Based on new biomarker tests that allow the diagnosis of Alzheimer’s disease some ten years before symptoms begin to appear, the National Institute of Health (NIH) is proposing to change the diagnostic criteria of Alzheimer’s disease, to permit diagnosis of the disease before a patient has started to exhibit the telltale signs of memory loss that are the hallmark of the disease. Scientists believe that the brain of patients who will go on to develop Alzheimer’s disease start to exhibit detectable changes in the brain (such as plaque or amyloid) some 10 years before the patient exhibits symptoms such as memory loss and confusion. Recent scientific advances, such as a PET scan of the brain developed by Dr. Daniel Skovronsky M.D. (recently reported on in The New York Times) allow scientists to detect these changes in the brain that are the precursors of Alzheimer’s disease. The NIH is proposing that doctors be able to diagnosis Alzheimer’s disease when these biomarker tests show the brain changes associated with Alzheimer, even if the person has not yet exhibited clinical symptoms. Within the next few years, it is expected that these tests will be available to the general public.

That means that you or your family members will be able to be tested before you have become impaired. Right now, the prospect of being tested when there is no cure seems like a scary one. But doctor’s ability to diagnose Alzheimer’s disease before a patient has started to exhibit memory loss carries with it the promise of being able to treat the disease and prevent it from progressing to the stage where memory loss is present. Scientists are optimistic for the first time that treatment will be available in the coming years to diagnose and treat Alzheimer’s disease before impairment sets in.

What the NIH is doing is important, to assure that patients receive early treatment for the disease. Insurance companies are not big on paying for preventive treatment, and by labeling certain persons as having Alzheimer’s, before memory loss appears, it will be easier for such persons to qualify for insurance coverage for whatever pre-memory loss treatment that becomes available.

To read the New York Times article (Promise Seen For Detection of Alzheimer's) about Dr. Skovronsky’s test for Alzheimer’s disease, click here.

To read the Times article ("Rules Seek to Expand Diagnosis of Alzheimer's) about the proposed change in diagnostic criteria for Alzheimer’s disease, click here.

Felicia Curran
www.ElderAdvocacyLaw.com
www.ElderAdvocacyBlog.com

If you missed The Savages when it was out in theaters last year, make a point of seeing it now on DVD. If the question is whether anything positive can come out of a situation where you have to put your dying parent in a nursing home, the film’s answer’s to this question is “You bet it can..” Jon and Wendy Savage (played by Philip Seymour Hoffman and Laura Linney)(pictured below) are a brother and sister in their late 30s, who haven’t seen much of each other or their elderly Dad in the last twenty years. It seems that their Mom abandoned the family when they were young, leaving them to be brought up by their Dad, whom we learn was physically and emotionally abusive. We are shown how this lack of a safe family life in their childhood years has left them each with an aversion to intimacy in their adult lives.

Nonetheless, when the Dad (played by Philip Boscoe) is diagnosed with Parkinson disease, and needs their help, they travel to Sun City Arizona, where he lives, and bring him back to live in a nursing home in Buffalo, New York where Jon Savage is a college professor. As they arrive at the Dad’s home with an “I love you” balloon, Wendy says to Jon that “maybe Dad just forgot us” to explain his lack of communication.

Lest you think that the nursing home scenario promises to be too depressing to be enjoyable, the opposite is true. There are truly hilarious scenes which the director/writer Tamara Jenkins uses to illustrate the sometimes absurd rituals that family members go through when putting their parents in a nursing home. Wendy, for example, is convinced that her father will like a designer red pillow from Urban Outfitters as much as she will, and she goes ballistic when she discovers that another nursing home resident (who actually does LIKE if not LOVE the red pillow) has appropriated the pillow (which her father could care less about). The tug of war that ensues when Wendy tries to get the pillow back is priceless. There is also a scene where the kids try to talk to the Dad about advance directives, where the Dad proves wiser than the kids, although he’s the one with Parkinson’s disease. And many others.

The film also uses animals (a dog and a cat) to affirm the value of human life. Keep your eye on the dog in particular.

To view a trailer/preview, double-click below on the picture:



Felicia Curran
www.ElderAdvocacyLaw.com

The New York Times reports that Stanford scientists believe that they have developed a blood test that can accurately diagnose Alzheimer’s disease years before symptoms of truly debilitating memory loss are apparent. Currently, Alzheimer's disease can only be diagnosed definitely after death through autopsy, and with clinical probability through a battery of memory and behavioral tests.

The test proceeds on the assumption that the brain of a person who is developing Alzheimer's sends out signals to the body's immune system, releasing certain proteins into the blood. The blood test looks for the presence of 18 proteins in the blood thought to carry that message. The test is reported to be 90 percent accurate in distinguishing the blood of people with actual Alzheimer’s from the blood of those without the disease, and to have an accuracy rate of 80 percent in predicting which patients with mild memory loss would go on to develop Alzheimer’s disease two to six years later.

The studies need to be replicated in another lab, and it is likely to be a few years before the test would be available to the average person at their doctor's office, but the test may be available next year on a research study basis.

It is also hoped that this will be the first step in finding a cure for the disease.

To read the Times article, click here.

Felicia Curran
www.ElderAdvocacyLaw.com

A California neurologist, Dr. William Rodman Shankle M.D., is reported to be using the drug Exelon to successfully treat patients diagnosed with early stage Alzheimer disease. The FDA approved Exelon in 2000, and it reportedly stops the breakdown of a chemical transmitter in the brain. According to the Orange County register, Dr. Shankle believes that early detection is the key to halting the disease’s progression.

The article describes Dr. Shankle’s treatment of retired obstetrician Dr. Marvin Sando, M.D. Marvin (pictured to the right) retired in 1999. A few years into retirement, his wife noticed some strange changes in her husband. Marvin, who once added rows of numbers in his head, struggled with calculations. An avid reader who juggled five or six books at a time, he could no longer follow when he turned to his place in a book.

"It was frustrating as the devil," Sando recalls. "(Before) I might begin a book and pick it up three months later, and after one or two sentences know exactly where I was." He also found himself forgetting who people in his life were.

In 2002, he saw Dr. Shankle (pictured here with Marvin), who, after testing, diagnosed him with AZ. Dr. Shankle put him on a regimen of medication, including Exelon, as well as lifestyle changes --mandatory daily walks, a glass of wine only on rare occasions, and Sudoku instead of crossword puzzles to give his mind a new challenge. Reportedly, within a few months, Sando's memory test score improved to 100 percent. A PET scan at five months revealed much more activity in the memory storage parts of his brain.

Nearly five years later, on a regimen of medication, he is virtually symptom-free, confirmed by his scores on memory tests, images in brain scans and the ease of his everyday life.

"Every day when I take that little pill, I think of how lucky I am to be here," says Marvin Sando. "I'm enjoying every day." "You can't get any more dramatic than completely reverting to normal," Shankle says.

Dr. Shankle says that most AZ patients aren't diagnosed early enough to fully benefit. Because early diagnosis of AZ is the key to the efficacy of this treatment, Dr. Shankle believes that everyone should have an annual memory test, starting at age 65, to screen for early signs of Alzheimer disease.

You can read the article by clicking here. If you or a family member have early stage Alzheimer’s, show the article to your family physician, and ask for a referral to a specialist who would be qualified to advise you on the best course of treatment.


Felicia Curran
www.ElderAdvocacyLaw.com

What would you do if you realized that your incidents of “forgetfulness” are actually manifestations of Alzheimer’s disease or other memory-impairment disease? Would you live with it and stay in your home with your family for as long as you could? Or would you make the decision to enter a nursing home now so as to spare your family the grief that comes with such a decision? That’s the premise from which the newly released film “Away From Her” starts. The film is directed by Canadian actress Sarah Polley in her directorial debut. It stars Julie Christie as the elderly Fiona, and follows Fiona as she makes the decision to enter a nursing home. The film is set in rural Canada, so it is a Canadian nursing home, which is much better than the typical nursing home in the United States. The Canadian setting leaves the film free to focus, not on the horrors of nursing home life, but rather on the life-changing effects of separation and memory loss.

Says Producer Simone Urdl, "The role of Alzheimer's in the film is a metaphor for how memory plays out in a long-term relationship: what we chose to remember, what we choose to forget."

On the NPR website, you can find Terry Gross's interview with Director Sarah Polley and with Olympia Dukakis, who also stars in the movie. In the Polley interview, she describes how Julie Christie had been reported to have memory problems of her own for years, of unknown origin, but how it did not affect Christie's beautiful performance of the Fiona character. For those interviews, click here.

Click here to read A.O. Scott’s review "Time's Wounds and the Heart's" from the New York Times. The New York Times site also has a short video clip of the film.


Felicia Curran
www.ElderAdvocacyLaw.com