(Editor’s Note: this is Part 3 of the new 3-part series writ­ten by Dr. Evian Gor­don draw­ing from his par­tic­i­pa­tion at the Per­son­al­ized Med­i­cine World Con­gress on Jan­u­ary, 23, 2012 at Stan­ford University.)

Work­ing with Health Care Indus­try Stake­hold­ers: Clin­i­cians, Pharma/Biotech, Pay­ers, PBMs, Lawyers, Medicare, FDA

Clin­i­cians seek clear val­i­dated “rules of thumb” that can be eas­ily imple­mented and fit into their work­flow and reim­burse­ment regime. Many are explor­ing “Clin­i­cal Deci­sion Sup­port (CDS)” tools on the web and solu­tions linked to “Elec­tronic Health Records” (EHR’s). CDC and EHR’s are seed­ing the ground for clin­i­cians to adopt robust Bio­mark­ers that are shown to be unam­bigu­ously clin­i­cally relevant.

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Test­ing Pro­gram Fails Sol­diers, Leav­ing Brain Injuries Unde­tected (ProPublica):

“In 2007, with road­side bombs explod­ing across Iraq, Con­gress moved to improve care for sol­diers who had suf­fered one of the war’s sig­na­ture wounds, trau­matic brain injury.

Law­mak­ers passed a mea­sure requir­ing the mil­i­tary to test sol­diers’ brain func­tion before they deployed and again when they returned. The test was sup­posed to ensure that sol­diers received proper treatment.

Instead, an inves­ti­ga­tion by ProP­ub­lica and NPR has found, the test­ing pro­gram has failed to deliver on its promise, offer­ing sol­diers the appear­ance of help, but not the real­ity. Read the rest of this entry »

(Editor’s Note: I recently came across an excel­lent book and resource, The Alzheimer’s Action Plan: The Experts’ Guide to the Best Diag­no­sis and Treat­ment for Mem­ory Prob­lems, just released in paper­back. Dr. Murali Doraiswamy, one of the authors and lead­ing Alzheimer’s expert, kindly helped us cre­ate a 2-part arti­cle series to share with Sharp­Brains read­ers advice on a very impor­tant ques­tion, “How can we help the pub­lic at large to dis­tin­guish Alzheimer’s Dis­ease from nor­mal aging — so that an inter­est in early iden­ti­fi­ca­tion doesn’t trans­late into unneeded wor­ries?” What fol­lows is an excerpt from the book, pages 3–8).

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As it turns out, Jane did not have Alzheimer’s. She con­sulted a doc­tor, who, in doc­s­peak, told her that the pas­sage of time (get­ting older) had taken a slight toll on her once-superquick mem­ory. She was slow­ing down a lit­tle, and if she relaxed, the name or date or other bit of infor­ma­tion she needed would come to her soon enough. She was still good at her job and home life. She had sim­ply joined the ranks of the wor­ried well.

Nor­mal brain aging, begin­ning as early as the for­ties in some peo­ple, may include:

• Tak­ing longer to learn or remem­ber information
• Hav­ing dif­fi­culty pay­ing atten­tion or con­cen­trat­ing in the midst of distractions
• For­get­ting such basics as an anniver­sary or the names of friends
• Need­ing more reminders or mem­ory cues, such as promi­nent appoint­ment cal­en­dars, reminder notes, a phone with a well­stocked speed dial

Although they may need some assis­tance, older peo­ple with­out a men­tal dis­or­der retain their abil­ity to do their errands, han­dle money, find their way to famil­iar areas, and behave appropriately.

How does this com­pare to a per­son with Alzheimer’s? When Alzheimer’s slows the brain’s machin­ery, peo­ple begin to lose their abil­ity to Read the rest of this entry »

Given the grow­ing media cov­er­age men­tion­ing the terms Cog­ni­tive Reserve and Brain Reserve, you may be ask­ing your­self, “What exactly is my Cog­ni­tive (or Brain) Reserve?”

The cog­ni­tive reserve hypoth­e­sis, tested in mul­ti­ple stud­ies, states that indi­vid­u­als with more cog­ni­tive reserve can expe­ri­ence more Alzheimer’s dis­ease pathol­ogy in the brain (more plaques and tan­gles) with­out devel­op­ing Alzheimer’s dis­ease symptoms.

How does that work? Sci­en­tists are not sure but two pos­si­bil­i­ties are con­sid­ered.
1. One is that more cog­ni­tive reserve means more brain reserve, that is more neu­rons and con­nec­tions (synapses) between neu­rons. Indi­vid­u­als with more synapses would then have more synapses to lose before the crit­i­cal thresh­old for Alzheimer’s Dis­ease is reached.
2. Another pos­si­bil­ity is that more cog­ni­tive reserve means more com­pen­satory processes. The brain of indi­vid­u­als with more cog­ni­tive reserve would use more alter­na­tive net­works to com­pen­sate for the dam­ages caused by the pathol­ogy in pre­vi­ously used networks.

In a newly pub­lished study, Roe and col­leagues from Wash­ing­ton Uni­ver­sity in St. Louis, used the num­ber of years of edu­ca­tion as a mea­sure of cog­ni­tive reserve. Why years of edu­ca­tion? Because pre­vi­ous stud­ies have shown that peo­ple who have more edu­ca­tion also exhibit a greater resis­tance to Alzheimer’s symp­toms, even while patho­log­i­cal changes are occur­ring in the brain (see Ben­nett el al., 2003 or Roe, Xiong, et al., 2008).

Roe and her col­leagues stud­ied 198 indi­vid­u­als whose mean age was 67. Out of these 198 indi­vid­u­als, 161 were non­de­mented and 37 were diag­nosed with Alzheimer’s Disease.

All the par­tic­i­pants in the study took a Read the rest of this entry »