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Weekly InSight: Spinal Taps and Alzheimer’s Disease

Performing a lumbar puncture (also known as an LP or spinal tap) may help physicians identify sooner if a person has Alzheimer’s disease or another type of dementia.

In a recent U.S. News & World Report article, PMC Co-Director Jason Karlawish, MD, outlined three reasons why there’s a potential benefit to diagnosing a disease early.

“One is so people know what’s up ahead in their own lives so they can make plans. Two, to explain the certain symptoms that you’re currently having and why you’re suffering,” Dr. Karlawish told U.S. News & World Report. “And three, to be able to get in treatment, whether that is pharmacologic or nonpharmacologic treatment, to try to improve your quality of life and ease your suffering.”

An LP is a diagnostic tool used to extract a small amount of cerbospinal fluid (CSF) from a person’s lower back. This fluid surrounds both the spinal cord and brain.

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Weekly InSight: Getting Involved With REVEAL-SCAN

You don’t need to have Alzheimer’s disease to make a difference in our understanding of the disease.

REVEAL-SCAN (Risk Evaluation and Education for Alzheimer’s Disease – the Study of Communication Amyloid Neuroimaging) is a volunteer-based, non-treatment clinical study conducted at the Penn Memory Center (PMC), as well as three other sites around the country (University of Michigan, Harvard University, and Duke University).

Study participants undergo a PET scan to observe whether they have “elevated” buildup of amyloid plaques in the brain, considered an early biomarker for Alzheimer’s disease. They also learn their personal estimated risk of developing the disease by age 85.

The primary objective of the study is to learn how individuals interpret and cope with this new information.

In a recent PMC article, Isabel Gurbarg, a 10-year veteran of PMC studies and a REVEAL-SCAN participant, explained why she makes time to be involved with research.

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How would you respond to your amyloid PET scan result?

REVEAL-SCAN study participant Isabel Gurbarg stands in the atrium of the Perelman Center for Advanced Medicine. If you are 65 to 80 years old, have a parent or sibling with Alzheimer’s disease and are interested in participating in REVEAL-SCAN at the Penn Memory Center, contact study coordinator Melissa Esparza at 215-662-6093 or melissa.esparza@uphs.upenn.edu.

by Joyce Lee

Isabel Gurbarg wanted to be sure.

More than a decade ago at the Penn Memory Center, then-Director Dr. Steve Arnold had diagnosed her mother with probable Alzheimer’s disease. But the only way to confirm the diagnosis would be through an autopsy procedure, Dr. Arnold told them.

And Gurbarg wanted to be sure.

“Her brain was all filled with amyloid,” Gurbarg recalled. Diagnosis: confirmed.

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‘Alive Inside: Using neuroimaging to detect covert consciousness in the brain-injured patient’

‘Alive Inside: Using neuroimaging to detect covert
consciousness in the brain-injured patient’

3 p.m. Thursday, February 28th
Ralston House, Room 241, 3615 Chestnut St.

Andrew Peterson, PhD
Assistant Professor, Greenwall Faculty Scholar, Institute for Philosophy and Public Policy, George Mason University
www.ippp.gmu.edu/andrew-peterson

 

This presentation provides an ethical analysis of the American Academy of Neurology practice guideline on disorders of consciousness. The analysis focuses on the guideline’s recommendations regarding the use of advanced neuroimaging methods to assess brain-injured patients.

Complex and multifaceted ethical issues have emerged because these methods alter the clinical understanding of consciousness. Dr. Peterson addresses issues of false hope and the prolongation of lives judged not worth living. He argues that, in spite of these concerns, there is significant benefit to using neuroimaging and electroencephalography to assess brain-injured patients.

This presentation is supported by the Penn Project on Precision Medicine for the Brain (P3MB).

Weekly InSight: ‘Time Out’ Is Recruiting Students and Families

We’re excited to announce Time Out is now recruiting students and families.

The award-winning mentorship and respite care program, which launched in 1986, had been on a three-year hiatus. We’re now working with Temple University’s Center for Intergenerational Learning to get it back up and running this spring.

Renee Packel, who cared for her late husband Arthur, a PMC patient, participated in the program about five years ago. Arthur was developing Alzheimer’s disease when his financial woes—which resulted in Packel closing his business and selling their house—began, The New York Times reported in 2010. The affordability of the Time Out program was particularly helpful, she told us last week.

The current cost to participate is $8.50 per hour (waived for eligible families), for up to 10 hours per week. During those hours, local college students give family members temporary relief from the daily responsibilities of caregiving.

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‘Time Out’ offering affordable respite care, mentorship opportunities

By Linnea Langkammer and Janissa Delzo

Two Philadelphia universities are partnering to offer affordable, in-home respite care to area families caring for older adults.

The Penn Memory Center (PMC) and the Temple University Intergenerational Center jointly revitalized Time Out, a support and mentorship program first launched in 1986.

Time Out will facilitate meaningful, in-home engagement through intergenerational companionship by connecting elderly individuals with PMC-trained college students. This includes conversation, reading, or mobility assistance, and may also include meal preparation, laundry, and light grocery shopping. It does not include personal care — such as bathing, dressing, feeding, or toileting — nor administering medications or therapies.

While private respite care may cost more than $20 an hour, Time Out care providers will be available for $8.50 an hour and up to 10 hours per week.

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Weekly InSight: Martin Luther King, Jr. Health Equity Symposium

We attended the 4th annual Martin Luther King, Jr. Health Equity Symposium, hosted by Penn Medicine’s Office of Inclusion and Diversity, on January 23. This year’s theme was “Achieving Population Health Through Health Equity.”

Keynote speaker Jonathan Woodson, MD, addressed the question: “What would Martin Luther King, Jr. do [in today’s world]?” Dr. Woodson, former Assistant Secretary of Health Affairs for the U.S. Department of Defense, highlighted MLK’s Letter from Birmingham Jail, which he wrote in April 1963 in response to white clergymen who publicly disapproved of his nonviolent protests.

The letter “provides a blueprint for action that is scalable and appropriate,” Dr. Woodson told the audience.

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Biomarkers in spinal taps ‘hold promise’ for more accurate diagnosis in Alzheimer’s disease

Diagram showing how you have a lumbar puncture. (Credit: Cancer Research UK)

By Sharnita Midgett

The goal of detecting Alzheimer’s disease earlier and more accurately in patients with cognitive symptoms has led to the development of new diagnostic tools. One tool is the use of spinal taps, which provide physicians with samples of cerebrospinal fluid (CSF) that are analyzed for levels of proteins associated with Alzheimer’s disease.

In a recent U.S. News & World Report article, PMC Co-Director Jason Karlawish, MD, discussed how Alzheimer’s disease is being redefined as a biological disease, with three biomarkers: amyloid plaques, tau tangles and deterioration of the nervous system.

“It holds promise for a more accurate diagnosis for the subset of people who have those biomarkers,” he told U.S. News & World Report. “It holds great promise for the development of treatments that can target those biomarkers.”

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Weekly InSight: Alzheimer’s Disease and a Blood Test

A study published in the journal Nature Medicine flooded mainstream media and Facebook feeds this week with headlines and stories claiming that a blood test may be able to detect Alzheimer’s disease (AD) more than a decade before symptoms appear.

One caveat overlooked or downplayed by many outlets, though: The study population involved individuals with a rare gene mutation that made them highly likely to develop AD.

“They are also generally significantly younger when they do,” PMC Co-Director David Wolk, MD, explained. “Such patients make up less than 1 percent of AD. So it remains to be seen how well this test will work in older individuals with more typical AD, but it is certainly promising as a marker of brain injury over time.” This injury could be due to Alzheimer’s disease but also many other brain diseases, added PMC Co-Director Jason Karlawish, MD.

In short: No, there is not yet a blood test able to predict Alzheimer’s.

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Goodbye Sunday Reads, Hello “Weekly InSight”

Letter from the Editor:
 
When we developed the Sunday Reads email in 2018, we said we welcomed feedback. And you, our readers, delivered.

You were less interested in hearing about all of the stories we were reading and discussion, more interested in hearing about why we found specific articles so noteworthy. You enjoyed when we turned the newsletter over to our social work team, and you wanted to hear from more academic disciplines at PMC and beyond. And one reader in particular challenged the name “Sunday Reads” after we sent it on a Wednesday the week of Thanksgiving. 

So we’re leaving “Sunday Reads” in 2018. This is our Weekly InSight, the email edition of our newsmagazine. We’ll tackle more individual issues and invite our colleagues to contribute short essays of their own. If there are specific topics or voices you’d like to see here, please let me know. 

-Terrence Casey

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