Posterior Cortical Atrophy

Researchers in the lab of Dr. Sebastian Crutch
at the University College London recently published some success in helping patients who can no longer visually process words and images read more accurately. The condition itself can often be caused by Alzheimer’s disease pathology and is called Posterior Cortical Atrophy. Keep an eye on for the app to be developed for prime time. It remains to be seen whether it would be useful to patients with PPA. Those with agrammatic, non-fluent PPA might be better able to read aloud with it, but those with semantic dementia would receive no better clues as to the meanings of words. Slide1

Medicare encouraging more quality time with your doctor?

Starting in January 2016, we in the U.S. will be able to put the time that we spend helping you with advanced care planning and discussion of advanced directives, end-of-life care into a reimbursable format. Until now, we technically have to have the patient present for a visit in which we are doing “counseling,” which could entail reviewing the reasons for medications, the diagnostic process, predicting future changes and needs, but  just get reimbursed as an add-on to a regular office visit that does not amount to anywhere near the time these things take. As of next year, we will have new CPT codes (99497 and 99498 for you MDs or billing agents out there) that will justify and encourage doctors to have these very important conversations with patients and their families! 

An Important New Resource for Working with Children Who Are Caregivers

Bravo, Dr. Jess Baker for these videos and goal to have no one graduate to middle school without being aware of dementia. Another way of helping children identify themselves as part of a worldwide community of caregivers. See “Children and grandchildren of people with dementia speak out” for description of the work and links to youtube videos.

PPA Gives New Insights to Localization of Language in the Brain

Hot off the presses: Marsel Mesulam and Sandy Weintraub’s group in Chicago (Northwestern Univ) have published interesting new maps of language comprehension that are based on PPA patient brain changes and not strokes. An area of the brain first described by Wernicke (one of the earliest neurologists) that has been “held responsible” for comprehension of words was identified by comparing stroke victims who had loss of language comprehension as their main deficit. Mesulam et al.’s paper shows that semantic dementia patients have word comprehension loss due to problems in an area in front of Wernicke’s area and sentence comprehension impairment due to problems in areas in two areas that barely intersect with Wernicke’s area. 

Although we have no cure for semantic dementia yet, these patients are teaching us more about the complexities of language function. 

This is very big news to those of us fascinated by aphasia and strips away over a century of oversimplification of language comprehension. The optimist in me hopes that this new insight will allow us to focus interventions (perhaps even through speech and language pathology) to help patients compensate for semantic dementia. 

Help Wanted: Adolescents Don’t Know How to Connect with Brain Health

I’m very proud of my last Univ of Toronto grad student, Adam Agate’s Masters of Science thesis. Pls see abstract about what needs to happen to make the future more dementia-free:

BACKGROUND: “Brain health” describes a wellness maintenance approach to optimizing cognitive, mobility, and behavioural function throughout the lifespan and encompasses, in addition to prevention of dementia, the stabilization of mood and emotion. Because a greater impact on modifiable dementia risk factors may result from the proactive prevention of related disorders (e.g., diabetes), more so than the reactive management of those disorders in mid-life, it behooves us to stoke brain health motivation among high school students. This may only be achieved by first clarifying high school students’ current understanding of brain health and how this impacts their decision-making of brain health behavior adoption. However, there is a dearth of research exploring adolescent’s concept of brain health.

OBJECTIVE: The goal of this qualitative, content analysis study was to understand the views about brain health held by high school students in grades 9 and 10, and how this impacts their adoption of brain healthy behaviours.

METHODS: Three semi-structured focus groups interviews explored attitudes of and experiences with brain health amongst 23 high school adolescents in the Greater Toronto Area. In addition, I surveyed the students’ definition of “brain health” and its importance in their lives. Thematic analysis on transcripts from the focus groups was conducted by three independent coders.

RESULTS: Three themes emerged from the data analyses regarding participants’ views of brain health: (1) Ambiguous Definition, (2) Lack of Understanding and (3) a Struggle for Relevance.

DISCUSSION: These themes contributed to adolescents feeling disconnected from the topic of brain health and therefore from its impact on the present and future. This disconnection emerged as a barrier to the adoption of healthy brain health behaviours, as participants described how the feeling of disconnection from brain health left them unable to actively make decide in favor of brain health.

CONCLUSION: This study found a major divide between the youth of our generation and the topic of brain health. This disconnection needs to be addressed through education efforts that build adolescents’ understanding about brain health while framing it as relevant in their lives. There is both a demand and need from students for the creation and implementation of meaningful learning experiences about the brain.

New and Cool

title_page02102015jpg_Page1 In case you were waiting for kids’ education on dementia in the Welsh language, here it is,

Courtesy of Betsan Juckes-Hughes of CPN Younger People with Dementia at Betsy Cadwalader University Health Board. Way to expand our international outreach, Betsan! [BTW, she’s been a delight to work with.]

Pharmaceutical Business- Caveat Emptor!

The latest in  a cry for help from pharma? On the one hand, we need pharma to keep investing in CNS research, which has an abysmally low hit rate for discoveries that make it to market and treat dementia. On the other hand, we have the federal appeals court to help protect us from shell games. See for recent shenanigans. [And by the way, not all of us prescribe the longer-acting version of memantine anyway.]