(CHICAGO) –  People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The study, published in the June issue of the American Journal of Psychiatry, finds that prior experience in adult day care may lessen this association.

The observational study involved 432 older persons with Alzheimer’s disease who were recruited from health care settings in the Chicago area. At baseline, they lived in the community and 196 participants were using day care services from 2 to 6 days a week for an overall mean of 1.7 days a week. At six month intervals for up to four years, they completed nine cognitive tests from which a composite measure of global cognition was derived.

On average, cognition declined at a gradually increasing rate for all participants.  During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

Study participants who had previous adult day care experience fared better.   As level of day care use at study onset increased, the association of nursing home placement with accelerated cognitive decline substantially decreased.  Thus, people using day care 3 to 4 days a week at the beginning of the study showed no increase in cognitive decline upon nursing home placement.

“The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence,” said study author Robert S. Wilson, Ph.D., a neuropsychologist at the Rush Alzheimer’s Disease Center.

The study also found that a higher level of education was associated with accelerated cognitive decline upon nursing home placement. Yet, day care use markedly reduced the association of education with accelerated cognitive decline in the nursing home; further evidence that there is a robust association between day care experience and cognition during the transition to a nursing home.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

Alternatively, the increased cognitive decline upon placement may reflect difficulty adapting to an unfamiliar environment, consistent with clinical reports of increased confusion and behavior problems in those with dementia during acute hospitalization or trips away from home. Patients who had prior adult day care services may have been better able to adjust to the unfamiliar environment.

“The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living,” said Wilson.

The research was supported by grants from the National Institutes on Aging, which leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline.

The Rush Alzheimer's Disease Center is one of  approximately 30 NIA-supported Alzheimer's Disease Centers across the U.S. which conduct basic science, clinical, and social and behavioral research on dementia and AD. General information on aging and aging research can be viewed at the NIA's home website, www.nia.nih.gov.

Diagnosis of Alzheimer's disease decades before symptoms appear would soon be possible, courtesy a 30-second test being developed by scientists.

The simple procedure, which detects the signs of Alzheimer's in those in their 40s, brings the hope of routine screening for dementia in as little as two years.

Those found to have a tiny piece of tell-tale damage to their brains could take preventative measures such as changing their diet and taking more exercise.

Quicker detection would allow earlier treatment and, with the help of new drugs, some who test positive might never develop the disease.

"The study lays open the possibilities for screening, early detection and intervention. The earlier we can intervene with people vulnerable to eventual dementia, the greater the chances of preventing or delaying the disease onset," the Daily Mail quoted David Bunce, lead researcher, as saying.

Experts said that delaying the onset of Alzheimer's by five years could halve the number of people who die with the condition, currently a third of over-65s.

At the moment, diagnosis is based on memory tests or expensive brain scans.

By contrast, the computer procedure, based on a simple test of reaction times, would be quick and easy.

Bunce, of Brunel University, used brain scans to find tiny lesions, each smaller than a grain of rice, in the white matter of apparently healthy men and women aged 44 to 48.

Around 15% of the 428 tested had the abnormalities, which occurred in the brain's memory hub.

Although the research did not show that these people went on to develop dementia, the lesions were similar to those discovered in post-mortem examinations of Alzheimer's patients - and were found in the same part of the brain.

The professor saw that those with the brain lesions performed more erratically in a test of reaction times, which involved watching for one of two lights on a screen and hitting a corresponding button.

Those with lesions had a mixture of slow and fast reaction times, whereas those with healthy brains had either consistently fast or slow responses.

The September issue of Archives of Neurology, one of the JAMA/Archives journals, features research, which finds that a simple blood test could diagnose Alzheimer’s disease.

Researcher Sid E. O’Bryant, Ph.D., of the Texas Tech University Health Sciences Center found that an initial analysis suggests that biomarkers in blood serum can be combined with clinical information to accurately classify patients with Alzheimer’s disease.

“There is clearly a need for reliable and valid diagnostic and prognostic biomarkers of Alzheimer’s disease, and in recent years, there has been an explosive increase of effort aimed at identifying such markers,” the authors write as background information in the article.
 
“It has been previously argued that, because of significant advantages, the ideal biomarkers would be gleaned from peripheral blood.” Identifying biomarkers in the blood has several advantages over other methods of classifying patients with Alzheimer’s disease, including detecting biomarkers in the cerebrospinal fluid and neuroimaging. Blood can be collected at any clinic or in-home visit and most patients will agree to the process, whereas not all facilities can conduct lumbar punctures to obtain cerebrospinal fluid. Older patients may not consent to lumbar puncture and may not be able to undergo neuroimaging because of pacemakers or other health issues.

O’Bryant along with colleagues in the Texas Alzheimer’s Research Consortium analyzed proteins in the serum of 197 patients diagnosed with Alzheimer’s disease and 203 controls without Alzheimer’s disease. Statistical analyses were used to create a biomarker risk score, which included levels of a number of protein biomarkers, including fibrinogen (a clotting protein), interleukin-10 (associated with the immune system) and C-reactive protein (an inflammatory marker).

The final biomarker risk score correctly identified 80 percent of the individuals with Alzheimer’s disease and accurately excluded 91 percent of the individuals without Alzheimer’s disease. When other factors were also considered—age, sex, education and whether an individual had the APOE gene, which is associated with risk for Alzheimer’s disease—the score correctly identified 94 percent of the individuals with Alzheimer’s disease and accurately classified 84 percent of participants who did not have the disease.

“In addition to offering more accessible, rapid and cost- and time-effective methods for assessment, biomarkers (or panels of biomarkers) also hold great potential for the identification of endophenotypes within Alzheimer’s disease populations that are associated with particular disease mechanisms,” the authors write. In the current study, “a disproportionate number of inflammatory and vascular markers were weighted most heavily in the analyses.” The findings provide support for the existence of an inflammatory subtype of Alzheimer’s disease, they note.

“The identification of blood-based biomarker profiles with good diagnostic accuracy would have a profound impact worldwide and requires further validation,” the authors conclude. “Additionally, the identification of pathway-specific endophenotypes among patients with Alzheimer’s disease would likewise have implications for targeted therapeutics as well as understanding differential progression among diagnosed cases. With the rapidly evolving technology and the analytic techniques available, Alzheimer’s disease researchers now have the tools to simultaneously analyze exponentially more information from a host of modalities, which is likely going to be necessary to understand this very complex disease.”