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Issue 43 Alzheimer’s Insights by Curation Health 7 July 2015
One of the most difficult issues in the detection and management of Alzheimer’s is how early to make a diagnosis. For a long time the difficulty lay in the uncertainty involved: how could we be sure? As science has evolved to enable a more certain diagnosis earlier, pressures on resources and costs have increased, tempting doctors back into uncertainty about raising expectations that may not be met. This question has huge implications for providers and professionals, but more widely for patients and the people who care for them.
Most read stories this week
Charity warns of a 'deeply worrying' lack of support for people suffering from dementia
Medics voice dementia care concerns
Protecting dementia sufferers from scammers gains ground in U.S.
Korean Healthtech Startup Closing In On Cure For Alzheimer's
Longtime CBS golf announcer reveals he has Alzheimer's Disease
Care Advice
Point of care perceptions betray worries
By some way the biggest story of the past few days – certainly across the UK – is the perception at street level of growing strains on the provision of adequate services for people living with dementia and for their caregivers. An Ipsos Mori poll reported in The Guardian records general satisfaction with the standards of safety and care across the NHS, but shows specific and growing concern for the sustainability of services in mental health generally, and with dementia services in particular.

Another poll may have wider implications. As part of its annual dementia report, the UK’s Alzheimer’s Society conducted a survey of more than 1,000 GPs that was more widely reported than was the report itself, as here in The Independent. The crux of it shows that more than 3/4s of respondents believe their patients are now relying more upon family and friends for care than they are on health and social services.

The immediate concerns arising from this reality – and there is a growing swell of anecdotal evidence as well as expressions of media alarm giving them credibility – are that GPs may be less inclined to give a diagnosis of dementia if expectations of services are raised that cannot subsequently be met; and that growing pressure on the GPs themselves will see their despair increase to the point that they quit.

Stories like this tend to generate cries for more cash, and there is always the worry that cynicism about government will increase if people think that government may be shirking its responsibility. As part of its annual report, the Alzheimer’s Society calls for a five-year plan to raise care standards, and it is hard to see how any five-year plan can evolve without a greater commitment to joined-up thinking as well as to greater resources being devoted to the point of care. Making “savings” at this critical point is poor economics, and only builds up bigger problems for tomorrow.

A good example of government commitment to joined-up thinking – or at least in one person operating within the American government – is this report in the Huffington Post. Senator Ed Markey has been doing a first-class job in developing a cross-party approach to consolidating top thinking and best practice in tackling Alzheimer’s. He certainly sees the need for significant funding increases, but his focus is on innovative research in pursuit of more successful and earlier interventions that can improve health outcomes and bring costs down over the longer term.

Earlier interventions depend upon early diagnosis. Refraining from making an early diagnosis is understandable on a human level but risks confusing the supply side from the demand side of the health services equation. If the patient is truly at the centre of any appropriately focused health service, then no service is being rendered simply by taking the pressure off the supplier. Patients have other reasons, and very good ones, from having an early diagnosis of Alzheimer’s. GPs need support in their dedication to providing a good service to the people who come to them for help.

Heard of “vishing”? Forewarned is forearmed…
Just days after this very welcome story appeared on the Reuters website, reporting on increasing efforts in the USA to protect people with dementia from scammers and fraudsters of various sorts, this sobering but helpful piece appeared on the BBC Business website, reporting a ruling by the UK Ombudsman that banks are not liable in most instances of vishing fraud.

Vishing: not a term that is known to many and, if it is something else for which banks do not need to take responsibility, it’s probably a useful term to know about. Derived from phishing, it involves fraudulent attempts to trick people into revealing personal data, parting with valuables, contracting for unwanted services or just handing over money. Vishing is so-called as it is done with the voice: scamming by telephone.

People are called up and persuaded to transfer money out of a personal account, usually by way of the “no hang-up” scam by which the fraudster stays on the line when the victim hangs up to call the bank, whereupon the fraudster happily stays on the line to take receipt of the ill-gotten gain. It seems that vishing victims swallowed their losses 63% of the time, with the banks covering losses only 37% of the time, so this article’s tips on not getting vished are more than a little useful, and not just for the elderly people who are the most common targets.

Alzheimer's Care Advice
Medical Devices
Neuromodulation device offers hope
If there were a weekly award given to the headline displaying the most obvious “RTWTS” – rose-tinted wishful thinking syndrome, it would go this week to the article on the Forbes Website announcing “Korean Healthtech Startup Closing In On Cure For Alzheimer’s”. If eyebrows weren’t raised upon first reading the headline, they’d be bouncing around after reading the article. A company called YBrain is making waves in a market known more widely for its triumphs in gaming applications, but its focus is on treatments for Alzheimer’s and depression. This itself is pretty good news inasmuch as the volume of stories about medical devices in these areas is thin.

The technology involves a wearable device that transmits a weak electronic signal to activate the firing of neurons that would otherwise be incapacitated by some problem in the brain. The belief is that monitoring electric activity in the brain will enable doctors to alleviate problems with cognition as well as disorders such as depression, addiction and schizophrenia. The science behind these objectives is not clear from the article, but it is clearly a device worth watching out for.

Medical Devices & Alzheimer's
Lifestyle Issues
Keep taking the (fishy) tablets
Always known to be good for everyone, healthy and not so healthy, fish oil supplements have emerged as good news for people with Alzheimer’s too. A small study that appeared in the Journal of the Federation of American Societies for Experimental Biology, and picked upon the MedicalXpress website, reported some clearance of the amyloid-beta protein that is a key hallmark of the disease, along with reduced inflammation in neurological tissues. While their study sample was small, researchers pointed out that the overall health benefits have long since been proven, there are no ill-effects, and fish oil tablets are inexpensive and easy to obtain.
Alzheimer's Lifestyle Issues
Drugs & Clinical Trials
Axovant is not hiding its light…
People whose amazement, if not investment interest, was spiked by the recent story on Axovant’s success in coming from nowhere to a £3 billion company valuation will be interested in some of the commentary inspired by its extraordinary early progress.

The company itself is maintaining its healthy public profile and, according to this brief story on the NewsMedical website, is scheduled to make a couple of presentations at the Alzheimer’s Association International Conference later this month.

Drugs & Clinical Trials
Medical Information
There’s a promising pipeline of innovation
Against the tide of rose-tinted wishful thinking (see Medical Devices, above), we find that innovation and development remains a numbers game involving lots of small initiatives that gain ground slowly, with a cumulative effect that offers more and more hope as time goes by. This past week saw a useful representation of such initiatives, including one article on the BloombergBusiness website, highlighting the growing pipeline of what it called “first-in-class” innovations, and featuring no fewer than 583 products with a diverse range of molecular targets.

Billionaire tech investor Peter Thiel is clearly inspired by the optimism of the sector, his recent investment in an early-stage therapy for Alzheimer’s being picked up on the FierceBiotech website. A story in the UK’s Guardian newspaper reported on research into a link between blood proteins and memory loss which offers hope not only for treating dementia but for keeping people generally healthier for longer.

And in conclusion, virtually, a neat story reported on the Medscape website originated from the annual meeting of the American Society of Clinical Psychopharmacology no less: a North Carolina-based company called NeuroCog Trials has developed a gaming-based Virtual Reality tool in which subjects’ performance in various daily tasks is assessed and measured in a controlled environment.

Latest Alzheimer's Medical Info
And Finally…
A useful way of keeping up with what any one aspect of the medical world is doing to advance the causes of research and improved care is to look at the programme for their big conferences. One of the world’s biggest when it comes to Alzheimer’s disease is the North American Alzheimer’s Association International Conference, being held later this month in Washington DC. Have a look at their schedule here.

Readers who might hope that an “And Finally” paragraph will at least be light-hearted if not downright amusing, and who may struggle to see a conference programme as being either of these, may instead enjoy this letter of complaint. In a week of sobering news, we are reminded that there’s still a lot that is right with the world.

More Alzheimer’s Disease Feeds on CurationHealth
Depression, Stress & Coping with Alzheimer’s
Alzheimer’s Care Advice
Alzheimer’s Lifestyle Issues
Latest Alzheimer’s Medical Info
Drugs & Clinical Trials
Medical Devices & Alzheimer’s
Tweets of the week twitter logo
DementiaToday (@DementiaToday)
Counseling has Benefits for Alzheimer’s Caregivers - # alzheimer #dementia
Alzheimer's Assoc. (@alzassociation)
A day in the life of an Alzheimer’s caregiver: #ENDALZ
Alzheimer's Assoc. (@alzassociation)
Music and art can enrich the lives of people with Alzheimer’s disease. Learn more: #MusicMonday #ENDALZ
Alzheimer’s may begin much earlier than experts thought
IMAGE (@MichaelJFoxOrg)
Counseling for #caregivers, without leaving your home:
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About Alzheimer’s Insights
Alzheimer’s Insights is an online newsletter created for consumers -- primarily patients and carers -- who live with the challenge of Alzheimer’s disease. Based upon intelligent search algorithms that scour the Internet for the most read, relevant and useful stories from around the world, it is curated and published each Tuesday by a team of health and publishing experts.
Tam McDonald  
Tam McDonald Senior Curator
A publishing professional with three decades of experience in health, hospitality and financial services publishing. His interest in the human brain goes back to his university days of studying philosophy. His commitment to securing the very best information about health matters goes back to his decade as a carer.
Explain This!
How can we expect our under-pressure GPs to make early diagnoses of Alzheimer’s when they know that care resources are inadequate, with more budget cuts on the way?
Click here to find out
Looking ahead…
Issue 44 14 July 2015
On the brink of what may be the world’s biggest gathering of dementia experts and care specialists, we look at what the American Alzheimer’s Association is setting out to achieve in Washington DC. What will be its measures of success?
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