Older people with the highest needs will be offered free personal home care, Gordon Brown announced.

In a speech at the Labour party conference, Mr Brown said that to provide security for pensioners for generations to come, health and social care services would be brought together under a new National Care Service in England.

People with dementia are hit the hardest by the current care charging system and many are spending their life savings on what is often poor quality care. This dementia tax must end.

It is good to see the Prime Minister highlighting the increasing numbers of people with dementia and the growing human and economic cost of this devastating condition.

A commitment to free personal care for people with the most complex needs living in their own homes sounds like a promising development. We now need to hear the substance behind the sound bite. What is meant by highest needs and what criteria will be used to judge this? As the country debates who pays for care, we must also take action on improving the very poor standards of care provided to many people with dementia.

Neil Hunt
Chief Executive

Source

A study published in Neurology by researchers in the US has found that declining financial skills could be an early indicator of Alzheimers disease in people with mild cognitive impairment (MCI).

The year long study worked with 87 people with MCI, 25 of whom developed Alzheimertype dementia during the study period and 62 who did not; and with 76 cognitively healthy people as controls. The group was tested at the beginning of the year and at the end with a tool called the Financial Capacity Instrument (FCI). This measured skills including understanding of financial concepts, cash transactions, bank statement management and bill payment.

This could be a useful indicator for doctors supporting people with memory problems.

Everyone struggles now and then to divide a restaurant bill or tot up your chequebook. However, this study suggests that if you already experience significant memory problems and start to notice a decline in your financial skills it could be a sign of developing dementia.

More research is needed into memory decline to begin to find useful, early indicators of the development of dementia. Dementia research is desperately underfunded. One million people will develop dementia in the next 10 years. We must act now.

Dr. Susanne Sorensen
Head of Research
Alzheimers Society

Reference
Declining financial capacity in mild cognitive impairment by K.L. Triebel, PsyD, R.Martin, PhD, H.R. Griffith, PhD et al

Families in Ohio and Pennsylvania who use Healthsenses stateoftheart eNeighbor® remote monitoring to help care for elderly relatives with Alzheimers disease or dementia say the technology has enabled them to keep their loved ones safe at home for longer and delay placing them permanently in secured memory care units. They also credit the Healthsense technology with improving their own quality of life by helping relieve the stress and strain of tending to seniors with Alzheimers or dementia.

“Without the eNeighbor system, I honestly dont think my mother would still be able to live at home with us,” said Mary White, who has used the Healthsense technology for about a year in her Toledo, Ohio residence to help care for her 88yearold mother, who has Alzheimers. “She does so much better here with me than in a nursing home. She eats better. She exercises more. She has more company here. It also gives me peace of mind. Before, I couldnt even go out to the mailbox to get the mail without worrying that she might open a door and wander off.”

An estimated 5.3 million Americans have Alzheimers disease, the most frequent cause of dementia and the seventh leading cause of death, according to the Alzheimers Association. As the baby boomer population ages, the number of people aged 65 and older with Alzheimers is expected to reach 7.7 million in 2030 and between 11 million and 16 million by 2050. The Alzheimers Association estimates that as many as 10 million people, including family members, currently provide unpaid care for individuals with Alzheimers.

Developed with grants from the National Institutes of Aging (NIA) and the Defense Advanced Research Projects Agency (DARPA), the eNeighbor system is built around a set of batteryoperated WiFi sensors placed in private homes or senior living residences to monitor residents daily living activities and wellness. These sensors include pressure sensors in beds to detect when a resident gets in or out of bed; motion detectors on walls to detect movement or inactivity; toilet sensors to monitor toilet usage; contact sensors on kitchen cupboards and refrigerator doors to monitor whether the resident is eating regularly; and door sensors that alert when the resident tries to leave the residence or enter potentially hazardous areas, such as stairways. eNeighbors “smart” operating system uses algorithms to analyze the sensor data and determine whether the resident requires assistance. The system automatically issues assistive prompts or alerts via any phone when the data indicate help is needed. Information and reports can also be accessed from a secure web portal.

White has several sensors installed in the upstairs portion of her home where her mother lives. A motion sensor by the stairs alerts her via a call to her cordless home phone if her mother attempts to come downstairs at any time between 9 p.m. and 9 a.m. And if her mother gets up at night to go to the bathroom, the system (including a bed sensor and motion sensors) alerts White if she has not returned to her bed within 10 minutes. Downstairs, the side, front and back doors are all installed with sensors that alert if theyre opened between the hours of 9 a.m. and 9 p.m. A pressure sensor on her mothers chair also notifies White whenever her mother gets out of the chair during daylight hours.

“Im able to get a lot more sleep now,” said White. “Before I had the Healthsense technology installed, Id always have to sleep with one ear open. It was the same in the daytime. I had to make sure my house was locked at all times. I couldnt even go out into the yard. I was running back and forth all the time, exhausting myself, worrying that shed get out into the street. Now, its a lot safer for her and its such a relief to me. I feel good that Im able to take care of her here in my own home.”

Eleanor Watts, also a Toledo, Ohio resident, has used the eNeighbor technology in her home for more than a year to help care for her 66yearold husband, who has Alzheimers. The sensor in his bed alerts her via the home phone whenever he gets up. “It has freed me up so much, especially in summer,” she said. “I can take my phone now and go and do some gardening in the back yard. Before, I was trapped in the living room. I had to be close enough to hear him, because I never knew when he would get up. The technology has really opened up my world. I feel it will definitely help keep him at home with me for longer. Its a great boon for the caregiver.”

Adrienne Briggs, a Philadelphia resident whose 70yearold mother came to live with her two years ago after she was diagnosed with dementia, began using the eNeighbor system 20 months ago. In addition to bed, motion and door sensors, her system is also set up to alert her if her mother does not return to bed at night within 10 minutes after getting up to use the bathroom. “The eNeighbor technology has definitely helped keep my mom out of a nursing home, and it has given me peace of mind, knowing that she is being monitored at night when Im asleep,” said Briggs. “Before, I was never really able to go into a deep sleep, because I would always be listening out for her.”

“More and more families are telling us that the eNeighbor system has helped prolong the time that their loved ones with Alzheimers or dementia are able to live at home with them,” said Brian Bischoff, President and CEO of Healthsense. “This is a significant qualityoflife benefit not only for the caregivers but also for the patients, because once they are admitted to memory care, they permanently give up whatever remaining level of independence they may still enjoy. There are also important financial implications. The longer a patients passage to higher acuity care can be postponed, the less costly it is for families, patients, providers and payors.”

White and Watts are participants in a NIAfunded twoyear research project titled “Impact of Monitoring Technology on Family Caregivers” currently underway at Miami University in Oxford, Ohio. The project is directed by Jennifer M. Kinney, Ph.D., professor of gerontology and research fellow of the Scripps Gerontology Center (SGC) and Cary S. Kart, Ph.D., senior researcher with the SGC. Briggss mother receives her eNeighbor system through NewCourtland, a leading nonprofit provider of community services, housing and nursing homes in Philadelphia. Mary White and Eleanor Watts are pseudonyms, used to protect the privacy of the research study participants.

Source

For close to a decade, pharmaceutical researchers have been in hot pursuit of compounds to activate a key nicotine receptor that plays a role in cognitive processes. Triggering it, they hope, might prevent or even reverse the devastation wrought by Alzheimers disease.

A new study from the Salk Institute for Biological Studies, however, suggests that when the receptor, alpha7, encounters beta amyloid, the toxic protein found in the diseases hallmark plaques, the two may actually go rogue. In combination, alpha7 and beta amyloid appear to exacerbate Alzheimers symptoms, while eliminating alpha7 seems to nullify beta amyloids harmful effects.

These findings, reported recently in The Journal of Neuroscience, may shed new light on the processes leading to Alzheimers and could have important implications for researchers seeking to combat the disease.

Intrigued by earlier studies showing that beta amyloid seemed particularly drawn to the alpha7 nicotinic receptors, researchers in the lab of Stephen F. Heinemann, Ph.D., in the Salk Molecular Neurobiology Laboratory, sought to determine whether the alpha7 receptors actually modulate the effects of beta amyloid in Alzheimers disease.

“Alpha7 is expressed all over the brain,” says Heinemann, whose group first identified the brain receptors that respond to nicotine. “All mammals have it, and its probably essential for something, but we dont know what.”

Hypothesizing that the alpha7 nicotinic receptors mediate beta amyloid effects in Alzheimers disease, Heinemanns team crossed mice engineered to lack the gene for alpha7 with a mouse model for Alzheimers disease, which had been genetically engineered to overexpress amyloid precursor protein (APP), an antecedent to beta amyloid. They then put the offspring through a series of memory tests.

Surprisingly, those with both mutations too much APP and no gene for alpha7 performed as well as normal mice. The Alzheimers mice, however, which had the alpha7 gene and also overexpressed APP, did poorly on the tests. Pathology studies revealed the presence of comparable amounts of plaques in the brains of both types of mice, but in those lacking the alpha7 gene, they appeared to have no effect. Similar disparities were evident in measurements of the synaptic function underlying learning and memory.

“All the results together gave us idea that yes, alpha7 is in part a mediator of the synaptic and cognitive pathology produced by beta amyloid accumulation,” says first author Gustavo Dziewczapolski, Ph.D., a postdoctoral researcher in Heinemanns lab.

The findings also suggest that researchers seeking therapeutic targets for Alzheimers may be more successful if they block the function of the alpha7 receptor or block beta amyloids access to alpha7 rather than try to activate the receptor.

Dziewczapolski and Heinemann plan to continue their investigations of the alpha 7/beta amyloid connection, with the hope of identifying the mechanism behind the relationship and determining why the synapses die in Alzheimers.

“An Alzheimers epidemic is threatening to swamp the medical system within 20 years, but all clinical trials for targets that the field has identified have failed because of side effects or because they dont work,” says Heinemann. “This is a completely different target.”

This work was supported in part by National Institutes of Health/National Institute of Aging, the Bundy Foundation, and the Ellison Medical Foundation.

About the Salk Institute for Biological Studies

The Salk Institute for Biological Studies is one of the worlds preeminent basic research institutions, where internationally renowned faculty probe fundamental life science questions in a unique, collaborative, and creative environment. Focused both on discovery and on mentoring future generations of researchers, Salk scientists make groundbreaking contributions to our understanding of cancer, aging, Alzheimers, diabetes, and cardiovascular disorders by studying neuroscience, genetics, cell and plant biology, and related disciplines.

Faculty achievements have been recognized with numerous honors, including Nobel Prizes and memberships in the National Academy of Sciences. Founded in 1960 by polio vaccine pioneer Jonas Salk, M.D., the Institute is an independent nonprofit organization and architectural landmark.

Source Salk Institute for Biological Studies

A study led by Johns Hopkins and Utah State University researchers suggests that a particularly close relationship with caregivers may give people with Alzheimers disease a marked edge over those without one in retaining mind and brain function over time. The beneficial effect of emotional intimacy that the researchers saw among participants was on par with some drugs used to treat the disease.

A report on the study, believed to be the first to show that the patientcaregiver relationship may directly influence progression of Alzheimers disease, is published in the September 2009 The Journals of Gerontology Series B Psychological Sciences and Social Sciences and currently available online.

“Weve shown that the benefits of having a close caregiver, especially a spouse, may mean the difference between someone with AD staying at home or going to a nursing facility,” says Constantine Lyketsos, M.D., M.H.S., the Elizabeth Plank Althouse Professor in Alzheimers Disease Research and director of the Johns Hopkins Memory and Alzheimers Treatment Center.

Lyketsos cautions that it remains unclear how or why this benefit was evident in the study, since the results may be due to milder forms of Alzheimers disease among those who reported close relationships. “A close relationship might prompt caregivers to deliver more attentive treatment, but it might be the other way around, with a milder illness helping caregivers stay close,” Lyketsos says. “Our next study is designed to detangle whats going on.”

Researchers have long been interested in the relationships between caregivers and Alzheimers disease patients, with many studies focusing on the wellbeing of caregivers. However, little was known about the converse relationshiphow caregivers affect the wellbeing of people with Alzheimers disease.

To find out, Lyketsos and colleagues at Johns Hopkins, Utah State, University of Washington, Duke University and Boston University examined 167 pairs of caregivers and Alzheimers patients. The pairs were recruited from the Cache County (Utah) Dementia Progression Study, which has tracked hundreds of people with Alzheimers and other types of dementia since 1994. All of the study participants live in Cache County, whose residents topped the longevity scale in the 1990 United States census.

Starting in 2002, the researchers met with patientcaregiver pairs in their homes every six months for periods up to four years. At each meeting, the patients underwent a battery of tests to assess physical, cognitive, functional and behavioral health. The researchers also interviewed the caregivers spouses, adult children or adult childreninlaw about the caregiving environment and gave them a survey to assess how close their relationships were with the patients. The survey asked caregivers to rate their level of agreement or disagreement with six statements, such as “My relationship with the care recipient is close”; “The care recipient makes me feel like a special person”; and “The care recipient and I can always discuss things together.”

At the outset of the study, all patients scored similarly on cognitive and functional tests. However, as time progressed, the researchers found marked differences between patients whose caregivers had scored their relationships as close or more distant on the surveys. Patients with whose caregivers felt particularly close to them retained more of their cognitive function over the course of the study, losing less than half as many points on average by the end of the study on a common cognitive test called the MiniMental State Exam (MMSE), compared to patients with more distant caregivers. Patients with close caregivers also scored better on a functional test called the Clinical Dementia Rating, remaining significantly closer to baseline over time compared to those with more distant caregivers.

The “closeness effect” was heightened for pairs in which the caregiver was a spouse, as opposed to an adult child or inlaw. Patients with close spouses declined the slowest overall, with scores on the MMSE showing changes over time similar to patients participating in recent clinical trials for FDAapproved Alzheimers drugs called acetylcholinesterase inhibitors.

“Weve shown that the benefits of having a close caregiver, especially a spouse, may be substantial. The difference in cognitive and functional decline over time between close and notasclose pairs can mean the difference between staying at home or going to a nursing facility,” says Lyketsos.

Middleaged people living alone have twice the risk of developing dementia and Alzheimers disease in later life compared with married or cohabiting people, while being widowed or divorced in midlife carries three times the risk, according to a study led by Miia Kivipelto from the Swedish medical university Karolinska Institutet and published on bmj.com.

As life expectancy is increasing in various regions of the world, dementia is becoming a growing public health concern. In 2005 an estimated 25 million people had dementia, and the number is expected to reach 81.1 million in 2040.

While there have been a number of studies linking being in a couple to good health and longevity this is one of the first studies to focus on midlife marital status and the risk of dementia.

So researchers based in Finland and Sweden interviewed a random sample of 2,000 men and women who took part in the cardiovascular Risk Factors, Aging and Dementia study. The participants came from two regions in Eastern Finland.

Individuals were initially surveyed at around 50 years of age and again around 21 years later. Participants were divided into the following groups married/cohabitant, single, divorced or widowed. The team also investigated whether there was a link between living alone and being a carrier of the apolipoprotein E e4 gene variant (or allele), the known genetic risk factor for Alzheimers disease.

The results reveal that people living without a partner during middle age had a much higher risk of developing cognitive impairment in late life compared to those living with a partner. Individuals who are widowed at this age are three times more likely to develop dementia. The study also concludes that carriers of apolipoprotein E e4 gene variant who lose their partners and remain living alone have the highest risk of developing Alzheimers disease.

The authors say these results are important for preventing dementia and cognitive impairment and that “supportive intervention for individuals who have lost a partner might be a promising strategy in preventive health care.”

These results also add to a growing body of evidence for the general importance of social factors in sustaining healthy brain functioning, they conclude.

This study strengthens the hypothesis that the development of cognitive impairment and dementia is a long process that is affected by various factors throughout life, writes researcher and epidemiologist Catherine Helmer in an accompanying editorial.

She believes that to understand the link between marital status and dementia, future research should focus on the stress caused by a separation and satisfaction with relationships. She also suggests that the findings could lead to preventive strategies that encourage unmarried, especially widowed, people to increase their social engagement by taking part in cultural, social, and sporting activities.

Link to paper

Link to editorial