Tag: Alzheimer’s disease
My colleague, Garrett Horrocks, recently blogged on a promising breakthrough in research relating to the early detection of Alzheimer’s disease. The research focused on the use of artificial intelligence to assist in the early detection of the disease.
Last week, I came across an interesting article that discusses a promising breakthrough in the United States in treatment for patients who suffer from Alzheimer’s disease and other degenerative diseases. The fact that treatment options continue to be explored by the science, engineering and medical community is hopeful, in light of last year’s announcement by the world’s largest pharmaceutical company, Pfizer, that it is pulling out of research into Alzheimer’s disease.
The treatment consists of implanting a “pacemaker” into the part of the brain responsible for executive and cognitive functions, such as planning, problem solving and judgment. The article explains that a battery pack is then placed in the chest, which sends electrical currents through the wires in a process called “deep brain stimulation” or DBS.
Studies on the use of the implant have shown that the subject patients’ cognitive and daily functional abilities as a whole declined much more slowly than Alzheimer’s patients in a matched comparison group who were not being treated with DBS.
The article highlights one study participant, Ms. Moore, who, prior to receiving the implant, was unable to cook meals or dress herself without assistance. According to the article, Ms. Moore was very fearful that her disease would take away her ability to play hymns on the piano, however, after two years of receiving DBS, she is still able to continue playing the piano and can now cook meals, select outfits and plan outings independently.
My colleague, Garrett, has pointed out in his recent blog that there could be many ways in which the use of artificial intelligence in the early detection of Alzheimer’s could impact succession and estate planning, such as a predictive diagnosis prompting a testator to take steps to implement an estate plan prior to the loss of capacity.
There is no global definition of capacity, and there are varying degrees of capacity that attract different legal tests. Capacity is decision, time and situation specific, such that a person may have capacity to do certain things, but not others, at different times and under different circumstances.
While the full impact of the use of the implant and DBS in treating Alzheimer’s is not yet clear, should the treatment continue with its successes, it may be possible that people living with Alzheimer’s who do not have testamentary capacity today, may have testamentary capacity sometime in the future.
Thanks for reading!
A recent study published by the Department of Radiology and Biomedical Imaging at the University of California at San Francisco represents a promising breakthrough in research relating to early detection of Alzheimer’s disease. At the core of the study, however, is a familiar yet unlikely trend: artificial intelligence.
The research team developed an algorithm to read and interpret PET scan images with a particular emphasis on monitoring and detecting changes in glucose uptake over extended periods of time. Glucose monitoring has historically been an important predictive factor in formulating a diagnosis of Alzheimer’s. Healthy cells generally display high levels of glucose uptake, indicative of robust cell activity. Conversely, lower glucose uptake suggests cell inactivity or death, for example, as a result of Alzheimer’s.
The slow, progressive nature of Alzheimer’s has historically rendered it difficult for radiologists to observe the subtle changes in glucose levels until symptoms had reached a stage at which they were no longer meaningfully reversible. The team at UCSF tailored the algorithm to detect subtle features that were imperceptible to the human eye.
To achieve this, the algorithm was fed thousands of PET scan images from thousands of patients at all stages of cognitive impairment, from no impairment through to late-stage Alzheimer’s. Over time, the algorithm learned to discern between the particular features of a given scan which were of assistance in predicting the eventual onset of Alzheimer’s and those which were not. At the conclusion of the study, the algorithm had correctly predicted the onset of Alzheimer’s in more than 92% of cases. Importantly, the algorithm was able to predict the onset of Alzheimer’s, on average, more than six years before the symptoms constituting a typical diagnosis had manifested.
Leaving aside the obvious benefits relating to treatment and reversibility, early detection of Alzheimer’s could stand to have numerous applications in the context of succession and estate planning. For example, a predictive diagnosis could spur a testator to take steps to implement a proper estate plan well before his or her capacity to do so could become a concern. In turn, the testator would have the security that their plan of succession would be carried out according to his or her instructions, reducing the risk of contentious post-death litigation.
Thanks for reading.
Please feel free to check out the following blogs on related topics:
This September marks the fifth annual World Alzheimer’s Month. World Alzheimer’s Month and World Alzheimer’s Day, which took place on Wednesday, are part of a campaign to increase awareness of dementia and related misconceptions.
In honour of World Alzheimer’s Day, Global News posted an article outlining five common misconceptions about dementia. They focused on the following:
- “Misconception: A diagnosis of Alzheimer’s disease or dementia means my life is over.” Individuals can continue to live and function normally for years despite a diagnosis with Alzheimer’s disease.
- “Misconception: Dementia is a disease of the elderly.” Although the likelihood of developing dementia and other memory issues may increase with age, early-onset dementia can affect individuals in their 40s or 50s. In Canada, approximately 16 thousand of those living with dementia are under the age of 65.
- “Misconception: There’s nothing I can do to prevent or stave off dementia.” Research suggests that there are ways to limit the risks of developing dementia, such as an active and social lifestyle and a healthy diet.
- “Misconception: Dementia and Alzheimer’s disease are all about memory loss.” Dementia goes deeper than memory loss and this misconception may trivialize the disease.
- “Misconception: One of my parents had Alzheimer’s disease, so I’m going to get it, too.” The most common forms of dementia do not appear to be genetically inherited, so the risk of developing Alzheimer’s is only loosely connected to family history of the disease.
Have a great weekend.
A recent fact sheet published by the World Health Organization indicates that worldwide there are approximately 47.5 million people living with dementia. Alzheimer’s disease is the most common cause of dementia and accounts for approximately 70% of these cases.
Of those who suffer from Alzheimer’s disease, approximately 60% have a tendency to wander. This places these individuals at increased risk of serious injury and can cause significant stress for their families and caregivers.
Inspired by his own grandfather’s battle with the Alzheimer’s, a New York City teen, Kenneth Shinozuka, has invented a wearable sensor called SafeWander that will immediately trigger an alarm on a cell phone when a patient suffering from Alzheimer’s is on the move.
The sensor comes in the form of a small button, which can be attached to the patients clothing, and has the ability to detect movement, for example, when a patient sits up in bed. This is particularly useful for those caring for a loved one who has a tendency to wander out of bed at night.
Shinozuka’s invention will no doubt create peace of mind for caregivers and help keep loved ones suffering from Alzheimer’s safe.
A short video which explains how the technology works and Shinozuka’s inspiration for its creation can be viewed here.
Thank you for reading.
We have recently highlighted some of the interesting ways in which medical and technological experts and policymakers across the globe are responding to dementia. With an aging population and the increasing prevalence of Alzheimer’s disease and other dementias, there is a growing need to focus on how to create a more dementia-capable society.
In instances where a individual living with dementia is no longer able to make decisions regarding their care, that responsibility falls to the individual’s substitute decision-maker. Substitute decision-makers may be required to make important and difficult decisions about the incapable person’s care, such as the use of caregivers and home support services.
Individuals who are tasked with making decisions regarding the care and companionship for people living with dementia may soon have a new option available to them. Reuters recently profiled Nadine, a humanoid robot developed by scientists at the Nanyang Technological University that may someday be used as a companion for individuals living with dementia.
According to the university, Nadine is a “social robot,” which means that she has a memory and personality of her own and is able to exhibit moods and emotions. Nadine currently works as a receptionist at the university, and could also serve as a personal assistant or companion to the elderly.
Nadine’s creator, Professor Nadia Thalmann of the Nanyang Technological University, has suggested that Nadine may be particularly useful as a companion for individuals who are living with dementia. She is quoted in Reuters as saying, “if you leave [individuals with dementia] alone they will be going down very quickly. So these people need to always be in interaction.”
With human-like features and emotional intelligence to boot, Nadine provides an interesting example of the creative ways in which technology could address the needs of people living with dementia. We recently highlighted another example: the story of “Paro” the harp seal, a Japanese automoton that was one of the earlier robotic inventions to be used in dementia care. However, it remains to be seen if this new technology will ultimately be put to use in individual and institutional care settings.
In the meantime, if you would like to see Nadine the humanoid robot at work, don’t miss this YouTube video of Nadine interacting with Professor Thalmann.
Thank you for reading and have a great weekend,
A recent decision arising from the British Columbia Court of Appeal addresses the ability of an elderly Alzheimer’s patient to provide consent to personal care decisions without speaking.
Bentley v. Maplewood Seniors Care Society involves a petition brought by Margaret Bentley’s daughter and husband to prevent Maplewood, the care facility in which Margaret has been a patient since 2009, to cease providing food and water to Margaret.
At the time of the hearing, Margaret was an 83-year-old woman who had been afflicted with Alzheimer’s Disease since at least 1999. Consequently, Margaret would sit “…slumped over in a chair or in bed most of the time, with eyes closed. She has not spoken since 2010 and does not appear to recognize anyone”.
Margaret’s family relied on evidence from as far back as 1991, including a living will (otherwise referred to as an advance directive), expressing Margaret’s wishes that, amongst other things, if there was no reasonable expectation of recovery from extreme physical or mental disability, she be allowed to die (and not be provided with nourishment or liquids). Interestingly, Margaret was a nurse in earlier years, who had experience with patients in ‘vegetative’ states due to Alzheimer’s Disease. Accordingly, one may think that these decisions were well thought out.
Maplewood argued that Margaret opened her mouth to accept nourishment or liquid. Should Margaret keep her mouth closed, as she did when at the dentist, or keep her teeth clenched, they would respect her decision and not attempt to feed her by means of a feeding tube or any other medical means.
The lower Court Judge considered various evidence from general practitioners, finding it significant that Margaret “…indicates preferences for certain flavours and eats different amounts at different times…”, and that the petitioners (family), had not established that Margaret’s behaviour was a mere reflex.
Importantly, the family did not seek to have Margaret declared incapable. Therefore, the Court found that Margaret consented to being given food and water by holding a spoon or glass to her lips. This did not amount to prodding and prompting. Since Maplewood did not go further when Margaret kept her mouth closed, their actions were within the scope of Margaret’s consent.
There is a new diet out there and it has been given the name of the MIND diet.
The MIND diet was developed by the researchers of Rush University Medical Centre which, if followed, may reduce the risk of developing Alzheimer’s disease by 53% according to their study. The MIND diet is purported to slow the rate of cognitive decline regardless of risk factors such as genetics, smoking and exercise.
The MIND diet is comprised of green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil and wine. It also provides for a list of foods to avoid which I excerpt from WebMD as follows,
- Red meat: Less than four servings a week
- Butter and margarine: Less than a tablespoon daily
- Cheese: Less than one serving a week
- Pastries and sweets: Less than five servings a week
- Fried or fast food: Less than one serving a week
Hope you’ve enjoyed this food for thought!
I recently came across an article published in the Globe and Mail titled, Ultrasound shows new promise as Alzheimer’s treatment.
The article describes how scientist are using ultrasound technology to break apart the neurotoxic amyloid plaques that typically result in memory loss and cognitive decline in those suffering from Alzheimer’s disease.
While still in the early clinical trial stages, scientists have found that the use of the non-invasive focused beams of an ultrasound almost completely cleared the plaques in 75 per cent of the animals, without any apparent damage to brain tissue. As such, this promising new discovery could be used to treat Alzheimer’s disease and restore memory. More detailed information about the research can be found here.
Research initiatives such the one outlined above are particularly important given the increasing prevalence of dementia in today’s society. A recent fact sheet published by the World Health Organization (the “WHO”) indicates that as of 2015, 47.5 million people are living with dementia worldwide.
Unfortunately, as a result of increased life expectancies and an aging boomer population, the number of dementia cases is expected to increase exponentially in the years to come. The WHO estimates there will be approximately 75.6 million people suffering from dementia by 2030, and 135.5 million by 2050.
Accordingly, dementia is quickly becoming a global health concern. Last week, the WHO hosted its first Ministerial Conference on Global Action Against Dementia in Geneva. The conference drew researchers, health officials and ministers from more than 80 countries around the world.
As such, it is likely that we will see an increase in government spending and a rise in research initiatives in this area, such as the one outlined above, in the months and years to come.
Thank you for reading,
After Alzheimer’s Disease, Lewy body Dementia (LBD) is one of the leading causes of dementia in the elderly, accounting for up to 20% of cases of dementia.
In Lewy body Dementia, abnormal protein structures called Lewy bodies develop in regions of the brain responsible for thinking and movement. These Lewy bodies were first described in 1912 by Friederich Lewy, a colleague of Alois Alzheimer.
LBD symptoms closely resemble those of both Alzheimer’s disease and Parkinson’s disease. The Alzheimer’s-like symptoms of LBD include fluctuating levels of attention and alertness, and a progressive loss of memory, language, reasoning and higher mental functions such as calculation. The Parkinson’s-like symptoms of LBD include rigidity, stiffness, stooped posture and a shuffling gait. Complex, well-formed, but oddly unthreatening visual hallucinations are one of the earliest and most common (>80% incidence) symptoms of LBD and usually consist of people, children or animals.
Here are some more quick facts about LBD:
· LBD is slightly more common in men than women. The average age of onset is 75 to 80 years of age.
· There is no single test to diagnose LBD. Like Alzheimer’s disease, a diagnosis of LBD is considered ‘possible’ or ‘probable’ after other possible diagnoses are considered and eliminated.
· Lewy body Dementia usually has a rapid onset and rapid progression. The average span of time between diagnosis and death is about 5 to 7 years.
· There are no know therapies to slow the progression of LBD, nor is there a known cure. The goal of treatment is to control the cognitive, psychiatric and motor symptoms of the patient.
Jennifer Hartman, Guest Blogger