Study finds blood test diagnosed Alzheimer's disease 90% of the time; early diagnosis is crucial with new medications available

2024 Alzheimer's disease facts and figures
special report graphic

By Melissa Patrick
Kentucky Health News

A new blood test can diagnose Alzheimer's disease better than a memory specialist or a primary care physician, according to a new study. 

The study, published in the Journal of the American Medical Association, found that the blood test, called PrecivityAD2, was 90% accurate in diagnosing Alzheimer's disease, compared to a 61% success rate among primary care doctors and a 73% success rate among memory specialists. All of the physicians used standard clinical methods for diagnosis that did not include brain scans or spinal taps. 

The researchers at Lund University in Sweden followed 1,213 people with an average age of 74 who were undergoing cognitive evaluations in both primary care and specialty clinics in Sweden.

Dr. Greg Cooper, director of the Norton Neuroscience Institute Memory Center in Louisville, explained that there are protein biomarkers that are indicative of Alzheimer's disease and can be identified through a a spinal tap, which is invasive, or a brain scan called a PET scan, which he said are not always available, are expensive and are not well-covered by insurance. 

But now, he said, there is a blood test that can accurately detect these biomarkers. The blood test works by measuring a combination of two ratios within a blood sample, including the phosphorylated tau protein and two amyloid-beta proteins, both considered  hallmarks of Alzheimer's disease. 

"Most people would prefer a blood test over a spinal fluid exam, a spinal tap," he said. 

Cooper added that the blood test should be used only on people who show signs of memory loss or have a diagnosis of mild cognitive impairment or dementia. In this group, he said, "It is a very accurate test." 

Further, he said this blood test will help people get an early diagnosis, which is needed to qualify for the two new drugs approved to modestly slow the symptoms of Alzheimer's: Leqembi and Kisunla. At this time, Cooper said it can take months or even years before a person can receive a diagnosis. 

"As newer medications become available . . . we need to do a better job of identifying people very early on, when they are the best possible candidates for these medications that we believe actually slow the progression of the disease."

According to the Alzheimer's Association, nearly 7 million Americans are living with Alzheimer’s disease, with this number projected to rise to nearly 13 million by 2050. In Kentucky, the association reports that 81,000 people aged 65 and older are living with Alzheimer's.

Cooper said the Norton memory center is already using this blood test, but there remains some barriers.

"The biggest barrier right now has been in terms of payments," he said. "So we are using this exact same test that was used in this study and the results are really quite good. But payment is an issue.Insurance does not always cover this and so there is often an out-of-pocket expense."

He said he is hopeful that with studies like this one and future U.S. Food and Drug Administration approval, insurance will eventually pay for it. " I think it is only a matter of time before insurance starts paying for it, "he said. "At this time, it's just simply too new." 

He said it "remains to be determined" if primary care doctors should do this blood test, largely related to their ability to do cognitive memory testing in their practices. With the advent of these new medications that require early diagnosis, he said there is a sense of urgency to diagnose people early on and a patient's first point of contact is often their primary care provider. 

"The worst thing in the world is to tell someone had I seen you six months or a year earlier, you might have been a candidate for one of these new treatments -- and now you're not," he said. "Tests like this will help accelerate that process and allow more people to benefit from these therapies."

Recognizing that many people are afraid of getting an Alzheimer's diagnosis, Cooper said: "I would simply argue that not receiving a diagnosis, if you have that underlying disease, doesn't make the disease go away. You can't ignore it. It will catch up with you eventually. But now, we have opportunities to take a proactive approach. Maybe we can't cure it, but we can do things that meaningfully impact the disease and can meaningfully impact and promote our quality of life. So it is an awful diagnosis, I can't take that away. But we can't help unless we take that first step. And so always keep in mind, there may be things that we can do. Don't run away from that." 

UK researcher wins $3.1 million grant to study proteins that go haywire and lead to dementia; one goal is early treatment of it

Maj-Linda Selenica, Ph.D., works in her lab on March 27, 2024. (UK photo by Carter Skaggs)

By Hilary Smith
University of Kentucky

A University of Kentucky professor has received a $3.1 million grant from the National Institute on Aging to continue her research that she thinks could lead to treatments for early dementia.

Maj-Linda Selenica, Ph.D., assistant professor in the UK College of Medicine and associate director of outreach and partnerships at UK’s Sanders-Brown Center on Aging, has been working on research surrounding misfolding of the protein TDP-43, which is common feature of many neurodegenerative diseases, including Alzheimer's disease.

The condition is found in 1 in 5 people over 80. When severe it is associated with episodic memory loss, mimicking Alzheimer's-type dementia, and hastens the cognitive decline in patients with co-existing Alzheimer's pathology, 

Proteins that fold into a different, incorrect shape than their normal functional form are often unable to perform their normal functions and can even become toxic to cells. They can clump, which can lead to neurodegenerative diseases like Alzheimer's.

“We have uncovered completely novel modification of TDP-43 that uniquely and irreversibly changes the cellular mechanisms in the brain,” said Selenica.

Scientists have few strategies to intervene in the disease process, but Selenica and her lab have discovered that peptidyl arginine deiminases (PADs) promote the conversion of amino acid arginine in TDP-43 to the amino acid citrulline. This process, called citrullination, modifies TDP-43 and may be a potential therapeutic target.

Selenica began her research at the University of South Florida, where her team made novel antibodies for the citrullinated TDP-43, which did not exist as research tools. The team was able to use these antibodies to start looking at the potential mechanisms.

“Alzheimer’s disease brains and dementia brains undergo longstanding stress, so we asked the same thing of the cellular models and cross-validated our findings in animal models,” said Selenica. “We obviously cannot mimic what happens in the human brain, but these models permit us to understand mechanisms that underlie the human disease.”

Selenica’s lab collaborated with Sanders-Brown’s Daniel Lee, an associate professor in the UK College of Medicine and co-investigator on the grant. He was first to investigate the effects of PAD-dependent tau citrullination in Alzheimer's. Their efforts now focus on better understanding how citrullination impacts TDP-43 and other proteins.

The terms “Alzheimer’s disease” and “dementia” are no longer interchangeable. Now scientists understand that a variety of diseases and disease processes contribute to dementia, which is why so much of the ongoing work within the labs at Sanders-Brown are connected in some way. Selenica and Lee’s laboratories are joining forces to focus on two prominent pathological hallmarks in dementia-related diseases.

Selenica’s colleague, Dr. Pete Nelson, a professor of pathology and laboratory medicine at UK and leader of neuropathology at Sanders-Brown, led a group of international experts who characterized TDP-43 effects as a new form of dementia. 

Selenica collaborated with Nelson to look at human brain tissues from the UK Alzheimer’s Disease Center Tissue Bank in Sanders-Brown. Nelson is also a co-investigator in this new grant.

Based on her research and the work that planned under the new NIA grant, Selenica is hopeful it can result in several therapeutic avenues to target TDP-43 early in the disease development process.

 “I’m hoping that several years from now we can develop disease-modifying therapeutic strategies and future biomarker assays targeting TDP-43 pathology,” Selenica said. And she doesn’t think the work will stop there. “I think this project will open the field to much more fruitful collaborations. It has us really thinking about, could we develop something to target all the pathologies at once?”

UK researcher says chemicals in plastics can speed Alzheimer's

Researchers at the University of Kentucky are studying chemical compounds used in the production of water bottles and their link to Alzheimer's disease. (Photo by monticelllo, iStock/Getty Images Plus)

By Lindsay Travis
University of Kentucky

Researchers at the University of Kentucky are studying how elements of our natural surroundings can be potential risk factors for Alzheimer’s disease — including chemicals widely used in plastics.

“Bisphenols can accelerate Alzheimer’s disease and lead to cognitive deficits. Simply: Be smart and stay smart by avoiding plastics,” says Anika Hartz, the UK professor leading the study.

Anika Hartz, Ph.D., is the lead resarcher. (Pete Comparoni, UK) 

“Identifying environmental risk factors for Alzheimer’s is critical to mitigate cognitive decline in humans,” said Hartz, who holds positions in the College of Medicine and the College of Pharmacy. She is also affiliated with UK's Sanders-Brown Center on Aging, one of the nation’s leading centers on aging, Alzheimer’s disease and related neurodegenerative disorders. It is one of 33 National Institute on Aging-funded Alzheimer’s research centers in the U.S.

The study is funded by a grant from the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health.

Alzheimer’s is a progressive and irreversible neurological disorder. It’s estimated that 6.2 million Americans aged 65 and older are living with the disease that affects cognitive function, memory and behavior.

Hartz and her colleagues are examining three types of bisphenols, chemical compounds used in the production of polycarbonate plastics and epoxy resins. Theys are commonly found in food containers, water bottles and the lining of cans.

“Human exposure to bisphenols is inevitable due to their widespread presence in the environment,” said Hartz. “Our data show that bisphenols trigger blood-brain barrier dysfunction and memory problems, both hallmarks of Alzheimer’s, indicating that environmental bisphenols are a critical yet underrecognized risk factor for the disease.”

Hartz’s research team provided some of the first evidence that the chemicals are a clinically relevant environmental risk factor for Alzheimer’s. Bisphenols are a concern because previous research has shown they can affect the endocrine system, which regulates hormones. The brain plays a complex role in that system.

UK researchers want to better understand how the chemicals’ disruption of the endocrine system impacts the blood-brain barrier function, potentially driving cognitive decline and accelerating Alzheimer’s disease.

“The goal of this project is to develop fundamental knowledge of environmental impacts on human health that will help promote healthier lives and reduce the burden of diseases and conditions related to aging,” said Hartz. “New insights are expected from our study that will open the door for future evidence-based health management aimed at preserving cognition in health and disease.”

The work builds on preliminary data funded by a pilot grant from the UK Center for Appalachian Research in Environmental Sciences. Hartz said, “Without the pilot funding, the strong support of the UK-CARES leadership Drs. Ellen Hahn and Erin Haynes, the entire UK-CARES team, my colleagues Drs. Bjoern Bauer, Kevin Pearson, Richard Kryscio, Bernhard Hennig, Peter Nelson, Scott Stanley and the continuous support from Dr. Linda Van Eldik and the team at the Sanders-Brown Center on Aging, this would have not been possible.”

This study brings together a multidisciplinary group of researchers spanning the colleges of Medicine, Pharmacy, Public Health and Martin-Gatton College of Agriculture, Food and Environment.

2023 was a tough year in many ways, but saw significant positive developments in science and medicine, Washington Post reports

2023 saw new understanding and the start of a treatment

for dementia, as clinical trials cotinue at the University

of Kentucky and other sites. (iStock photo via Washington Post)

Kentucky Health News

Despite wars, the most mass killings since 2006 and the hottest average temperatures in human history, "2023 also was a year with significant positive developments, including in scientific research and medicine," The Washington Post reports, with a motive: "Research has indicated that uplifting news can provide an emotional buffer against distressing news and feelings of hopelessness — and even encourage optimism or action." Here are some things the Post listed:

The World Health Organization approved a new malaria vaccine that has been shown to be much more effective than the only previous vaccine against the potentially deadly disease. "The WHO said it expects the vaccine, which costs $2 to $4 per dose and has been shown to reduce symptomatic cases by 75 percent after three doses within a year, to be available by the middle of 2024," the Post reports. The U.S. has about 2,000 cases of malaria each year, most of them contracted in other nations.

The Food and Drug Administration approved the first pill to treat postpartum depression, which affects up to one in five womenand can cause "experience intense hopelessness and, in rare cases, psychosis — and it can last for years," the Post notes. "The new drug is taken once a day for two weeks and, unlike the existing treatment of an IV injection that may take as long as 60 hours to administer in a health-care setting, it can be taken at home."

The FDA also approved two gene-therapy treatments for sickle-cell disease, "a rare and debilitating condition that affects around 100,000 Americans, most of them Black. The disease causes extreme, constant pain and can drastically cut the life span of those affected," the Post notes. "Both are intensive, expensive procedures — and require chemotherapy, which has significant side effects. But patients who have received the treatments have spoken of its profoundly beneficial impact on their lives."

Scientists made progress in understanding dementia, the Post reports. One study "suggested that lifestyle habits, including regular mental and physical activity, eating a healthful diet, and regular social contact were linked with a slower rate of memory decline," the Post reports. "Another found that living in areas with more natural green spaces was associated with lower rates of hospital admissions for diseases including dementia, while separate research indicated that the use of hearing aids could cut the risk of cognitive decline by nearly half."

Meanwhile, the FDA approved, for the first time, to a drug that modestly slows Alzheimer’s disease. While difficult questions about safety, effectiveness and cost remain, many neurologists say that having a drug that slows Alzheimer’s is nonetheless a milestone after years of failed trials. The University of Kentucky is one of the sites of the clinical trials, and at last report was still seeking participants.

Meat-heavy diet raises risk for Alzheimer's disease, study finds, predicting U.S. cases of the disease will grow 50% by 2038

Researcher Steve Blake diagrammed how different foods create greater risk for Alzheimer's disease (AD). AGEs are compounds formed in the body when proteins react with sugar; they increase the risk of many diseases.

Kentucky Health News

Americans' meat-rich diets make them more vulnerable to Alzheimer's disease, according to a study published in the peer-reviewed Journal of Alzheimer's Disease. "Diets that are more plant-based, like the Mediterranean diet and traditional diets in China, Japan, and India, are shown to reduce risk, especially when compared to the Western diet," says a press release about the study by nutrition scientists.

"Alzheimer’s disease rates rise in these countries as they make the nutrition transition to the Western diet," the release notes. "This study identifies dementia risk factors including higher consumption of saturated fats, meat (especially red meat such as hamburgers and barbeque) as well as processed meats such as hot dogs, and ultra-processed foods high in sugar and refined grains.

The study also helps explain why certain foods increase or reduce the risk of Alzheimer’s. "Meat raised risk of dementia the most by increasing risk factors such as inflammation, insulin resistance, oxidative stress, saturated fat, advanced glycation end products, and trimethylamine N-oxide," the release says. The study identified several foods that protect against Alzheimer’s, such as nuts, omega-3 fatty acids, whole grains, green leafy vegetables, colorful fruits and vegetables, and beans and other legumes (plants that fix nitrogen).

Ultra-processed foods can increase the risk of obesity and diabetes because they lack the ingredients found in whole plant foods that deter dementia away, such as anti-inflammatory components and antioxidants. Ultra-processed foods make poverty is an important driver of Alzheimer’s disease, because they are usually cheaper sources of energy than fruits, vegetables, whole grains, and other more nutritious foods.

"The paper also suggests that Alzheimer’s disease rates in the U.S. are projected to increase by 50% from 2018 levels by 2038," the release saus. "This calculation is based on comparing trends of obesity in the U.S. with Alzheimer’s disease trends. This comparison shows a 20-year lag between obesity rates and Alzheimer’s disease rates. This estimate is very close to the estimate published by the Alzheimer’s Association in 2018, an estimate of a 56% increase."

The researchers said, "Our estimate suggests that the rising trend of obesity, due to consumption of meat and ultra-processed foods, is the force driving dementia. Although our personal risk of Alzheimer’s disease can be reduced with diet, it is expected that those who continue to eat the Western diet will continue to have a higher risk."

The study, a review of other published research, was conducted by Steven Blake of the Maui Memory Clinic in Hawaii and William Grant of San Francisco's Sunlight, Nutrition and Research Center. It was endorsed by other experts.

“Grant and Blake comprehensively review and synthesize the role of dietary factors in Alzheimer’s disease,” said Dr. Edward Giovannucci, a professor of utrition and epidemiology at Harvard University. “Evidence from diverse perspectives support that a diet that emphasizes fruits, vegetables, legumes, nuts, whole grains, and … de-emphasizes meat, especially red meat, saturated fats, and ultra-processed foods is associated with lower risk of Alzheimer’s disease. Physical inactivity and obesity also contribute to higher risk.”

Op-ed looks at ways to address loneliness, which is linked to a number of health conditions; Ky. is above average for loneliness

Kentucky ranks in the top 20 states for loneliness, which can involve far more than feelings of sadness from being alone. Research shows it is linked to strokes, heart disease, dementia, inflammation and suicide.

"It breaks the heart literally as well as figuratively," opinion columnist Nicholas Kristof writes for the New York Times as part of a series titled "How America Heals," aimed at finding ways to fix this problem. 

The physical and societal harms that come from loneliness are so bad that America's top public-health official, Surgeon General Vivek H. Murthy, issued a rare advisory with a framework to rebuild social connection and community in the U.S. in May.

Graph from surgeon general's advisory,
"Our Epidemic of Loneliness and Isolation" 

Loneliness is as deadly as smoking 15 cigarettes a day and more lethal than consuming six alcoholic drinks a day, according to Murthy. It is also more dangerous than physical inactivity, obesity and air pollution, he says. 

Research also shows America has been growing lonelier. A majority of adults (58 %) report experiencing loneliness, according to a Morning Consult survey commissioned by The Cigna Group, a health-insurance company.

An Aging In Place study found that Kentucky tied with Arkansas for loneliness at 18th among states, with scores of 5.16 on a 10-point scale. Maine was first at 7.6, and Utah was best off, at 0.72. The study noted that more than half of Utahns identify as Mormons, which "may contribute to the low numbers of divorce and single-person households."

The study looked at a range of factors, including the percentage of single-person households, number of people widowed, number of people divorced, searches for dating apps per 10,000 people and searches for friendship apps per 10,000 people, to determine which states struggle the most with loneliness.

Kristof writes that there are ways to build connections that bind us together and writes about some of those approaches taken by the United Kingdom, which he says "is the pioneer of these efforts, having established the post of minister for loneliness in 2018. Britain oversees public-private partnerships that collectively knit millions of people together with programs like nature walks, songwriting workshops and community litter pickups." And, he adds, other countries have followed suit.  

"That’s because if the researchers are correct, social isolation probably kills far more people in the West each year than terrorists and murderers, and it costs the public enormous sums in unnecessary health costs," Kristof writes. "Countermeasures can make a huge difference: One review of 148 studies concluded that social connections increase the odds of an individual’s surviving over roughly the next seven years by about 50 percent." 

Kristof says he writes from troubles he's witnessed: "More than one-quarter of the children who rode the No. 6 school bus with me in Yamhill, Oregon, have died from drugs, alcohol, suicide and other so-called deaths of despair. These pathologies are linked to social isolation." 

However, he notes that despite the economic devastation of during the Great Depression, mortality then didn’t rise but actually fell." He attributes this to the "strength of community institutions -- like churches, men's and women's clubs and extended families -- that existed during that time." 

Ninety-odd years later, "Those community institutions have frayed," he writes. "Now we’re on our own, and perhaps that’s why so many are also dying alone." 

Kristof says he recognizes that it's not easy to rebuild such networks, but says we have to try, and offers some suggestions. 

"The steps to tackle loneliness aren’t grand, high-tech or expensive. In fact, one of the strategies is simply to get people back into old-fashioned patterns like eating meals together, holding parties and volunteering to help one another out," he writes.

He notes that the U.K. ministry has spent "some $100 million" to address loneliness since 2018, often to support local initiatives. One of those is a local, weekly family-style luncheon for women and children, many of them immigrants who struggle with English. 

He says decline of religious attendance has left a gap in community building, but "church buildings can still provide a physical architecture for connections, even if the faith architecture has eroded." 

He also points to several community-wide events to combat loneliness, including an event held for King Charles's coronation in May called “The Big Help-Out” to encourage people to come together and volunteer, and 6 million people, almost a tenth of the nation's population, did so. "The response was so impressive that this may become an annual event," he writes.

Why did loneliness increase? Kristof says the trends toward larger homes and longer working hours has left less time to share meals, and he notes studies that show social media has led to people being more lonely. Pets and talking robots have been suggested as solutions, he writes, but "It seems that there’s something to be said for friends who are living, breathing human beings." 

In his advisory, Surgeon General Murthy offered a strategy to address loneliness that begins with building up infrastructure that enables social connection: physical infrastructure such as parks and libraries, and social infrastructure to weave together volunteers or enthusiasts with similar interests.

Britain can serve as a model for this, Kristof writes. He points to a town that has has trained more than 1,100 volunteers to be “community connectors" who engage people and encourage them to join events or participate in programs. He also points to the idea of a "chatty bench" adopted in the U.K., Sweden and Australia, a bench with a sign encouraging strangers to talk to each other. 

"Solutions to loneliness are like that — little nudges to encourage us to mingle the way we evolved to," Kristof writes, suggesting that government do more: "President Biden, how about creating a senior government post analogous to a minister for loneliness? And mayors and governors, how about some chatty benches in American parks, along with volunteers deputized to bring us out for nature walks and sing-alongs?"

Some experts say Alzheimer's drug is brilliant first step to a cure; others say it's a waste of money that shortchanges the poor

Photo from Eisai Co., maker of the drug

By Arthur Allen
KFF Health News

The first drug purporting to slow the advance of Alzheimer’s disease is likely to cost the U.S. health care system billions annually even as it remains out of reach for many of the lower-income seniors most likely to suffer from dementia.

Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review (ICER), a nonprofit that evaluats the cost-effectiveness of health care.

The Food and Drug Administration gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it. The drug is still in a clinical trial being conducted at many unversities, including the University of Kentucky.

Patients with early Alzheimer’s disease who took lecanemab in the trial showed mental decline five months later than other subjects over an 18-month period, but many suffered brain swelling and bleeding. Although those side effects usually resolved without obvious harm, they apparently caused three deaths.

The great expense of the drug and its treatment raises questions about how it will be paid for, and who will benefit.

“In the history of science, it’s a significant achievement to slightly slow down progression of dementia,” said John Mafi, a researcher and associate professor of medicine at UCLA. “But the actual practical benefits to patients are very marginal, and there is a real risk and a real cost.”

To qualify for Leqembi, patients must undergo a PET scan that looks for amyloid plaques, the protein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqembi in the major clinical test of the drug developed brain hemorrhaging or swelling, a risk that requires those taking the drug to undergo frequent medical checkups and brain scans called MRIs.

In anticipation of additional costs from the Leqembi drug class, the Centers for Medicare and Medicaid Services (CMS) in 2021 increased monthly premiums for Medicare patients by 15%, and premiums may rise again in 2024 after a slight decline this year.

Such increases can be a significant burden for many of the 62 million Medicare subscribers who live on fixed incomes. “Real people will be affected,” Mafi said. He contributed to a study that estimated lecanemab and related care would cost Medicare $2 billion to $5 billion a year, making it one of the most expensive taxpayer-funded treatments.

In its analysis, ICER suggested that Leqembi could be cost-effective at an annual price of $8,900 to $21,500. In an interview, David Rind, ICER’s chief medical officer, said $10,000 to $15,000 a year would be reasonable. “Above that range doesn’t seem like a good place,” he said.

Whatever its price, patients may be delayed getting access to Leqembi because of the relative shortage of specialists capable of managing the drug, which will require genetic and neuropsychological testing as well as the PET scan to confirm a patient’s eligibility. A similar drug, Eli Lilly’s donanemab, is likely to win FDA approval this year.

Already there are long waits for the testing needed to assess dementia, Mafi said, noting that one of his patients with mild cognitive impairment had to wait eight months for an evaluation.

Such testing is not readily available because of the lack of effective treatment for Alzheimer’s, which has helped to make geriatrics a relatively unappealing specialty. The United States has about a third as many dementia specialists per capita as Germany, and about half as many as Italy.

“Time is of the essence” for the neuropsychological testing, Mafi said, because once a patient’s cognitive ability declines below a certain threshold, they become ineligible for treatment with the drug, which was tested only in patients in the earliest stages of the disease.

Mafi’s study estimates that patients without supplemental Medicare coverage will have to pay about $6,600 out of pocket for each year of treatment. That could put it out of reach for many of the one in seven  “dual eligible” Medicare beneficiaries whose income is low enough to simultaneously qualify them for Medicaid. The two programs are responsible for about 20% of physician bills for drug infusions, but they don’t always cover the full amount.

Some practitioners, such as cancer centers, cover their Medicaid losses by charging privately insured patients more. But since almost all lecanemab patients are likely to be on government insurance, that “cross-subsidization” is less of an option, said Soeren Mattke, director of the Center for Improving Chronic Illness Care at the University of Southern California.

This poses a serious health-equity issue because “dual eligibles are low-income patients with limited opportunities and education, and at higher risk of chronic illnesses including dementia,” Mattke said in an interview. Yet many doctors may not be willing to treat them, he said. “The idea of denying access to this group is just appalling.”

Eisai spokesperson Libby Holman said the company is reaching out to specialists and primary-care physicians to make them aware of the drug, and that reimbursement options were improving. Eisai will provide the drug at no cost to patients in financial need, she said, and its “patient navigators” can help lock down insurance coverage.

“A lot of clinicians are excited about the drug, and patients are hearing about it,” said David Moss, chief financial officer of INmune Bio, a company that has another Alzheimer’s drug in development. “It’s a money center for infusion centers and MRI operators. It provides reasons for patients to come into the office, which is a billing thing.”

Outstanding doubts about Leqembi and related drugs have given urgency to efforts to monitor patient experiences. CMS is requiring Leqembi patients to be entered into a registry that tracks their outcomes. The agency has established a registry, but the Alzheimer’s Association, the leading advocacy group for dementia patients, is funding its own database to track those being treated, offering physician practices $2,500 to join it and up to $300 per patient visit.

In a letter to CMS on July 27, a group of policy experts said CMS should ensure that any and all Leqembi registries create and share data detailed enough for researchers and FDA safety teams to obtain a clear picture of the drug’s real-world profile.

The anti-amyloid drugs like lecanemab have created a polarized environment in medicine between those who think the drugs are a dangerous waste of money and those who believe they are a brilliant first step to a cure, said ICER’s Rind, who thinks lecanemab has modest benefits.

“People are as dug in on this as almost anything I’ve ever seen in medicine,” he said. “I don’t think it’s healthy.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling, and journalism. Learn more about KFF.

May is Better Hearing and Speech Month; state says 700,000 Kentuckians have some degree of hearing loss; here are signs

From a Commonwealth of Kentucky press release

With approximately 15% of American adults reporting difficulty hearing, state officials are encouraging people to learn the signs of hearing loss—and to seek care during Better Hearing and Speech Month in May.

“We know that more than 700,000 Kentuckians of all ages are experiencing some degree of hearing loss. We encourage people to have a professional check their hearing and also to protect their hearing from loud noises,” Gov. Andy Beshear said.

Signs of hearing loss in adults include the following:

• Difficulty following conversations
• Difficulty hearing in noisy environments
• Hearing ringing, roaring or beeping in one or both ears
• Failure to respond to spoken words
• Muffled hearing
• Constant frustration hearing speech and other sounds
• Avoidance of conversation

“Our hearing is key to so many aspects of our lives, but it’s something that many people undervalue until they are having severe hearing difficulties,” said Virginia Moore, executive director of the the Kentucky Commission on the Deaf and Hard of Hearing. “Even then, some people wait years to receive treatment, if ever. This is despite the fact that audiologists can help people in many different ways.

“Hearing loss is much more than a simple nuisance. Left unaddressed, it can affect us in a variety of ways, including increased risk for physical danger such as falling or missing warning signals like a fire alarm; mental health problems, including social isolation and depression; and cognitive decline, including earlier onset of dementia. Our personal relationships, career success and health-care costs can be affected as well.”

As a first step, Moore urged anyone concerned about their own hearing or that of a loved one to seek an evaluation from a certified audiologist. Private insurance, Medicaid and Medicare generally cover such evaluations. People can take this step even if they think they cannot afford hearing aids or other hearing services. Audiologists can advise people on ways to make hearing aids more affordable. In addition, various organizations offer financial assistance.

Aside from hearing aids, audiologists can identify other ways to improve a person’s listening and communication skills. They also can help families support loved ones affected by hearing loss.

If you are experiencing any of the signs above or if you think you have hearing loss, see your doctor or a licensed audiologist to assess the degree of your hearing loss, treat it and develop a plan to prevent further loss. There are several assistive technologies available through KCDHH’s Telecommunications Access Program, which can help you stay connected to emergency information and health-care providers. For more information, visit the KCDHH website.

This article was written and published several days before the May 6 death of KCDHH Executive Diretcor Virginia Moore.

Alzheimer's drug under study at University of Ky. and other sites has shown it is 'the first crack in the iceberg,' UK researcher says

By Al Cross
Kentucky Health News

A partially approved drug for Alzheimer's disease that slowed memory decline and loss of functional ability in a study is “the first crack in the iceberg for us,” says a Kentucky researcher involved in the study.

Dr. Greg Jicha of the University of Kentucky, one of about 100 study sites, told reporters last week that he expects more progress.  “Hopefully the day will come when Alzheimer’s will be no more,” he said. “This is fundamentally the start of that process.”

Dr. Greg Jicha (UK photo by Mark Cornelison)

Jicha said in a UK news release, “For the first time, having a medication that we understand can fundamentally change the disease process is the first step and it’s a giant step,” said Jicha. “It tells us and teaches us all that we are on the path to the eventual cure for Alzheimer’s that we’re all looking for.”

On Jan. 6, the Food and Drug Administration approved the drug lecanemab for Alzheimer's patients who have mild cognitive impairment or are in the mild dementia stage of the disease.

That's the population being studied in clinical trials, which have found that the drug slowed memory decline by 27 percent and the loss of functional ability by 40%. While the drug does not cure the disease, it "could mean two to two and a half more years of functional life," Jicha told reporters. "That is meaningful; an extension of quality of life."

Jicha said several medicines are available for Alzheimer's, but they treat only symptoms of the disease, and the last one was approved 20 years ago.

The drug removes from the brain the amyloid proteins that are believed to cause Alzheimer's. The plaques can show up in people with very mild memory problems, Jicha said; one of three Americans over age 65 have them.

The study continues, to see if the drug can be used to remove plaques earlier and delay onset of teh disease, Jicha said. "Hopefully we’ll have that answer in the next five to seven years."

UK is still recriting participants for the study. It uses a simple blood test for the protein or likelihood of buildup. If there is a high likelihood, imaging of the brain can see the plaques may be performed. If they are found, the person gets into the study. But only half of them get the drug; the others get a placebo, which is standard for clinical trials. They could get the drug if the study is successful, Jicha said.

To learn more about the study, call 1-800-AHEAD-70 or to find a trial site location enrolling near you, visit www.AHEADstudy.org.

The next step in the study could lead to approval for payments by Medicare and private insurance. The drug's manufacturer, the Japanese firm Esai, says it would like to charge $26,000 a year for the treatment, which requires an infusion every two weeks. Jicha said the Institute for Clinical and Economic Review, a nonprofit organization that does clinical and cost-effectiveness analyses of treatments, has suggested an annual price of $21,000.

Study identifies six factors linked with lower risk of dementia; expert says 'It may never be too late to improve your brain health'

A new study of more than 29,000 older adults in China has identified six habits "that are linked with a lower risk of dementia and a slower rate of memory decline," Annabelle Timsit of The Washington Post reports. "Eating a balanced diet, exercising the mind and body regularly, having regular contact with others, and not drinking or smoking . . . were associated with better cognitive outcomes in older adults." Specifially, the six modifiable lifestyle factors were:

• Exercise: At least 150 minutes of moderate activity or 75 minutes of vigorous activity per week.
• Diet: Appropriate daily amounts of at least seven of 12 food items (fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts and tea).
• Alcohol: Never drank, or drank occasionally.
• Smoking: Never smoked, or a former smoker.
• Cognitive activity: Exercising the brain at least twice a week (examples: reading and playing cards).
• Social contact: Engaging with others at least twice a week (examples: attending community meetings or visiting with friends or relatives).

The study was conducted from 2009 to 2019 and published in the British Medical Journal. "While researchers have long known that there is a link between dementia and factors such as social isolation and obesity, the size and scope of the new study adds substantial evidence to a global body of research that suggests a healthy lifestyle may help brains age better," Timsit writes. "It also suggests that the effects of a healthy lifestyle are beneficial even for people who are genetically more susceptible to memory decline — a 'very hope-giving' finding for the millions of individuals around the world who carry the APOEε4 gene, a major risk factor for Alzheimer’s disease, said Eef Hogervorst, chair of biological psychology at Loughborough University, who was not involved in the study."

Timsit notes, "Memory naturally declines gradually as people age. Some older people may develop dementia, an umbrella term that can include Alzheimer’s, and generally describes a deterioration in cognitive function that goes beyond the normal effects of aging. But for many, 'memory loss can merely be senescent forgetfulness,' write the authors of the BMJ study — like forgetting the name of that TV program you used to love, or that pesky fact you wanted to look up.

"Memory loss is no less damaging for being gradual, and age-related memory decline can in some cases be an early symptom of dementia. But the good news, the researchers say, is that it 'can be reversed or become stable rather than progress to a pathological state.' . . . At the start of the study, researchers conducted baseline memory tests as well as testing for the APOE gene. They also surveyed participants about their daily habits. Participants were sorted into one of three groups — favorable, average and unfavorable — based on their lifestyle. Over the course of the study, the researchers found that people in the favorable group (four to six healthy factors) and average group (two to three) had a slower rate of memory decline over time than people with unfavorable lifestyles (zero to one healthy factor). People living favorable lifestyles that included at least four healthy habits were also less likely to progress to mild cognitive impairment and dementia. . . . Notably, this held true even for people who carried the APOE gene associated with a higher risk of Alzheimer’s disease.

"Some of the study’s findings differ from the results of other large studies conducted in the United States and in Europe, says Hogervorst. For instance, the BMJ study found that the lifestyle factor with the greatest effect on reducing memory decline was a balanced diet. Other studies have suggested that diet matters less in old age than physical and mental exercise, says Hogervorst. Still, its results align with the broad scientific consensus that there is a link between how we live and our cognitive function as we age — and perhaps more important, suggest that it may never be too late to improve your brain health."

UK's Sanders-Brown center is among first sites to test a promising new drug to slow Alzheimer's, and is looking for study participants

Mike Brown of Morehead is one of the participants in the current Alzheimer's disease study at UK.

Story and photos by Hillary Smith

University of Kentucky

The University of Kentucky is a site for the first-ever clinical trial to test an investigational antibody for people who have no cognitive symptoms of Alzheimer’s disease but may have “preclinical” AD. 

In September, drug maker Eisai announced positive results from a third-phase study evaluating lecanemab, an investigational antibody for treatment of mild cognitive impairment due to AD and mild AD dementia (collectively known as early AD) with confirmed presence of amyloids, abnormal proteins that form plaques that disrupt brain function.

Just last week, at the International Clinical Trials on Alzheimer’s Disease meeting in San Francisco, Eisai presented results that demonstrate an almost complete removal of amyloid plaques from the brain of those with early Alzheimer’s, an effect that was associated with a 27 percent slowing of mental decline. The study also showed that lecanemab leads to a 31% lower risk of the next stage of disease.

The next study will test whether those effects in the clinically symptomatic population are similar in people whose lab tests indicate they have amyloids in the brain, or preclinical AD. That excites Dr. Greg Jicha, director of clinical trials at UK’s Sanders-Brown Center on Aging, one of 75 sites for the study.

Dr. Greg Jicha (UK photo by Mark Cornelison)

“When doctors, researchers and scientists from across the globe, including myself, saw the data for the first time, the excitement was contagious,” Jicha said. “We all realized that for the first time ever in the history of drug development for Alzheimer’s disease, we have broken down the barriers that will one day move us to a cure. Our excitement was propelled by the knowledge that we can succeed eventually in eradicating Alzheimer’s and that even better medicines are on their way.”

Jicha says UK has been working with patients to provide access to lecanemab for over a decade, and has successfully removed amyloids from dozens of brains.

“We think we are taking this one over the finish line,” Jicha said. “I see hundreds of patients each year that are shocked that they have received the death sentence of Alzheimer’s disease. As of now, there are no cures for this fatal disease that is the sixth-leading cause of death in the U.S. We need to know if we can screen and stop this disease before it destroys the lives of those we love or takes our own lives.”

Looking for a path forward as they age as well as a way to help others are big reasons why many get involved in research at UK.

“I’m retired and just want to help people anyway I can,” said Mike Brown, who participates in research at Sanders-Brown alongside his friend Jim Jackson. The duo travels from Morehead every two weeks along with their wivefor their visit.

“We make a fun little day out of it,” said Sharon Jackson, Jim's wife. “We always try to eat somewhere different.”

Jim Jackson is a retired pediatrician. With his medical background, “I knew I wanted to be part of it,” he said “This is the way science works.”

Dr. Jim Jackson of Morehead is another participant in the study.

Jackson and Brown have been participating for several months in the Eisai study, starting the medication in May 2020. That part of the study, as in most clinical trials, had a placebo group. They are still blinded for that part of the study, so they do not know yet if they had been receiving lecanemab. “You just have to be optimistic and know you are helping others,” Jackson said.

Both of them qualified for, and are now in, the open-label extension of the study, which began in November 2021. This allows them to confidently get lecanemab for several months. Hearing the recent news about the early results for this drug provided an extra dose of enthusiasm for the couples.

“I am just so thankful Jim is part of this, because if it prolongs his memory any amount, it is very much worth it,” said Sharon. “Dr. Jicha and the team here at UK are so great and informative. We always have a comfortable experience here. We are so blessed to have a place like this right here in Kentucky. More people should consider getting involved and using the resources offered at Sanders-Brown.”

Jicha says they are proud that Sanders-Brown, founded by Col. Harland Sanders and John Y. Brown Jr. of Kentucky Fried Chicken fame, is at the forefront of these discoveries.

“You might think such possibilities are limited to the rich and famous; you might think such possibilities are only available in Washington, D.C., New York, Chicago or L.A.," Jicha said. "But you should know that the UK Sanders-Brown Center on Aging is at the forefront of these discoveries, bringing them here to Kentucky long before they may be available to others in the United States.”

The study is the first AD trial to recruit people as young as 55 who are at risk of developing symptoms of AD as they get older.  

Researchers want to make sure the opportunity is available to a wide range of the population. “We especially want to reach out to those that have experienced health care discrimination,” said Jicha. “If you live in a rural area or are a person of color, you should know that we value you as much as we do everyone else. An effort this important needs to be available to everyone.”

Jicha says researchers believe the future of healthy brain aging is within their grasp. “For many, it may be too late for lecanemab to help, but we are not giving up on them either. We have over a dozen active experimental medicine trials for anyone at risk, currently experiencing memory loss, or even those with more advanced stages of Alzheimer’s disease or other forms of dementia. If you are looking to do more for yourself or a loved one, please reach out to us now.”

The study is funded by the National Institutes of Health and Eisai, a U.S. subsidiary of the Tokyo -based firm Eisai Co. Ltd. It seeks 1,165 participants from North America and has more than 100 study locations, including Japan, Singapore, Australia and Europe.

To learn more about the study, call 1-800-AHEAD-70 or to find a trial site location enrolling near you, visit www.AHEADstudy.org. Learn more about enrolling in aging studies at Sanders-Brown here.

Here are some simple tips to help you stay healthier as you age: Keep your mind and body active, keep exploring . . .

Photo illustration from iStock/Getty Images Plus

By Kelly Parsons
University of Kentucky

What goes up and never comes down? Your age!

September is Healthy Aging Month, an observance designed to celebrate the positive aspects of growing older.

Keeping in touch with your neighbors, community and world around lowers the risk of dementia. Staying social and engaged improves your brain health. There are many ways you can engage in activities, including programs at your local senior center, the Silver Sneakers program and volunteering.

Aging can be filled with opportunities for self-growth and exploration of the world around us. Healthy Aging Month reminds us that engaging in social and productive activities has been shown to lower blood pressure, improve mood and live longer.

We experience significant changes as we age: retirement, moving to a new area, changes in health status or mobility can all impact our ability to stay connected. These events can result in a loss of connection which can cause you to become isolated and/or feel lonely.

Here are five ways to celebrate Healthy Aging Month and promote healthy aging in your life:

Get active: The body is the vessel of the soul. That is why taking care of it is one of the most important elements of healthy aging. When it comes to exercising, keeping a routine is key. Finding a workout partner, joining a dance class, or getting outside and enjoying some fresh air are all great ways to stay active and have fun while doing it! Sooner than you know it you’ll be looking forward to your next workout. (Research on chimpanzees suggests it's physical inactivity that makes us frail, National Geographic reports.)

Keep your mind sharp: Keeping your mind active will allow you to stay as mentally sharp as you’ve ever been. Learning new recipes, playing word or number games, learning to play a musical instrument or joining a book club are fun ways to exercise your mind.

Keep exploring: Keep your life exciting by visiting new places, volunteering and traveling. Local libraries, senior centers and universities have programs for all interests. For example, the University of Kentucky has the Office of Lifelong Learning (OLLI) program, which offers educational and enrichment opportunities for people age 50 and older.

Stay on top of your health status: Over time, it can be easy to lose track of routine doctors' visits, but as we age it is more important than ever to stay on top of our health. Make this September the month to re-up on annual shots and checkups. Remember, Medicare will pay for your annual wellness visit. Keeping up with your health conditions can help prevent serious health issues.

Stay motivated: Sometimes, getting older can take a toll on your mental and emotional health. Know that you are not alone. Finding a community can help to keep you motivated.

Whether you're in your 40s or in your 80s, it's never too soon (or too late) to begin your journey of healthy aging. Celebrate Healthy Aging Month by making the choice to take care of yourself for yourself.

Strawberries could reduce chance of Alzheimer's, study finds

Photo illustration from berries.com

Strawberries could help protect your brain from Alzheimer’s disease, according to a new study from researchers at Rush University in Chicago.

They found that a compound in strawberries, pelargonidin may be associated with less neurofibrillary tau tangles in the brain. "Tau tangles are one of the hallmarks of Alzheimer’s disease, which is caused by abnormal changes with tau proteins that accumulate in the brain," a Rush news release said. The study was published in the Journal of Alzheimer’s Disease.

“We suspect the anti-inflammatory properties of pelargonidin may decrease overall neuroinflammation,” said Dr. Julie Schneider, author of the study. Inflammation in the brain has been linked to tau tangles and other Alzheimer's pathologies.

"Among berries, strawberries are the most abundant source of pelargonidin," the release says. 

Researchers got their data from a long-term study in more than 40 retirement communities and senior public housing units across northern Illinois that began in 1997. It had 575 brain autopsies and dietary information developed from a questionnaire for up to nearly 20 years prior to death, the release said. "Each person received annual, standardized testing for cognitive ability in five areas — episodic memory, working memory, semantic memory, visuospatial ability and perceptual speed."

Puja Agarwal, an author of the study and a nutritional epidemiologist and assistant professor of internal medicine at Rush, cautions, “The study was an observational study and does not prove a direct causal relationship. Further research is needed to understand the role of nutrition in Alzheimer’s disease, but this study gives us hope on how specific dietary components such as berry may help brain health.”

Your brain needs proper diet and exercise, too; it's something to remember in June, Brain and Alzheimer's Awareness Month

Photo illustration by Daniel de la Hoz, iStock/Getty Images Plus

By Dr. Greg Jicha

University of Kentucky

Healthy brain aging is a concern for all of us. June is recognized as Brain and Alzheimer’s Awareness Month. It’s normal to struggle with small things such as recalling names — and we all experience some slowing of the thought processes with advanced age — but everyone hopes to avoid serious cognitive impairment.

Some cognitive difficulties, such as Alzheimer’s disease, have underlying pathological causes that we are still working to understand. However, we know that brains can also lose function simply through poor physical, mental and social health. Many of the causes of cognitive decline are preventable.

Just as we create exercise regimens for the body, we should create a routine for brain health.

As a general rule, what is good for heart health is good for brain health. Getting regular exercise, eating well and maintaining a healthy weight all promote a healthy brain.

People of all ages, particularly seniors, benefit from leaving the house, engaging in learning activities and having an active social life. It is important to commit to a schedule that encourages all of these healthy brain aging activities.

Summer, in many ways, is an ideal time to set up a routine for healthy brain aging. Warm weather offers the opportunity to get physical exercise through gardening and walking. Many community organizations offer summer classes in dance, photography, art, music and other hobbies.

Summer also is the season of farmers markets and fresh produce. Fresh fruits and vegetables contain compounds called plant polyphenols. These compounds, which help plants fight off disease, have been observed in animal models to extend lifespan by promoting general cellular health. Blackberries, raspberries, blueberries and red wine are all good sources of polyphenols.

Anyone interested in healthy brain aging also can practice “neurobics.” These “aerobics for the brain” are activities that can be thrown into the daily schedule on a whim. Examples include taking a different route home, shopping at a different grocery store, or purposely driving or walking through an unfamiliar neighborhood. These simple activities activate the problem-solving areas of the brain as the person navigates unfamiliar territory.

Social engagement is key for seniors, who might find their social circle shrinking as friends and relatives move, develop serious illness or die.

Senior centers offer great resources for social activities. Something as simple as gathering with others for a regular card game can help keep the cognitive functions of the brain sharp. For some seniors, moving into a senior-living community is ideal, because it provides increased opportunities for structured activities and socialization with peers.

Through socialization, hobbies, lifelong learning, healthy eating, physical activity and challenging their brain on a daily basis, most people have the capacity to achieve healthy brain aging.

I have seen some patients reverse mild cognitive impairment simply by adopting a healthier lifestyle — so it’s never too late to encourage healthy brain aging.

Greg Jicha, M.D., Ph.D, is assistant professor of neurology in the University of Kentucky College of Medicine and UK's Sanders-Brown Center on Aging.

UK begins world's first clinical trial to slow a form of dementia recently discovered by a team co-chaired by a UK faculty member

Drs. Pete Nelson and Gregory Jicha discuss their research.
(University of Kentucky photo by Mark Cornelison)

By Hilary Smith
University of Kentucky

The motivation driving the work of Pete Nelson, M.D., Ph.D., is personal. His grandmother, Sylvia Becker, died with Alzheimer's disease, and he says his mother then grew terrified of developing the disease.

"It gives me purpose in life to attack that," Nelson said. As an experimental neuropathologist at the University of Kentucky's Sanders-Brown Center on Aging, he is guided by that motivation. "It is most every researcher's dream to help identify and classify a disease, and then to go on and help beat it."

Nelson, who is the R.C. Durr Foundation Chair in Alzheimer's Disease at UK, accomplished the first part of that dream back in 2019, when a group of international researchers he co-chaired discovered a new form of dementia named limbic-predominant age-related TDP-43 encephalopathy, more commonly known as LATE.

Symptoms of LATE mimic Alzheimer's disease by causing memory loss and problems with thinking and reasoning in old age. But researchers found the LATE-affected brain looks very different from the Alzheimer's brain.

Now, a couple of years after this discovery, Nelson is working towards the second part of the dream, with the world's first clinical trial for LATE officially underway by his colleagues at UK.

Greg Jicha, M.D., Ph.D., is director of clinical trials at Sanders-Brown and leader of one of the best clinical dementia teams in the country.

"Our collaboration with the basic scientists as always is key. We couldn't have done this without Dr. Nelson's discoveries," said Jicha. "For the first time ever, we are looking at folks participating in our research who we think are heading down the path of Alzheimer's, but now by checking simple blood tests and sometimes spinal fluid, we may be able to say while it looks like Alzheimer's symptomatically … it is actually LATE."

Research Subject No. 1: Ned and Lu-Ann Farrar were married in 1984. They've done many things in their nearly 40 years as a team, including raising two children while both pursuing meaningful careers. Most recently, their teamwork has been focused on Ned's health.

In 2018, after retiring from teaching orchestra in Fayette County Public Schools, Ned was diagnosed with Alzheimer's disease. He took part in an earlier study at Sanders-Brown and was in the evaluation process for another when they refined his diagnosis to LATE, which Nelson and his team had just discovered.

Lu-Ann said, "I asked Dr. Jicha if this was good news or bad news and he told us that anytime someone tells you your brain is not full of beta-amyloid, that is a good thing."

Jicha then told the Farrars that there were plans in the works for a trial regarding LATE and that he would keep them updated. About three months ago, they got the call.

"Ned is research subject number one, which is pretty exciting," said Lu-Ann.

The Farrars have called Lexington home for decades now, and they say it is truly a blessing that the place making these groundbreaking discoveries and then advancing them towards a potential treatment is right in their backyard. Sanders-Brown not only helps evaluate and treat Ned, but they also give LuAnn guidance by providing honest, knowledgeable and compassionate answers.

"I'm not a researcher, but I am pretty sure you can't fix something if you don't know what it is," said LuAnn. "Research and clinical trials may seem like the long road, but it is so foundational to real, effective treatments. Their commitment to curing these diseases is profound, evidenced by the work they do every day, including thoughtful consideration of Ned and his diagnosis and his treatment options."

The disease: LATE is a disease estimated to affect 40% of people over the age of 85. Jicha says the medication in this research study may slow or perhaps even stop LATE in its tracks as a disease-modifying therapy.

The discovery of LATE, which has led to this trial, is crucial to their overall fight to help people with their memory.

"The issues of end-stage dementia, memory loss and mild cognitive impairment are largely incurable, and it is not just all about Alzheimer's disease," said Jicha, who holds the Robert T. & Nyle Y. McCowan Chair in Alzheimer's at UK. "It is about many different diseases and understanding that complexity helps us to move forward with medicines that don't just put a band-aid on memory, but instead actually begin to target the root of the problem."

As with many diseases related to aging, people often ask, "Why did I come down with this? Why me?" In most cases, Jicha says, it is a combination of things. There can be genetic factors that predispose the individual to developing dementia, so some diseases can be seen running in families.

There can also be environmental factors. Identifying those risk factors can help doctors understand what is happening in the brain at the cellular level and maybe find an existing medication that influences the disease course — which is exactly what is happening with the research on LATE.

"The genetic discoveries by Dr. Nelson in his lab have shown us that there is a key element of potassium channel that allows nerve cells to either be healthy or diseased," said Jicha.

The treatment: Based on that knowledge, they identified a drug already used around the world, except in the United States, where it is not yet approved. The medicine has been used for quite some time for heart conditions and researchers at UK believe it could slow or even stop LATE dementia.

"The folks that have been taking this medicine have reduced cardiovascular and cerebrovascular disease," said Jicha. "They are healthier, they have reduced rate of death and longer lifespans. For us, what's really amazing is that modulating the potassium channel with this medicine doesn't just make the heart healthier, but may make the brain healthier, too."

It has been a complex process to bring a drug not yet approved in the United States into the country. Jicha and Nelson are both gratified to say that the medication is finally at UK for their participants who appear to be at high risk for LATE.

Advances in science and treatments are not possible without research volunteers like Ned Farrar. Through the years, researchers at Sanders-Brown have been blessed with thousands of such volunteers, and hope to continue bringing in new participants who are interested in knowing if they are at risk.

"This is the best place to do clinical trials in the country," said Nelson, who is thrilled to know this stage of his LATE discovery is in the very capable hands of Jicha's team at UK. "Some research volunteers are going to be at risk for Alzheimer's disease and they have options, there are also other people who are going to be at risk for other diseases, and they have very few resources in the whole world, but here they have an option. That is extraordinary."

For those who are believed to be at risk for LATE, UK is now the only place in the world where providers can do something about it thanks to this trial. Participants in the 2-year study are required to do a clinic visit about every three months. During those visits, clinical trial participants go through memory and thinking tests and receive their study drug dose. As with all studies, there is a placebo.

Volunteers sought: While the Sanders-Brown volunteer cohort is among the most robust in the country, more research volunteers are needed.

"We need to get more people in line, especially people beyond age 75," said Jicha. "We are looking for the person who might have scratched their head every now and then and said, 'Am I developing a memory problem?' People even with mild memory problems that remain engaged in their daily activities; people who use their GPS a little bit more or are having to write everything on their calendar. These are the kind of people we want to get to because that is where we can make the most impact."

Both Jicha and Nelson note how crucial it is to be proactive once you notice changes, even if it seems very minimal.

"Let us help figure out why, because once we know why, it doesn't really matter what the cause is … We have things to offer you that can help," said Jicha. "The earliest we can get to folks to stop the process the more of the brain we can save and that is just critically important."

Nelson believes even those at risk for LATE who receive the placebo during the trial will be better off for participating because of the care of Dr. Jicha, who Nelson jokingly refers to as "Dr. Vitamin J."

"He has an eight-month waitlist outside of clinical trials – there is a reason for that," Nelson said. "He is one of the best neurologists in the world. Everybody in this trial – whether they get a placebo or the drug – they get Dr. Jicha."

This new clinical trial for LATE is a hallmark of the collaboration that goes on at UK, how Sanders-Brown is a worldwide leader in Alzheimer's and dementia research, and how the researchers share a common link as teammates.

"We are all fighting these horrible diseases, and they are a great enemy to have because they are so bad," said Nelson. "For me, it is a spiritual thing. This passion is shared by others here at this center. We really care. This is our common ambition. If we could just start beating these diseases one after another … what a life well-spent that would be."

That goal is also shared by those volunteering to participate in research.

"How awesome would it be if a patient at Sanders-Brown would be the first person to be rid of dementia?" Lu-Ann Farrar asked. "That is almost beyond belief. Ned and I are very clear about clinical trials – he may not get the medicine, but we know that someone will."

For more information on how to get involved with research at Sanders-Brown, call (859) 323-5550 or fill out the research interest form.