1. Designing dementia friendly care homes

    May 16, 2016 by Ashley

    From the Bournemouth University media release:

    senior alzheimerAs the population ages and demography changes, the UK is facing an unprecedented challenge of how to care for and support its older people.

    While the fact that people are living longer should be celebrated, the flip side is that age-related illness such as dementia are on the rise and it’s important for us, as a country to find solutions and alleviate the difficulties people may face as a result.

    Under the supervision of Associate Professor Jan Wiener, one of BU’s PhD students, Mary O’Malley, has been exploring how people with dementia learn to navigate unfamiliar environments and what consequences this could have for dementia care home building guidelines.

    “My research is looking at ways to reduce potential spatial disorientation for older adults, both those with memory difficulties and those without,” explained Mary, “By exploring this issue, I hope it will lead to design changes in the living environment that supports successful orientation.”

    I’m looking at people’s wayfinding systems and how navigational tools are used in care homes, and how these might help or hinder people’s abilities to find their way around,” continues Mary, “I’m looking at the strategies people use to learn new environments and I’m also going into retirement developments and asking people how they find their way around and what helps them to navigate unfamiliar places — for me, it’s important to hear the users’ voice when it comes to designing the environment.”

    Mary is undertaking a mixed methods PhD, which is gathering both qualitative and quantitative data. By carrying out a number of studies and drawing on expertise from BU’s Psychology Department, BU’s Dementia Institute (BUDI) and external architecture expertise, Mary is taking a rounded, interdisciplinary approach to her work. For her, bridging the gap between disciplines has been very beneficial.

    “If you were just approaching this from one angle, one discipline, you’d miss so much valuable information,” said Mary, “To be able to improve the design environment, it’s really important to get input from different subject areas. There’s no singular way of doing this, so it’s great to draw on expertise from a spectrum of disciplines.”

    As she explained, “In psychology, we have a lot of knowledge about way-finding and how people navigate around environments, but not a lot of that has been translated into applied settings. There’s lots of potential to apply and test out this knowledge for older people in retirement settings and care homes, both of which are places where this research could make a real impact.”

    While design guidelines are often applied to care homes, there are lots of other spaces used by older people and people with memory problems which could benefit from better wayfinding guidelines — hospitals, retirement homes and shopping centres are just a few examples. Given the prominence of the idea of dementia friendly communities, Mary’s research is very timely.

    In order to carry out her research, Mary has been going out to retirement homes and care homes, and learning from their residents about their experiences of navigating their environments. She has also been using some of the state-of-the-art technology available in the Psychology Department to create virtual environments which older people navigate their way around.

    One of her studies looked at how people learn a new route and which navigational strategies people use when learning it. “The results showed that older adults who performed lower on a neuropsychological assessment, suggesting possible atypical aging, had difficulties with some specific measures of route memory– they found it hard to translate and to identify a recently learned route from a map perspective, and interestingly, there were significant differences between two separate forms of landmark memory which we would like to further investigate,” explained Mary.

    “We want to follow-up these findings with a second study which will explore how useful ‘you are here’ maps are for certain demographics and in certain environments,” said Mary, “Additionally, we want to see whether a certain placement of landmarks would make a difference in how well a route is learned. For this we are going to be using a virtual care home environment, which will allow us to change the variables, such as corridor layout and where landmarks are placed.”

    Mary’s research is already having an impact, as one of the retirement homes where she has been carrying out her qualitative research is intending to have a full re-design based on the findings and reports made by the residents living there. Ultimately, Mary’s aim is to use her research to influence designers and architects to create built environments which are easier for older people and people with memory loss to navigate. The main tool for achieving this will be through informing building guidelines and regulations — something Mary is keen to develop.


  2. New cases of dementia in the UK fall by 20 percent over two decades

    April 25, 2016 by Ashley

    From the University of Cambridge media release:

    seniors_companionshipThe UK has seen a 20% fall in the incidence of dementia over the past two decades, according to new research from England, led by the University of Cambridge, leading to an estimated 40,000 fewer cases of dementia than previously predicted. However, the study, published today in Nature Communications, suggests that the dramatic change has been observed mainly in men.

    Reports in both the media and from governments have suggested that the world is facing a dementia ‘tsunami’ of ever-increasing numbers, particularly as populations age. However, several recent studies have begun to suggest that the picture is far more complex. Although changing diagnostic methods and criteria are identifying more people as having dementia, societal measures which improve health such as education, early- and mid-life health promotion including smoking reduction and attention to diet and exercise may be driving a reduction in risk in some countries. Prevalence (the proportion of people with dementia) has been reported to have dropped in some European countries but it is incidence (the proportion of people developing dementia in a given time period) that provides by far the most robust evidence of fundamental change in populations.

    As part of the Medical Research Council Cognitive Function and Ageing Study (CFAS), researchers at the University of Cambridge, Newcastle University, Nottingham University and the University of East Anglia interviewed a baseline of 7,500 people in three regions of the UK (Cambridgeshire, Newcastle and Nottingham) between 1991 and 1994 with repeat interviews at two years to estimate incidence. Then 20 years later a new sample of over 7,500 people from the same localities aged 65 and over was interviewed with a two year repeat interview again. This is the first time that a direct comparison of incidence across time in multiple areas, using identical methodological approaches, has been conducted in the world.

    The researchers found that dementia incidence across the two decades has dropped by 20% and that this fall is driven by a reduction in incidence among men at all ages. These findings suggest that in the UK there are just under 210,000 new cases per year: 74,000 men and 135,000 women — this is compared to an anticipated 250,000 new cases based on previous levels. Incidence rates are higher in more deprived areas.

    Even in the presence of an ageing population, this means that the number of people estimated to develop dementia in any year has remained relatively stable, providing evidence that dementia in whole populations can change. It is not clear why rates among men have declined faster than those among women, though it is possible that it is related to the drop in smoking and vascular health improving in men.

    Professor Carol Brayne, Director of the Cambridge Institute of Public Health, University of Cambridge, says: “Our findings suggest that brain health is improving significantly in the UK across generations, particularly among men, but that deprivation is still putting people at a disadvantage. The UK in earlier eras has seen major societal investments into improving population health and this appears to be helping protect older people from dementia. It is vital that policies take potential long term benefits into account. ”

    Professor Fiona Matthews from the Institute of Health and Society, Newcastle University and the MRC Biostatistics Unit, Cambridge adds: “Public health measures aimed at reducing people’s risk of developing dementia are vital and potentially more cost effective in the long run than relying on early detection and treating dementia once it is present. Our findings support a public health approach for long term dementia prevention, although clearly this does not reduce the need for alternative approaches for at-risk groups and for those who develop dementia.”

    The researchers argue that while influential reports continue to promote future scenarios of huge increases of people with dementia across the globe, their study shows that global attention and investment in reducing the risk of dementia can help prevent such increases.

    “While we’ve seen investment in Europe and many other countries, the lack of progress in access to education, malnutrition in childhood and persistent inequalities within and across other countries means that dementia will continue to have a major impact globally,” says Professor Brayne. “Our evidence shows that the so-called dementia ‘tsunami’ is not an inevitability: we can help turn the tide if we take action now.”

    Dr Rob Buckle, director of science programmes at the Medical Research Council, which funded the study, added: “It is promising news that dementia rates, especially amongst men, have dropped by such a significant amount over the last twenty years, and testament to the benefits of an increased awareness of a brain-healthy lifestyle. However, the burden of dementia will continue to have significant societal impact given the growing proportion of elderly people within the UK population and it is therefore as important as ever that we continue to search for new ways of preventing and treating the disease. This study does, however, reinforce the importance of long-term, quality studies that create a wealth of data of invaluable resource for researchers.”


  3. Brain study reveals how long-term memories are erased

    March 31, 2016 by Ashley

    From the University of Edinburgh media release:

    mri scanVital clues about how the brain erases long term memories have been uncovered by researchers.

    The study in rats reveals how forgetting can be the result of an active deletion process rather than a failure to remember.

    It points towards new ways of tackling memory loss associated with conditions such as Alzheimer’s disease and other types of dementia.

    The findings could also help scientists to understand why some unwanted memories are so long-lasting — such as those of people suffering from post-traumatic stress disorders.

    Memories are maintained by chemical signalling between brain cells that relies on specialised receptors called AMPA receptors. The more AMPA receptors there are on the surface where brain cells connect, the stronger the memory.

    The team led by the University of Edinburgh found that the process of actively wiping memories happens when brain cells remove AMPA receptors from the connections between brain cells.

    Over time, if the memory is not recalled, the AMPA receptors may fall in number and the memory is gradually erased.

    The researchers also showed that actively forgetting information in this way helps the animals to adapt their behaviour according to their surroundings.

    Blocking the removal of AMPA receptors with a drug that keeps them at the surface of the cell stopped the natural forgetting of memories, the study found.

    Drugs that target AMPA receptor removal are already being investigated as potential therapies to prevent memory loss associated with diseases such as Alzheimer’s and dementia.

    However, researchers say that active forgetting could be an important facet of learning and memory. Further research is needed to understand what consequences blocking this process could have on the ability to take on new information and retrieve existing memories.

    Dr Oliver Hardt, of the Centre for Cognitive and Neural Systems at the University of Edinburgh, said: “Our study looks at the biological processes that happen in the brain when we forget something. The next step is to work out why some memories survive whilst others are erased. If we can understand how these memories are protected, it could one-day lead to new therapies that stop or slow pathological memory loss.”

    The study is published in The Journal of Neuroscience.


  4. Drug prevents key age-related brain change in rats

    February 10, 2016 by Ashley

    From the Society for Neuroscience media release:

    brain scansAs brain cells age they lose the fibers that receive neural impulses, a change that may underlie cognitive decline. Researchers at the University of California, Irvine recently found a way to reverse this process in rats.

    The study was published Feb. 3, 2016 in The Journal of Neuroscience. Researchers caution that more studies are needed, but the findings shed light on the mechanisms of cognitive decline and identify potential strategies to stem it.

    “There’s a tendency to think that aging is an inexorable process, that it’s something in the genes and there’s nothing you can do about it,” said study co-author Gary Lynch. “This paper is saying that may not be true.”

    The researchers studied dendrites — the branch-like fibers that extend from neurons and receive signals from other neurons — in rats. Evidence from other studies in rodents, monkeys, and humans indicates that dendrites dwindle with age and that this process — called dendritic retraction — occurs as early as middle age.

    The team, led by Lynch, Julie Lauterborn, and Linda Palmer, wanted to know whether dendritic retraction was already underway in 13-month-old or “middle-aged” rats and, if it was, could they reverse it by giving rats a compound called an ampakine. Ampakines had previously been shown to improve age-related cognitive deficits in rats as well as increase production of a key growth factor, brain-derived neurotrophic factor (BDNF) in the brain.

    The researchers housed 10-month-old male rats in cages with enriched environments. Unlike standard cages, these enhanced cages provided ample space, a large running wheel, and several objects for the rats to explore. Eleven rats received an oral dose of the ampakine each day for the next three months while the other 12 rats received a placebo. During this three-month window the researchers conducted behavioral testing by monitoring the rats’ activity as they explored an unfamiliar environment. After three months the researchers examined an area of the rats’ brains associated with learning and memory, the hippocampus, and compared that with the hippocampi of two-and-a-half-month-old or “adolescent” rats.

    “Middle-aged” rats given the placebo had shorter dendrites and fewer dendritic branches than the younger rats. The brains of rats given the ampakine, however, were mostly indistinguishable from the young rats — dendrites in both were similar in length and in the amount of branching. What’s more, the researchers also found that treated rats had significantly more dendritic spines, the small projections on dendrites that receive signals from other neurons, than either the untreated rats or the young rats.

    The researchers found that anatomical differences between the rats also correlated with differences in a biological measure of learning and memory: the treated rats showed enhanced signaling between neurons — a phenomenon called long-term potentiation.

    Finally, differences between treated rats and untreated rats appeared in behavioral testing. Typically, rats placed in a new environment spend a lot of time randomly exploring. As they become more familiar, they settle into predicable patterns of activity. Rats receiving ampakine settled into predictable patterns in a foreign play arena by the second day of testing whereas the placebo group of rats continued randomly exploring.

    The treated rats had better memory of the arena and developed strategies to explore,” Lynch said, pointing out that they had in effect reversed the effects of aging in the brain.

    “The importance of optimizing cognitive function across the lifespan cannot be overstated,” said Carol Barnes, a neuroscientist at the University of Arizona who studies the effects of aging on the brain and was not involved in the study. This study “is particularly interesting because the drug effect was selective in the brain functions and behaviors that were changed. This is the kind of specificity that could make translation to the clinic possible,” she added.

    However, the researchers caution that much work remains to be done before the drug is tested in people.

    “The next step is to repeat the study,” Lynch said, noting there are a lot of implications associated with this research and they need to proceed with care. The researchers would also want to explore how many days of treatment are necessary to see the same results and whether the drug would also work in older rats and females as well as males.

     


  5. Mentally challenging activities key to a healthy aging mind

    January 25, 2016 by Ashley

    From the IOS Press media release:

    senior computer userOne of the greatest challenges associated with the growing numbers of aged adults is how to maintain a healthy aging mind. Taking up a new mental challenge such as digital photography or quilting may help maintain cognitive vitality, say researchers reporting in Restorative Neurology and Neuroscience.

    Recent evidence suggests that engaging in enjoyable and enriching lifestyle activities may be associated with maintaining cognitive vitality. However, the underlying mechanism accounting for cognitive enhancement effects have been poorly understood.

    Investigators at the University of Texas at Dallas proposed that only tasks that involved sustained mental effort and challenge would facilitate cognitive function. Senior author Denise Park and lead author Ian McDonough compared changes in brain activity in 39 older adults that resulted from the performance of high-challenge activities that required new learning and sustained mental effort compared to low-challenge activities that did not require active learning. All of the participants underwent a battery of cognitive tests and brain scans using functional magnetic resonance imaging (fMRI), an MRI technology that measures brain activity by detecting changes associated with blood flow.

    Participants were randomly assigned to the high-challenge, low-challenge, or placebo groups. The high-challenge group spent at least 15 hours per week for 14 weeks learning progressively more difficult skills in digital photography, quilting, or a combination of both. The low-challenge group met for 15 hours per week to socialize and engage in activities related to subjects such as travel and cooking with no active learning component. The placebo group engaged in low-demand cognitive tasks such as listening to music, playing simple games, or watching classic movies. All participants were tested before and after the 14-week period and a subset was retested a year later.

    The high-challenge group demonstrated better memory performance after the intervention, and an increased ability to modulate brain activity more efficiently to challenging judgments of word meaning in the medial frontal, lateral temporal, and parietal cortex regions of the brain. These are brain areas associated with attention and semantic processing. Some of this enhanced brain activity was maintained a year later.

    This increased neural efficiency in judging words was demonstrated by participants showing lowered brain activity when word judgments were easy and increasing activity when they became hard. This is a pattern of response typical of young adults. Before participating in the high-challenge intervention, the older adults were processing every item, both easy and hard, with maximum brain activity. After participation, they were able to modulate their brain activity to the demands of the task, thus showing a more efficient use of neural resources. This change in modulation was not observed in the low-challenge group.

    The findings show that mentally demanding activities may be neuroprotective and an important element for maintaining a healthy brain into late adulthood.

    “The present findings provide some of the first experimental evidence that mentally-challenging leisure activities can actually change brain function and that it is possible that such interventions can restore levels of brain activity to a more youth-like state. However, we would like to conduct much larger studies to determine the universality of this effect and understand who will benefit the most from such an intervention,” explained senior author Denise C. Park, PhD, of the Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas.

    Ian McDonough, who is now an assistant professor of Psychology at the University of Alabama and was first author on the study, said: “The study clearly illustrates that the enhanced neural efficiency was a direct consequence of participation in a demanding learning environment. The findings superficially confirm the familiar adage regarding cognitive aging of ‘Use it or lose it.'”

    Denise Park added, “Although there is much more to be learned, we are cautiously optimistic that age-related cognitive declines can be slowed or even partially restored if individuals are exposed to sustained, mentally challenging experiences.”


  6. Study suggests brain’s “garbage truck” may hold key to treating Alzheimer’s and other disorders

    July 8, 2013 by Ashley

    From the University of Rochester Medical Center press release via ScienceDaily:

    senior alzheimerIn a perspective piece appearing today in the journal Science, researchers at University of Rochester Medical Center (URMC) point to a newly discovered system by which the brain removes waste as a potentially powerful new tool to treat neurological disorders like Alzheimer’s disease. In fact, scientists believe that some of these conditions may arise when the system is not doing its job properly.

    “Essentially all neurodegenerative diseases are associated with the accumulation of cellular waste products,” said Maiken Nedergaard, M.D., D.M.Sc., co-director of the URMC Center for Translational Neuromedicine and author of the article. “Understanding and ultimately discovering how to modulate the brain’s system for removing toxic waste could point to new ways to treat these diseases.”

    The body defends the brain like a fortress and rings it with a complex system of gateways that control which molecules can enter and exit. While this “blood-brain barrier” was first described in the late 1800s, scientists are only now just beginning to understand the dynamics of how these mechanisms function. In fact, the complex network of waste removal, which researchers have dubbed the glymphatic system, was only first disclosed by URMC scientists last August in the journal Science Translational Medicine.

    The removal of waste is an essential biological function and the lymphatic system — a circulatory network of organs and vessels — performs this task in most of the body. However, the lymphatic system does not extend to the brain and, consequently, researchers have never fully understood what the brain does its own waste. Some scientists have even speculated that these byproducts of cellular function where somehow being “recycled” by the brain’s cells.

    One of the reasons why the glymphatic system had long eluded comprehension is that it cannot be detected in samples of brain tissue. The key to discovering and understanding the system was the advent of a new imaging technology called two-photon microscopy which enables scientists to peer deep within the living brain. Using this technology on mice, whose brains are remarkably similar to humans, Nedergaard and her colleagues were able to observe and document what amounts to an extensive, and heretofore unknown, plumbing system responsible for flushing waste from throughout the brain.

    The brain is surrounded by a membrane called the arachnoid and bathed in cerebral spinal fluid (CSF). CSF flows into the interior of the brain through the same pathways as the arteries that carry blood. This parallel system is akin to a donut shaped pipe within a pipe, with the inner ring carrying blood and the outer ring carrying CSF. The CSF is draw into brain tissue via a system of conduits that are controlled by a type support cells in the brain known as glia, in this case astrocytes. The term glymphatic was coined by combining the words glia and lymphatic.

    The CSF is flushed through the brain tissue at a high speed sweeping excess proteins and other waste along with it. The fluid and waste are exchanged with a similar system that parallels veins which carries the waste out of the brain and down the spine where it is eventually transferred to the lymphatic system and from there to the liver, where it is ultimately broken down.

    While the discovery of the glymphatic system solved a mystery that had long baffled the scientific community, understanding how the brain removes waste — both effectively and what happens when this system breaks down — has significant implications for the treatment of neurological disorders.

    One of the hallmarks of Alzheimer’s disease is the accumulation in the brain of the protein beta amyloid. In fact, over time these proteins amass with such density that they can be observed as plaques on scans of the brain. Understanding what role the glymphatic system plays in the brain’s inability to break down and remove beta amyloid could point the way to new treatments. Specifically, whether certainly key ‘players’ in the glymphatic system, such as astrocytes, can be manipulated to ramp up the removal of waste.

    The idea that ‘dirty brain’ diseases like Alzheimer may result from a slowing down of the glymphatic system as we age is a completely new way to think about neurological disorders,” said Nedergaard. “It also presents us with a new set of targets to potentially increase the efficiency of glymphatic clearance and, ultimately, change the course of these conditions.”


  7. Study identifies protein that contributes to cognitive decline in Alzheimer’s

    July 2, 2013 by Ashley

    From the Columbia University Medical Center press release via EurekAlert!:

    confused seniorResearchers at Columbia University Medical Center (CUMC) have demonstrated that a protein called caspase-2 is a key regulator of a signaling pathway that leads to cognitive decline in Alzheimer’s disease.

    The findings, made in a mouse model of Alzheimer’s, suggest that inhibiting this protein could prevent the neuronal damage and subsequent cognitive decline associated with the disease. The study was published this month in the online journal Nature Communications.

    One of the earliest events in Alzheimer’s is disruption of the brain’s synapses (the small gaps across which nerve impulses are passed), which can lead to neuronal death. Although what drives this process has not been clear, studies have indicated that caspace-2 might be involved, according to senior author Michael Shelanski, MD, PhD, the Delafield Professor of Pathology & Cell Biology, chair of the Department of Pathology & Cell Biology, and co-director of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at CUMC.

    Several years ago, in tissue culture studies of mouse neurons, Dr. Shelanski found that caspace-2 plays a critical role in the death of neurons in the presence of amyloid beta, the protein that accumulates in the neurons of people with Alzheimer’s. Other researchers have shown that caspase-2 also contributes to the maintenance of normal synaptic functions.

    Dr. Shelanski and his team hypothesized that aberrant activation of caspase-2 may cause synaptic changes in Alzheimer’s disease. To test this hypothesis, the researchers crossed J20 transgenic mice (a common mouse model of Alzheimer’s) with caspase-2 null mice (mice that lack caspase-2). They compared the animals’ ability to negotiate a radial-arm water maze, a standard test of cognitive ability, with that of regular J20 mice and of normal mice at 4, 9, and 14 months of age.

    The results for the three groups of mice were similar at the first two intervals. At 14 months, however, the J20/caspase-2 null mice did significantly better in the water maze test than the J20 mice and similarly to the normal mice. “We showed that removing caspase-2 from J20 mice prevented memory impairment — without significant changes in the level of soluble amyloid beta,” said co-lead author Roger Lefort, PhD, associate research scientist at CUMC.

    Analysis of the neurons showed that the J20/caspase-2 null mice had a higher density of dendritic spines than the J20 mice. The more spines a neuron has, the more impulses it can transmit.

    “The J20/caspase-2 null mice showed the same dendritic spine density and morphology as the normal mice—as opposed to the deficits in the J20 mice,” said co-lead author Julio Pozueta, PhD. “This strongly suggests that caspase-2 is a critical regulator in the memory decline associated with beta-amyloid in Alzheimer’s disease.”

    The researchers further validated the results in studies of rat neurons in tissue culture.

    Finally, the researchers found that caspase-2 interacts with RhoA, a critical regulator of the morphology (form and structure) of dendritic spines. “It appears that in normal neurons, caspase-2 and RhoA form an inactive complex outside the dendritic spines,” said Dr. Lefort. “When the complex is exposed to amyloid beta, it breaks apart, activating the two components.” Once activated, caspase-2 and RhoA enter the dendritic spines and contribute to their demise, possibly by interacting with a third molecule, the enzyme ROCK-II.

    This raises the possibility that if you can inhibit one or all of these molecules, especially early in the course of Alzheimer’s, you might be able to protect neurons and slow down the cognitive effects of the disease,” said Dr. Lefort.


  8. Study suggests memory improves for older adults using computerized brain-fitness program

    by Ashley

    From the UCLA press release via EurekAlert!:

    computer gaming seniorsUCLA researchers have found that older adults who regularly used a brain-fitness program on a computer demonstrated significantly improved memory and language skills.

    The UCLA team studied 69 dementia-free participants, with an average age of 82, who were recruited from retirement communities in Southern California. The participants played a computerized brain-fitness program called Dakim BrainFitness, which trains individuals through more than 400 exercises in the areas of short- and long-term memory, language, visual-spatial processing, reasoning and problem-solving, and calculation skills.

    The researchers found that of the 69 participants, the 52 individuals who over a six-month period completed at least 40 sessions (of 20 minutes each) on the program showed improvement in both immediate and delayed memory skills, as well as language skills.

    The findings suggest that older adults who participate in computerized brain training can improve their cognitive skills.

    The study’s findings add to a body of research exploring whether brain fitness tools may help improve language and memory and ultimately help protect individuals from the cognitive decline associated with aging and Alzheimer’s disease.

    Age-related memory decline affects approximately 40 percent of older adults. And while previous studies have shown that engaging in stimulating mental activities can help older adults improve their memory, little research had been done to determine whether the numerous computerized brain-fitness games and memory training programs on the market are effective in improving memory. This is one of the first studies to assess the cognitive effects of a computerized memory-training program.


  9. Study suggests storytelling program may help change medical students’ perspectives on dementia

    June 29, 2013 by Ashley

    From the Pennsylvania State University press release via EurekAlert!:

    doctor with patientTreating patients with dementia can be viewed as a difficult task for doctors, but Penn State College of Medicine researchers say that storytelling may be one way to improve medical students’ perceptions of people affected by the condition. Participation in a creative storytelling program called TimeSlips creates a substantial improvement in student attitudes.

    Daniel George, assistant professor of humanities, tested the effects of the TimeSlips program in an elective course he teaches at the college. Fourth-year medical students worked with patients at Country Meadows, a Hershey-based assisted living community. These patients are affected by advanced dementia and live in a memory-support unit requiring a locked environment.

    Medical students commonly perceive persons with dementia as being challenging to work with.

    “We currently lack effective drugs for dementia, and there’s a sense that these are cases where students can’t do much to benefit the patient,” George said. “The perception is that they’re hard to extract information from, you don’t know if that information is reliable, and there are often other complicated medical issues to deal with.”

    TimeSlips is a non-pharmacological approach to dementia care that uses creative storytelling in a group setting and encourages participants to use their imagination rather than focusing on their inability to remember chronologically. Pictures with a staged, surreal image –for example, an elephant sitting on a park bench — are shared with all participants, who are encouraged to share their impressions of what is happening in the picture. As part of George’s elective, medical students spent one month facilitating TimeSlips with groups of five to 10 residents and helping the residents build stories in poem form during their interactions.

    “All comments made during a session — even ones that do not necessarily make logical sense — are validated and put into the poem because it is an attempt to express meaning,” George said. “The sessions become energetic and lively as the residents are able to communicate imaginatively, in a less linear way. In the process, students come to see dementia differently. It is very humanizing, revealing personality and remaining strengths where our culture tends to just focus on disease, decline and loss.”

    Student attitudes were measured before and after the TimeSlips experience using a validated instrument called the Dementia Attitudes Scale. A significant improvement in overall attitude was observed over the course of the program, and students also demonstrated significant increases on sub-scales measuring comfort with people with dementia and knowledge about interacting with and treating these patients. Results were reported in the journal Academic Medicine.

    “In talking with my students, they consistently express their anxieties about medical school training them to see patients as a diagnosis rather than as a fully-fledged person,” George said. “An activity like TimeSlips, which emphasizes the creative spirit in people with fairly advanced dementia, helps give students a richer sense of who the person was and what made them tick.”

    At Penn State College of Medicine, which emphasizes the humanities in medical care and established the first Department of Humanities at a medical school in the nation, George hopes to expand TimeSlips volunteer opportunities to include all medical students and not exclusively fourth-year students. By reaching students earlier in their education and exposing them to a creative activity involving people with dementia, he hopes that TimeSlips could help nudge more trainees into geriatric medicine.

    As the incidence of dementia-related conditions is rising globally, the demand for high-quality, humanistic geriatric care is becoming more urgent,” George said.

    There has already been an effort to extend TimeSlips volunteer opportunities to nurses, faculty, staff and patients.

    “Several patients from our hospital, Penn State Milton S. Hershey Medical Center, have already begun taking part in the program,” he said. “Even though they are experiencing their own illnesses, they are able to find purpose in helping another vulnerable population through creative storytelling.”


  10. Study suggests blocking overactive receptor in Alzheimer’s recovers memory loss and more

    June 22, 2013 by Ashley

    From the Montreal Neurological Institute and Hospital press release via EurekAlert!:

    brain scanA new study shows that memory pathology in older mice with Alzheimer’s disease can be reversed with treatment.

    The study by researchers from the Montreal Neurological Institute and Hospital – The Neuro, at McGill University and at Université de Montréal found that blocking the activity of a specific receptor in the brain of mice with advanced Alzheimer’s disease (AD) recovers memory and cerebrovascular function. The results, published in the Journal of Neuroinflammation in May, also suggest an underlying mechanism of AD as a potential target for new therapies.

    “The exciting and important aspect of this study is that even animals with advanced pathology can be rescued with this molecule” says Dr. Edith Hamel, neuroscientist at The Neuro and lead investigator on the paper in collaboration with Dr Réjean Couture at the Department of Physiology at Université de Montréal. “We have rarely seen this type of reversal of AD symptoms before in our mouse model at this advanced age – when mice have been developing AD for one year.”

    The researchers found an increased level of a receptor known as bradykinin B1 receptor (B1R) in the brain of mice with AD, a receptor involved in inflammation.  “By administering a molecule that selectively blocks the action of this receptor, we observed important improvements in both cognitive and cerebrovascular function,” says Dr. Baptiste Lacoste, research fellow who conducted the study at The Neuro and now pursuing his training at Harvard Medical School in Boston.

    Alzheimer’s disease destroys nerve cells and also compromises the function of blood vessels in the brain. Not only were there improvements in learning and memory, but also marked recovery in blood flow and vascular reactivity, i.e. the ability of cerebral vessels to dilate or constrict when necessary.” Proper functioning of blood vessels in the brain is vital to providing nutrients and oxygen to nerve cells, and vascular diseases represent important risk factors for developing AD at an advanced age.x

    “Another interesting result that has not been seen before in our mouse model is a reduction by over 50% of toxic amyloid-beta peptide,” adds Dr. Hamel.  “In Alzheimer’s disease, protein fragments called amyloid-beta have a deleterious effect on the blood and nervous systems. Normally, these protein fragments are broken down and removed. In Alzheimer’s disease, the protein fragments clump together — a factor believed to contribute to neuronal and vascular dysfunction. We are not sure if these decreases contribute to the functional recovery, but we hope that our findings will aid in clarifying this issue and identifying new targets for therapeutic approaches.”

    The results show that an increase in B1R is associated with amyloid-beta plaques in Alzheimer’s disease mice with impaired memory, and that chronic blockade of B1R significantly improves learning, memory, cerebrovascular function, and several other pathological AD hallmarks in mice with a fully developed pathology. Together, these findings confirm a role of B1R in AD pathogenesis and the role of neuroinflammation as an underlying mechanism in AD. The next step would be to further investigate potential blockers of the bradykinin B1R as a potential treatment for AD in humans.

    This study was funded by the Canadian Institutes of Health Research and a postdoctoral fellowship award from the Alzheimer Society of Canada.

    Link to the study:  http://www.jneuroinflammation.com/content/10/1/57/abstract