USA2 SPOTLIGHT

A February 10, 2017 Exome article explored the role that Trump’s pick for Food and Drug Administration commissioner will have. Trump wants to slash FDA rules by 75-80%. But could the FDA make changes to help more Alzheimer’s drugs get into and through clinical trials? This process is daunting because AD takes so long to advance. Drug makers would love to use a biological signal that shows a drug is working—a short cut. “We haven’t had any experience that the FDA is being too tight or over-regulating Alzheimer’s drugs,” says George Vradenburg, Chairman, UsAgainstAlzheimer’s. “They’re willing, ready, and able to evaluate drugs that are successful in clinical trials. But they haven’t received any.” Trump’s FDA could also broaden “right to try” rules, giving desperate patients, not enrolled in clinical trials, access to experimental drugs.

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A February 10, 2017 New York Times article reported on Karen Pence’s (the Vice-President’s wife) support of art therapy. Art therapy is a form of psychotherapy where mental health professionals use art to help patients explore feelings not easily expressed in words. Pence has been a board member of the art therapy program, Tracy’s Kids since 2011, and helped raise funds for a children’s hospital to hire full-time art therapists. “I want to get more people aware of art therapy, not only for children who are going through an illness, but adults as well who have gone through trauma,” said Mrs. Pence. Most states don’t offer licenses to art therapists, meaning they can’t bill insurance. Often, private donors fund art therapists in states without licensure. Dr. Anjan Chatterjee, Neurology Chairman at Pennsylvania Hospital, believes art therapy may capitalize on what Alzheimer’s patients can still do, like drawing, so it can improve the sense of well-being. A few small trials suggest art therapy engages attention and improves neuropsychiatric symptoms, social behavior and self-esteem for AD patients.

A February 9, 2017 Forbes article reported on the lack of “demential experts” in America, and begins with a thought experiment: what kind of doctor should a concerned daughter take her forgetful mother to? Jason Karlawish, the article’s author, was part of an “amyloid imaging task force” trying to answer the question, and charged with developing guidelines for the appropriate use of a new brain scan that measures amyloid. They readily created detailed guidance on the kinds of patients who should have the test, and the kind of doctor who should order it: a “dementia expert.” But then they faced a roadblock: who is a dementia expert? The agreed-upon answer is a geriatrician, neurologist or psychiatrist who devotes a “substantial proportion” (at least 25% of patient contact) of practice to diagnosing and caring for adults with cognitive problems. There aren't a lot of doctors who meet this criterion because it’s not economically viable to have a clinical practice focused on AD. The care system needs to change and funds allocated for the time it takes to care for older adults with cognitive impairments.

RESEARCH, SCIENCE AND TECHNOLOGY

A February 9, 2017 Neurology Advisor article reported on a study published in the Journal of Alzheimer's Disease showing that a combination of two drugs (donepezil and choline alphoscerate) can be a beneficial alternative for reducing behavioral and psychological symptoms of dementia in patients with mild and moderate Alzheimer's disease. The study was a double-blind, randomized trial from the clinical research department at the Telemedicine and Telepharmacy Center of the University of Camerino, Italy. It looked to evaluate the effects of behavioral and psychological symptoms of dementia: mood disorders (anxiety, apathy, and depression), psychotic symptoms (delusions and hallucinations), aberrant motor behaviors (pacing, wandering, and other purposeless behaviors), and inappropriate behaviors (agitation, disinhibition, and euphoria). The researchers also examined the severity of caregiver distress. Anna Carotenub, PhD, lead trial researcher, suggested that the drug combination could have positive outcomes for patients with mild and moderate Alzheimer's disease.

GLOBAL PERSPECTIVES

A February 10, 2017 BBC News article reported on the new Dementia Risk Reduction Campaign, from the Welch government, launching with a 10-day road show visiting large shopping centers and employers. Its aim is to reduce people's risk of developing dementia by 60% by encouraging them to live healthier lives. The campaign follows research by Prof Peter Elwood at Cardiff University, who found a healthier life can reduce a person's risk of getting early onset dementia. In his study, he looked at the lifestyle habits of middle-aged men from 1979-2014 and monitored factors which contribute to diseases like cancer and dementia, such as smoking, diet and exercise. "Longevity of life is useless unless you have quality," said Leighton Jones, 82, a study participant.