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Credit: Creative Commons, Mike MacKenzie

By Steve Graff

Editor’s Note: This article was originally published by Penn Medicine News.

When the biotech company Biogen stopped a clinical trial investigating a drug known as aducanumab to slow Alzheimer’s, disappointment swept through the neurology community. “This one hurts,” one neurologist told CNN in March. “Alzheimer’s patients just can’t get a break.” The drug, which reduces amyloid, a nefarious protein believed to drive the disease, had slowed cognitive decline in animals. But studies in humans showed the intervention was too late. Damage—likely from the early buildup of the protein—had already been done, and patients’ outcomes weren’t improving as the trial progressed. Other promising drugs remain in the pipeline, but that trial—which included several Penn patients—was yet another reminder of the staggering complexity of Alzheimer’s.

“This a disease that can start up to 20 years before any symptoms become obvious,” said Yong Fan, PhD, an assistant professor of Radiology in the Center for Biomedical Imaging Computing and Analytics at Penn. “So if you could predict the disease earlier, you would have a better chance to cure it with drugs.”

Fortunately, the field of detection has made significant strides over the years to help get there. Researchers are consistently finding better ways to track rogue proteins and predict the progression of cognitive decline with biomarkers, neuroimaging, and more recently and arguably most impressively, the rapidly advancing technology touching nearly every part of medicine today: artificial intelligence.

By Sally Sapega

Editor’s Note: This article was originally published on Penn Medicine News.

Please join the Penn Memory Center for a series of free events featuring one of the most renowned and influential scholars and writers on psychiatry, anthropology, global health, and cultural issues in medicine. Dr. Arthur Kleinman is the author of The Soul of Care: The Moral Education of a Husband and a Doctor, available for pre-order through Penguin Random House.

By Danny Yarnall 

Jessica Nuñez first walked into the Memory Disorders Clinic on July 10, 1995, having recently finished her sophomore year at Thomas Alva Edison High School. She admittedly didn’t know what to expect from her new summer job. 

“I did not know anything about the memory center. I did not know anything about Alzheimer’s disease. I just needed a part-time job in the summertime,” said Jessica, now in her 25th — and final — year at what has become the Penn Memory Center. A research coordinator since 2003, Jessica will be leaving PMC in August to pursue new career opportunities.

By Sharnita Midgett

Carolyn L. Whitaker walks into the Perelman Center for Advanced Medicine for her visit. As a returning participant of the Aging Brain Cohort Study (ABC), she follows the now-familiar routine: 

Melissa Kelley

1. check in with the research coordinator
2. review medical history
3. remove all metal 

She prepares to spend the next few hours in or preparing to go in two MRI scanners, the 3 Tesla (3T) and the 7 Tesla (7T). During the scan, she waits to hear the voice of her coordinator, Melissa Kelley, letting her know how much time she has left in the scanner. For her, this has become her favorite part of the study.

“It allows me to just lay down somewhere from 45 minutes to an hour and just be quiet. It’s like a gift,” she said.

Penn Memory Center co-director Jason Karlawish, MD, was a guest on the latest episode of the Dementia Matters podcast, hosted by Dr. Nathaniel Chin of the University of Wisconsin. The episode was a one-on-one conversation about the changing definition of Alzheimer’s disease.

Chin and Karlawish aimed to demystify some of the surrounding confusion around Alzheimer’s stemming from stigma, explain the interchangeable use of the disease with the broader “dementia,” and discuss the emerging research in biomarker screenings to disclose Alzheimer’s risk in individuals.

“The ‘brand’ of Alzheimer’s has been stretched to its limits,” Karlawish said. “We’ll use ‘Alzheimer’s’ to denote a specific disease, but also it’ll be the overarching term that captures the general problem.”

You can listen to the full episode here or subscribe to the Dementia Matters podcast on iTunes, Spotify, Podbean, Stitcher, or Google Play Music.

By Sharnita Midgett

Driver A is a Penn Memory Center patient who is referred to the Bryn Mawr Driver Rehab Program and fails the driver evaluation. He had an inkling that it was time to stop driving, and after listening to the concerns of family members, Driver A takes the keys out of his pocket and gives them to his family. “You’re right,” he says. “I’m going to stop driving now.” The family comes to a resolution on next steps.

Driver B is also referred to the Bryn Mawr Driver Rehab Program. She fails the test but does not want to stop driving. She is convinced her driving is fine, even after running several red lights, and argues with her family about needing to give up her keys. “I need to drive to take care of my family,” she says. “I don’t want to depend on other people.”

Tom Kalina, MS/OTR, CDRS, certified driving rehabilitation specialist for the Bryn Mawr Driver Rehab Program, sees each of these scenarios frequently when working with driving and dementia.

Kalina has seen cases where people were referred to the program because they were significantly lost by several states away. Sometimes it can take a couple days to find a person who has become lost. 

“These same people might come in for the evaluation and drive fairly well,” he said. 

Dr. Lauren McCollum (center) is a Cognitive and Behavioral Neurology Clinical Fellow in the Penn Memory Center.

By Leah Fein

Penn Memory Center (PMC) researchers found tau, a protein in the brain, may help distinguish Alzheimer’s disease from other forms of cognitive impairment.

Lauren McCollum, cognitive and behavioral neurology clinical fellow; Laura Wisse, PMC Scholar; and David Wolk, PMC co-director presented their poster titled “Cognitive Profiles in Amyloid-Positive MCI & Alzheimer’s Disease with and without Tau” at the American Academy for Neurology Annual Meeting.

By Danny Yarnall

The My Alzheimer’s Story Project, a seven-city tour gathering interviews with everyday Americans dealing with and researching Alzheimer’s, completed filming in Philadelphia this summer.

Documentary filmmakers Zach Jordan, Peter Schankowitz, and their crew partnered with Penn Memory Center and AARP, and traveled around the country conducting more than 80 interviews for the film. These interviews will also be used by University of Pennsylvania researchers to gain insight into patients and direct individual care.

Jordan’s previous film, Carpe Kilamanjaro (2016) documented his father’s and his own journey as his father battled with Alzheimer’s and served as inspiration for the MyAlzheimer’s Project.

Jordan, 42, sat down with AARP to discuss the takeaways and what he learned meeting with a diverse group of Alzheimer’s patients and their caregivers from Los Angeles to Philadelphia.

“Nobody has ever done anything like this before, so it’ll be very interesting to see how it pans out,” he told AARP.

By Danny Yarnall

PMC scholar Emily Largent, PhD, JD, RN, was a featured guest on the Good Law/Bad Law legal podcast hosted by University of Pennsylvania law school alumnus Aaron Freiwald. The episode’s topic was “aid in dying” — a set of laws that allow terminally-ill patients who meet specific requirements to take medication to end their own life. 

The issue has been thrust into the national spotlight as Maine and New Jersey are set to become the eighth and ninth states to allow aid in dying in the U.S., joining Oregon, Washington, Vermont, Montana, California, Colorado, and Hawaii, as well as the District of Columbia. Largent broke down the ethical and legal debates behind the issue as well as adding her own experience as a nurse and bioethicist in the discussion.

“On one hand, we think the clinicians should really set out the range of options for patients when they’re making decisions about a course of treatment,” Dr. Largent said on the podcast. “…At the same time, I think suggesting hastening death brings it back to being incompatible to the role of traditional medical ethics.”

You can listen to the full episode here.

Dr. Largent was also interviewed in a recent New York Times story on the subject.