaks up existing plaques. The research team also determined curcumin is more effective in inhibiting formation of the protein fragments than many other drugs being tested as Alzheimer's treatments. The researchers found the low molecular weight and polar structure of curcumin allow it to penetrate the blood-brain barrier effectively and bind to beta amyloid.

Indian Spice Curry Could Treat Alzheimers

In earlier studies, the same research team found curcumin has powerful antioxidant and anti-inflammatory properties, which scientists believe help ease Alzheimer's symptoms caused by oxidation and inflammation. ``Curcumin reduced the accumulation of beta-amyloid and the associated loss of proteins'' in the synapses, or gaps, between individual brain cells. Synapses connect nerve cells and are crucial for memory. Keeping synapses free of plaque is important because ``their loss correlates well with memory decline in Alzheimer's”, according to researcher Dr. Sally Frautschy of the University of California, Los Angeles.

"The prospect of finding a safe and effective new approach to both prevention and treatment of Alzheimer's disease is tremendously exciting," said principal investigator Gregory Cole. He is professor of medicine and neurology at the David Geffen School of Medicine at UCLA, associate director of the UCLA Alzheimer's Disease Research Center, and associate director of the Geriatric Research, Education and Clinical Center at the VA Greater Los Angeles Healthcare System at Sepulveda, Calif.

"Curcumin has been used for thousands of years as a safe anti-inflammatory in a variety of ailments as part of Indian traditional medicine," Cole said. "Recent successful studies in animal models support a growing interest in its possible use for diseases of aging involving oxidative damage and inflammation like Alzheimer's, cancer and heart disease. What we really need, however, are clinical trials to establish safe and effective doses in aging patients."

Alzheimer's disease (AD) is an irreversible, progressive brain disorder that occurs gradually and results in memory loss, unusual behavior, personality changes, and a decline in thinking abilities. These losses relate to the death of brain cells and the breakdown of the connections between them.

The disease is the most common form of dementing illness among middle and older adults, affecting more than 4 million Americans and many millions worldwide. The prevalence of Alzheimer's among adults ages 70-79 in India, however, is 4.4 times less than the rate in the United States.

Widely used as a food dye and preservative, and in some cancer treatments, curcumin has undergone extensive toxicological testing in animals. It also is used extensively in traditional Indian medicine to treat a variety of ailments.

Indian Spice Curry Could Treat Alzheimers

A different study of more than 1,000 older men in Singapore n 2006 also found that those who ate lots of curry-spiced food did better on memory tests than those who rarely ate the spice. The findings from Singapore suggest curry may help keep the aging brain in top shape. But to get the proof that curcumin fights cancer or Alzheimer's or arthritis, researchers will have to conduct large clinical trials, Cole says, and those studies will be expensive and take years to complete.

Professor Murali Doraiswamy, director of the Mental Fitness Laboratory at the Department of Psychiatry, Duke University Medical Center, Carolina, supported the point that curcumin, from which turmeric is made, might prevent the spread plaque found in the brains of Alzheimer's patients. Prof Doraiswamy said: "Studies seem to show that you need only consume what is part of the normal diet – but the research studies are testing higher doses to see if they can maximize the effect. It would be equivalent of going on a curry spree for a week. Don't expect an occasional curry to counterbalance a poor lifestyle. However, if you have a good diet and take plenty of exercise, eating curry regularly could help prevent dementia."

Sources and Additional Information:

http://www.usatoday.com/news/health/2007-01-07-curry-cover_x.htm

http://www.tgdaily.com/general-sciences-features/42699-curry-could-cure-alzheimers

http://www.telegraph.co.uk/health/healthnews/5436618/Curry-may-prevent-Alzheimers-disease-expert-says.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1702408/

http://www.scienceblog.com/cms/node/6556

Art Therapy for Alzheimer's

People often say that art “speaks” to them. When words and thoughts fail, as in the case of Alzheimer’s dementia, the symbolic language of art can tell a story, express an emotion or recreate a memory that may otherwise be left untold.

The Memories in the Making Art Program began in 1988 in Orange County, California, when Selly Jenny, whose mother had Alzheimer’s disease, explored the use of an art program to identify how much dementia patients could reveal about themselves through the medium of art. The program is now service of the Alzheimer’s Association, and has expanded to over 26 chapters across the nation.

While Alzheimer’s and dementia damage the portions of the brain that have to do with memory and planning complex tasks, the portions that is involved in emotion and in aesthetic appreciation remain intact for much longer.

Patients with the disease have difficulty with attention and concentration, but experts say that art therapy has provided an extraordinary outlet. Therapists have witnessed an increase in freedom and spontaneity, calming of agitation, relief of isolation, and improved communication through art sessions. Dr. Gene Cohen, director of the Center on Aging at George Washington University, has studied the effect of art on people with Alzheimer’s. “Art is a wonderful activity that taps into imagination. Even with the loss of memory, the capacity for imagination still has its place.”

There is research that suggests that art helps Alzheimer’s patients. In a small study, weekly sessions of art therapy helped patients focus their attention for up to 30 to 45 minutes, and the completion of the project brought pleasure and satisfaction. "It is an opportunity to express themselves even after some of their standard human communications abilities of expression have gone,'' said Peter Reed, director of care services for the Alzheimer's Association.

Art therapy can also help with the depression that comes along with the disease. A 1999 study at Brighton University found that Alzheimer’s sufferers who took part in art therapy showed a significant improvement to their symptoms after a ten-week course.

In addition to memory loss, the disease can affect muscle memory and coordination. Art therapy can help patients regain some function because it actively engages both hemispheres of the brain. For those who have problems carrying out movements, facilitators will use a hand-over-hand technique, which guides the artist so he or she can do it on their own.

Art therapy might be particularly beneficial to people with Alzheimer’s disease because though they gradually lose the ability to express themselves with words, other parts of their brain that deal with colors and composition can still be used and developed. Even people with advanced Alzheimer’s disease can continue to create art.

Just viewing art can have a therapeutic effect on Alzheimer’s patients as well. Patients with dementia often develop what doctors call the “four A’s” – anxiety, aggression, agitation, and apathy. The four A’s tend to fade in front of artwork, and have a calming effect. “Emotional memory” may come alive, and the patient begins to relate to people and places in their past.

Well-known Woodland Hills physician, Dr. Arnold Bresky, calling himself a “preventive gerontologist” has been successfully utilizing art therapy for patients that have Alzheimer’s and dementia. He claims he has achieved a 70% success rate with in improving his patient’s memories. Bresky assures that helping them to paint and draw reduces their memory loss.

Dr. Bresky calls his program a “Brain Tune Up” and says it’s a multi-disciplinary approach that also implements music. Bresky states that his art therapy program helps people with Alzheimer’s and dementia exercise their brains.

“The brain works through numbers and patterns,” Bresky says. “The numbers are on the left side of your brain, the patterns are on the right side. What I’m doing is connecting the two sides.”

“And we’re getting the brain to grow new cells. It’s called `brain plasticity.’ The brain changes physically to the environment.”

How Does Art Therapy Help Someone with Alzheimer’s?


A number of benefits are associated with art therapy. These include:

• New way to communicate. Art therapy allows people with Alzheimer’s disease to connect with others in a different, non-verbal way. And it's a healthy method of helping your loved one to express thoughts and feelings and let go of some of the negative emotions they may be experiencing.
• Improved concentration. Art therapy focuses on other possibly untapped areas of the brain and helps to improve concentration in people with Alzheimer's. Art therapy emphasizes abilities that are still available and can be developed rather than focusing on those that have been lost.
• Better behavior. Both viewing and creating art can have a calming effect on someone with Alzheimer’s disease. Similar to the effects of listening to music or playing with pets, "art therapy may promote relaxation, improve mood, and decrease disruptive behavior," says Dr. Faison.
• Closer relationships. Art therapy can bring a caregiver and a loved one with Alzheimer’s disease closer together. When other methods of contact become difficult, art therapy reminds the caregiver that the person with Alzheimer’s is still there.

How Can Caregivers Utilize Art Therapy at Home?


Though this form of therapy is done by professional art therapists in facilities, caretakers at home can also use some of the methods. Art therapy may provide significant benefits to the difficult task of caring for a patient with Alzheimer’s Disease. Art allows the patient to connect with others around them non-verbally, communicating in a way that can express thoughts, feelings, and emotions. The therapy may promote relaxation and decrease disruptive behavior. And most of all, art therapy can bring a caregiver closer to their loved one.

Here are some ways that you can incorporate the fundamentals of art therapy into your home-care regimen:

• Make an art project part of your regular routine. Don’t worry about the result; just let the person with Alzheimer’s enjoy the process.
• Provide safe and non-toxic materials. Watercolors are a good choice for painting; crayons and coloring books for adults work well; and sculpting with clay is also a good option for people with Alzheimer's.
• Establish friendships. You might consider enrolling your loved one in an art class with other people who have Alzheimer’s disease. This will help your loved one to get involved socially with others and can give you a much-needed break. Many Alzheimer’s adult day care centers have art therapy programs.
• Go to a museum. Seeing art is also a valuable part of this form of therapy and it gives you and your loved one the opportunity to share an activity together, get out of the house, and get some exercise.
• Scrapbooking. Making a scrapbook is an increasingly popular activity that both caregivers and persons with Alzheimer’s disease can do together. Picking out colorful backgrounds and placing favorite photographs into an album can wake up old memories and stimulate a sense of togetherness and shared happiness.

Review the video trailer to documentary "I Remember Better When I Paint", narrated by Oscar-winning actress Olivia de Havilland (of Gone with the Wind), and features a stirring interview with Yasmin Aga Khan, daughter of acclaimed American actress, and Alzheimer's sufferer, Rita Hayworth, who took up painting while struggling with the disease and produced beautiful works of art also featured in the film. The documentary deals with common myth about Alzheimer's that it is a veritable death sentence. That once diagnosed, a person will ultimately deteriorate into an unrecognizable shell of his/her former self. But as the filmmakers demonstrate, this need not be the case. The creative arts can reunite even a late stage Alzheimer's sufferer with parts of his/her former self. These non-medicinal options render success rates comparable to their pharmaceutical counter-parts. Indeed, art therapy can provide outlets of expression for an Alzheimer's sufferer where conventional means of expression prove insufficient.

I remember better when I paint

Sources and Additional Information:

http://www.emaxhealth.com/1506/91/34402/art-therapy-can-improve-quality-life-alzheimer’s-patients.html

http://www.everydayhealth.com/alzheimers/alzheimers-art-therapy.aspx

http://www.arttherapyblog.com/art-therapy-seniors/art-therapy-helps-alzheimers-patients-improve-memory/

http://www.huffingtonpost.com/rosalia-gitau/art-therapy-for-alzheimer_b_495914.html

Neuropsychological Testing for Alzheimer’s

Standard psychological/psychiatric evaluation, if there is even slight suspicion on the Alzheimer’s disease, should be complemented by additional neuropsychological tests, conducted to determine more specifically the type and level of cognitive impairment people are exhibiting, as well as their strengths and preserved abilities. Information about preserved abilities is important to help form a treatment plan and recommendations about environmental modifications that would be useful (e.g., job modifications, looking for a more supportive living environment, etc.).

Neuropsychological testing is used in the evaluation of Alzheimer's disease to learn more about the nature and level of a person's impairment. The testing is often conducted by a neuropsychologist (a psychologist who specializes in the relationship between the brain, behavior, and functioning). Several tests are available that can narrow the range of possible diagnoses by producing test patterns that resemble Alzheimer's or other conditions. A neuropsychologist might use one test or a whole battery of them, depending on the individual.

Neuropsychological tests measure memory, concentration, visual-spatial, problem solving, counting, emotional states and language skills and the "scores" on these tests contribute to a ratings scale which is used as evidence to support a diagnoses. When considering rating scales in general and dementia in particular, it is important to keep the following items in mind:

1. A rating scale is only as good as the clinician using it. This means that rating scales are subject to "operator error" and need to be viewed in the context of the "complete" package of evidence.
2. Rating scales do not confirm a diagnosis. This means that they are used to assess and monitor suspected or diagnosed cognitive problems. They are part of the evaluation and management of dementia based disease, but are not "diagnostic tools" unto themselves.
3. Rating scales do not exist in a vacuum. This means that they need to be viewed in the context of the applicant’s entire medical history and clinical findings. While the results can form a piece of the puzzle, they by no means represent the entire puzzle.

A variety of tests are available that can narrow the range of possible diagnoses by identifying patterns indicative of Alzheimer's, head injury, stroke, or other conditions. For example, someone with a head injury may exhibit amnesia (an inability to learn and recall new information and/or problems remembering previously learned information or past events) as the most prominent symptom, while someone with Alzheimer's will show short-term memory impairment, but not necessarily amnesia. A neuropsychologist might administer one test or a whole battery of them, depending on the individual.

Some of the more common tests include:

-        Neuropsychiatric Inventory (NPI)

The Neuropsychiatric Inventory (NPI) evaluates a wider range of psychopathology than comparable instruments (Cummings et al, 1994). Assesses 12 neuropsychiatric disturbances common in dementia: Delusions, hallucinations, agitation, dysphoria, anxiety, apathy, irritability, euphoria, disinhibition, aberrant motor behavior, night-time behavior disturbances, and eating disturbances. It is scored from 1 to 144 and severity and frequency are independently assessed. The NPI has been translated into a number of languages and it is now used widely in drug trials.

-        Clock drawing test

The clock drawing test takes only 2 minutes to administer and assesses cognitive or visuospatial impairment (Brodaty & Moore, 1997; Shulman et al, 1986). The main advantages are its simplicity of administration and the non-threatening nature of the task. The patient is asked to draw a clock face marking the hours and then draw the hands to indicate a particular time (e.g. 10 minutes to 2).

-        ADAS-Cog (Alzheimer's Disease Assessment Scale-Cognitive)

An 11-part test that takes 30 minutes to complete and is considered more thorough than the Mini-Mental State Exam. The ADAS-Cog focuses on attention, language, orientation, executive, and memory skills.

-        Blessed Test

One of the older neuropsychological tests, the Blessed Test takes only 10 minutes and assesses memory, attention, concentration, and the ability to complete activities of daily living, such as bathing, dressing, grooming, and eating.

-        CANTAB (Cambridge Neuropsychological Test Automated Battery)

This unique tool includes 13 interrelated computerized tests of memory, attention, and executive functioning. The battery is administered through a computer by using a touch-sensitive screen. Research has shown the CANTAB to be relatively unbiased regarding a person's language and culture. It's also been shown to be quite sensitive to warning signs of Alzheimer's disease.

-        Cognistat (Neurobehavioral Cognitive Status Examination)

The Cognistat assesses language, construction (the ability to copy or assemble items in a two- or three-dimensional space), memory, mathematical calculations, and reasoning/judgment. The test takes approximately 10 minutes when the person shows no cognitive impairment; for those who are cognitively impaired, the test can take 20 to 30 minutes.

-        Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD)

This test provides a global rating of behavioral symptoms such as verbal aggression, physical aggression, and hyperactivity. In addition to diagnosis, the scale is often used when clinicians want to determine how well medications are working to manage someone's behavioral symptoms.

-        Dementia Rating Scale - 2 (DRS-2)

This is a 15-20 minute measure of cognitive impairment, which yields scores in five areas: attention, initiation/perseveration (i.e., the ability to start or stop doing a task), construction, conceptualization (interpreting what is seen, heard, etc., into an idea or a conclusion), and memory.

Obviously, diagnosing Alzheimer's is a complex process because the physician (or team of health care professionals) has a great deal of information to sort through. Most of the cognitive tests that have been used to decide whether someone has Alzheimer's disease or vascular dementia have not been very helpful when used alone. A new report published by the American Psychological Association concluded that when older people are confused and forgetful, doctors should base their diagnoses on many different types of information, including medical history and brain imaging.

Sources and Additional Information:

http://alzheimers.about.com/od/diagnosisofalzheimers/tp/neuropsychtests.htm

http://alzheimer.ucdavis.edu/faq/tests/index.php

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=15334&cn=231

http://www.sciencedaily.com/releases/2009/07/090708132822.htm

Red Wine as effective weapon against Alzheimer’s Disease

Scientists call it the "French paradox" — a society that, despite consuming food high in cholesterol and saturated fats, has long had low death rates from heart disease. Research has suggested it is the red wine consumed with all that fatty food that may be beneficial — and not only for cardiovascular health but in warding off certain tumors and even Alzheimer's disease. So, red wine, together with Coffee and Marijuana, appears to be a strong natural weapon against merciless illness.

Alzheimer's researchers at UCLA, in collaboration with Mt. Sinai School of Medicine in New York, have offered a framework mechanism on how red wine may actually reduce the incidence of the disease. Reporting in the Nov. 21, 2008 issue of the Journal of Biological Chemistry, David Teplow, a UCLA professor of neurology, and colleagues show how naturally occurring compounds in red wine called polyphenols block the formation of proteins that build the toxic plaques thought to destroy brain cells, and further, how they reduce the toxicity of existing plaques, thus reducing cognitive deterioration.

Polyphenols comprise a chemical class with more than 8,000 members, many of which are found in high concentrations in wine, tea, nuts, berries, cocoa and various plants. Past research has suggested that such polyphenols may inhibit or prevent the buildup of toxic fibers composed primarily of two proteins — Aß40 and Aß42 — that deposit in the brain and form the plaques which have long been associated with Alzheimer's. Until now, however, no one understood the mechanics of how polyphenols worked.

Teplow's lab has been studying how amyloid beta (Aß) is involved in causing Alzheimer's. In this work, researchers monitored how Aß40 and Aß42 proteins folded up and stuck to each other to produce aggregates that killed nerve cells in mice. They then treated the proteins with a polyphenol compound extracted from grape seeds. They discovered that polyphenols carried a one-two punch: They blocked the formation of the toxic aggregates of Aß and also decreased toxicity when they were combined with Aß before it was added to brain cells.

"What we found is pretty straightforward," Teplow said. "If the Aß proteins can't assemble, toxic aggregates can't form, and thus there is no toxicity. Our work in the laboratory, and Mt. Sinai's Dr. Giulio Pasinetti's work in mice, suggest that administration of the compound to Alzheimer's patients might block the development of these toxic aggregates, prevent disease development and also ameliorate existing disease."

The researchers, from Mount Sinai School of Medicine, studied Mice, which were portraying alterations in the brain akin to Alzheimer's in 2006. The mice were fed with doses of Cabernet Sauvignon. It was observed that benefits of red wine was noticeably higher than the effects of ethanol or water; the mice showed remarkable reduction in the trademark alterations associated with memory in Alzheimer's disease. Indeed, Cabernet Sauvignon's contribution is crucial, preventing plaque accumulation in the brain, a distinguishing feature in the development of Alzheimer’s.

Researchers Dr. Giulio Maria Pasinetti and Dr. Jun Wang said "This study supports epidemiological evidence indicating that moderate wine consumption, within the range recommended by the FDA dietary guidelines of one drink per day for women and two for men, may help reduce the relative risk for AD clinical dementia."

Scientists at The Feinstein Institute for Medical Research have performed their own investigation on how and why a substance in red grapes and red wine lowers amyloid beta levels that accumulate in the brains of Alzheimer’s patients. Medicines targeting amyloid beta (Abeta) that make up the clumps in the hallmark plaques are now in many phases of experimental testing. The hope is that clearing out amyloid beta before it accumulates could stave off the disease and reduce symptoms.

Scientists at the Feinstein hope to develop this natural substance, called resveratrol, for the treatment of Alzheimer’s. Valorie Vingtdeux, PhD, and her colleagues have discovered that a specific protein —AMPK — controls Abeta levels. AMPK is interesting because it is a metabolic sensor in the cells and throughout the body. It senses levels of ATP, the body’s fuel source. When ATP levels drop, AMPK is activated to prepare the cells to adjust to the metabolic change in the body when fuel is low. It’s like a driver moving along at 50 miles per hour and slowing down when there is trouble ahead. Resveratrol activates AMPK, and in turn this protein lowers Abeta levels. Dr. Vingtdeux has presented these findings at the Society for Neuroscience in Washington, DC. The work has been done so far in cell culture, but Philippe Marambaud, PhD, who oversees the research, said there is every reason to believe that a similar process takes place in nature. “We hope that this result will translate into beneficial effects for Alzheimer’s patients someday,” said Dr. Marambaud. This is an important finding because the scientists identified a new potential molecular target — AMPK — to lower Abeta levels in Alzheimer’s.

Sources and Additional Information:

http://www.sciencedaily.com/releases/2008/11/081121092454.htm

http://www.bio-medicine.org/medicine-news/Red-Wine-3A-One-Drink-A-Day--Keeps-Alzheimers-At-Bay-21-14542-1/

http://www.cbsnews.com/stories/2006/09/20/health/webmd/main2026049.shtml

http://feinsteininstitute.typepad.com/feinsteinweblog/2009/01/red-wine-and-alzheimers.html

http://www.environmentalhealthnews.org/ehs/newscience/resveratrol-may-slow-plaque-formation-in-brain/

17 Myths and Facts about Alzheimer's Disease

According to the Alzheimer's Association, about 5 million Americans are living with Alzheimer's disease today -- a figure that's expected to increase as the baby boom generation ages. The disorder causes neurons, or cells in the brain, to malfunction and die. The onset of Alzheimer's usually happens after the age of 60, but early-onset Alzheimer's can affect younger people. Though scientists have learned much about the illness in the last decade, many questions remain about the causes, stages, and treatment of Alzheimer's. It's not surprising, then, that patients' and caregivers' understanding of the disease is often off-target. Myths and half-truths only add to fear of the disease, which can prevent people from getting help that could improve their quality of life.

Here are 17 common myths about Alzheimer's -- busted.

Myth: If you're forgetful, you're getting Alzheimer's disease.

Reality: Memory loss is a key symptom of Alzheimer's, but forgetfulness doesn't mean you have the disease. Even if your forgetfulness is due to more than simple aging, there are still many causes for dementia that lead to a decrease in cognitive function; physicians will make an Alzheimer's diagnosis only after other conditions have been ruled out.

Myth: Memory loss is a natural part of aging.

Reality: In the past people believed memory loss was a normal part of aging, often regarding even Alzheimer’s as natural age-related decline. Experts now recognize severe memory loss as a symptom of serious illness. Whether memory naturally declines to some extent remains an open question. Many people feel that their memory becomes less sharp as they grow older, but determining whether there is any scientific basis for this belief is a research challenge still being addressed.

Myth: Most people with Alzheimer’s are oblivious to their symptoms.

Reality: Typically someone in the early stage of Alzheimer’s disease does realize, at least part of the time, that something’s wrong. (Whether they recognize it as Alzheimer’s is another matter.) Most people with the disorder are aware that they’re experiencing memory lapses, for example, or that they’re starting to have trouble doing certain familiar tasks (following a favorite card game, cooking a particular recipe). Insight varies by individual, and the degree of awareness can shift from day to day.

Depending on their level of awareness and attitude toward correction, people with Alzheimer’s may appreciate being gently told when they make a mistake due to memory loss, disorientation, or another disease symptom. On the other hand, self-awareness of symptoms can make someone frustrated, angry, scared, or socially withdrawn. As the disease progresses and symptoms worsen, awareness of the situation is likely to decline.

Myth: An x-ray of the brain can diagnose Alzheimer's disease.

Reality: Unfortunately, the brain changes that cause Alzheimer's can not be seen with an x-ray. However, promising new tests using MRI and other imaging techniques are in development. Physical examination is important to rule out other conditions; the disease is then most often diagnosed by a series of tests of mental status.

Myth: If you have a family member with Alzheimer's, you'll get it, too.

Reality: In rare cases, early-onset Alzheimer's is inherited through genes. This familial form of Alzheimer's causes just 7% of all Alzheimer's cases. Genetics plays a small role for those people who don't have this form of Alzheimer's but who do get the disease later in life. If you have a parent, brother or sister with the disease, you have a slightly higher risk of getting it.

Myth: Aluminum in products we use causes Alzheimer's.

Reality: Most of us use products every day that contain aluminum. Food prepared in aluminum pots and pans carries trace amounts of the metal. Many underarm antiperspirants also contain aluminum. There is no scientific evidence that aluminum exposure causes Alzheimer's. Although the disease's exact cause is unknown, most research suggests that several factors, such as age, genetic susceptibility and overall quality of health, ultimately contribute to whether or not someone develops the disease.

Myth: Aspartame causes memory loss.

Reality: This artificial sweetener, marketed under such brand names as Nutrasweet and Equal, was approved by the U.S. Food and Drug Administration (FDA) for use in all foods and beverages in 1996. Since approval, concerns about aspartame's health effects have been raised.  According to the FDA, as of May 2006, the agency had not been presented with any scientific evidence that would lead to change its conclusions on the safety of aspartame for most people. The agency says its conclusions are based on more than 100 laboratory and clinical studies.

Myth: Flu shots increase risk of Alzheimer’s disease

Reality: A theory linking flu shots to a greatly increased risk of Alzheimer’s disease has been proposed by a U.S. doctor whose license was suspended by the South Carolina Board of Medical Examiners. Several mainstream studies link flu shots and other vaccinations to a reduced risk of Alzheimer's disease and overall better health. 

• A Nov. 27, 2001, Canadian Medical Journal report suggests older adults who were vaccinated against diphtheria or tetanus, polio, and influenza seemed to have a lower risk of developing Alzheimer’s disease than those not receiving these vaccinations.
• A report in the Nov. 3, 2004, JAMA found that annual flu shots for older adults were associated with a reduced risk of death from all causes.

Myth: Silver dental fillings increase risk of Alzheimer's disease.

Reality: According to the best available scientific evidence, there is no relationship between silver dental fillings and Alzheimer's. The concern that there could be a link arose because "silver" fillings are made of an amalgam (mixture) that typically contains about 50 percent mercury, 35 percent silver and 15 percent tin. Mercury is a heavy metal that, in certain forms, is known to be toxic to the brain and other organs.

Many scientists consider the studies below compelling evidence that dental amalgam is not a major risk factor for Alzheimer's. Public health agencies, including the FDA, the U.S. Public Health Service and the World Health Organization, endorse the continued use of amalgam as safe, strong, inexpensive material for dental restorations.

• March 1991, the Dental Devices Panel of the FDA concluded there was no current evidence that amalgam poses any danger.
• National Institutes of Health (NIH) in 1991 funded a study at the University of Kentucky to investigate the relationship between amalgam fillings and Alzheimer's. Analysis by University statisticians revealed no significant association between silver fillings and Alzheimer's. 
• October 30, 2003, a New England Journal of Medicine article concluded that current evidence shows no connection between mercury-containing dental fillings and Alzheimer's or other neurological diseases. 

Myth: All old people have Alzheimer's disease.

Reality: Even though age is an important risk factor for Alzheimer's, the majority of old people do not have the disease. It's important to note that normal aging doesn't necessarily include dementia or Alzheimer's.

Myth: Alzheimer’s disease affects only old people.

Reality: Though the majority of patients with AD are above 65 years old, there are also cases, when the disorder affects people in their 50^th or even 40^th. That is why it is important to understand that the symptoms of AD, such as memory problems, are not part of normal aging. The earlier the disorder is detected – the more effective management of it could be.

Myth: Men are at higher risk of developing Alzheimer's than women.

Reality: Alzheimer's disease affects both men and women that is true but it is believed to be more common in women. The reason for this claim is based on the unrelated fact that women live longer than their opposite sex so are more likely to develop the disease at some stage of their life.

Myth: Alzheimer's disease is preventable.

Reality: There is no treatment that can prevent Alzheimer’s disease. There is, however, a growing amount of evidence that lifestyle choices that keep mind and body fit may help reduce the risk. These choices include being physically active; eating healthy foods including fresh fruits, vegetables and fish; keeping your brain challenged; reducing stress, keeping an eye on your blood pressure, blood sugar and cholesterol levels; avoiding traumatic brain injury; and keeping socially active.

Myth: Alzheimer’s disease can be cured with pills, herbs, or supplements.

Reality: Currently there is no cure for Alzheimer’s disease. Modern pharmaceutical options can only slow down the progression of the disorder. The effect of herbs, such as ginkgo biloba, vitamins E, B and C, as well as folic acid and selenium, on patients with Alzheimer’s disease is also not yet fully understood, and the history of their use for AD treatment contains many controversies and vagueness. There are some evidences of beneficial effect of the said remedies, but it is definitely too early to claim that they are able of curing Alzheimer’s disease.

Myth: Alzheimer’s disease makes people hostile, violent, and aggressive.

Reality: As a matter of fact, Alzheimer’s disease affects different people in different ways. Some patients develop certain changes in their behavioral patterns, like becoming violent or aggressive, and some do not. It is important to understand that the symptoms of AD may be frightening and scary first of all for a patient himself; that is why it is important to educate yourself, as well as a patient, about the disorder, and what to expect from it in order to prevent aggressive responses from a patient. Try to improve his usual surroundings in accordance with his specific demands, do not expose him to stressful events, and make him feel comfortable even with his gradually decreased abilities.

Myth: People with Alzheimer's disease cannot understand what is going on around them.

Reality: Some people with Alzheimer's disease understand what is going on around them; others have difficulty. The disease does affect a person's ability to communicate and make sense of the world around them, although it affects each person differently. When we assume someone does not understand, feelings can be hurt unintentionally. The fact is a person with Alzheimer's disease is still the same person as before and needs to be treated with dignity and respect.

Myth: Life with Alzheimer's disease isn't worth living.

Reality: There is no single course for Alzheimer's disease, which typically can be a part of a person's life for many years. Memory loss and communication problems can cause frustration and anger. With help, though, a person with Alzheimer's can have a meaningful and productive life. According to the National Institute of Neurological Disorders, several medications have been approved for early- and middle-stage Alzheimer's, including Aricept(donepezil), Exelon (rivastigimine),  Namenda (memantine), and Razadyne (galantamine; formerly Reminyl). A number of other medications can be used to control anxiety, depression, sleeplessness, and agitation, any or all of which may accompany the disease.

Sources and Additional Information:

http://alzheimers.about.com/lw/Health-Medicine/Conditions-and-diseases/Myths-and-Realities-of-Alzheimers-Disease.htm

http://www.pillwatch.com/info/alzheimers-disease-myths-and-realities.html

http://www.alz.org/alzheimers_disease_myths_about_alzheimers.asp

http://www.memorystudy.org/alzheimers_myths.htm

http://www.poststat.net/rightathome/pub.59/issue.1059/article.4339/