About Us







Health & Wellness: Nutrition, Fitness, Diet, Relationships …

Posted: February 25, 2018 at 4:44 am


Jenny Albers Im a great mom because of the baby whos gone

Eighteen months after my loss, I was blessed to bring another baby home, a boy. This time, I...

After suffering a sudden heart attack that left him in a temporary coma last year, Bob Harper...

Reviewers on Amazon claim this silk eye mask is a must-have when it comes to catching some zzz's....

You weren't particularly sick today. Just a slight cold. You could have gone to school and been...

Warn your doctor before taking the medication if you have heart disease

When an urge strikes for something chocolate and indulgent, Joy Bauer has you covered.

Celebrity trainer Ben Bruno shares three exercises that will help you get in shape in a short...

Emily Dumler, a young mom who was battling non-Hodgkin's lymphoma, said her faith played a crucial...

A new immunotherapy treatment called CAR T completely changed the life of Emily Dumler, a young...

After being hospitalized for more than 40 days, Emily Dumler, a young mom from Kansas with three...

Any time they want to feel close to him, they cuddle with the "Daddy Blanket" made out of his...

Bruises can sometimes signal certain problems.

After a heart attack women are more likely to die than men. The main reason: they're not getting...

FluMist, the needle-free, nasal spray flu vaccine, won the endorsement of federal vaccine advisers...

How many do you have in your home?

Our children are taught to be quiet in lockdowns and rush to hide in closets and bathrooms, and...

The popular daytime talk-show host revealed the news to viewers during Wednesday's episode of...

Spice up your meals with one simple dish you can use throughout the week to make things in the...

Eat healthy, or at least healthier, with these low-calorie meals from popular chain restaurants...

Adam Rippon and Alexa Scimeca Knierim weigh in on how they master it all without feeling like...

In a Medical Mysteries and Miracles segment on Megyn Kelly TODAY, Kevin Daly and his wife Rachelle...

After open heart surgery, Kevin Daly thought he addressed the extent of his medical woes. But...

It was Valentines Day and the Alzheimers patients in a nursing home had something to love

Powder sprinkled helped children build tolerance but doctors warn about safety risks

The family learned that 70 percent of people who need a bone marrow donation rely on anonymous...

Kathie Lee Gifford opened up about her faith and coping with feelings of loneliness in a new...

The next time you want to skip a workout or reach for a donut, use this "magic" word to get yourself...

Including something called Anti-Monkey Butt.

A simple bouquet of flowers can help you start your day on a happy note.

How do you use your Alexa?

When Bri Blank discovered that she weighed 306 pounds she knew it was time to take control of...

When a Yale University psychology professor set out to teach a new course on how to be happy,...

Mike Adamle has set up an initiative to help fellow players, and to educate others about brain...

Once my husband comes down with a cold, there is no way to keep him from drafting his last will...

OK, I'm not a big "feelings-y" person. I don't like hugging all that much and I'm not great with...

People used to tell me how much I'd miss this when I had tears streaming down my face and I wondered...

Helene Z. Miller shows the world that you're never too old to dance with a little help from her...

It sure was fun, but it wasn't easy!

Scientists have assumed the placebo's power depended on deception. Now a new study shows patients...

Breakup bombshells like this can make us worry about the state of marriage itself, and the ability...

Brian Balthazar joins TODAY to emcee a Family Feud-style battle of the sexes.

Our Guys Tell All panel returns on TODAY to field more questions.

Follow this link:
Health & Wellness: Nutrition, Fitness, Diet, Relationships ...

Long Life in Pictures: Tips on Sleep, Diet, and More

Posted: February 10, 2018 at 11:45 am


IMAGES PROVIDED BY:

1)H Singh/Custom Medical Stock Photo

2)Jupiterimages/Brand X Pictures

3)Samir Hussein/WireImage

4)Bill Hatcher/National Geographic

5)Thomas Hawk/Flickr

6)Gina Cholick/OJO Images

7)MCT/McClatchy-Tribune

8)Melissa Tse/Flickr

9) Thinkstock

10)Peter Cade/Riser

11)Tim Hall/Cultura

12) Shelby Ross/Riser

13)Remi Benali/The Image Bank

14)Shalom Ormsby/Stone+

15)Ocean/Corbis

16) Le Club Symphonie/OJO Images

17)Wesley Hitt/Photographers Choice RF

18)Altrendo Images

SOURCES:

Preventative Medicine Research Institute: The Proven Lifestyle.

The Lancet Oncology.

Friedman, H. and Martin, L. The Longevity Project.

Journal of Epidemiology and Community Health.

Journal of Clinical Oncology.

The New England Journal of Medicine.

British Medical Journal.

Archives of Internal Medicine.

New Scientist.

AARP.

Journal of the American College of Cardiology.

National Sleep Foundation

Asia Pacific Journal of Public Health.

U.S. Department of Health and Human Services

Social Sciences Medicine.

Obesity.

American Journal of Respiratory and Critical Care Medicine.

British Journal of Sports Medicine.

CDC.

American Heart Association.

Health Psychology.

University of Colorado at Boulder.

University of Texas Health Science Center at Houston.

Medline Plus.

Bicycle Helmet Safety Institute.

Harvard Medical School Division of Sleep Medicine.

Journal of the American Medical Association.

Journal of Epidemiology.

American Association for Cancer Research.

PLoS Medicine.

Archives of General Psychiatry

Rush University Medical Center.

Read more here:
Long Life in Pictures: Tips on Sleep, Diet, and More

Longevity FAQ Laura Deming

Posted: at 11:45 am


Senescent cell removal135%2016Does not affect rotarod performance, object discrimination. Slight delay in wound closure.1Rapamycin110%2009Late-life rapamyicn treatment extends lifespan (pooled females from multiple-site NIA study)2NR105%2016Claim an increase in running distance3Catalase117%2005Mitochondrially-targeted catalase expression extended mouse lifespan compared to control4Sirt6 overexpression115%2012Sirt6-overexpression increases male mouse lifespan5Metformin106%2013In males, small but significant lifespan extension after metformin application6DN-IB110%2013Dominant negative to downregulate IKK-beta activity, delivered to hypothalamus of middle-aged mice7Klotho120%2005Overexpression under human elongation factor 1 promoter increases lifespan, slight fertility loss8S6K1118%2009KO of S6K1 extends lifspan compared to wildtype mice9p66128%1999Mutation of a p66shc, member of proto-oncogene locus SHC, extends lifespan. May be just due to cancer effect.10Lowering protein:carbohydrate ratio128%2014Varied protein, carbohydrate, and total energy levels.11Fat-specific insulin receptor knockout mice111%2003Fat-specific insulin receptor knockout mice show a significant increase in lifespan12C57BL/6 mice with NZB/OlaHsd mitochondrial mutations120%2016Same nuclear, different mitochondrial DNA.13Fasting mimicking diet112%2015FMD followed by 10 days of normal, then repeat14Rapamycin127%2014Rapamycin from 9 months of age, weight decreased ~30% at highest dose15Brain-specific Sirt1 expression116%2013Brain-specific Sirt1 expression in female mice increases lifespan over wildtype16SRT1720104%2014Start diet at 28 weeks of age, very small increase on lifespan17Spermidine111%2016Polyamine, administered in drinking water18Atg5 overexpression117%2013Transgenic mice ubiquitously expressing Atg5 (crucial for autophagasome confirmation) live longer.19Telomerase124%2012Paper showing telomerase therapy increasing life20Insulin receptor substrate null132%2008Insulin receptor substrate 1 null mouse lifespan extension in females21Snell Dwarf Mice142%2001Snell dwarf mouse paper showing life extension22Ames Dwarf Mice168%1996Original Ames dwarf mouse paper showing life extension23s-Arf/p53113%2007An extra copy of p53 and upstream regulator Arf/p16Ink4a increases lifespan24Slow growth during lactation106%2004Male mice suckled by dams fed a low-protein diet lived longer than their control cohort25Methionine restriction111%2005Methionine restriction increases mouse lifespan, here median lifespan increase in mice that survived at least 1 yr.26Rapamycin (3 months)114%2016Lifespan given from time of treatment which was 23-24 mo, used 24 mo to get percentage so this is an estimate27GHR-BP138%2000Mice deficient in growth hormone receptor / binding protein live longer (female mean, not median, lifespan shown here)28mTOR116%2013mTOR depletion extends lifespan29PTEN overexpression112%2012Overexpression of PTEN, a tumor suppressor which counteracts PI3K, extends mouse lifespan30Myc (+/-)121%2015Claim no correlation between weight and lifespan31FGF-21139%2012Hepatic-specific expression of FGF-21 (which suppresses growth hormone and reduces the production of IGF) increases lifespan, female lifespan shown here32BubR1 overexpression114%2012Kinase which localizes to kinetochore, overexpression increases lifespan33AC5 KO132%2007AC5 knockount mice lived longer than control, potentially linked to effects on cAMP production and beta-adrenergic receptor signaling.3417-alpha-estradiol112%201317-alpha-estradiol extended lifespan in males, but not females (as expected)35Acarbose122%2013Acarbose extended male more than female lifespan36TRPV1 -/-114%2014Resting exchange ratio similar at 16 mo to 3 mo37SRT2104106%2014Start diet at 28 weeks of age, very small increase if there38Hcrt-UCP2128%2006UCP2 under hypocretin promoter lowers core body temp, increases lifespan39G6PD overexpression114%2016Reduces NADP+40IGF-1 Receptor Brain KO (+/-)109%2008Brain-specific IGF-1 Receptor +/- mice live longer than WT41SURF-1 KO121%2007Mutations in SURF1, a cytochrome c oxidase assembly factor, extend lifespan. Mitochondrial.42Litter enlargemnet (CR)118%200950% enlargement of litter in first 20 days, to induce caloric restriction43mclk-1 heterozygous115%2005A heterozygous knockout of mclk1 (important in mitochondrial respiration) results in mouse lifespan extension compared to wildtype44Nordihydroguairaitic acid112%2008NDGA and aspirin extend lifespan by a little bit. Small molecule.45Aspirin108%2008NDGA and aspirin extend lifespan by a little bit. Small molecule.46SOD mimetic carboxyfullerene115%2008Carboxyfullerene, described as an SOD mimetic, increased the lifespan of treated mice compared to wildtype control47Removal of visceral fat tissue108%2008Removal of visceral fat tissue increases lifespan over control48Low glycotoxin diet112%2007Low glycotoxin (low levels of AGE's) shown to extend lifespan49Per2 (-/-)118%2016Lifespan study incomplete50Neonatal metformin120%2015Animals recieved on 3, 5, 7th day after birth - bad for females, good for males.51GHRH KO146%2013GHRH (Growth-Hormone Releasing Hormone) disruption extends lifespan, presumably through the insulin/IGF pathway axis52Sod-2 overexpresion104%2007Overexpression of SOD-2 targeted to the mitochondrion increases mouse lifespan relative to wildtype53Metallothionein cardiac-specific expression114%2006Cardiac-specific expression of antioxidant metallothionein extended the lifespan of wildtype mice compared to WT FVB control.54IGF1R(+/-)121%2013Tyrosine kinase receptor activated by IGF1/255Ink4a/Arf/Ink4b116%2009Encodes 2 CDKs (p16 and p15), and Arf (upstream of p53)56Adult-onset Ghr (-/-)100%2016Male mice have >2x higher insulin than female mice57Ovary Transplantation117%2003Original paper showing that transplantation of young ovaries into old animals could result in lifespan increase58UCP-1 transgenic111%2007Transgenic mice with skeletal muscle-specific UCP1 had increased longevity. Small increase if there.59PAPP131%2010Knockout of PAPP-A (which enhances IGF-1 activity by degrading the inhibitory IGF-binding protein) increases lifespan over wildtype, female lifespan shown here60CR diet with lard132%201540% decrease starting at 4 months61loss of function of Riib (PKA subunit)114%2009Knockout of RIIbeta, a subunit of PKA, increased lifespan in mice compared to wildtype62Myostatin (+/-)109%2015Knockout induces double-muscle mice63Akt1 +/-113%2013Haploinsufficiency of Akt1 increases mouse lifespan relative to wildtype. Insulin/IGF-1 pathway.64miR-17117%2014Not clear if there is a main function for miR-1765NDGA111%2015Makes up ~12.5% of the dry weight of leaves66FAT10ko119%2014Ubiquitin-like protein which can signal for protein to go to proteasome.67Intranasal Hsp70116%2015Seemed to extend lifespan when started at 17 months68RasGRF1(-/-)120%2011Ras-guanine nucleotide exchange factor (Ras-GRF1) -/- mice displayed increased lifespan compared to wildtype.69Lmna-Lcs (Lamin C alone)113%2014Body weight and tumor incidence increase in mice expressing only Lamin-C70Cisd2 overexpression119%2011Cisd2 transgenic mice (expressing more of it) lived longer than wildtype. Cisd2 is a transmembrane protein expressed on the mitochondrial outer membrane and associated with a human longevity locus.71metoprolol110%2013Administration of the beta-adrenerginc receptor blocker metoprolol to mice increased lifespan compared to wildtype72nebivolol106%2013Administration of the beta-adrenerginc receptor blocker nebivolol to mice increased lifespan compared to wildtype73uPA (in ocular lens/CNS nerve cells)118%1997uPA expression under alpha-crystallin promoter increases lifespan, small/eat less74MIF-1 KO116%2010MIF-1 knockout mutant (T-cell derived cytokine) extends lifespan75mGsta4-null113%2009Enzyme protects against lipid peroxidation, weird that less of its activity might increase lifespan76Muscle-specific GHRKO109%2015Knockout under muscle creatinine kinase promoter77CAM-(1A)AR mice110%2011Mice with a constitutively active mutant form of the alpha1-adrenergic receptor (CAM-alpha1aAR) lived longer than wildtype control78Cardiac-specific catalase overexpression113%2007Overexpression of catalase specifically in the heart in mice79Icariin108%2015Flavonoid80miR-29 brain-specific KO112%2016miR-29 highly expresed in brain during development81Bi-maternal mice128%2010Mice prepared to be bi-maternal were found longer-lived than their normal cohort82RNase-L(-/-)127%2007Knockout of RNase-L, which accelerates cell senescence when expressed, increases lifespan in mice compared to wildtype83hMTH1-Tg116%2013Express high levels of hMTH1 hydrolase, thought to degrade 8-oxodGTP and 8-oxoGTP. Oxidative stress.84DGAT-1 -/-126%2012Knockout of DGAT1, which catalyzes triglyceride synthesis, extends mouse lifespan relative to wildtype85IGFBP-2 overexpression105%2016Proteins bind IGF1/2, degraded during pregnancy, delay in sexual maturity86PAPP-A on high-fat diet105%2015Males chosen so no adverse developmental effect on fat depots87clk-1(-/-) with clk-1 transgene128%2014clk-1 functions in ubiquinone synthesis, but levels weren't very affected.88AgRP -/-110%2006Neuropeptide that is appetite stimulator, overexpression leads to hyperphagia and obesity.89Bone marrow transplantation106%2013Bone marrow transplantation from young to old mice was claimed to extend lifespan90Young blood injections94%2014Resulted in decreased lifespan91Nas(-/-) mice125%2011Hyposulfatemic NaS1 null mice (Nas1 -/-) had an increased lifespan compared to wildtype control.92Cyclophilin D (+/-)119%2017Decrease in maximum lifespan93PAPP-A in adults120%2017Tamoxifen-induced knockdown94Mtbp (+/-)120%2016Rotarod, open field, blood glucose, insulin, IGF-1 were the same.95

Go here to see the original:
Longevity FAQ Laura Deming

Find a Holistic Practitioner Local Search | Alternative …

Posted: February 9, 2018 at 2:40 pm


Home Find a Holistic Practitioner Local Search

Other practitioner search options available:

Nationwide Practitioners (USA)

International Practitioners (Global)

When alternative therapies are used in place of conventional medicine, it is considered to be alternative medicine. When alternative therapies are used in addition to conventional medicine, they are viewed as complementary medicine.

Holistic Practitioners use an approach to medicine that emphasizes treating the person as a whole, with special attention to the interconnections of the mind and body and of the systems within the body. A Holistic practitioner medicine stresses the patients role in health care through such means as positive attitudes, sound diet, and regular exercise. With a Holistic Practitioner, the therapeutic emphasis is on supporting or stimulating the organisms self-healing processes, rather than treating the symptoms or the disease.

Alternative Medicine Doctors use the approach to medicine that emphasizes treating the person as a whole, with special attention to the interconnections of the mind and body and of the systems within the body.

The main difference between conventional medicine and Alternative Medicine Doctors is they are concerned about the prevention of disease and pay attention to and deal with the cause by treating the body as a whole. It focuses on preventing disease before it starts. Alternative Medicine Doctors view the presence of disease as an imbalance of the emotional, mental and physical state of a person and endeavor to support and strengthen the immune system by natural means.

Alternatives for Healing, a leading Natural Health, Alternative Medicine and Holistic Health Resource Directory.

If you are unfamiliar with a particular holistic practitioners or alternative medicine doctor or holistic health therapy, please visit our Holistic and Alternative Medicine Therapy Definitions section to find a brief definition of the different therapies listed with us.

Please make sure to visit other areas of Alternatives for Healing to find great alternative medicine and holistic health information.

Thank you for visiting Alternatives for Healing!

Follow this link:
Find a Holistic Practitioner Local Search | Alternative ...

M&M’S Nutrition – mms.com

Posted: February 8, 2018 at 12:41 pm


Back Home

M&M'S brand handles your hunger so you can handle, well, anything. It is a treat that can be enjoyed as part of a balanced diet and healthy lifestyle.

M&M'S brand is owned by Mars Incorporated, a leading global food company. Mars is committed to addressing health and wellness issues and promoting healthy lifestyles. We are committed to acting responsibly and making a positive contribution to these issues through offering a range of different pack sizes, improving the nutritional content of our products, ensuring clarity of nutritional information on packaging, whilst at the same time providing responsible communication about our products through our self-imposed Marketing Code.

GDAs stand for Guideline Daily Amounts. GDAs aim to help you understand how much of a specific nutrient you are consuming in a given product. Because Mars wants you to know as much about the food you eat as possible, our GDA labels can easily be found on the front and back of our packaging. M&M'S brand is available in a variety of pack sizes to suit your individual needs.

GDA's are based on a 2,000 calorie diet. To learn more visit http://www.marshealthyliving.com *No DV defined

See the rest here:
M&M'S Nutrition - mms.com

Pajaro Valley Unified School District – School Nutrition And …

Posted: February 7, 2018 at 6:42 am


Good nutrition and learning go hand in hand!

The Food & Nutrition Services Department is made up of a team of nutrition professionals that are dedicated to students' health, well being, and their ability to learn. We support learning by promoting healthy habits for lifelong nutrition and fitness practices.

Meals, foods, and beverages sold or served at schools meet state and federal requirements which are based on the USDA Dietary Guidelines. We provide students with access to a variety of affordable and appealing foods.

________________________________________________________________________________

Free & Reduced Meal Applications

2017-18 School Year

We are currently accepting free and reduced meal applications for the 2017-2018 school year. You may apply at the Food & Nutrition Services (FNS) Office: Monday through Friday from 7:00am to 3:00pm. The FNS Office is located at the District Office at 294 Green Valley Rd, Watsonville in the back of the building.

This year we are also offering the option to complete your application online. Please select the following link to register and complete your Free and Reduced meal application.

Read the original here:
Pajaro Valley Unified School District - School Nutrition And ...

Alzheimer’s Disease: Symptoms, Stages, Life-Expectancy

Posted: February 1, 2018 at 12:45 pm


Alzheimer's disease facts

What is Alzheimer's disease?

Alzheimer's disease (AD) is a slowly progressive disease of the brain that is characterized by impairment of memory and eventually by disturbances in reasoning, planning, language, and perception. Many scientists believe that Alzheimer's disease results from an increase in the production or accumulation of a specific protein (beta-amyloid protein) in the brain that leads to nerve cell death.

The likelihood of having Alzheimer's disease increases substantially after the age of 70 and may affect around 50% of persons over the age of 85. Nonetheless, Alzheimer's disease is not a normal part of aging and is not something that inevitably happens in later life. For example, many people live to over 100 years of age and never develop Alzheimer's disease.

What's the difference between Alzheimer's disease and dementia?

Dementia is a syndrome characterized by:

Although some kinds of memory loss are normal parts of aging, the changes due to aging are not severe enough to interfere with the level of function. Although many different diseases can cause dementia, Alzheimer's disease is the most common cause for dementia in the United States and in most countries in the world.

Who's at risk for getting Alzheimer's disease?

The main risk factor for Alzheimer's disease is increased age. As a population ages, the frequency of Alzheimer's disease continues to increase. Ten percent of people over 65 years of age and 50% of those over 85 years of age have Alzheimer's disease. Unless new treatments are developed to decrease the likelihood of developing Alzheimer's disease, the number of individuals with Alzheimer's disease in the United States is expected to be 13.8 million by the year 2050.

There are also genetic risk factors for Alzheimer's disease. Most people develop Alzheimer's disease after age 70. However, less than 5% of people develop the disease in the fourth or fifth decade of life (40s or 50s). At least half of these early onset patients have inherited gene mutations associated with their Alzheimer's disease. Moreover, the children of a patient with early onset Alzheimer's disease who has one of these gene mutations has a 50% risk of developing Alzheimer's disease.

Common forms of certain genes increase the risk of developing Alzheimer's disease, but do not invariably cause Alzheimer's disease. The best-studied "risk" gene is the one that encodes apolipoprotein E (apoE).

This means that in majority of patients with Alzheimer's disease, no genetic risk factor has yet been found. Most experts do not recommend that adult children of patients with Alzheimer's disease should have genetic testing for the apoE4 gene since there is no treatment for Alzheimer's disease. When medical treatments that prevent or decrease the risk of developing Alzheimer's disease become available, genetic testing may be recommended for adult children of patients with Alzheimer's disease so that they may be treated.

Many, but not all, studies have found that women have a higher risk for Alzheimer's disease than men. It is certainly true that women live longer than men, but age alone does not seem to explain the increased frequency in women. The apparent increased frequency of Alzheimer's disease in women has led to considerable research about the role of estrogen in Alzheimer's disease. Recent studies suggest that estrogen should not be prescribed to post-menopausal women for the purpose of decreasing the risk of Alzheimer's disease. Nonetheless, the role of estrogen in Alzheimer's disease remains an area of research focus.

Other risk factors for Alzheimer's disease include:

Some studies have found that Alzheimer's disease occurs more often among people who suffered significant traumatic head injuries earlier in life, particularly among those with the apoE4 gene.

In the majority of Alzheimer's disease cases, however, no specific genetic risks have yet been identified.

People with Alzheimer's disease experience symptoms and signs in varying degrees. Some of the warning symptoms and signs include

Ten warning signs and symptoms of Alzheimer's disease

The following list of warning signs include common symptoms of Alzheimer's disease. Individuals who exhibit several of these symptoms should see a physician for a complete evaluation.

It is normal for certain kinds of memory, such as the ability to remember lists of words, to decline with normal aging. In fact, normal individuals 50 years of age will recall only about 60% as many items on some kinds of memory tests as individuals 20 years of age. Furthermore, everyone forgets, and every 20 year old is well aware of multiple times he or she couldn't think of an answer on a test that he or she once knew. Almost no 20 year old worries when he/she forgets something, that he/she has the 'early stages of Alzheimer's disease,' whereas an individual 50 or 60 years of age with a few memory lapses may worry that they have the 'early stages of Alzheimer's disease.

What are the stages of Alzheimer's disease?

The onset of Alzheimer's disease is usually gradual, and it is slowly progressive. Memory problems that family members initially dismiss as "a normal part of aging" are in retrospect noted by the family to be the first stages of Alzheimer's disease. When memory and other problems with thinking start to consistently affect the usual level of functioning; families begin to suspect that something more than "normal aging" is going on.

Problems of memory, particularly for recent events (short-term memory) are common early in the course of Alzheimer's disease. For example, the individual may, on repeated occasions, forget to turn off an iron or fail to recall which of the morning's medicines were taken. Mild personality changes, such as less spontaneity, apathy, and a tendency to withdraw from social interactions, may occur early in the illness.

As the disease progresses, problems in abstract thinking and in other intellectual functions develop. The person may begin to have trouble with figures when working on bills, with understanding what is being read, or with organizing the day's work. Further disturbances in behavior and appearance may also be seen at this point, such as agitation, irritability, quarrelsomeness, and a diminishing ability to dress appropriately.

Later in the course of the disorder, affected individuals may become confused or disoriented about what month or year it is, be unable to describe accurately where they live, or be unable to name a place being visited. Eventually, patients may wander, be unable to engage in conversation, erratic in mood, uncooperative, and lose bladder and bowel control. In late stages of the disease, persons may become totally incapable of caring for themselves. Death can then follow, perhaps from pneumonia or some other problem that occurs in severely deteriorated states of health. Those who develop the disorder later in life more often die from other illnesses (such as heart disease) rather than as a consequence of Alzheimer's disease.

What causes Alzheimer's disease?

The cause(s) of Alzheimer's disease is (are) not known. The "amyloid cascade hypothesis" is the most widely discussed and researched hypothesis about the cause of Alzheimer's disease. The strongest data supporting the amyloid cascade hypothesis comes from the study of early-onset inherited (genetic) Alzheimer's disease. Mutations associated with Alzheimer's disease have been found in about half of the patients with early-onset disease. In all of these patients, the mutation leads to excess production in the brain of a specific form of a small protein fragment called ABeta (A). Many scientists believe that in the majority of sporadic (for example, non-inherited) cases of Alzheimer's disease (these make up the vast majority of all cases of Alzheimer's disease) there is too little removal of this A protein rather than too much production. In any case, much of the research in finding ways to prevent or slow down Alzheimer's disease has focused on ways to decrease the amount of A in the brain.

How Alzheimer's disease diagnosed?

No specific blood test or imaging test exists for the diagnosis of Alzheimer's disease. Alzheimer's disease is diagnosed when:

Ten other causes of dementia are:

Because many other disorders can be confused with Alzheimer's disease, a comprehensive clinical evaluation is essential in arriving at a correct diagnosis. Such an assessment should include at least three major components; 1) a thorough general medical workup, 2) a neurological examination including testing of memory and other functions of thinking , and 3) a psychiatric evaluation to assess mood, anxiety, and clarity of thought.

Such an evaluation takes time - usually at least an hour. In the United States healthcare system, neurologists, psychiatrists, or geriatricians frequently become involved. Nonetheless, any physician may be able to perform a thorough evaluation.

The American Academy of Neurology has published guidelines that include imaging of the brain in the initial evaluation of patients with dementia. These studies are either a noncontrast CT scan or an MRI scan. Other imaging procedures that look at the function of the brain (functional neuroimaging), such as SPECT, PET, and fMRI, may be helpful in specific cases, but generally are not needed. However, in many healthcare systems outside of the United States, brain imaging as not a standard part of the assessment for possible Alzheimer's disease.

Despite many attempts, identification of a blood test to diagnose Alzheimer's disease has remained elusive. Such testing is neither widely available nor recommended.

What treatment and management options are available for Alzheimer's disease patients?

The management of Alzheimer's disease consists of medication based and non-medication based treatments. Two different classes of pharmaceuticals are approved by the FDA for treating Alzheimer's disease: cholinesterase inhibitors and partial glutamate antagonists. Neither class of drugs has been proven to slow the rate of progression of Alzheimer's disease. Nonetheless, many clinical trials suggest that these medications are superior to placebos (sugar pills) in relieving some symptoms.

Alzheimer's disease medications

In patients with Alzheimer's disease there is a relative lack of a brain chemical neurotransmitter called acetylcholine. (Neurotransmitters are chemical messengers produced by nerves that the nerves use to communicate with each other in order to carry out their functions.) Substantial research has demonstrated that acetylcholine is important in the ability to form new memories. The cholinesterase inhibitors (ChEIs) block the breakdown of acetylcholine. As a result, more acetylcholine is available in the brain, and it may become easier to form new memories.

Four ChEIs have been approved by the FDA, but only donepezil hydrochloride (Aricept), rivastigmine (Exelon), and galantamine (Razadyne - previously called Reminyl) are used by most physicians because the fourth drug, tacrine (Cognex) has more undesirable side effects than the other three. Most experts in Alzheimer's disease do not believe there is an important difference in the effectiveness of these three drugs. Several studies suggest that the progression of symptoms of patients on these drugs seems to plateau for six to 12 months, but inevitably progression then begins again.

Of the three widely used ChEIs, rivastigmine and galantamine are only approved by the FDA for mild to moderate Alzheimer's disease, whereas donepezil is approved for mild, moderate, and severe Alzheimer's disease. It is not known whether rivastigmine and galantamine are also effective in severe Alzheimer's disease, although there does not appear to be any good reason why they shouldn't.

The principal side effects of ChEIs involve the gastrointestinal system and include nausea, vomiting, cramping, and diarrhea. Usually these side effects can be controlled with change in size or timing of the dose or administering the medications with a small amount of food. A majority of patients will tolerate therapeutic doses of ChEIs.

Glutamate is the major excitatory neurotransmitter in the brain. One theory suggests that too much glutamate may be bad for the brain and cause deterioration of nerve cells. Memantine (Namenda) works by partially decreasing the effect of glutamate to activate nerve cells. Studies have demonstrated that some patients on memantine can care for themselves better than patients on sugar pills (placebos). Memantine is approved for treatment of moderate and severe dementia, and studies did not show it was helpful in mild dementia. It is also possible to treat patients with both AchEs and memantine without loss of effectiveness of either medication or an increase in side effects.

In 2014, Namzaric was FDA approved for use as a fixed-dose combination of memantine hydrochloride extended-release (an NMDA receptor antagonist) and donepezil hydrochloride (an acetylcholinesterase inhibitor) for treatment of moderate to severe Alzheimer's.

Memantine ER (extended release) is currently marketed under the name Namenda XR, and it is used to treat moderate to severe Alzheimer's.

Non-drug based treatments for Alzheimer's disease

Non-medication based treatments include maximizing patients' opportunities for social interaction and participating in activities such as walking, singing, dancing that they can still enjoy. Cognitive rehabilitation, (whereby a patient practices on a computer program for training memory), may or may not be of benefit. Further studies of this method are needed.

Treatment of psychiatric symptoms in Alzheimer's disease

Symptoms of Alzheimer's disease include agitation, depression, hallucinations, anxiety, and sleep disorders. Standard psychiatric drugs are widely used to treat these symptoms although none of these drugs have been specifically approved by the FDA for treating these symptoms in patients with Alzheimer's disease. If these behaviors are infrequent or mild, they often do not require treatment with medication. Non-pharmacologic measures can be very useful.

Nevertheless, frequently these symptoms are so severe that it becomes impossible for caregivers to take care of the patient, and treatment with medication to control these symptoms becomes necessary. Agitation is common, particularly in middle and later stages of Alzheimer's disease. Many different classes of agents have been tried to treat agitation including:

Studies are conflicting about the usefulness of these different drug classes. It was thought that newer, atypical antipsychotic agents such as clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa, Zydis), quetiapine (Seroquel), and ziprasidone (Geodon) might have advantages over the older antipsychotic agents because of their fewer and less severe side effects and the patients' ability to tolerate them. However, more recent studies have not demonstrated superiority of the newer antipsychotics. Some research shows that these newer antipsychotics may be associated with increased risk of stroke or sudden death than the older antipsychotics, but many physicians believe this question is still not resolved.

Apathy and difficulty concentrating occur in most Alzheimer's disease patients and should not be treated with antidepressant medications. However, many Alzheimer's disease patients have other symptoms of depression including sustained feelings of unhappiness and/or inability to enjoy their usual activities. Such patients may benefit from a trial of antidepressant medication. Most physicians will try selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), citalopram (Celexa), or fluoxetine (Prozac), as first-line agents for treating depression in Alzheimer's disease.

Anxiety is another symptom in Alzheimer's disease that occasionally requires treatment. Benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) may be associated with increased confusion and memory impairment. Non-benzodiazepine anxiolytics, such as buspirone (Buspar) or SSRIs, are probably preferable.

Difficulty sleeping (insomnia) occurs in many patients with Alzheimer's disease at some point in the course of their disease. Many Alzheimer's disease specialists prefer the use of sedating atypical antidepressants such as trazodone (Desyrel). However, other specialists may recommend other classes of medications. Sleep improvement measures, such as sunlight, adequate treatment of pain, and limiting nighttime fluids to prevent the need for urination, should also be implemented.

What is the prognosis for a person with Alzheimer's disease?

Alzheimer's disease is invariably progressive. Different studies have stated that Alzheimer's disease progresses over two to 25 years with most patients in the eight to 15 year range. Nonetheless, defining when Alzheimer's disease starts, particularly in retrospect, can be very difficult. Patients usually don't die directly from Alzheimer's disease. They die because they have difficulty swallowing or walking and these changes make overwhelming infections, such as pneumonia, much more likely.

Most persons with Alzheimer's disease can remain at home as long as some assistance is provided by others as the disease progresses. Moreover, throughout much of the course of the illness, individuals maintain the capacity for giving and receiving love, sharing warm interpersonal relationships, and participating in a variety of meaningful activities with family and friends.

A person with Alzheimer's disease may no longer be able to do math but still may be able to read a magazine with pleasure. Playing the piano might become too stressful in the face of increasing mistakes, but singing along with others may still be satisfying. The chessboard may have to be put away, but playing tennis may still be enjoyable. Thus, despite the many exasperating moments in the lives of patients with Alzheimer's disease and their families, many opportunities remain for positive interactions. Challenge, frustration, closeness, anger, warmth, sadness, and satisfaction may all be experienced by those who work to help the person with Alzheimer's disease.

The reaction of a patient with Alzheimer's disease to the illness and his or her capacity to cope with it also vary, and may depend on such factors as lifelong personality patterns and the nature and severity of stress in the immediate environment. Depression, severe uneasiness, paranoia, or delusions may accompany or result from the disease, but these conditions can often be improved by appropriate treatments. Although there is no cure for Alzheimer's disease, treatments are available to alleviate many of the symptoms that cause suffering.

Caring for the caregiver and Alzheimer's disease resources

Caring for the caregiver is an essential element of managing the patient with Alzheimer's disease. Caregiving is a distressing experience. On the other hand, caregiver education delays nursing home placement of Alzheimer's disease patients. The 3Rs -

Repeat,

Reassure, and

Redirect

can help caregivers reduce troublesome behaviors and limit the use of medications. The short-term educational programs are well liked by family caregivers and can lead to a modest increase in disease knowledge and greater confidence among caregivers. Educational training for staffs of long-term care facilities can decrease the use of antipsychotics in Alzheimer's disease patients.

Caregivers should be directed to support services, particularly the Alzheimer's Association (1-800-272-3900, http://www.alz.org/chapter/).

References

Alzheimer's Association.10 Early Signs and Symptoms of Alzheimer's.<http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp>

UpToDate.Clinical manifestations and diagnosis of Alzheimer disease.

UpToDate. Patient information: Dementia (including Alzheimer disease) (Beyond the Basics).

UpToDate. Treatment of dementia.

Excerpt from:
Alzheimer's Disease: Symptoms, Stages, Life-Expectancy