- Email: [email protected]
O1-03-02
Oral O1-03-01: Intervention and Treatments 1 of the major tau kinase, GSK3. This is predicted to limit A oligomerinduced cognitive deficits and tau pathology. GSK3 inhibition blocked A oligomer-induced JNK and cognitive deficits in oligomer-infused rats. DHA reduced A accumulation in APP Tg mice by a novel mechanism involving APP sorting. APP Tg mice on the high n-6 diet have highly significant loss of the actin-regulatory dendritic spine protein, drebrin. We argue that oligomer-induced drebrin-related defects play a critical role in initiating cognitive deficits. AD clinical trial results found that DHA (as fish oil) had little impact on cognitive decline in established AD patients, but might have been effective at the earliest stages (MMSE ⬎27). Major region-specific drebrin loss has been reported to begin in MCI with a sharp fall-off at very early stages of AD (MMSE⬎26) -without further progression. Conclusions: DHA can limit A production in vivo by a novel mechanism. Oligomer-induced dendritic spine loss is reflected in drebrin loss and should be a major target. Because it occurs very early, treatments that may mitigate oligomer-induced postsynaptic pathology, including DHA intervention, should begin very early, either in MCI or with primary prevention. SUNDAY, JUNE 10, 2007 ORAL O1-03 INTERVENTION AND TREATMENTS 1 O1-03-01
THE ROLE OF DIETARY SUPPLEMENTS AND HERBS IN THE TREATMENT AND PREVENTION OF ALZHEIMER’S DISEASE
Patrick Massey, Alexian Village (WI)/Alexian Brothers Hospital Network (IL), Elk Grove Village, IL, USA. Contact e-mail: [email protected] Background: Americans often use complementary and alternative medicine with some estimates exceeding 60%. Herbs and dietary supplements, such as gingko biloba and huperazine A, are often used as a way to enhance memory and cognition and as a way to possibly prevent dementia. There is a growing body of research that select dietary supplements may indeed help memory and cognition. However, patients and family members rarely reveal dietary supplement use to their physicians and other health care providers and safety and drug interactions are a concern. Unfortunately most health care providers’ knowledge of dietary supplements is limited. As a result, positive research on dietary supplements is rarely incorporated into Alzheimer’s disease programs. Some programs have integrated both conventional and unconventional medical therapies with acceptance from both medical providers and community. Objective(s): To discuss the expanding research on dietary supplements and dementia with a focus on efficacy and safety. To discuss how to integrate the use of dietary supplements into a comprehensive program for the prevention and treatment of Alzheimer’s disease. To discuss the increasing request for dietary supplements by the community at large and how this impacts medical providers. To discuss how to determine selection of specific supplements based on external reviews and manufacturing standards. Methods: Literature review as well as results of published clinical research. Results: Increased understanding about the expanding research on dietary supplements and dementia with a focus on efficacy and safety. Increased understanding of how to integrate the use of dietary supplements into a comprehensive program for the prevention and treatment of Alzheimer’s disease. Increased understanding about dietary supplements by the community at large and how this impacts medical providers. Increased understanding of how to determine quality supplements based on external reviews and manufacturing standards. Conclusions: The options for Alzheimer’s disease treatment and prevention are extremely limited. New drugs in development may take years before general clinical use. Select dietary supplements may present immediate beneficial additions to medical therapy. In addition, dietary supplement use in the US is increasing and health care providers need to have a greater understanding about their potential and limitations.
O1-03-02
S171
COMPUTER BASED COGNITIVE TRAINING WITH MINDFIT® IMPROVED COGNITIVE PERFORMANCES ABOVE THE EFFECT OF CLASSIC COMPUTER GAMES: PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND INTERVENTION STUDY IN THE ELDERLY
Amos D. Korczyn1, Chava Peretz2, Vered Aharonson3, Nir Giladi2, 1 Sackler School of Medicine, Tel-Aviv University and NexSig Israel, TelAviv, Israel; 2Tel-Aviv Medical Center, Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel; 3Tel-Aviv University, NexSig Israel, Tel-Aviv, Israel. Contact e-mail: [email protected] Background: Computer games training can improve cognitive performances (CP). Objective: To compare the effects of home-training with the recently developed MindFit® computer based package (CogniFit LTD, Israel) to classic computer games on CP in elderly people. Method: Self-referred volunteers, aged 50⫹, were randomly assigned to practice at home (3 months, 3 times a week for half an hour each session) with MindFit® package or with pre-chosen classic computer games. CP was assessed blindly at baseline and after 3 months by the computerized neuropsychological battery, NexSig®. Linear models were used to evaluate the differences in CP scores between and within groups. Results: 121 people completed the protocol (34 dropped out during training): 66 in the Mindfit® group and 55 in the games group), which were similar in baseline characteristics. The MindFit® group improved significantly in total NexSig® score (p⬍.0001) and in all 8 sub-scores (p⬍.0031 in 7 sub-scores) while the games-group improved in total NexSig® score (p⫽.0146) and in 5 sub-scores (p⬍.0472). The MindFit® training group achieved higher post intervention total score, compared to the games group (p⫽.0817), especially in subjects with lower baseline CP (baseline scores modified the training effect). MindFit® training had a significant superiority in 3 cognitive domains: spatial short term memory (p⫽.0001), visuo-spatial learning (p⫽.0012) and focused attention (p⫽.0019). Conclusions: Computerized cognitive training with MindFit® was better than classic computer games for improving cognitive abilities. These results demonstrate that home training with a specially designed computer-based program can improve several cognitive domains which have an important role in daily life such as driving. People with lower baseline CP gained more than those with normal cognition, thus demonstrating the potential therapeutic effect of home based computer games training in the elderly. Future studies should specifically assess the role of home based cognitive training on the rate of cognitive decline and the long term carry over effect. O1-03-03
HOME VISITS MAY IMPROVE RECRUITMENT IN AD CLINICAL TRIALS
Jason HT Karlawish, Mark S. Cary, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Academic and pharmaceutical investigators need research on how redesigning clinical trials (RCTs) might increase willingness to participate (WTP) among potential participants and their caregiver-knowledgeable informants (KIs) to meet the challenge of recruiting and retaining sufficient participants to complete trials on time. Objective: We used the marketing research technique of conjoint analysis to identify how alterations in 4 attributes of RCT design impact WTP: risk, home visits for a subset of study appointments, a car service to the study site, or increased (67-33) chance of receiving active treatment. Method: 108 KIs of community dwelling, very mild to severe stage AD patients were asked to rate their WTP on a 7 point scale for 8 RCTs that varied combinations of the 4 attributes. The fractional factorial design measured main effects and the interaction between home visits and a car service. Results: The highest utility was for home visits (0.89) which essentially compensated for the disutility of a high risk trial (-0.85). The combination of home visits and a car service was redundant, with almost no increase in utility over home visits alone. Table 1 shows predicted WTP for the various combinations of
THE ROLE OF DIETARY SUPPLEMENTS AND HERBS IN THE TREATMENT AND PREVENTION OF ALZHEIMER’S DISEASE
Patrick Massey, Alexian Village (WI)/Alexian Brothers Hospital Network (IL), Elk Grove Village, IL, USA. Contact e-mail: [email protected] Background: Americans often use complementary and alternative medicine with some estimates exceeding 60%. Herbs and dietary supplements, such as gingko biloba and huperazine A, are often used as a way to enhance memory and cognition and as a way to possibly prevent dementia. There is a growing body of research that select dietary supplements may indeed help memory and cognition. However, patients and family members rarely reveal dietary supplement use to their physicians and other health care providers and safety and drug interactions are a concern. Unfortunately most health care providers’ knowledge of dietary supplements is limited. As a result, positive research on dietary supplements is rarely incorporated into Alzheimer’s disease programs. Some programs have integrated both conventional and unconventional medical therapies with acceptance from both medical providers and community. Objective(s): To discuss the expanding research on dietary supplements and dementia with a focus on efficacy and safety. To discuss how to integrate the use of dietary supplements into a comprehensive program for the prevention and treatment of Alzheimer’s disease. To discuss the increasing request for dietary supplements by the community at large and how this impacts medical providers. To discuss how to determine selection of specific supplements based on external reviews and manufacturing standards. Methods: Literature review as well as results of published clinical research. Results: Increased understanding about the expanding research on dietary supplements and dementia with a focus on efficacy and safety. Increased understanding of how to integrate the use of dietary supplements into a comprehensive program for the prevention and treatment of Alzheimer’s disease. Increased understanding about dietary supplements by the community at large and how this impacts medical providers. Increased understanding of how to determine quality supplements based on external reviews and manufacturing standards. Conclusions: The options for Alzheimer’s disease treatment and prevention are extremely limited. New drugs in development may take years before general clinical use. Select dietary supplements may present immediate beneficial additions to medical therapy. In addition, dietary supplement use in the US is increasing and health care providers need to have a greater understanding about their potential and limitations.
O1-03-02
S171
COMPUTER BASED COGNITIVE TRAINING WITH MINDFIT® IMPROVED COGNITIVE PERFORMANCES ABOVE THE EFFECT OF CLASSIC COMPUTER GAMES: PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND INTERVENTION STUDY IN THE ELDERLY
Amos D. Korczyn1, Chava Peretz2, Vered Aharonson3, Nir Giladi2, 1 Sackler School of Medicine, Tel-Aviv University and NexSig Israel, TelAviv, Israel; 2Tel-Aviv Medical Center, Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel; 3Tel-Aviv University, NexSig Israel, Tel-Aviv, Israel. Contact e-mail: [email protected] Background: Computer games training can improve cognitive performances (CP). Objective: To compare the effects of home-training with the recently developed MindFit® computer based package (CogniFit LTD, Israel) to classic computer games on CP in elderly people. Method: Self-referred volunteers, aged 50⫹, were randomly assigned to practice at home (3 months, 3 times a week for half an hour each session) with MindFit® package or with pre-chosen classic computer games. CP was assessed blindly at baseline and after 3 months by the computerized neuropsychological battery, NexSig®. Linear models were used to evaluate the differences in CP scores between and within groups. Results: 121 people completed the protocol (34 dropped out during training): 66 in the Mindfit® group and 55 in the games group), which were similar in baseline characteristics. The MindFit® group improved significantly in total NexSig® score (p⬍.0001) and in all 8 sub-scores (p⬍.0031 in 7 sub-scores) while the games-group improved in total NexSig® score (p⫽.0146) and in 5 sub-scores (p⬍.0472). The MindFit® training group achieved higher post intervention total score, compared to the games group (p⫽.0817), especially in subjects with lower baseline CP (baseline scores modified the training effect). MindFit® training had a significant superiority in 3 cognitive domains: spatial short term memory (p⫽.0001), visuo-spatial learning (p⫽.0012) and focused attention (p⫽.0019). Conclusions: Computerized cognitive training with MindFit® was better than classic computer games for improving cognitive abilities. These results demonstrate that home training with a specially designed computer-based program can improve several cognitive domains which have an important role in daily life such as driving. People with lower baseline CP gained more than those with normal cognition, thus demonstrating the potential therapeutic effect of home based computer games training in the elderly. Future studies should specifically assess the role of home based cognitive training on the rate of cognitive decline and the long term carry over effect. O1-03-03
HOME VISITS MAY IMPROVE RECRUITMENT IN AD CLINICAL TRIALS
Jason HT Karlawish, Mark S. Cary, University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Academic and pharmaceutical investigators need research on how redesigning clinical trials (RCTs) might increase willingness to participate (WTP) among potential participants and their caregiver-knowledgeable informants (KIs) to meet the challenge of recruiting and retaining sufficient participants to complete trials on time. Objective: We used the marketing research technique of conjoint analysis to identify how alterations in 4 attributes of RCT design impact WTP: risk, home visits for a subset of study appointments, a car service to the study site, or increased (67-33) chance of receiving active treatment. Method: 108 KIs of community dwelling, very mild to severe stage AD patients were asked to rate their WTP on a 7 point scale for 8 RCTs that varied combinations of the 4 attributes. The fractional factorial design measured main effects and the interaction between home visits and a car service. Results: The highest utility was for home visits (0.89) which essentially compensated for the disutility of a high risk trial (-0.85). The combination of home visits and a car service was redundant, with almost no increase in utility over home visits alone. Table 1 shows predicted WTP for the various combinations of