Monthly Archives: September 2016

Staying loyal to a great doctor

Staying loyal to a great doctor or a genius hairdresser—that’s just smart. But when it comes to birth control, sticking with the same method throughout the years isn’t always the right move. “Your contraceptive should fit your health, lifestyle, and values,” says Michele Curtis, MD, a professor of obstetrics and gynecology at the University of Texas Medical School at Houston. That’s because the more comfortable you are with your birth control, the more likely you are to use it consistently—meaning less risk of an unintended pregnancy.

Whether you’re 25 or 45, condoms are a must to guard against STDs. But since condoms also have a higher failure rate than other forms of birth control, it’s wise to double up. Hormonal contraceptives—the Pill, patch, or vaginal ring—are highly effective. As a bonus, they can also help regulate periods, reduce PMS symptoms, and lower the risk of some cancers.

If you want to avoid an estrogen-containing method, you can pair condoms with an intrauterine device (IUD)—either the hormone-free copper ParaGard or the progestin-containing Mirena. Other good options include Implanon, a progestin-releasing implant that’s inserted in the upper arm for up to three years; and Depo-Provera, a progestin injection that’s given every three months.

Reduced protein buildups associated with Alzheimer

Eating a healthy diet, getting regular physical activity, and maintaining a normal weight appear to reduce protein buildups in the brain associated with Alzheimer’s disease, according to a new study published in the September issue of the American Journal of Geriatric Psychiatry.

These lifestyle factors are already recommended for safeguarding against dementia, and have previously been shown to reduce shrinkage and atrophy of the brain. But this is the first study to demonstrate how they can directly influence abnormal protein growth in people who have subtle memory loss, researchers say.

This is significant, the study authors wrote in their paper, because it’s been estimated that up to half of Alzheimer’s cases can be attributed to modifiable risk factors such as low education, smoking, physical inactivity, and obesity. Even a 10 to 25 percent reduction in these risks could potentially prevent nearly 500,000 cases in the United States.

The study included 44 adults, ages 40 to 85, who’d been experiencing mild memory problems but had not been diagnosed with dementia. They provided information about their diet, exercise levels, body mass index (BMI), and other lifestyle factors. Then they were given a PET scan—a type of brain imaging test—to measure different levels of protein in their brain.

The researchers were looking for two specific types of protein: deposits of beta-amyloid plaque and knotted threads of tau protein tangles. Both types are considered key indicators of the development of Alzheimer’s disease.

Although the study could not prove a cause-and-effect relationship, it did find “moderate but significant” differences between participants with healthy lifestyles and people without. Specifically, people who got plenty of physical activity and had a normal BMI had fewer plaque deposits and tangles than those who got less exercise and had higher BMIs. The same went for those who followed a healthy diet—in this case, the Mediterranean diet—versus those who didn’t.

“The fact that we could detect this influence of lifestyle at a molecular level before the beginning of serious memory problems surprised us,” says lead author David Merrill, M.D., Ph.D., assistant clinical professor at UCLA’s Semel Institute for Neuroscience and Human Behavior.

Merrell says that doctors have long appreciated the fact that exercise and diet can improve muscle and heart function. But there seem to be additional effects they’re just starting to understand: “Some older patients of mine report similar benefits for their sharpness and memory on days when they go for a long walk or eat fish like salmon,” he says.

The new study reinforces the idea that habits that are good for the body are also good for the brain, says Merrill—and that they seem to have an impact on abnormal protein buildup “for years, if not decades, prior to the diagnosis of Alzheimer’s disease.”

In their paper, the authors also suggest that improving more than one of these lifestyle factors may lower Alzheimer’s disease risk more than focusing on any one factor alone. Luckily, they point out, eating healthier, getting more exercise, and losing weight often go hand-in-hand.

Merrell says it’s never too early, or too late, to adopt healthier habits—a belief he puts into practice when treating patients at UCLA. “We try to meet all patients and family members where they are,” he says, “recommending a guided increase in physical activity along with greater adherence to a Mediterranean style diet.” This helps to improve both their physical and mental health over time, he adds, no matter where they started.

Alzheimers Disease Treatments

No one wants to hear “You’ve got Alzheimer’s disease,” a progressive memory-robbing disorder that doesn’t have a cure. But the diagnosis may not be quite as grim as it was in the past

There are now a handful of medications that can help ease symptoms, like memory loss and confusion. What’s more, the evidence suggests that there are certain lifestyle changes that might help, and there are other types of treatments that address specific symptoms (rather than the underlying cause of the disease) that may make life a little easier for people with Alzheimer’s.

While the number of treatments is limited—and far from a perfect solution—“there is value in getting the proper care,” said James Hendrix, Ph.D., director of global science initiatives at the Alzheimer’s Association in Chicago. Treating symptoms can give people more time, allowing them to make decisions about their future while they still can, he explained.

Scientists continue to explore potential disease pathways to treat and prevent this insidious brain disorder, which affects more than 5 million Americans.

Here’s a rundown of current therapies, lifestyle changes, and promising treatments on the horizon that could help people with Alzheimer’s disease.

Approved for treating mild, moderate, and severe Alzheimer’s symptoms, donepezil doesn’t stop the disease. But it does prevent the breakdown of a brain chemical called acetylcholine, believed to be important for memory, thinking, and reasoning.

This medicine comes as a once-daily tablet, so it’s easy for patients to take and doctors to adjust the dosage.

“You can start a patient on 5 milligrams a day and after several weeks move them up to 10 milligrams,” said Gregory Jicha, M.D., Ph.D., professor of neurology at the University of Kentucky and a neurologist at the UK Sanders-Brown Center on Aging.

Side effects include gastrointestinal (GI) problems, like nausea, diarrhea, and vomiting. Other potential side effects include muscle cramps, fatigue, and weight loss.

Treat Alzheimers failed to show dramatic benefit

The third try wasn’t the charm for Eli Lilly’s Alzheimer’s drug solanezumab. In EXPEDITION3, the third test of the drug since it was developed in 2006, the compound failed once again to show significant benefit for people with mild forms of the disease.

“The results of the solanezumab EXPEDITION3 trial were not what we had hoped for and we are disappointed for the millions of people waiting for a potential disease-modifying treatment for Alzheimer’s disease,” said John Lechleiter, chairman, president and chief executive officer of Lilly, in a statement. The company will not continue to pursue approval of the drug for treatment of mild Alzheimer’s.

Solanezumab is among the first of a new group of treatments that are designed to address the brain disorder at its root cause, rather than just relieve symptoms. Had it been successful, it would have been the first so-called disease-modifying treatment, or therapy that slowed progression of Alzheimer’s. The compound sticks to the free-floating forms of the protein amyloid, which build up into damaging plaques in the brain. Lilly scientists had hoped that their agent, an amyloid antibody, would soak up enough of the circulating amyloid so that there weren’t enough fragments around to aggregate into the toxic plaques. “By increasing the rate of clearance of amyloid with solanezumab, we are making the brain younger in a sense,” Dr. Eric Siemers, medical director of the Alzheimer’s Disease Team at Lilly, told TIME earlier while describing the compound.

In the study, 2,100 people with mild dementia and evidence of amyloid in the brain confirmed by PET scans were randomly assigned to solanezumab or placebo. After 18 months, there was no significant difference between them on measures of cognitive decline.

“It’s clearly disappointing for all of us [in the Alzheimer’s field],” says Dr. Dennis Selkoe, co-director of the center for neurology at Brigham and Women’s Hospital. Selkoe was not involved in the study but has patients who are enrolled in it.

The company came under fire over the summer when it changed the endpoint of the trial. Originally, Lilly was going to determine the success of solanezumab by looking at two measures: how it affected thinking skills such as memory and reasoning, and whether it changed a person’s ability to function independently and perform daily activities such as dressing, bathing and feeding. But just before the final data on the last patient was collected in October, Lilly changed the outcomes so that the drug’s success would rest solely on the cognitive changes, with the functional ones as a secondary measure of success. Critics pointed out that functional changes tend to be more challenging to show and that the company made the change to maximize the chances of a positive outcome.

The company maintains that the shift simply reflected better understanding of how Alzheimer’s affects the brain; cognitive declines happen before functional ones, so detecting the latter would take a longer, more expensive study than an 18-month trial.

EXPEDITION3 was Lilly’s third chance to show that solanezumab was worth approving. In the previous two studies, people with either mild or moderate Alzheimer’s participated and the results were similarly negative. As knowledge about the disease improved, researchers learned that amyloid starts to build up years, perhaps even decades, before the first symptoms of memory and cognitive problems start. In response, Lilly launched EXPEDITION3, limiting the participants to people with mild forms of the disease. The company also took advantage of better imaging techniques that could document the presence of amyloid in the brain; in the previous two studies, anywhere from 20% to 30% of the volunteers did not actually have amyloid. (At the time, doctors were diagnosing people based only on their symptoms and performance on cognitive tests.)

The fact that the trial did not show benefit even among people with mild Alzheimer’s doesn’t necessarily spell the end of anti-amyloid approaches. It could simply mean that the drug treatment wasn’t started early enough in the disease to make a difference. Other anti-amyloid compounds, including one developed by Biogen, for example, have recently shown encouraging results in reducing amyloid plaques as well as improving cognitive skills. That agent, aducanumab, is designed to bind preferentially to the early clumps of amyloid as they form plaques, and therefore may be more useful in mild or moderate patients who are already showing signs of memory loss and other cognitive problems. “I don’t think we will abandon attempts to slow down Alzheimer’s with amyloid-lowering,” says Selkoe. “We’ve always known that solanezumab is a weak antibody, which is why it also doesn’t have many side effects. There is a balance between efficacy and safety, and while solanezumab was not that powerful, the idea was that the Food and Drug Administration, in approving the first disease-modifying Alzheimer’s treatment, needs to have a drug that can be used safely, and first do no harm.”