A New Era of Screening & Prevention for Alzheimer’s Disease
Report from the AAIC in Copenhagen
There’s been a steady stream of news from the AAIC14 in Copenhagen, held July 12-17. The international summit brings together 4,500 professionals from 80 countries involved in Alzheimer’s treatment, patient care, and research.
Never in the history of Alzheimer’s disease (AD) has so much attention focused on ways to prevent it. “First and foremost, it may be modifiable. It’s not a fate without the possibility of change,” says William E. Klunk, MD, PhD, professor of psychiatry and neurology at the University of Pittsburgh, who led a news briefing at AAIC.
Indeed, from Copenhagen, new research findings have validated the importance of a number of “modifiable risk factors” that can be alleviated by healthy behaviors. If started early enough, these targeted interventions can have a major impact on delaying or preventing AD symptoms in vulnerable individuals.
Determining who’s “at risk” for AD is another major research focus at this year’s AAIC. There are proposed new screening techniques that may surprise you.
FINGER Points to Modifiable Risk Factors and Their Role in Prevention
Among the biggest news at AAIC is the FINGER study (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), the largest-ever randomized clinical trial devoted to Alzheimer’s prevention. Its two-year results show that in individuals at risk for AD, exercise, diet and other behavioral changes significantly improved overall cognitive functioning after two years, compared with controls.
In FINGER, 1,260 participants aged 60-77 years were randomly assigned to one of two groups. A control group received regular medical attention and cognitive testing, but no intervention for modifiable risks. The other group participated in a program of nutritional guidance, physical exercise, cognitive training, social activities, and management of heart health risk factors. Among these “lifestyle interventions” were:
- Group sessions and individual sessions to improve their diet by adding fruits, vegetables, and fish, and avoiding saturated fats
- Intensive exercise several times each week that consisted of weight training to build muscle mass and cardiovascular training
- Cognitive training exercises practiced in group and individual sessions
- Scheduled consultations with nurses and physicians to track cholesterol, blood pressure, and other cardiovascular risks
After two years, the intervention group performed significantly better than controls on a comprehensive cognitive examination and also on specific tests of memory, executive function (complex aspects of thought such as planning, judgment, and problem-solving), and cognitive processing speed.
There will be an extended, 7-year follow up to these initial FINGER results. It will measure the incidence of AD and dementia in both groups, and also evaluate biomarkers of AD, such as amyloid deposits observed with MRI and PET brain imaging.
Staying in the Game of Mental Fitness
An analysis has confirmed what many AD specialists have already put in practice – the idea that brain-stimulating activities help to preserve brain volume and functions. While other research has shown to be helpful after AD is diagnosed, this may be the first study to demonstrate a preventive effect. The study also is unique in that it highlighted game playing (cards, checkers, crosswords and other puzzles) over reading and other cognitive activities.
Stephanie Schultz, B.Sc., of the Wisconsin Alzheimer's Disease Research Center, analyzed data on 329 participants in the Wisconsin Registry for Alzheimer's Prevention (WRAP). All participants had AD risk factors, such as a parent with AD (74%), or carrying the apolipoprotein E ε4 risk allele, a genetic mutation associated with AD (40%). Their mean age was 60 years.
Each subject had been assessed using a comprehensive neuropsychological battery, a structural T1 MRI, and a Cognitive Activity Scale (CAS), which reflected how often they engaged in 10 common cognitive activities, such as reading books, attending lectures, and playing games.
Imaging results showed that parts of the brain responsible for memory, thinking, and executive functioning, were significantly larger in subjects who were frequent game players compared with infrequent players. These structural changes were observed in some of the brain areas most affected in early AD, Schultz said during an AAIC news briefing.
In addition, results from the cognitive assessment showed that frequent game players had significantly higher scores for verbal learning and memory, also affected by early Alzheimer’s, as well as on cognitive speed and flexibility.
It may be that game playing “serves a unique role in preserving brain and cognitive health," Schultz concluded.
A gene called Apolipoprotein E (ApoE) appears to be a risk factor for the late-onset form of AD. There are three forms of this gene: ApoE2, ApoE3 and ApoE4. Roughly one in four Americans has ApoE4 and one in twenty has ApoE2. While inheritance of ApoE4 increases the risk of developing AD, ApoE2 substantially protects against the disease.