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Wk1 Discussions: Initial Reactions to Older People with Radical Changes

Wk1 Discussions: Initial Reactions to Older People with Radical Changes

Wk1 Discussions: Initial Reactions to Older People with Radical Changes

What initial steps would you think about taking if an older person close to you radically changed his/her behavior over a short period of time ?

Minimum 300 words

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Textbook

Innes, A. (2009). Dementia Studies: A Social Science Perspective. Thousand Oaks, CA: Sage. (paperback version)

ISBN 978-1-4129-2164-0

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    wk1_nyt_purgingcell.pdf

    Reprints This copy is for your personal, noncommercial use only. You can order presentation-ready copies for distribution to your colleagues, clients or customers here or use the “Reprints” tool that appears next to any article. Visit www.nytreprints.com for samples and additional information. Order a reprint of this article now.

     

    November 2, 2011

    Purging Cells in Mice Is Found to Combat Aging Ills By NICHOLAS WADE In a potentially fundamental advance, researchers have opened up a novel approach to combating the effects of aging with the discovery that a special category of cells, known as senescent cells, are bad actors that promote the aging of the tissues. Cleansing the body of the cells, they hope, could postpone many of the diseases of aging.

    The findings raise the prospect that any therapy that rids the body of senescent cells would protect it from the ravages of aging. But many more tests will be needed before scientists know if drugs can be developed to help people live longer.

    Senescent cells accumulate in aging tissues, like arthritic knees, cataracts and the plaque that may line elderly arteries. The cells secrete agents that stimulate the immune system and cause low-level inflammation. Until now, there has been no way to tell if the presence of the cells is good, bad or indifferent.

    The answer turns out to be that the cells hasten aging in the tissues in which they accumulate. In a delicate feat of genetic engineering, a research team led by Darren J. Baker and Jan M. van Deursen at the Mayo Clinic in Rochester, Minn., has generated a strain of mouse in which all the senescent cells can be purged by giving the mice a drug that forces the cells to self-destruct.

    Rid of the senescent cells, the Mayo Clinic researchers reported online Wednesday in the journal Nature, the mice’s tissues showed a major improvement in the usual burden of age-related disorders. They did not develop cataracts, avoided the usual wasting of muscle with age, and could exercise

     

     

    much longer on a mouse treadmill. They retained the fat layers in the skin that usually thin out with age and, in people, cause wrinkling.

    “I am very excited by the results,” said Dr. Norman E. Sharpless, an expert on aging at the University of North Carolina. “It suggests therapies that might work in real patients,” he said.

    Dr. van Deursen’s work is the first to show that removing senescent cells is beneficial. If confirmed, it “will be considered a fundamental advance by our field,” Dr. Sharpless said.

    Aging research is a relatively young field because until 20 or so years ago the prospect of defeating age seemed hopeless. Then researchers found that the lifespan of laboratory animals could be extended by manipulating certain genes, setting off a hunt for drugs that might influence the corresponding genes in people. This line of research remains promising but has produced few tangible results so far. The discovery that senescent cells seem to be the cause of tissue degeneration opens out a new direction for researchers on aging to explore.

    Judith Campisi, at the Buck Institute for Research on Aging, said the new finding was the first proof that senescent cells can drive the aging process. “So it’s really quite a breakthrough,” she said.

    In both mice and people, senescent cells are few in number but have major effects on the body’s tissues. Killing the cells should therefore have large benefits with little downside. The gene-altering approach used on the mice cannot be tried in people, but now that senescent cells appear to be harmful, researchers can devise ways of targeting them. Wk1 Discussions: Initial Reactions to Older People with Radical Changes

    Drugs already exist to combat some of the inflammatory hormones secreted by senescent cells. The body’s immune system, which probably clears away senescent cells all the time but does so less efficiently with age, could perhaps be trained to attack senescent cells more aggressively. Or researchers could one day develop specific drugs to kill the cells, when the differences between ordinary and senescent cells are better understood.

    Dr. van Deursen said he thought it worth trying to eliminate senescent cells after the finding that they reliably switch on a characteristic marker gene known as

     

     

    p16-Ink4a. In his mice, he arranged that the genetic element that switches on the marker gene would also prime a mechanism to make the cell self-destruct. The mechanism fired only when the mice were dosed with a specific drug. The result was that only senescent cells were at risk from the drug, and that they could be purged at any desired time in the mouse’s lifetime.

    In a second experiment, the mice were not given the cell-cleaning drug until they were middle-aged. Their cataracts had already developed by then and were irreversible, but aging was delayed in their fat and muscle tissues.

    It may be that senescent cells are beneficial in youth but harmful in old age, when the immune system seems to clear them less rapidly from the body. The second mouse experiment suggests that middle age would be an effective time for clinical intervention, assuming humans behave in the same way.

    If aging of the tissues is delayed by eliminating senescent cells, the mice should, in principle, have lived longer. Dr. van Deursen said this was not the case in this experiment only because he had chosen a fast-aging strain of mice in order to save himself time. These particular mice succumb to heart attacks at an early age, regardless of the state of their tissues. The Mayo Clinic team plans to repeat its experiment with an ordinary strain of mouse that normally lives three years or more, to see if its life span is extended as expected. Wk1 Discussions: Initial Reactions to Older People with Radical Changes

    The Mayo Clinic finding “is a really important step forward for the field,” said Dr. Campisi of the Buck Institute.

    The purpose of research on aging, she said, is not to let people live a thousand years, as portrayed in science fiction, but to increase health span, the proportion of people’s natural lives that they live in good health.

    “People used to see aging as a rusting nail — there’s nothing you can do about it,” Dr. Campisi said. “But we now know that there are processes that are driving aging, and that those processes can be meddled with.”

     

     

    • Purging Cells in Mice Is Found to Combat Aging Ills
      • By NICHOLAS WADE
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    Week 1 Discussions: Initial reactions to older people with radical changes.

    What initial steps would you think about taking if an older person close to you radically changed his/her behavior over a short period of time ?  (Please refer to the syllabus for the discussion guidelines.)

     

     

    Week 1 Lecture Notes

    What is Alzheimer’s Disease?

    Alzheimer’s disease (AD) is an age-related, non-reversible brain disorder that develops over a number of years and causes irreversible dementia. A person with AD loses intellectual functioning over time as structural changes take place in the brain.

    Alzheimer’s disease begins with deficits in short-term memory, attention span, and orientation to the environment. Early symptoms may include difficulty remembering names and events, lack of interest in usual activities, boredom, and depression. As the brain damage progresses symptoms can include a loss of abilities in judgment, reasoning, and verbal skills. Mid-stage disease symptoms usually include impaired judgment, disorientation, confusion, and changes in behavior. Speaking coherently also becomes more difficult at this stage. Basic psychomotor skills such as eating and walking are usually lost in the last stage of this disease.1

    Credits: image @ getty images

     

    Click on the video2 to learn more about Alzheimer’s disease.

    References:

    1. American Academy of Neurology. (year unknown). Alzheimer’s Disease. Retrieved from: https://www.aan.com/professionals/practice/pdfs/dem_pat.pdf

    2. NIH Senior Health. (2002). What Is Alzheimer’s Disease. Alzheimer’s Disease. Video retrieved from: https://nihseniorhealth.gov/videolist.html#alzheimersdisease

    What is the Prevalence of Alzheimer’s Disease?

    Alzheimer’s Disease Facts and Figures, released by the Alzheimer’s Association in 2014, reveals the burden of Alzheimer’s and dementia on individuals, caregivers, government, and the nation’s healthcare system. (These are highlights, you can access the full report from the Overview page)

     

    · Latest figures estimate that 5.2 million Americans live with this disease. It is the 6th leading cause of death for people in the United States. (Interestingly, this number is down by .2 million from 2011)

    · One out of every eight people aged 65 and older has Alzheimer’s disease.

    · Almost two-thirds of American seniors living with AD are women.

    · One in every 6 women and one in 11 men who reach age 65 can expect to develop Alzheimer’s disease in their lifetime.

    · The number of Americans with AD and other dementias are expected to triple by 2050 unless there are medical breakthroughs to prevent, slow or stop the disease.

    References:

    1. Alzheimer’s Association, (2014) Alzheimer’s Disease Facts & Figures, Alzheimer’s Dementia Volume 10, Issue 2.

     

    Week 1 Lecture Notes

    What does Alzheimer’s Disease do to the Brain?

    Billions of nerve cells (neurons) are involved in the brain work that goes on in our heads. These neurons connect at millions of points (synapses) to form networks. Signals move through these networks as electric charges forming the basis of our memories, thoughts, and feelings. Alzheimer’s disease interferes with the way the electric charges travel within the nerve cells and also with the cells’ connections to each other. This disease interference leads to nerve cell death and tissue loss throughout the brain. Plaques and tangles of protein fragments build up between nerve cells and collect among dead and dying cells. The loss of connections between neurons first results in memory and learning deficits. As neurons die throughout the brain, the regions affected shrink in size. Overtime the brain gets a lot smaller. Almost all functions are damaged that affect thinking, planning and remembering. 1

    The general progression of this brain damage involves the following: Earliest Alzheimer’s changes may begin twenty years or more before any significant signs or symptoms appear. Some regions of the brain begin to shrink. Short term memory loss is the first visible feature.

    Over time the disease passes through three main stages: mild, moderate, and severe. The mid-stage of the disease usually lasts from two to ten years, frequently six years or more. The severe stage of Alzheimer’s disease may last from one to five years.2

     

    Iimage adapted from http://www.namenda.com/About/Stages.aspx3

     

    References:

    1. American Academy of Neurology. (unknown year). Alzheimer’s Disease. Retrieved from: http://www.aan.com/professionals/practice/pdfs/dem_pat.pdf

    2. Namenda.com. (unknown year). Symptoms and Stages of Alzheimer’s, Retrieved from: http://www.namenda.com/sections/about-alzheimers-disease/symptoms-and-stages.aspx

    3. Image © Istockphoto/Julie Felton

     

    Week 1 Lecture Notes

    Inside the Brain: Alzheimer’s Brain Tour

    Please visit the  Alzheimer’s Brain Tour (Links to an external site.) , a short slide show from the Alzheimer’s Association that is helpful in understanding the severity of this brain damage. 1 The Brain Tour is a 16-slide presentation that destroys the myth that Alzheimer’s is normal aging.

     

    Directions:

    1. Click on the Alzheimer’s Brain Tour link  (Links to an external site.) to open the wepage in a new tab or window.

    2. On each slide, roll over the colored text to view special features on the slide.

    3. Click the Next button on the upper-right corner to go to the next page.

     

    Credits: Image adapted from www.alz.org

     

    References:

    1. Alzheimer’s Association.(unknown year). Brain Tour. Retrieved from: http://www.alz.org/research/science/alzheimers_brain_tour.asp

    What Causes Alzheimer’s Disease?

    An early onset form of Alzheimer’s disease is extremely rare, appears in multiple generations of the same family and is considered gene related. Research studies have yet to determine cause or causes of late-onset Alzheimer’s disease. Studies on environmental causes such as exposure to therapeutic radiation, anesthesia, and presence of metals like aluminum in the brain have failed to be conclusive at this point.

    Although we don’t know for sure the exact causes of late-onset Alzheimer’s disease, they appear to include genetic, environmental, and lifestyle factors. Research studies have identified certain risk factors that can be associated with Alzheimer’s disease and other dementias: 1

    1. Age–the older one gets, the higher the risk

    2. Having mild cognitive impairment (MCI)

    3. Experiencing a stroke

    4. Inheriting ApoE-e4 gene from one or both parents

    5. Health conditions like high blood pressure, diabetes, and high cholesterol

    6. Obesity in women 2, 3

     

    Research evidence is growing that links the health of the brain to the overall health of the heart and blood vessels. The greatest risk factor is getting older, but persons with vascular risk factors and disease are the second largest risk group and the only group that is currently open to intervention. Identifying preventable or modifiable risk factors for dementia has become a major public health priority across the world. The following vascular factors and conditions are established risks for cognitive decline and dementia: 4

    Vascular Risk Factors for AD and other dementias
    History of stroke or TIAs High cholesterol
    Type 2 diabetes Smoking
    High blood pressure Alcohol misuse
    Congestive heart failure Atrial Fibrillation
    Physical inactivity Low folate
    Obesity Oxidative stress

     

    Many of these risk factors can be managed and positively changed to not only decrease the likelihood of developing cardiovascular disease, but to decrease the chances of experiencing dementia-related cognitive decline.

    References:

    1. American Academy of Neurology. (unknown year). Alzheimer’s Disease. Retrieved from: http://www.aan.com/professionals/practice/pdfs/dem_pat.pdf

    2. Alzheimer’s Association.(2010). Risk Factors for Alzheimer’s Disease. in 2010 Alzheimer’s Disease Facts and Figures. Retrieved from: http://www.alz.org/documents_custom/report_alzfactsfigures2010.pdf p. 7-8

    3. Stephan, B. & Brayne, C. (2008). Vascular factors and prevention of dementia. International Review of Psychiatry, 20(4): 344-356

    4. O’Brien, J. T. et al. (2003). Vascular cognitive impairment, Lancet Neurology, 2, p. 89-98, in Stephan & Brayne, 2008.

     

    What is Dementia?

    Dementia is a disorder that is a result of breakdown of the neuron connections in the brain caused by diseases of the brain such as Alzheimer’s which is the most common cause of dementia among people age 65 and older. Dementia can also be caused by systemic abnormalities such as metabolic syndrome in which the combination of high blood pressure, high cholesterol and diabetes causes confusion and memory loss. Wk1 Discussions: Initial Reactions to Older People with Radical Changes

    Dementia is characterized by cognitive and behavioral problems that become increasingly severe over the course of time interfering with normal activities and personal relationships. Dementia sufferers gradually lose their ability to solve problems and to control emotions. Personality changes often lead to behavioral issues like agitation, delusions and hallucinations. Memory loss is a symptom of dementia, but it does not necessarily imply that you have dementia. 1

    How do We Recognize Dementia?

    A diagnosis of dementia requires that two or more brain functions are significantly impaired without the loss of consciousness. For example, significant loss in both memory and language skills might lead to a dementia diagnosis. Many different diseases and health conditions can cause dementia or dementia-like symptoms. 2

     

    References:

    1. National Institute of Neurological Disorders and Stroke. Dementia Information Page. Retrieved from at: http://www.ninds.nih.gov/disorders/dementias/dementia.htm

    2. National Institute of Aging. Caregiver Guide. Retrieved from http://www.nia.nih.gov/

     

    Dementias, Alzheimer’s Disease vs. Normal Aging

    How is memory loss from AD and related dementias different from normal aging?

     

     

     

    · Alzheimer’s disease and related disorders cause large declines in intelligence, memory and learning abilities.

    · Normal aging does not cause large declines in these areas. A mild decline in memory and learning ability can be age-related but this condition is not life-threatening and does not lead to progressive brain deterioration like that caused by dementia. (Benign senescent forgetfulness)

    · Dementia is more commonly found in very elderly individuals but it is not a normal part of the aging process.

    Which Health Conditions can Cause Dementia or Dementia-like Symptoms?

    The following health conditions have side effects that can be mistaken as signs of the presence of AD or other brain damage but if untreated could lead to irreversible dementia:1:

    · Vascular problems including multiple strokes

    · Heart & Lung problems

    · Brain tumors

    · Medication side effects

    · Combined metabolic disorders like high cholesterol, high blood pressure & diabetes

    · Nutritional deficiencies

    · Infections

    · Anoxia or hypoxia- lack of oxygen to brain

    Causes of Reversible Dementia-like Symptoms Dementia symptoms that are caused by the following physical conditions or side effects from drugs are often reversible if a person receives treatment for the underlying medical issue(s) before any serious brain damage takes place.1

    · Prescription drugs, OTC(over the counter) meds, street drugs

    · Alcohol toxicity

    · Dehydration

    · Electrolyte imbalance

    · Hypothyroidism/Hyperthyroidism

    · Fever from infections-UTI (urinary tract infections), pneumonia

    · TIAs (transient ischemic attacks)

    · Depression

    Causes of Irreversible Dementia The following diseases are known to be the cause of dementia symptoms that cannot be stopped causing irreversible dementia:1:

    · Alzheimer’s disease — the most common

    · Huntington’s disease — genetic disorder (called Mad Cow Disease in the United Kingdom)

    · Cruetzfeldt-Jacob disease –rare fatal brain disorder

    · Frontaltemporal disorder — rare, causes extreme behavior changes but does not affect spatial skills or memory

    · Lewy body dementia (LBD) — delusions, hallucinations & depression core to

    · Vascular dementia — caused by strokes and transient ischemic attacks

    · Korsakoff syndrome — wet brain, alcoholic encephalopathy

    · AIDS — acquired immune deficiency syndrome

    · Parkinson’s disease — motor system disorder

     

    References:

    1. National Institute of Neurological Disorders and Stroke. (2010). Dementia Information Page. Retrieved from at: http://www.ninds.nih.gov/disorders/dementias/dementia.htm

     

    How can You Tell if Dementia Symptoms are Related to Alzheimer’s Disease?

    There is no single test that proves that a person has AD. Doctors can usually determine that a person has dementia but it is sometimes difficult to pin down the exact cause of it. An extensive medical workup is needed to establish a diagnosis of Alzheimer’s disease. This would likely include a review of a client’s medical history, mental status tests, a thorough physical exam, diagnostic tests and a neurological exam. This combination of tests can also rule out treatable conditions such as depression, prolonged grief, drug toxicity, and/or nutritional deficiencies or vitamin B12 as the source of behavioral and personality changes. These tests evaluate the client’s overall health condition looking for any conditions that might affect the brain.

    A standard medical workup for AD now often includes an MRI (Magnetic Resonance Imaging, structural imaging) for information about the shape, position, or volume of brain tissue. Shrinkage in specific brain regions could possibly be an early sign of Alzheimer’s disease. An MRI or a CT (Computed Tomography) scan can also detect evidence of other problems such as tumors, strokes, damage from head trauma or from a build-up of fluid.

    PET (Positron Emission Tomography) scans and other functional imaging techniques that show how well cells are working in different regions of the brain are being used to research their potential for use in treating AD. 1
    Credits: Image @ Alzheimer’s Disease Education and Referral Center, National Institute on Aging. Brain scans done with PET (Positron Emission Tomography) show how Alzheimer’s affects brain activity. The left image shows a normal brain, while the right is from a person with Alzheimer’s. The blue and black areas in the right image indicate reduced brain activity resulting from the disease.

     

     

     

    References:

    1. Alzheimer’s Association. (2010). Steps to Diagnosis. Retrieved from: http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp

     

    Are there Cures for Alzheimer’s Disease?

    The short answer is No.

    There are no known cures for Alzheimer’s disease at this time. A few drugs have been approved for treating this disease, but at this point they have shown limited success in slowing down the rate of decline. Current drugs cannot stop or reverse the effects of Alzheimer’s disease. These drugs appear to help individuals for only a few months to a very few years.Wk1 Discussions: Initial Reactions to Older People with Radical Changes

     

    How can Pharmaceuticals Help Relieve or Reduce Symptoms Associated with Alzheimer’s Disease?

    Cholinesterase Inhibitors (ChEis)

    Currently three cholinesterase inhibitors are commonly prescribed to slow down or stabilize the progression of Alzheimer’s disease by stopping loss of the chemical neurotransmitter acetylcholine (often abbreviated (ACh)  in the brain. Acetycholine deficiency occurs in AD and is related to both cognitive and non-cognitive symptoms. ChEis, Aricept, Razadyne and Namenda are being used to prevent the acceleration of cell death for persons in the early to moderate stages of dementia. These medications have been shown to help cognitive symptoms like memory loss which can have a positive effect on activities of daily living by improving behavior and mood. (Alzheimer’s Association, 2014)

    Currently, a growing number of herbal remedies, dietary supplements and “medical foods”are promoted to improve memory or to delay or prevent AD and other dementias. Safety and effectiveness of these products are based on testimonials, tradition and a very small body of scientific research. The U.S. Food & Drug Administration (FDA) does not require approval for marketing of  these dietary supplements or “medical foods”at this time. Examples include: Caprylic adid and coconut oil, Concerns, Coenzyme Q10, Coral calcium, Gingo biloba, Huperzine A, Omega-3 fatty acids, Tramiprosate andPhosphatidylserine.( Alzheimer’s Association, Alternative Treatments, 2014). Wk1 Discussions: Initial Reactions to Older People with Radical Changes

     

     

    Readings & Media

    By the end of week 1, please complete the following readings:

    · Syllabus

    · Week 1 lecture notes

    · Visit the site:

    · Brain Tour featured on the Alzheimer’s Association website. (Directions included.)

    · Articles: Optional – For those who are interested-won’t be on exams!

    · Purging cells in mice is found to combat aging ills. Preview the document View in a new window

    · It Could Be Old Age, or It Could Be Low B12. Preview the document View in a new window

    Discussions

    Please participate in the following discussions via the Discussions tool for this week.

    · Icebreaker: Introduce Yourself

    · Week 1 Discussions: Initial reactions to older people with radical changes.

    Looking Ahead

    · Term paper topic is due week 3.

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