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The Food and Drug Administration (FDA) has postponed its decision on the Alzheimer’s drug donanemab, which was expected by the end of March. Instead, the FDA will ask an independent panel of experts to review questions about the drug. Eli Lilly and Company, the drug’s manufacturer, confirmed this development.

The FDA’s request for an advisory committee follows a longer than expected wait for a decision that was expected by the end of 2023 and then sometime in the first quarter of 2024.

The published and presented data on donanemab describe a drug that’s much like lecanemab, an effective treatment for persons with mild cognitive impairment or mild-stage dementia, which is dispensed by infusion every two weeks. Donanemab was attractive to some patients because it required a monthly infusion.

“This is a surprise, but it’s not a cause for worry; the data show the drug’s effective,” said Penn Memory Center Co-Director Jason Karlawish, MD. “Most likely, FDA will ask the committee to weigh in on how to translate the study’s design into the FDA guidance for how to prescribe it.”

He noted the study of donanemab enrolled persons with certain levels of tau protein in their brain, and that the drug was discontinued after amyloid was cleared. Tau is one of the pathological hallmarks of Alzheimer’s disease.

“Neither of these design features is part of how we prescribe lecanemab. Should they be for donanemab? And if so, why not lecanemab? Those are great questions for an advisory committee to weigh in on,” Dr. Karlawish said.

The PMC will provide updates on the timing of the hearing and its outcomes.

Read more in The New York Times.

By Judy George, MedPage Today

The 2024 ballot may have the oldest pairing of presidential candidates, with President Joe Biden at age 81 and former President Donald Trump at age 77. Each candidate has publicly shown moments of forgetfulness in recent weeks, but what that means isn’t clear.

The failure to remember a specific event or date may or may not point to cognitive problems, maintains geriatrician Jason Karlawish, MD, co-director of the Penn Memory Center at the University of Pennsylvania in Philadelphia, and author of The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease Into a Crisis and What We Can Do About It.

The diagnosis of cognitive impairment requires a careful assessment by a trained clinician, Karlawish says. In an exclusive interview with MedPage Today, he discusses the distinction between memory and forgetfulness, how clinicians determine cognitive impairment, and how popular media reports can muddy the picture.

For a translated version of this article, please click here.

Editor’s note: Andrew Beltran is no longer in this role. For inquiries about PMC’s outreach efforts, please contact Terrence Casey.

By Meghan McCarthy 

As the Penn Memory Center (PMC) continues to develop new research opportunities for Latinos in Philadelphia, it has a new coordinator dedicated to these efforts: Andrew Beltran. 

Latinos are developing Alzheimer’s disease and related dementias (ADRD) at a rate higher than any other racial or ethnic group in the United States, according to the Centers for Disease Control and Prevention. And yet they are frequently underrepresented in research.  

Starting with the hire of Beltran, PMC is building relationships with Latino communities in Philadelphia, conducting health needs assessments, holding health education events, and evaluating the accessibility of research, clinical care, and training.  

“Equitable dementia care begins with equitable research,” said Terrence Casey, director of communications and outreach. “And equitable research begins with making our neighbors in Philadelphia part of the conversation from the beginning.” 

 

Making the Move to a Residential Care Community

Deciding whether to move your loved one from home to a memory or personal care community is a time full of unknowns, myths, and misunderstandings. Join Lorri Bernstein and Mindy Mozenter from Senior Living Specialists Philly as they dispel these myths and cover decision-making, expected costs, and emotional support.

 

By Victor Ekuta, MD
Penn Memory Center Clark Scholar 

I was in my 3rd year of medical school when I first heard the phrase that “time is brain.” Coined in a 1993 editorial by Dr. Camilo Gomez, this pivotal concept emphasizes the critical importance of early intervention in preserving brain health after a stroke. “Unquestionably,” Dr. Gomez wrote, “the longer therapy is delayed, the lesser the chance that it will be successful, and early intervention will probably be a major determining factor in the limitation of the damage of neurons.” 

Recent advancements in stroke neuroimaging have not only affirmed but quantified this urgency. For every untreated minute in an ischemic stroke, the average patient sheds a staggering 1.9 million neurons. For every hour, the loss of neurons is equivalent to almost 3.6 years of normal aging. In essence, this reaffirms the fundamental truth: time is, undeniably, brain! 

Greetings, and Happy New Year!

During this time of year when we pause and reflect, it’s important to embrace whatever journey we are on, to cherish what’s important, and to be open to what lies ahead. The turn of the new year celebrates renewal, and it is in that spirit that I announce my next chapter.

After 20 years of service at Penn, I am leaving to start my own therapy and consultation service. I’ve devoted decades to supporting families living with Alzheimer’s disease and other dementias at the Penn Memory Center. Now, I will bring my experience to broader audiences through my private practice. I am now accepting new clients. If you or someone you know can benefit from my services, please reach out. My contact information is below.

Felicia Greenfield, Cait Kearney, Leah Fein, and Meg Kalafsky at AAIC  

By Meghan McCarthy 

When Cait Kearney joined the Penn Memory Center (PMC), she was a recent college graduate without full-time work experience. 

In the three years since, Kearney has had positions at PMC created for her, published hundreds of newsletters, led training programs, represented the center at an international conference, and most recently completed her master’s in professional writing from Northern Arizona University.  

Simply put, our communications team would not be the same without her. As she embarks on her newest chapter, we’re looking back at her journey and incredible contributions.  

This is Kearney’s PMC story.  

By Jake Johnson

Sleep can change in key ways as we age, and while these changes are normal, this transition can be confusing and frustrating for some older adults. 

However, there is good news, said UPenn Associate Professor of Medicine Nalaka Gooneratne, MD, MSc: By making a few adjustments to how you approach sleep, you can reduce these frustrations and continue to get good quality sleep. 

1. Older adults need less sleep, so adjust your sleep schedule accordingly

The biggest change in sleep you may experience as you get older is that you need less of it.  

“Typically, older adults need about half an hour to an hour less sleep than they needed when they were middle-aged adults,” Dr. Gooneratne said. “And many older adults who feel like they’re sleeping worse—sometimes it’s because they’re trying to get as much sleep as they had when they were younger, but their body just doesn’t need it anymore.”  

Seven hours of sleep is typical for older adults. The best way to adjust for a shorter sleep schedule, Dr. Gooneratne said, is to first choose a time you want to wake up and then count backwards by seven. So, if you want to wake up at 7 a.m., you will probably have to go to bed around 12 a.m. or you will run the risk of lying in bed awake for a few hours.  

But if staying up feels too difficult, you can try waking up earlier. For example, a 10 p.m. bedtime would mean waking up around 5 a.m. 

2. Stick to a sleep schedule as much as possible 

Once you’ve chosen when you want to get up, try and stick to that schedule as much as possible, Dr. Gooneratne said. Keeping a regular schedule will let your body know when you want to get up and help you fall asleep at night. 

“If they want to sleep in, it’s okay to sleep in one night a week, but they really shouldn’t sleep in more than that,” he said. “That’s a particular challenge for many older adults because many of them are retired.” 

 

3. You may wake up in the middle of the night more—do something unstimulating to pass the time

Another normal sleep development as we get older is that we tend to wake up in the middle of the night more often. It’s normal to be awake for up to an hour in the middle of the night as an older adult. 

While this can feel frustrating, Dr. Gooneratne said the best thing you can do is try not to fight it and find an activity that is calming and relatively dry.  

Usually, things on your smartphone or TV are too engaging to easily fall back asleep, so try reading or writing instead. If you’re a religious person, this could be a good time to say prayers, he said.

4. Look out for sleep conditions, and talk to your doctor

Older adults are also more at risk for sleep conditions, which can disrupt sleep, he said. The most common of these sleep conditions is sleep apnea, which is characterized by snoring and gasping during sleep.  

He said to look out for any signs of snoring, gasping, or choking in you or your partner and tell your doctor, as sleep apnea can greatly interfere with your sleep quality.  

Talk to you doctor as well about how medications you’re taking interact with sleep, as these could also disrupt your sleep.  

More sleep tips 

Exercise can help 

If you’re struggling with insomnia, exercise is a great way to make sure you feel tired at the end of the day, Dr. Gooneratne said. 

For people over 65, the CDC recommends 150 minutes of exercise a week that is moderate-intensity, like brisk walking, or 75 minutes of vigorous-intensity such as hiking or jogging.  

Use technology to manage and track sleep 

Dr. Gooneratne also recommended a few devices to help you keep track of your sleep. 

If you’re going on a trip, Jet Lag Rooster by Sleepopolis can help you come up with a plan to help reduce the effects of jetlag. Type in where you’re flying from and flying to, when you’re departing and arriving, and when you normally go to bed and wake up, and the website calculates a plan to transition you to a new time zone.  

Fitbits are another device that will track your sleep; however, Dr. Gooneratne said to ignore REM sleep tracker and sleep score because they are often inaccurate. Pay attention to the amount of time it says you slept because this is fairly accurate and can give you a sense of how much you’re waking up in the night.  

Overall, while it might be hard, the best thing you can do is not overly fixate on how much sleep you’re getting. If devices bring you more anxiety around sleep, then it’s best to ditch them completely.  

 

Originally published on BBC.com.

According to Dr. Mark Lachs, of Weill Cornell Medicine and his colleague, Dr. Jason Karlawish, from the Penn Memory Center, financial capacity can be one of the first things to decline when the brain is damaged through disease or age.

They want this process to be identified as a condition they call Age Associated Financial Vulnerability – a pattern of risky behavior that is inconsistent with choices that would previously have been made.

Dr. Karlawish says: “Financial decision-making is very challenging cognitively. Even with mild cognitive impairment, you can make mistakes with finances, even though you’re otherwise doing generally OK in your daily life.”

Read more on BBC.com