Conference Looks at Alzheimer's from Beyond the Brain
One of the most important messages coming from the Wisconsin Alzheimer’s Institute’s Alzheimer’s Disease Annual Update conference wasn’t officially on the agenda: to more effectively treat Alzheimer’s and related dementias, one must look beyond the brain.
The conference, which was held November 8 at the Madison Concourse Hotel, drew almost 300 health care professionals from across Wisconsin and beyond. The presentations focused on diverse topics including the role of diet and insulin, the vascular dementias, the role of caregivers, management of behavior and the role of the health care system.
It’s easy to understand why a broad approach is needed to treat and prevent Alzheimer’s. According to the Alzheimer’s Association, there are 5.4 million Americans with Alzheimer’s, which affects the lives of nearly 15 million unpaid caregivers. The prevalence of Alzheimer’s in Wisconsin is predicted to increase by 30 percent by 2025.
Insulin Resistance May Play a Role in Alzheimer’s
Dr. Suzanne Craft, professor of internal medicine and research director of the Sticht Center on Aging at the Wake Forest School of Medicine, discussed insulin resistance as a new pathway to Alzheimer’s disease. Insulin, a hormone that helps regulate metabolism, plays a key role in healthy brains by protecting against toxic proteins, enhancing memory and increasing the chemicals and synapses that brain cells use to communicate.
Insulin resistance occurs when cells in the body no longer respond to insulin and is associated with Type 2 diabetes and Alzheimer’s. Fifty percent of Alzheimer’s patients are insulin-resistant, and research has shown that insulin-resistant older adults with pre-diabetes or newly diagnosed diabetes have patterns of reduced brain metabolism similar to early Alzheimer’s.
Poor diet, lack of exercise and stress are among the factors that contribute to insulin resistance, and the link between insulin resistance and Alzheimer’s provides one more reason to be concerned about our nation’s obesity epidemic. In Wisconsin, more than 60 percent of adults are overweight or obese.
“This is a worrisome pattern of a confluence of events in our society,” she said. “But I think ultimately, it’s very hopeful, because this is a set of risk factors that we can identify. We identify them in mid-life, we can identify them before any symptoms have occurred, and we do have ideas of how to treat them. And if we’re successful in treating them, we should be able to prevent or at least delay the onset of Alzheimer’s disease.”
One hopeful treatment is a nasal injection of insulin. In one of Craft’s recent studies, the Study of Nasal Insulin to Fight Forgetfulness (SNIFF), 104 adults with early Alzheimer’s were given either a placebo or insulin delivered much like a nasal spray for four months.
Craft and her colleagues then measured brain cognition and function, and brain energy metabolism. The results showed that the placebo group worsened over time, but the insulin-treated group did not show a dramatic decline. Among patients who received a higher dose of insulin, brain function actually stabilized.
The next step will be the launch of a larger clinical trial, which will be carried out at 30 sites, including Wisconsin, beginning December 1. If successful, Craft and colleagues will seek approval from the Food and Drug Administration (FDA) for intranasal insulin as an Alzheimer’s treatment.
While the nasal injection shows promise, lifestyle changes can provide benefits. Exercise and diet are powerful tools against insulin resistance, and research has shown that diets high in saturated fat and sugar lead to an increase in amyloid and inflammation - two markers of Alzheimer’s – in spinal fluid.
Regarding exercise, Craft noted that “exercise is the single-most insulin-sensitizing intervention that you can undertake, moreso than any pill.”
“I don’t accept that we need to find the pill that simulates exercise,” she said. “I think we need to address how we can get people to enjoy and practice exercise.”
10 Warning Signs of Alzheimer's
Early detection is important with Alzheimer's in order to get the maximum benefit from available treatments. An early diagnosis also allows more time to plan for the future. Decisions regarding care, living arrangements, financial and legal issues, and other important issues can be addressed. If you notice any of these warning signs in yourself or a loved one, schedule an appointment with a doctor.
- Memory loss that disrupts daily life
- Challenges in planning or solving problems
- Difficulty completing familiar tasks at home, work or leisure
- Confusion with time or place
- Trouble understanding visual images and spatial relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
Learn more about seeking an evaluation for yourself or a loved one:
Wide Range of Topics
The Alzheimer’s Annual Update conference featured topics that underscored the need to approach Alzheimer’s diagnosis and treatment from a variety of angles.
- Dr. Kenneth Robbins, adjunct professor of psychiatry at the UW School of Medicine and Public Health and senior editor of caring.com, discussed the results of a survey of caregivers that measured factors such as impact on emotional and physical well-being, as well as financial issues.
- Dr. Diane Book, stroke program director and associate professor at the Medical College of Wisconsin, discussed vascular dementias, which refer to a decline in thinking skills resulting from reduced blood flow to the brain. Part of her talk focused on CADASIL, an inherited cerebrovascular disease that may cause multiple strokes and lead to dementia.
- Dr. Amy Kind, assistant professor of medicine (geriatrics) at the UW School of Medicine and Public Health, discussed the effect of fragmented health systems on transitional care. Kind led the VA-Coordinated Transitional Care (C-TraC) study, which found that weekly telephone contact with a nurse substantially reduced hospital re-admissions for high-risk patients.
- Dr. Peggy Szwabo, associate clinical professor at Saint Louis University, discussed behavioral interventions for dementia patients. She addressed issues such as environment and sleep patterns, as well as recent innovations such as “memory cafes,” where patients and caregivers can share connect and provide support in a low-stress setting. A memory cafe recently started in Watertown.
- Dr. Art Walaszek, associate professor of psychiatry at the UW School of Medicine and Public Health, discussed medication management of behavioral and psychological symptoms of dementia. He stressed that the evidence is limited, and that in many cases, the risks may outweigh the benefits.
The Alzheimer’s Disease Annual Update was jointly sponsored by the Wisconsin Medical Society and Wisconsin Alzheimer’s Institute. It was presented in conjunction with the Wisconsin Alzheimer’s Disease Research Center; University of Wisconsin School of Medicine and Public Health; the Geriatric Research, Education and Clinical Center at William S. Middleton Memorial Veterans Hospital; and the Wisconsin Geriatric Education Center.
Date Published: 11/19/2013