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As the Alzheimer’s disease (AD) field moves closer to using genetic and biomarker data to identify people at risk, researchers are urgently trying to tackle whether and how to disclose that information to people in both routine clinical care and research settings. This past February, the Alzheimer Research Forum, an online scientific knowledge base for Alzheimer’s disease, published a detailed account of the issues involved and ongoing studies aimed at these goals. At the 2012 Alzheimer’s Association International Conference in Vancouver, three of the featured researchers updated attendees on their projects at a plenary session dedicated to the topic.

One topic of discussion at the AAIC session was the questions of whether it is psychologically harmful to divulge ApoE4 carrier status, which is associated with a higher risk of Alzheimer’s disease, to cognitively normal people. Jason Karlawish, MD, explored perhaps an even more contentious issue of whether doctors or researchers should reveal plaque status to cognitively normal people, as research on whether cognitively normal people with plaque progress to Alzheimer’s disease is at an earlier stage. “We have great concern that it may cause despair,” said Dr. Karlawish.

Alzheimer Research Forum

Washington Post – “Aging is not a mild form of dementia,” says cellular neurobiologist John Morrison, who specializes in aging. Until recently, many scientists thought brain cells died as we aged, shrinking our brains and shedding bits of information that were gone forever. Newer findings indicate that cells in disease-free brains stay put; it’s the connections between them that break. With this new perspective has come an explosion of research into how we can keep those connections, and our brain function, intact for longer.

Washington Post

Researchers from the Perelman School of Medicine at the University of Pennsylvania found a new way of diagnosing and tracking Alzheimer’s disease, using an innovative magnetic resonance imaging (MRI) technique called Arterial spin labeling (ASL) to measure changes in brain function. The team determined that the ASL-MRI test is a promising alternative to the current standard, a specific PET scan that requires exposure to small amounts of a radioactive glucose analog and costs approximately four-times more than an ASL-MRI. Two studies now appear in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association and Neurology. “In brain tissue, regional blood flow is tightly coupled to regional glucose consumption, which is the fuel the brain uses to function. Increases or decreases in brain function are accompanied by changes in both blood flow and glucose metabolism,” explained John A. Detre, MD, professor of Neurology and Radiology at Penn, senior author on the papers, who has worked on ASL-MRI for the past 20 years. “We designed ASL-MRI to allow cerebral blood flow to be imaged noninvasively and quantitatively using a routine MRI scanner.”

Penn Medicine News Release

American Medical News reports that one-third of physician visits include at least one family member in the exam room. Even as the push toward the patient-centered medical home stresses the invaluable role that families can play in improving compliance and health outcomes, the presence of a relative raises a host of complicated issues for physicians to navigate. “Now you’ve got potentially two patients in the room,” says Jason Karlawish, MD, professor of Medicine and Medical Ethics. “You even have a kind of third patient, which is the relationship between the family member and the patient. If you ignore that, you ignore it at your own peril.” One step to making the interaction with patients’ relatives a positive one is to assess why they came along, says Dr. Karlawish, a geriatrician. “Ask questions,” he says. “Just as you ask the patient for their chief complaint, you can turn to the family member and say, ‘And you, is there anything in particular that you wanted to bring up?’

American Medical News article

Aging Well looks at challenges primary care physicians face when coordinating elders’ care with other physicians who also treat the patient. John Bruza, MD, an associate professor of Geriatric Medicine in the Perelman School of Medicine, says that at Penn all of the health network’s subspecialties use the same EHR system. This has made the management of some highly complex patients much easier. “It facilitates almost instantaneous communication with providers,” says Bruza. In fact, that kind of coordination works so well among complex patients—those seeing multiple doctors on a regular basis—that Bruza says he may encourage certain patients to reconsider an outside specialist they’re seeing in order to try to keep everything within the same health system or network. “That’s not something I’d recommend for the majority of my patients but for those that are quite complex, I might suggest they consider it,” he says.
Aging Well article

AlzForum covers new research from the laboratory of Virginia Lee, PhD, director of the Center for Neurodegenerative Disease Research. A major challenge of studying diseases marked by intracellular protein aggregates is getting those pesky clumps to form in the lab under anything resembling realistic circumstances. A study in the October 6 issue of Neuron takes Parkinson’s disease research a step forward in this direction. The Penn team developed a cell model that uses preformed α-synuclein fibrils to induce Lewy body pathology, synaptic dysfunction, and death in wild-type mouse neurons. “The fact that you can take some fibrils, toss them into primary neuron cultures, and recapitulate pathology you see in PD patients suggests you have a simple but powerful system for studying the consequences of α-synuclein pathology in a dish,” said Lee.

AlzForum article

The possibility that anesthesia and surgery produces lasting cognitive losses has gained attention over past decades, but direct evidence has remained ambiguous and controversial. Now, researchers at the Perelman School of Medicine at the University of Pennsylvania provide further evidence that Alzheimer’s pathology may be increased in patients after surgery. “We have long sought a clearer picture of the true impact of anesthesia and surgery on the central nervous system,” said lead study author Roderic Eckenhoff, MD, Austin Lamont Professor of Anesthesia at Penn. “Although not definitive, this human biomarker study gives some credibility to the notion that anesthesia and surgery produce an inflammatory insult on the brain and accelerate chronic neurodegenerative diseases like Alzheimer’s.”

AlzForum article

New research from the Perelman School of Medicine adds to the growing evidence that anesthesia and surgery may be associated with the progression of chronic brain diseases, particularly Alzheimer’s disease. “We have long sought a clearer picture of the true impact of anesthesia and surgery on the central nervous system,” study author Roderic Eckenhoff, MD, the Austin Lamont Professor of Anesthesia, said in a HealthDay article. “Although not definitive, this human biomarker study gives some credibility to the notion that anesthesia and surgery produce an inflammatory insult on the brain and accelerate chronic neurodegenerative diseases like Alzheimer’s,” Eckenhoff added.

HealthDay article

USA Today – For people with type 2 diabetes, intense treatment doesn’t slow decline in thinking skills, a new study found. Super-strict blood sugar control actually appeared to increase study participants’ risk of death, the researchers found. People older than 70 with type 2 diabetes are twice as likely to suffer mental impairment as those without diabetes, researchers say. Intensively controlling blood sugar has been shown to reduce the odds of diabetes complications, such as vision, kidney and circulation problems, so it seemed likely that it might also slow any cognitive decline related to the condition.

USA Today Article

USA Today – People with diabetes are at significantly higher risk of developing all types of dementia, including Alzheimer’s disease, finds a new study that bolsters previous research connecting the two illnesses. The study of more than 1,000 people in Japan found that 27 percent of those with diabetes developed dementia, compared to 20 percent of people with normal blood sugar levels. Further, the study showed that pre-diabetes — higher than normal blood sugar levels — also raised the risk of dementia.

USA Today Article