Alzheimer's Association Highlights Special JAMA Aging Issue: Neurology Study on Wine and Alzheimer's Disease 11/12/2002
From: Elizabeth Wilson, 312-335-4078 e-mail: elizabeth.wilson@alz.org Bonnie Hogue, 202-393-7737, e-mail: bonnie.hogue@alz.org, both of the Alzheimer's Association or Scott Triebetz of Tricom Associates, Inc. 703-276-2772 e-mail: scott@tricomassociates.com CHICAGO, Nov. 12 -- Two leading scientific journals are releasing Alzheimer-related studies this week. The Wed., Nov. 13 issue of the Journal of the American Medical Association (JAMA) is dedicated to aging and the November issue of Neurology has an article assessing whether amount or type of alcohol use is associated with risk of dementia. The Alzheimer's Association and its national network of chapters, is the largest national voluntary health organization dedicated to advancing Alzheimer's research and helping those affected by the disease. Having awarded $136 million in research grants, the Association ranks as the top private funder of research into the causes, treatments, and prevention of Alzheimer's disease. The Association also provides education and support for people diagnosed with the condition, their families and caregivers. FROM JAMA: "Alzheimer's Disease 'It's Okay, Mama, If You Want to Go, It's Okay'" -- is a comprehensive view of end-of-life issues framed in the context of one family's story of the decline and death of their mother from Alzheimer's. The article presents an in-depth look at the decision-making process as care needs change, including preparing for lack of decision-making capacity, preparing for progressive decline, community care, the move to a nursing home, nutrition and hydration, and management of late-stage care including hospice. Ladislav Volicer, M.D., Ph.D., co-author of the article, is a member of the Alzheimer's Association's Ethics Advisory Panel. While the Association did not fund this research, it has funded previous work by Volicer. -- An early discussion of peaceful dying and other end-of-life issues should occur between family, caregivers and the individual with Alzeimer's as soon after diagnosis as possible. The individual with Alzheimer's and his or her family should discuss what to expect as the disease progresses and allow the individual with Alzheimer's to express his or her wishes for end of life care. Though this is a hard conversation to have, the article demonstrates how not having these conversations makes the final decisions for the family more painful and difficult than they might have been otherwise. -- Feeding tubes should not be considered the standard of care for Alzheimer's patients. The article addresses the many difficulties involved in feeding patients with dementia but emphasizes that natural feeding should be maintained. In Alzheimer's disease "tube feeding does not prevent aspiration, improve function or quality of life, increase comfort, or promote weight gain." In addition, tube feeding results in "decreased pleasure from eating, less human contact, and, frequently, the need to use restraints to prevent the patient from removing the tube." -- The economic and social impact of Alzheimer's disease is enormous. According to the article, "Family caregiving can distress and disable caregivers causing intense physical, emotional and financial burden, yet families provide unpaid care for AD valued at $65 billion per year. ... Medicare expenses for persons with AD are 70 percent higher than for other beneficiaries." -- Medicare needs to be improved to meet the health care needs of beneficiaries with chronic health conditions such as Alzheimer's disease. In addition, Congress should make changes to ensure access for people with Alzheimer's disease to appropriate hospice and palliative care at the end of life. -- Research that leads to better treatment and prevention of this disease is the best hope of alleviating this economic and social burden. "Vitamin E and C Supplements and the Risk of Dementia" is a short report on a population-based study of Japanese-American men followed up since 1965-68 as part of the Honolulu Heart Program. The study concludes that there is no decreased risk of dementia in this population as a result of taking Vitamin E and C supplements. -- Though other observational studies have shown an association between higher intake of vitamins E and C and a decreased risk of dementia, it is not surprising that there are also studies of this kind that do not show this association. The effect of Vitamin E on dementia is currently being investigated as one part of a larger ongoing controlled study of memory impairment. Results from this study may provide a clearer explanation of Vitamin E's impact on dementia. -- More clinical trials are necessary to determine whether many drugs showing promise in epidemiological studies are truly useful. Clinical trials are expensive and will require increased federal funding for NIH. -- This study underscores how critical it is for Congress to increase Alzheimer's disease research funding to $1 billion as soon as possible and to enact the appropriations bills this year. A failure by Congress to act this year on the Labor-HHS research appropriations, the bill that funds Alzheimer research, will slow progress toward finding the answers for people with Alzheimer's. "Effects of Cognitive Training Intervention With Older Adults" is a randomized controlled trial of older adults (aged 65-94) without dementia in which participants were offered cognitive training, including training in memory, reasoning and speed of processing, and then tested two years later to see if the improvements in these measures held. The researchers found that subjects retained the cognitive improvements gained in training, though there was no evidence that there was any impact on their ability to perform daily tasks. -- This study included only adults with no cognitive impairment and does not address Alzheimer's disease. -- This study shows a training effect but does not address improvements in everyday functioning or decreases in cognitive decline. -- This is a good study by a quality research group that serves to illustrate how difficult this kind of study is to conduct. A very long-term study, of 15 years or more with a large sample size, may be needed to address the question of the effects of cognitive training on the daily lives or development of cognitive impairment in older adults. FROM NEUROLOGY: "Amount and type of alcohol and risk of Dementia" is a study that included 1709 participants, aged 65 and older, in the Copenhagen City Heart Study, who were screened with the Mini-Mental State Examination at entry and examined for dementia fifteen years later. Eighty-three subjects were diagnosed with dementia. Type and extent of alcohol use was assessed on the basis of interviews at the beginning of the study. The researchers found that monthly intake of beer was associated with increased risk of dementia, while monthly intake of red wine was associated with decreased risk of dementia. Amount of alcohol use seemed to have no effect on risk. The researchers speculated that the presence in red wine of flavonoids, which are known to have an anti-oxidative activity, accounted for the decreased risk. -- This study suggests that the anti-oxidative elements in red wine may be responsible for the reduced risk of dementia. -- Observational studies of alcohol consumption are often conflicting. Such studies are dependent on self-reported behaviors and may contain a variety of errors. In addition, because development of Alzheimer's may be the result of a combination of genetic and behavioral factors, the effect of one factor like alcohol consumption may be minimal and difficult to determine. -- Studies on the risks of alcohol use are difficult to compare because of differences in design. -- It would be inappropriate to make broad public health recommendations on the basis of an observational study like this. Further, the public health impact of recommending alcohol consumption is unpredictable. |