by Richard J. Hodes, M.D., Director, National Institute on Aging, National Institutes of Health

The FDA’s approval of the Biogen-Eisai drug, aducanumab, marks a milestone achievement in Alzheimer’s disease research. This drug is the first approved treatment shown to slow progression of this disease. It is also a reflection of the years of research and momentum we see in Alzheimer’s research more broadly.

FDA approved aducanumab to treat patients with Alzheimer’s using the Accelerated Approval pathway, under which the agency “approves a drug for a serious or life-threatening illness that may provide meaningful therapeutic benefit over existing treatments when the drug is shown to have an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients and there remains some uncertainty about the drug’s clinical benefit.” FDA further stated that “at the end of the day, we followed our usual course of action when making regulatory decisions in situations where the data are not straightforward.”

The FDA also stated that “approval is based on a surrogate or intermediate clinical endpoint (in this case reduction of amyloid plaque in the brain).” Additionally, “drug companies are required to conduct post-approval studies to verify the anticipated clinical benefit. These studies are known as phase 4 confirmatory trials. If the confirmatory trial does not verify the drug’s anticipated clinical benefit, FDA has regulatory procedures in place that could lead to removing the drug from the market.”

NIA thanks the many individuals who have participated in the clinical trials that have led us to this point. Advancements like this underscore the enormous importance of participating in clinical trials, today and in the future.

While the NIH provided no direct support for the drug development of aducanumab, our years of funding have been integral to this and other promising therapeutic approaches to treating Alzheimer’s disease. For example, NIA supported basic science investigations behind the discovery of immunotherapies like aducanumab, as well as translational research for next-generation immunotherapies. Additionally, the selection of participants for aducanumab clinical trials hinged on amyloid PET imaging, a technology that would not exist today without the publicly funded research supported by the NIA.

Today’s announcement is indeed significant, yet the work does not end here. Bolstered by significant investments in this research in recent years, NIA will continue to press forward with its robust and diverse research portfolio in the area of therapy development, building on the advancements we have achieved thus far. We will continue to evolve our understanding about Alzheimer’s and to develop more ways to detect, treat, and prevent this disease. We’re closer than ever to living in a world in which this condition may not take the enormous toll it does today.

by Alzheimer’s DiseaseCognitive HealthDementiasHealth Care ResearchMental & Emotional Health

About 14% of older adults with dementia filled prescriptions for multiple medications that target the central nervous system (CNS), or the brain and spinal cord, according to a recent study. The use of multiple medications, called polypharmacy, can increase the risk of serious side effects. Taking combinations of CNS-active drugs can lead to an increased risk of falling, breathing issues, and heart problems. In addition, some CNS-active drugs can affect thinking and memory — a side effect that is especially troubling in people with dementia. The NIA-supported study, led by researchers at the University of Michigan, was published in JAMA on March 9.Nurse giving an older adult medications.

Medications affecting the CNS are used to treat depression and other mental health conditions, prevent seizures, and reduce pain. Older adults who have dementia sometimes have behavioral and psychological symptoms, such as agitation or delusions. Health care providers may prescribe CNS-active drugs to treat those symptoms, but evidence of the drugs’ effectiveness for the symptoms is limited.

To better understand how many people with dementia received a combination of these drugs, researchers looked at Medicare claims data on more than 1 million adults ages 77 to 88 who had dementia. The researchers analyzed the number and timing of prescriptions filled to estimate the number of people who likely took combinations of the drugs.

The researchers found that 13.9% of these adults filled prescriptions for three or more CNS-active drugs for more than 30 days in a row. More than half of those adults had the drugs for more than 180 days. The researchers also found that people who were prescribed a combination of CNS-active drugs had higher rates of insomnia, mental health conditions, and pain not associated with cancer and seizure disorders. However, the researchers could not, based on the claims data, determine whether the drugs were prescribed to treat those conditions.

The researchers identified some limitations of their study that could point to areas for further investigation. The study may have overestimated the number of people who actually took the drugs because it counted prescriptions filled. The study did not look at the reasons the drugs were prescribed or their dosages. It also did not determine whether the adults who took a combination of CNS-active drugs had health problems that the drugs could cause, such as falls.

This study is the first to examine the number of adults with dementia who live in the community — not in nursing homes — and take a combination of CNS-active drugs. As the number of adults living with dementia increases, better understanding how these drugs are used, their effects, and associated risks could help health care providers and dementia patients make safer, well-informed care decisions.

This research was supported by NIA grant R01AG056407.

How to Set Fitness Goals

Write a Plan to Add Exercise and Physical Activity to Your Life

Deciding to become physically active can be one of the best things you can do for your health. Exercise and physical activity are not only great for your mental and physical health, but they can help keep you independent as you age. Now, let’s talk about getting started.

How Much Activity Do Older Adults Need?

According to the Physical Activity Guidelines for Americans (PDF, 14.5M) you should do at least 150 minutes (2 ½ hours) a week of moderate-intensity aerobic exercise, like brisk walking or fast dancing. Being active at least 3 days a week is best, but doing anything is better than doing nothing at all. You should also do muscle-strengthening activities, like lifting weights or doing sit-ups, at least 2 days a week. The Physical Activity Guidelines also recommend that as part of your weekly physical activity you combine multiple components of exercises. For example, try balance training as well as aerobic and muscle-strengthening activities. If you prefer vigorous-intensity aerobic activity (like running), aim for at least 75 minutes a week.

How Older Adults Can Get Started with Exercise

Exercise and physical activity are great for your mental and physical health and help keep you independent as you age. Here are a few things you may want to keep in mind when beginning to exercise.

Start Slowly When Beginning Exercise

The key to being successful and safe when beginning a physical activity routine is to build slowly from your current fitness level. Over-exercising can cause injury, which may lead to quitting. A steady rate of progress is the best approach.

To play it safe and reduce your risk of injury:

Begin your exercise program slowly with low-intensity exercises.

Warm up before exercising and cool down afterward.

Pay attention to your surroundings when exercising outdoors.

Drink water before, during, and after your workout session, even if you don’t feel thirsty. Play catch, kickball, basketball, or soccer.

Wear appropriate fitness clothes and shoes for your activity.

If you have specific health conditions, discuss your exercise and physical activity plan with your health care provider.

Don’t forget to test your current fitness level for all 4 types of exercise—endurance, balance, flexibility, and strength. You may be in shape for running, but if you’re not stretching, you’re not getting the maximum benefit from your exercise. Write down your results so you can track your progress as you continue to exercise.

Make notes about how these test exercises feel. If the exercises were hard, do what’s comfortable and slowly build up. If they were easy, you know your level of fitness is higher. You can be more ambitious and challenge yourself.

Many people enjoy warm-weather outdoor activities like walking, gardening, or playing tennis. Make sure to play it safe in hot weather. Too much heat can be risky for older adults and people with health problems. Being hot for too long can cause hyperthermia—a heat-related illness that includes heat stroke and heat exhaustion.

If you want to be active when it’s hot outside:

Check the weather forecast. If it’s very hot or humid, exercise inside with videos online, or walk in an air-conditioned building like a shopping mall.

Drink plenty of liquids. Water and fruit juices are good options. Avoid caffeine and alcohol. If your doctor has told you to limit liquids, ask what to do when it is very hot outside.

Wear light-colored, loose-fitting clothes in natural fabrics.

Dress in layers so you can remove clothing as your body warms up from activity.

Know the signs of heat-related illnesses and get medical help right away if you think someone has one.

Tips for exercising in cold weather

You can exercise outdoors in the winter, but take a few extra steps to stay safe before braving the cold. Exposure to cold can cause health problems such as hypothermia, a dangerous drop in body temperature.

If you want to walk, ski, ice skate, shovel show, or do other outdoor activities when it’s cold outside:

Check the weather forecast. If it’s very windy or cold, exercise inside with videos online and go out another time.

Watch out for snow and icy sidewalks.

Warm up your muscles first. Try walking or light arm pumping before you go out.

Pick the right clothes. Wear several layers of loose clothing. The layers will trap warm air between them. Avoid tight clothing, which can keep your blood from flowing freely and lead to loss of body heat.

Wear a waterproof coat or jacket if it’s snowy or rainy. Wear a hat, scarf, and gloves.

Learn the signs of hypothermia.

by National Institute of Health

Food can be unsafe for many reasons. It might be contaminated by germs—microbes such as bacteria, viruses, or molds. These microbes might have been present before the food was harvested or collected, or they could have been introduced during handling or preparation. In either case, the food might look fine but could make you very sick. Food can also be unsafe because it has “gone bad.” Sometimes, you may see mold growing on the surface.

For an older person, a food-related illness can be life threatening. As you age, you have more trouble fighting off microbes. Health problems, like diabetes or kidney disease, also make you more likely to get sick from eating foods that are unsafe. So be careful about how food is prepared and stored.

Some foods present higher risks than others. Here are some tips on selecting lower-risk food options:

Eat fish, shellfish, meat, and poultry that have been cooked to a safe minimum internal temperature, instead of eating the food raw or undercooked.

Drink pasteurized milk and juices instead of the unpasteurized versions.

Make sure pasteurized eggs or egg products are used in recipes that call for raw or undercooked eggs, such as homemade Caesar salad dressings, raw cookie dough, or eggnog.

Always wash vegetables, including all salad ingredients, before eating. Cooked vegetables also are a lower-risk option than raw vegetables.

Choose cooked sprouts instead of raw sprouts.

Choose hard or processed cheeses, cream cheese, or mozzarella, or any cheese that is clearly labeled “Made from Pasteurized Milk” instead of soft cheese made from unpasteurized (raw) milk, such as Brie, Camembert, blue-veined, or queso fresco.

Heat up hot dogs, deli meats, and luncheon meats to 165 °F (steaming hot), instead of eating the meat unheated.

Changing Taste and Smell

As you grow older, your senses of taste and smell might change. Some illnesses, like COVID-19, or health conditions can change your senses of smell and taste. Certain medicines might also make things taste different. If you can’t rely on your sense of taste or smell to tell that food is spoiled, be extra careful about how you handle your food. If something doesn’t look, smell, or taste right, throw it out—don’t take a chance with your health.

Smart Storage

Food safety starts with storing your food properly. Sometimes that’s as simple as following directions on the container. For example, if the label says “refrigerate after opening,” do that! It’s also a good idea to keep any canned and packaged items in a cool place.

When you are ready to use a packaged food, check the date on the label. That bottle of juice might have been in your cabinet so long it is now out of date. (See Reading Food Labels to understand the date on the food label.)

Try to use refrigerated leftovers within 3 or 4 days to reduce your risk of food poisoning. Throw away foods older than that or those that show moldy areas.

Injuries from falls and car crashes are more common as we age. These injuries can have devastating effects. But these injuries can be prevented so you can stay healthy and independent longer.

More than 1 in 4 older adults report falling each year—this results in about 36 million falls.1 Falls can cause serious injuries such as broken bones or a head or brain injury.2 But falls are not a normal part of aging—they can be prevented.

There are simple steps you can take to keep yourself from falling and to stay healthy and independent longer.

Tell your doctor if you have fallen, if you feel unsteady when standing or walking, or if you are afraid you might fall.
Ask your doctor or pharmacist to review the medicines you take. Some medicines might make you dizzy or sleepy which can increase your risk of falling.
Have an eye doctor check your eyes at least once a year and update your eyeglasses as needed.
Have your doctor check your feet at least once a year and discuss proper footwear to reduce your risk of falling.
Ask your doctor about health conditions like depression, osteoporosis, or hypotension that can increase your risk for falling.

Get rid of trip hazards like throw rugs, and keep floors clutter free.
Brighten your home with extra lighting or brighter light bulbs.
Install grab bars in the bathroom(s)—next to the toilet and inside and outside of your bathtub or shower.
Install handrails on both sides of staircases.

Preventing a Motor Vehicle Crash
Driving helps older adults stay mobile and independent. But the risk of being injured in a traffic crash increases as we age.

As we age, declines in vision and cognitive function (ability to reason and remember), as well as physical changes, might affect our driving abilities.

You can take action to stay safer on the road and stay independent longer.
There are simple steps you can take to stay safe on the road.
Buckle Up Every Time!
Always wear a seat belt as a driver or a passenger. If you are in a crash, wearing a seat belt is one of the most effective ways to reduce your chance of getting injured. It can even save your life.

Drive when conditions are safest.

Drive during daylight and in good weather.
Conditions such as poor weather (like rain or snow) and driving at night increase your chance of a crash.
Never drink and drive.

Alcohol reduces coordination, impairs judgement, and increases the risk of being in a crash.
Before you drive, find the safest route with well-lit streets, intersections with left-turn signals, and easy parking.
Watch your distance.

Leave a large following distance between your car and the car in front of you. You may experience delayed reflexes or slower reaction time as you age.
Don’t drive distracted.

Avoid distractions in your car, such as listening to a loud radio, talking or texting on your phone, and eating.
Get a ride.

Consider alternatives to driving, such as riding with a friend or family member, taking a ride share service, or using public transportation if possible.

by Laurie Ryan Chief, Clinical Interventions and Diagnostics Branch,

Division of Neuroscience and Nina Silverberg Director, Alzheimer’s Disease Centers Program, Division of Neuroscience

Each year, about 6,000 American children are born with Down syndrome (DS), the most common chromosomal disorder. Adults with DS are at very high risk for developing Alzheimer’s disease (AD). Virtually all adults with DS have brain changes consistent with AD by age 40, and a high percentage of them go on to develop dementia by their late 60s. But there is wide variation in age at dementia symptom onset, which suggests there are additional genetic, biological, and environmental factors that modify disease progression. We need further and more intensive research to better understand how AD develops in people with DS and to develop possible treatments to delay or prevent it.

To tackle this challenge, in 2018, NIH launched the Investigation of Co-occurring Conditions Across the Lifespan to Understand Down Syndrome (INCLUDE) Project. INCLUDE supports DS-related research across the lifespan via basic science, clinical studies, and clinical trials. INCLUDE prioritizes the rapid and broad sharing of data, biosamples, knowledge, and tools to the wider research community along with training the next wave of DS-integrated scientists.

The Alzheimer’s Clinical Trials Consortium-Down Syndrome (ACTC-DS) is one such INCLUDE-supported program. It builds upon the NIA-supported Alzheimer’s Clinical Trials Consortium to conduct AD clinical trials in adults with DS in the United States and Europe, including sites that are part of the NIH-supported Alzheimer’s Biomarkers Consortium – Down Syndrome (ABC-DS). ACTC-DS’s first project is the Trial-Ready Cohort – Down Syndrome, which aims to create a cohort of adults living with DS who are interested in participating in future AD clinical trials and willing to undergo blood tests, brain imaging, and cognitive testing.

NIA and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) have a long-standing history of collaboration in AD and DS research. In September 2020, we were pleased to build upon this history and host a virtual meeting of the NIA-funded Alzheimer’s Disease Research Centers (ADRCs) and the NICHD-supported Eunice Kennedy Shriver Intellectual and Developmental Disabilities Research Centers (IDDRCs). The workshop connected a wide range of investigators from multiple institutions and encouraged collaborations within and among the sites.

Several joint projects are now in development as a result of the introductions fostered during this meeting. Attendees discussed and were encouraged to use the Down syndrome-specific module developed by the National Alzheimer’s Coordinating Center and available for use by ADRCs and IDDRCs. This DS clinical and cognitive assessment module is harmonized with some of the ABC-DS clinical and neuropsychological measures. Data and biosamples generated from the participants who are being evaluated with the module will also be available for broader sharing.

If you’re passionate about DS and AD research, join us! The resources from these important collaborative efforts will be available for investigators who are interested in further expanding DS and AD research. To learn more about INCLUDE Project funding opportunities and supported investigators and projects, visit the INCLUDE website. Please reach out to Laurie Ryan, Nina Silverberg, and Melissa Parisi with additional questions.

by Chair-Elect of NCOA’s Board of Directors and President & CEO of Greenlee Global, LLC

Key Takeaways

We all deserve to lead happy and healthy lives free from abuse as we age, yet older people are mistreated more often than we think.

Older adults are mistreated more often than we think due to the lack of supports in our communities.

It doesn’t have to be this way. In support of World Elder Abuse Awareness Day (WEAAD) today, get involved in creating a stronger society that safeguards our communities and prevents abuse.

It could be happening to your neighbor, your aunt, or someone you know from church. It could be physical, emotional, or financial. Almost always, it is silent.

It is elder abuse, and it is more prevalent than you might think. Studies have found that at least one in 10 older adults living in the community experienced some form of abuse in the prior year. In almost 60% of incidents, the perpetrator is a family member.

Elder abuse is a hidden crime that robs older adults of their dignity, money, health, and in some cases, their lives. June 15 is World Elder Abuse Awareness Day, a chance to shine a spotlight on this global challenge—and work as individuals and as a society to stop it.

While elder abuse is silent, there are warning signs. Some may be clearly visible—such as bruises or bedsores. Others may show up in unexpected ways. An older adult who was engaged and alert may become depressed and uninterested in people and activities they used to love. There may be sudden changes in the person’s finances that cannot be explained.

Each of us plays a role in understanding and reporting elder abuse. If you know of an older adult who is in immediate, life-threatening danger, call 911. If you suspect abuse, contact your local Adult Protective Services office by calling the Eldercare Locator at 1-800-677-1116.

While each of us as individuals needs to be vigilant, government needs to step up. In 2010, NCOA advocated for passage of the Elder Justice Act, the first comprehensive legislation to coordinate elder abuse prevention at the federal level. But it has taken more than 10 years to finally secure significant funding for it.

In response to the pandemic, the 2020 year-end funding bill included $100 million in emergency funding for elder justice programs. The American Rescue Plan signed by President Biden in March invests another $276 million per year in the Elder Justice Act over the next two years.

These resources are sorely needed and will be used quickly. But more work remains. NCOA continues to follow the lead of the Elder Justice Coalition in endorsing key bills to address financial exploitation, empower financial institutions, and strengthen activities on the judicial side of this effort. That includes the Stop Senior Scams Act and Elder Abuse Protection Act already introduced in the 117th Congress.

Abuse of any person at any age is intolerable. We must do all we can to ensure that every American is safe.

Alzheimer’s disease and related dementias change the way people remember, think, and act. These diseases can be devastating for the individuals who have them and for their families and caregivers. Taking action against Alzheimer’s and related dementias is a priority for the federal government.

The National Alzheimer’s Project Act (NAPA), signed into law in January 2011, called for a coordinated national plan to accelerate research and improve care and services for people living with Alzheimer’s and related dementias and their families.

As the economic costs of care continue to climb — along with costs associated with loss of independence and quality of life — we are more driven than ever to discover, develop, disseminate, and implement solutions that will improve the lives of those with dementia, their caregivers, and their communities.

Prevent and effectively treat Alzheimer’s disease by 2025

Optimize care quality and efficiency

Expand supports for people with Alzheimer’s disease and their families

Enhance public awareness and engagement

Track progress and drive improvement

Alzheimer’s is the sixth leading cause of death for Americans. In 2017, it accounted for an estimated 120,000 deaths.

An analysis conducted by NIH-supported researchers found that total social costs from health care and caregiving spending for a person with probable dementia in the last five years of life was an estimated $287,000, compared with $175,000 for an individual with heart disease and $173,000 for someone with cancer.

Agencies across the federal government support efforts to carry out the National Plan.

The National Institutes of Health (NIH) is made up of Institutes, Centers, and Offices that conduct and fund research into all aspects of human health. The National Institute on Aging (NIA) leads NIH’s efforts in clinical, behavioral, and social research in Alzheimer’s and related dementias through efforts aimed at finding ways to treat and ultimately prevent the disorder. NIA collaborates closely with the National Institute of Neurological Disorders and Stroke (NINDS), which manages a research portfolio targeting Alzheimer’s disease-related dementias. NIA and NINDS work with Institutes and Centers across NIH to fund related projects. NIH also collaborates with the Department of Veterans Affairs to leverage health data from millions of older veterans to contribute to Alzheimer’s research.

NIH-funded research is conducted both in NIH laboratories and at institutions and small businesses around the country. A cornerstone of NIH’s Alzheimer’s research is a group of more than 30 Alzheimer’s Disease Research Centers across the U.S. These centers conduct research to advance scientific discoveries, provide research resources for the broader research community, and work to translate research advances into improved diagnosis, treatment, and care. NIA also supports several large infrastructure programs designed to support drug development, scientific collaboration, data sharing, and clinical research.

In addition, NIA and NINDS have announced the development of a groundbreaking new research center on the NIH campus in Bethesda, Maryland. The Center for Alzheimer’s Disease and Related Dementias Research (CARD) will bring together scientists from multiple NIH Institutes and Centers to support basic, translational, and clinical research on Alzheimer’s and related dementias. The center’s efforts will complement and enhance the work of thousands of researchers working across the globe to find a treatment or cure for these diseases.

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. These functions include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.

While dementia is more common as people grow older (up to half of all people age 85 or older may have some form of dementia), it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia. One type of dementia, frontotemporal disorders, is more common in middle-aged than older adults.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Alzheimer’s disease is the most common cause of dementia in older adults. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia—a combination of two or more types of dementia. For example, some people have both Alzheimer’s disease and vascular dementia.

What are the Different Types of Dementia?

Hispanic man with dementia sitting in a parkVarious disorders and factors contribute to the development of dementia. Neurodegenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:

Alzheimer’s disease

Frontotemporal disorders

Lewy body dementia

Other types of progressive brain disease include:

Vascular contributions to cognitive impairment and dementia

Mixed dementia, a combination of two or more types of dementia

Other conditions that cause dementia-like symptoms can be halted or even reversed with treatment. For example, normal pressure hydrocephalus, an abnormal buildup of cerebrospinal fluid in the brain, often resolves with treatment.

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

Side effects of certain medicines

Emotional problems, such as stress, anxiety, or depression

Certain vitamin deficiencies

Drinking too much alcohol

Blood clots, tumors, or infections in the brain

Delirium

Head injury, such as a concussion from a fall or accident

Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

Argyrophilic grain disease, a common, late-onset degenerative disease

Creutzfeldt-Jakob disease, a rare brain disorder

Huntington’s disease, an inherited, progressive brain disease

Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury

HIV-associated dementia (HAD)

The overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist—a doctor who specializes in disorders of the brain and nervous system—or other medical specialist who knows about dementia.

To diagnose dementia, doctors first assess whether a person has an underlying treatable condition such as abnormal thyroid function, normal pressure hydrocephalus, or a vitamin deficiency that may relate to cognitive difficulties. Early detection of symptoms is important, as some causes can be treated. In many cases, the specific type of dementia a person has may not be confirmed until after the person has died and the brain is examined.