Stem Cell Transplantation: Caveat Emptor!!

A patient asked before my last clinic in Kona whether she should look into stem cell transplantation for her condition, which is not quite exactly like progressive supranuclear palsy. Apparently someone on O’ahu was going to offer this procedure. I double-checked with my colleague Dr. Mark Tuszynski at the neuroregenerative lab, and there is no tried and true stem cell therapy for Alzheimer’s or Parkinson’s disease or ALS currently. Despite this, there are unregulated stem cell clinics all over:

Beware. I know it sounds like great therapy, but it is a complex process, and there’s been lots of tinkering to make stem cells a) grow into the right kind of specialized cells, b) grow into the right places, and c) insinuate themselves functionally into their neighborhoods. Worst case scenario: you have given yourself a brain tumor where cells grow and take up space but can’t integrate with the existing, embattled neural tissue.

Another Thing I Thought I Wouldn’t See in My Lifetime

Not for dementia care yet, but the FDA has given the nod to an epilepsy drug that is made with a 3D printer! See here for some details. This is pretty incredible, even if you wouldn’t have the chemicals to print with your home laserjet at this time. The pill apparently melts in the patient’s mouth, which is great for those who are still recovering from a seizure and can’t swallow safely yet.

Very reminiscent of the goodies Star Trek: The Next Generation was able to create using Holodeck scifitechnology. Does anyone else remember when Dr. Beverly Crusher made Worf a new spinal cord and transplanted it?


Click here for info in general about what goals of printable meds might be. Apparently, makers of Spiritam have a line of 3D printable medical  products they’re bringing forward

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.