Monday, October 23, 2006

Self-portraits of an Artist with Dementia

From The New York Times:

Self-Portraits Chronicle a Descent Into Alzheimer’s
By DENISE GRADY
The New York Times
Published: October 24, 2006

When he learned in 1995 that he had Alzheimer’s disease, William Utermohlen, an American artist in London, responded in characteristic fashion.

“From that moment on, he began to try to understand it by painting himself,” said his wife, Patricia Utermohlen, a professor of art history.

Mr. Utermohlen’s self-portraits are being exhibited through Friday at the New York Academy of Medicine in Manhattan, by the Alzheimer’s Association.

The paintings starkly reveal the artist’s descent into dementia, as his world began to tilt, perspectives flattened and details melted away. His wife and his doctors said he seemed aware at times that technical flaws had crept into his work, but he could not figure out how to correct them.

“The spatial sense kept slipping, and I think he knew,” Professor Utermohlen said. A psychoanalyst wrote that the paintings depicted sadness, anxiety, resignation and feelings of feebleness and shame.

Dr. Bruce Miller, a neurologist at the University of California, San Francisco, who studies artistic creativity in people with brain diseases, said some patients could still produce powerful work.

“Alzheimer’s affects the right parietal lobe in particular, which is important for visualizing something internally and then putting it onto a canvas,” Dr. Miller said. “The art becomes more abstract, the images are blurrier and vague, more surrealistic. Sometimes there’s use of beautiful, subtle color.”

Mr. Utermohlen, 73, is now in a nursing home. He no longer paints.

[ ... Read the full article, with slide show ... ]

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From the website of The New York Academy of Medicine:

Art Exhibition: The Later Works of William Utermohlen

Location: The New York Academy of Medicine, Presidents Gallery

In 1995, the artist William Utermohlen was diagnosed with Alzheimer’s disease. It was then he embarked on a series of self-portraits that poignantly and powerfully depict his journey living with the disease. This exhibition showcases these later works where one can see the artist’s attempts to stay connected to the world around him while he loses the ability to communicate in other ways. His work remains a testimony to the creative and human spirit that resides in all people living with dementia. The exhibition is being hosted by the Alzheimer’s Association, New York City Chapter, and supported by Myriad Pharmaceuticals, Inc. A companion evening lecture event—Portraits & Promises in Alzheimer’s Disease—will be held on October 25, 2006.

The exhibition is free to the public and open daily from 9:00 AM to 5:00 PM from Sunday, October 22, to Friday, October 27, 2006.

For more information and to register contact Donald Morcone (212)822-7272, dmorcone@nyam.org

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Anthony H. Risser | |

Saturday, October 21, 2006

FDA: Alzheimer Disease, Aricept (donepezil hydrochloride)

From the FDA last week:

FDA Approves Expanded Use of Treatment for Patients With Severe Alzheimer's Disease
FOR IMMEDIATE RELEASE
P06-168
October 13, 2006

Media Inquiries:
Susan Cruzan, 301-827-6242
Consumer Inquiries:
888-INFO-FDA

The Food and Drug Administration (FDA) today approved Aricept (donepezil hydrochloride) for the treatment of severe dementia in patients with Alzheimer's Disease.

Aricept was previously approved for the treatment of mild to moderate dementia of the Alzheimer's type.  It now becomes the first product approved for the treatment of all degrees of severity of the disease.

 "Alzheimer's Disease is a devastating, age-associated brain disorder that affects an estimated 4.5 million Americans -- and, as our population grows older, this number is expected to multiply," said Dr. Steven Galson, director of the Center for Drug Evaluation and Research. "Today's approval makes available another treatment for those with severe dementia."

FDA approved Aricept to treat patients with mild to moderate Alzheimer's Disease ten years ago after two clinical trials demonstrated that patients receiving the drug performed better than patients who received placebo. Today's approval is based on two additional randomized, placebo-controlled, 24-week clinical studies conducted in Sweden and Japan in more than 500 patients with severe Alzheimer's Disease.

In these studies, the effectiveness of treatment with Aricept was determined by evaluating the patients' cognitive functions such as memory, language, orientation and attention, as well as their overall functioning. The results showed that patients on Aricept performed better on both measures compared to placebo.

Aricept is manufactured by Eisai Inc., Teaneck, N.J.

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Anthony H. Risser | |

Brain Fiction

In the past two years there have been quite a number of fictional works dealing with the brain and its disorders.

I just found a new entry to that niche area of fiction in one of my neighborhood bookstores this afternoon: The Echo Maker by Richard Powers (FSG Press). The condition, Capgras. The dedication page, a quote by Luria.

Powers has done some remarkable fiction with the intertwine of Glenn Gould's recordings of Bach's Goldberg Variations and DNA in the massive The Gold Bug Variations and with medical science, artificial intelligence, and virtual reality in other works.

Thursday, October 19, 2006

Alzheimer Disease: New Clinical Trial Foci

From an NIH press release from 18 October 2006: 

New Alzheimer’s Clinical Trials To Be Undertaken by NIA Nationwide Consortium

The Alzheimer’s Disease Cooperative Study (ADCS), a federally-established consortium conducting clinical trials on Alzheimer’s disease (AD), will receive $52 million over six years to conduct several new trials, the National Institutes of Health (NIH) announced today. The award is a cooperative agreement between the NIH’s National Institute on Aging (NIA) and the University of California, San Diego (UCSD), which coordinates the consortium of nearly 70 sites in the United States and Canada.

The purpose of the award is to test drugs for their effectiveness in slowing down the progression or treating the symptoms of AD, as well as to investigate new methods for conducting dementia research. Specifically, researchers will focus on possible therapies aimed at affecting the beta amyloid peptide and the tau protein, both involved in the development of AD.

“We have learned a great deal from basic and observational research about how Alzheimer’s and other neurodegenerative diseases develop,” says Richard J. Hodes, M.D., Director of the NIA. “The consortium’s work will translate this knowledge in clinical trials of interventions that target the mechanisms underlying Alzheimer’s disease.”

Among the new studies to be undertaken are:


Docosahexaenoic Acid (DHA) — This trial will examine whether treatment with DHA, an omega-3 fatty acid found in fish, will slow decline in AD. Observational studies associate high fish consumption with reduced risk of AD in people, and studies in mouse models of AD show that dietary DHA reduces brain levels of beta amyloid, oxidative damage associated with beta amyloid, and neurotoxicity.


Intravenous Immunoglobulin (IVIg) — There is increased interest in passive immunization strategies against AD. IVIg contains naturally-occurring antibodies against beta amyloid, and preliminary studies have shown that IVIg may improve cognition. In addition, research has demonstrated that IVIg increased levels of anti-beta amyloid antibodies in plasma and promoted clearance of beta amyloid from cerebrospinal fluid. The new ADCS trial will more definitively demonstrate whether IVIg is useful clinically for treating AD.

Lithium — The biological activity of lithium, which has been shown in animal models to block abnormal changes in tau, has created interest in lithium as a novel treatment for AD. ADCS investigators will undertake a pilot biomarker study to see whether the drug can lower tau and beta amyloid levels in cerebrospinal fluid and be safely tolerated in older AD patients.

Home-Based Assessment — Older individuals, particularly the very elderly, may have physical, social and health limitations that make it difficult for them to take part in research trials. This study, conducted in people aged 75 and older, will examine the use of mail-in questionnaires, automated telephone technology and computerized data collection to assess cognitive, functional, and other factors in the home environment to see how home-based assessments might be used in primary prevention trials. Such an approach could significantly reduce the cost and increase the feasibility of participation in these long-term, costly clinical trials.



These projects join ongoing ADCS trials testing whether statins and high-dose folate/B6/B12 supplements can slow the clinical signs of AD, as well as a study of valproate to determine whether this drug can either slow decline or help delay the agitation and psychosis that often emerge in AD patients.

Leon Thal, M.D., chair of the Department of Neurosciences at the UCSD School of Medicine and principal investigator of the ADCS, notes that the selection of compounds for testing was enhanced by seeking ideas from the biotechnology sector as well as from individual investigators and the consortium’s members. “We have been able to bring together a larger universe of people studying therapies for Alzheimer’s, and I think this group of studies reflects new thinking in how to approach the disease,” he says.

This ADCS consortium was first established in 1991 as an infrastructure of leading researchers to carry out clinical trials for promising new therapies for AD. Investigators have tested such compounds as vitamin E, the anti-Parkinson’s disease drug selegiline, estrogen, anti-inflammatories and donepezil for their potential in slowing down or preventing cognitive impairment and/or dementia. Recently, positive but limited effects have been shown in slowing the development of dementia with donepezil.

To date, approximately 4,600 people have participated in the ADCS studies. Neil Buckholtz, Ph.D., who leads the federal government’s partnership with the consortium as chief of the Dementias of Aging Branch of the NIA, recognized the efforts of the study participants and their families. “Participating in research takes time and dedication, and the efforts of the participants and their families stand out,” Buckholtz notes. “We are deeply grateful for their help in finding new and better ways to treat and prevent Alzheimer’s disease.” As the new round of trials gets underway, stepped up public participation will be essential for their success, Buckholtz says, and he urges the public to learn more about how to take part in such research. (See information, below)

Alzheimer’s disease affects an estimated 4.5 million people in the U.S. It increases dramatically with age, affecting approximately 40-50 percent of people age 85 and older. The numbers of people with AD are expected to rise dramatically with the aging of the population over the next few decades.

The NIA, one of 27 institutes and centers at the NIH, is part of the U.S. Department of Health and Human Services. It leads the federal effort to support and conduct basic, clinical, and social and behavioral studies on aging generally and AD specifically. NIA supports the Alzheimer’s Disease Education and Referral (ADEAR) Center, which provides information on clinical studies and other research to the public, health professionals, and the media. ADEAR can be contacted toll-free at 1-800-438-4380 or by viewing www.nia.nih.gov/alzheimers.

As the studies mentioned above move forward, more information will be available at the ADEAR website about participation. NIA invites the public to sign up for e-mail alerts, which will let subscribers know when trials begin recruitment and generally when new information about AD is available.

A list of the 35 primary ADCS sites appears on the NIA website at website.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit nih.gov.

Sleep Deprivation and Learning

From the Science website:

Asleep at the Memory Wheel

By Greg Miller
ScienceNOW Daily News

18 October 2006

ATLANTA, GEORGIA--Going a night without sleep may cause your hippocampus to go on strike. A new study has caught this crucial memory-encoding brain region slacking off in college students the day after they've pulled an all-nighter. The study is one of the first to investigate how sleep deprivation interferes with memory mechanisms in the human brain.

Neuroscientist Matthew Walker of Harvard University and his colleagues paid 10 undergraduate students to forgo a night's sleep. The next day, the students viewed a series of 30 words, and two days later--after having two nights to catch up on their sleep--the students returned to the lab and took a test to see how well they remembered the words they'd seen.

The students recalled about 40% fewer words overall than a group of 10 students who had slept normally, Walker reported here yesterday at the annual meeting of the Society for Neuroscience. But the researchers also found that the emotional content of the words made a big difference in what people remembered. Previous studies have found that both positive and negative emotions bolster memory, but in the current study, negatively charged words (such as cancer or jail) seemed to penetrate the sleep-deprived brain more deeply than positive ones (such as happy or sunshine). Indeed, sleep-deprived students were only 19% worse than their well-rested counterparts at remembering negative words, but 59% worse
for positive words. Walker suspects the difference may reflect an evolutionary safeguard against forgetting potential threats.

[ ... Read the full article ... ]