by Geri Piazza, assistant editor, NIH Research Matters

Alzheimer’s disease is an irreversible brain disorder that affects more than 5 million Americans. It slowly worsens and destroys memory and thinking skills.

Previous research has linked memory and thinking problems with visible changes that take place in the brain. People with Alzheimer’s have abnormal deposits of proteins called amyloid plaques and tau tangles. Plaques obstruct communication between nerve cells (or neurons) in the brain. Tau tangles disrupt processes in the cells and cause them to die.

Treatment may slow memory loss, but there’s no cure for Alzheimer’s disease. A better understanding of how the disease progresses may lead to more effective treatments.

A research team led by Drs. Manolis Kellis and Li-Huei Tsai of the Massachusetts Institute of Technology set out to identify the unique sets of genes that are turned on, or expressed, during Alzheimer’s in every major cell type in the prefrontal cortex. This region of the brain is involved in functions affected by Alzheimer’s disease: high-level thinking, making decisions, and attention.

The study was funded in part by NIH’s National Institute on Aging (NIA) and other NIH support. Results were released online in Nature as an accelerated article preview on May 1, 2019.

Brain tissue samples were donated by religious clergy who participated in a long-term aging study. Some developed Alzheimer’s disease during the study, and all agreed to donate brain tissue for research after death. Information about plaques and tangles, cognitive function score, and other markers of Alzheimer’s disease had been collected for all the participants.

The research team assessed data from 24 people with high amyloid levels and 24 with low levels. There were equal numbers of men and women, and participants were matched for age and level of education.

The researchers used single-cell sequencing technology to look at the genes expressed in every single cell within a sample. They analyzed protein-coding genes from more than 80,000 brain cells. They were able to distinguish six main types, including neurons and nearby supporting cells, and 40 distinct subtypes.

Both neurons and supporting cells had gene expression patterns in the Alzheimer brains that weren’t seen in the control brains. One noteworthy difference was in the genes related to myelination, the process of wrapping a fatty coating around nerve cell fibers to help them transmit signals. Another was that men and women of the same age and disease severity had different gene expression patterns. The women’s patterns were more abnormal.

The team also compared differences in gene expression between early-stage and late-stage Alzheimer’s disease. They identified distinct changes in all the major cell types early in the disease process. Genetic signatures related to myelination were affected in most cell types, suggesting a key role in the disease.

“This study provides, in my view, the very first map for going after all of the molecular processes that are altered in Alzheimer’s disease in every single cell type that we can now reliably characterize,” Kellis says. “It opens up a completely new era for understanding Alzheimer’s.”

Mondays- Bone Builders strength building class (9am-10:30am), Gentle Yoga with Nate (2pm-3pm)

Tuesdays- Find your Fit with Heidi (11am-11:45am), Aquatics with Mary from 1:30-2:30pm (2nd and 4th Tuesday/monthly)

Wednesdays- Gentle yoga with Nate (2pm-3pm)

Thursday- Bone Builders strength building class 9am-10:30am, Find your fit with Heidi (11am-11:45am)

They will be having their second annual family day with residents, associates in partnership with Koinonia and their foster families on Saturday, August 8, from 11am-3pm. There will be swimming, outdoor games, a taco truck and more. This will also e open to the public.

750 Clyde River Place | Oxnard, CA  93036
805.366.3446

www.clearwateratriverpark.com

by George Landrith President of Frontiers of Freedom, a public policy think tank

Congressional leaders and some White House officials reportedly favor “binding arbitration.” This proposed reform would allow government-appointed officials to dictate how much Medicare pays for new medicines. Proponents say arbitration could slash what the government spends on drugs. 

Binding arbitration is just a clever name for government price controls. It would distort the free market and limit patients’ access to the newest medicines. 

Medicare covers nearly all FDA-approved drugs. Part B generally covers medicines that doctors administer through injection or IV drips, while Medicare Part D covers most pills. In each, drug prices are determined by negotiations between pharmaceutical companies and insurance companies or hospitals. 

Under the proposed arbitration system, government officials wouldn’t have to accept the prices that result from these negotiations. 

Officials could call upon a third-party “arbitrator” to set the price for new drugs. If these officials trigger arbitration, pharmaceutical companies would have to suggest a fair price for their drugs and make the case to the arbitrator. 

Government officials would argue for their own suggested price. After considering both sides, the arbitrator would render a final, legally binding decision. 

Congressional leaders haven’t fully fleshed out the details of their proposal. 

One thing is certain, however. Government officials would hand-pick arbitrators who are on their side. Arbitration isn’t a true alternative to the government setting prices — it’s just a way for government officials to outsource the dirty work. 

Since the arbitrator’s decision would be legally binding, drug manufacturers wouldn’t be able to appeal an unfair verdict. Nor would there be a way to hold arbitrators accountable. 

Binding arbitration would smother medical innovation. 

Successful drug development requires substantial investment. The FDA only approves about one in ten experimental medicines that begin the first phase of clinical trials. Accounting for this massive failure rate, it costs $2.5 billion and takes more than a decade to develop a single new drug. 

Drug companies rely on just a few successful drugs to recoup their investments. Price controls make this already difficult process even harder. As a result, they discourage investors from putting money towards future projects. That means fewer lifesaving drugs for patients. 

Just look across the pond. Fifty years ago, Europe produced more than half of the world’s medicines; America produced just 30 percent. But then, countries like Germany and the United Kingdom embraced price controls — while the United States let the free market flourish. 

Today, scientists invent more than half of the world’s medicines in America. Meanwhile, the entire continent of Europe produces less than a third of medicines. American patients have access to more innovative therapies than patients anywhere else in the world — including Europe. 

Binding arbitration would sacrifice Americans’ access to the most innovative medicines. Lawmakers should nip this policy in the bud before patients pay the ultimate price. 

by Carol Bradley Bursack

Many times, in-home caregivers’ best efforts are met with anger or even abuse dished out by the elder they are intended to care for. It is crucial for the family and hired caregiver(s) to determine the underlying reason for a senior’s lack of cooperation and find ways to remedy the situation.

I believe that fear is the foundation of much of a senior’s reluctance and even disrespect for non-family caregivers. The presence of an outsider may suggest to them that their family can’t (or doesn’t want to) take care of their needs. It also magnifies the extent of the elder’s care needs, making them feel especially vulnerable. This combination of concerns can create the perfect storm, especially if they are prone to lashing out when angry. Of course, the family members who arrange these services get an earful, but the professional caregiver becomes the primary target for sending the message that outside help is neither wanted nor needed.

People of all ages dread the idea of losing their independence, but many seniors are living this reality and trying to come to terms with it. Aging is hardly a graceful process, so who can blame our elders for digging their heels in?

If a senior is still of sound mind, emphasize that home care enables them to continue living safely in their own home. This in itself is an overarching symbol of independence. The right caregiver will pick up on this strong desire to be self-sufficient and provide assistance in ways that allow the senior to retain as much control as possible.

Adapting to in-home care is much smoother when the family is confident in the hire. Know what to look for in a provider and interview caregivers before services begin to determine a good match. With this approach, if something seems off, you have the opportunity to correct your decision before it actually becomes a problem.

It can be challenging to encourage a mentally healthy senior to accept outside help, but Alzheimer’s disease and other forms of dementia can make this process even more complex.

Depending on the progression of the condition, a senior may not be able to fully participate in the hiring process. Nonetheless, introducing potential caregivers beforehand to see how both parties get along is still a valuable step. Dementia patients’ moods and capabilities fluctuate from day to day, though, so keep this in mind when trying to help a loved one to warm up to someone new.

Paranoia, hallucinations and delusions are common symptoms that a dementia caregiver should know how to handle. Look for someone who is trained in this kind of care and knows how to communicate with and calm their clients. Having a family member present during the first few shifts while everyone gets to know each other can reassure a senior that they are safe and in good company.

A senior with dementia may not ever be comfortable with a particular caregiver, even though the aide is making a considerable effort to do everything right. Regardless of the reason, some matches just do not take, and the care team may have to simply request another caregiver.

You know your loved one best, so do whatever you can to help make them more comfortable with this new arrangement. Assure them that you are still their primary caregiver, but explain that you need help. Emphasize that the professional caregiver is there to assist both of you and that you are closely monitoring the process and their wellbeing.

Communicate openly with the caregiver and the home care company about any challenges you experience. Understanding the source of the senior’s resistance will help you cope with this problem, and a care team meeting may be instrumental in brainstorming solutions together.