Experts from the Penn Memory Center are back from the 2011 Alzheimer’s Association International Conference, held in Paris, where they presented new data and discussed the ongoing challenges in Alzheimer’s diagnosis, treatment and care and some of the ethical struggles associated with newly developed tests to predict and diagnose the disease.
Presentation Discusses Cognitive Resilience
In early findings from one Penn study, researchers found that positive personality traits were associated with better cognitive performance in a detailed computerized test battery of memory, attention and other cognitive abilities. Lead author Susanne Steinberg, MD, presented the findings at AAIC, unveiling baseline data from a longitudinal, cohort study of 136 American adults aged 65 or older.
Participants had higher cognitive scores at the outset of the study if they were more conscientious and had a positive coping style (despite sometimes having experienced severe life stress). Some evidence was presented that suggested that not only formal education but also leisure cognitive stimulating activity contributed to cognitive performance. The researchers see these baseline data as the initial step in the development of a resilience index by identifying potential factors that predict cognitive stability in late life.
The research team included Penn's Mary Sammel, ScD, associate professor of Biostatistics; Mitchel Kling, MD, associate professor of Psychiatry; Natalia Louneva from Geriatric Psychiatry, as well as Penn Memory Center's Hannah McCoubrey, Stephanie Yuen, Carol Edwards, psychologist Melissa Livney, PsyD, and the Penn Memory Center director, Steven Arnold, MD, the study's senior author.
AAIC has posted a summary of the session from Mayo Clinic's Ronald Peterson and Dr. Steinberg's entire presentation, so you can watch online. The study was also featured by national syndicate HealthDay news.
Single Traumatic Brain Injury Linked to Dementia
In Paris, a large study of older war veterans suggested those who experienced traumatic brain injury (TBI) during their lives had more than two times the risk of developing dementia. Also this month, Douglas Smith, MD, professor of Neurosurgery and director of Penn's Center for Brain Injury and Repair reported in the journal Brain Pathology that two hallmark pathologies of Alzheimer's disease were found years after a single TBI, providing pathological data to support the epidemiological observation of an increased risk of developing Alzheimer's disease following a TBI.
TBI survivors showed a high density and wide distribution of neurofibrillary tau tangles and amyloid-beta plaque pathology far beyond what was found in controls. Specifically, about a third of the cases showed tangle pathology years after a single TBI, similar in appearance to the tangles found after repetitive TBI and in neurodegenerative diseases such as Alzheimer’s disease. Moreover, the amyloid-beta plaques were not only found years after TBI, but the majority of cases displayed diffuse as well as "neuritic" plaques with the same character as "senile" plaques also found in Alzheimer's disease. This suggests that years after a single TBI, amyloid-beta plaques may return and become neuritic.
These findings suggest that Alzheimer's disease-like neurodegeneration may be initiated or accelerated following a single traumatic brain injury, even in young adults.
Smith told USA Today that with so many soldiers returning from war affected by blasts, the relationship between TBI and dementia needs to be sorted out. It's unknown at this point how many soldiers have a history of brain injury, he says. "I'm even worried for people psychologically. People worry a lot about, 'Am I going to get Alzheimer's disease?'"
Dr. Smith also spoke with MSNBC.com and the Philadelphia Inquirer.
Understanding Complexity of Test Results, Genetic Risks
In other news, Jason Karlawish, MD, professor of Medicine in Geriatrics and Medical Ethics, weighed in on the debate about testing for Alzheimer's even in the absence of effective treatments, telling the Associated Press that, "The phrase you often hear is that the 'Big A' (Alzheimer's) has replaced the 'Big C' (cancer)" as a major source of fear.” But a researcher using one of these tests, such as a spinal fluid check for a substance that may predict Alzheimer's risk, has no obligation to disclose the results to a patient until there is a meaningful treatment for the disease, Karlawish argued at the conference.
In addition, Dr. Karlawish also commented on a five-country survey presented at AAIC which found that Alzheimer's is the second most-feared disease after cancer, except in Poland, where it's third, behind cancer and heart disease. Eight in 10 respondents said they would go to a doctor if they experienced confusion or memory loss. As many as 99% would take a family member with memory loss to the doctor. While fear of the disease is high, denial is lessening. "People understand that the value of a physician visit is not simply to write prescriptions for memory pills but to help a patient and family make sense of memory loss and, as a result, relieve their suffering," Karlawish told USA Today.
Elisabeth McCarty Wood, a genetic counselor at the University of Pennsylvania Center for Neurodegenerative Disease Research, also spoke with USA Today about the risk of Alzheimer's disease. There are no magic equations that can tell the offspring of someone with Alzheimer's whether they will succumb to it, and at what age it will strike, said McCarty Wood. "The biggest challenge I face when talking with families is that we're not at the point where we can give someone a number as to what their own personal risk is," she says. McCarty Wood says genetic testing is definitive for only 2% to 3% of the Alzheimer's population.
Were you following all the research coming out of AAIC? What Alzheimer's research captured your attention recently?