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ALZHEIMER'S DEMENTIA
Our parents are getting old... Could they also get Alzheimer's? What should we do?
NEW TECHNOLOGICAL APPROACHES IN ALZHEIMER'S DIAGNOSIS AND TREATMENT
Dementia is defined as the loss of cognitive function. This includes impairment in thinking, memory, logic, communication, personality, and cognitive speed. The most common types of dementia are Alzheimer's disease and vascular dementia (due to multiple vascular infarctions).
Alzheimer's disease (AD) is the most common form of dementia. It is a progressive and degenerative disease of the brain affecting 5% of people between the ages of 65-74 and 50% of those over 85. There is no single known cause of Alzheimer's disease, but several factors can significantly contribute to its development. Apolipoprotein E variation is a genetic factor associated with the development of this disease. Head trauma can cause Alzheimer's. The most prominent features of the disease are amyloid plaques and tangled neuronal fibers that disrupt the brain's normal organization and function. These first appear in the temporal lobe of the brain, the area responsible for memory and speech. Changes in brain electrical activity are observed in the same areas, with an increase in slow brain waves (theta waves) and a decrease in alpha and beta waves and brain connections. Low levels of education are thought to negatively contribute to Alzheimer's.
**ACCURATE DIAGNOSIS IS IMPORTANT**
**Before dementia fully develops, approximately 12 years before the onset of symptoms, changes in brain electrical activity begin. FDA-approved QEEG and neurometric imaging technology, which examines brain electrical changes, helps physicians in making a preliminary diagnosis with an accuracy rate of over 90%. During this period, the patient may have symptoms similar to those of depression. When memory tests and depression scales are examined, depression and dementia can present with very overlapping symptoms. This can make it difficult to differentiate between the two diseases.** However, QEEG NxLink neurometric analysis can differentiate Depression from Primary Degenerative Dementia with a high accuracy rate of 91.9-92.2%, and Alzheimer's and Vascular Dementia with a high accuracy rate of 95%. This is crucial for finding the correct diagnosis and directing us to the correct treatment. Furthermore, research aimed at slowing the progression of the disease can be prioritized during this period.
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DISAPPOINTMENT IN DRUG TREATMENT
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Alzheimer's drugs are only 50% effective, and some patients experience very serious side effects. Despite investing large sums of money in R&D, pharmaceutical companies have stated that they have been disappointed by the results of research conducted to date and have not achieved the desired outcomes for Alzheimer's disease. Companies, stating that they have not even been able to slow the progression of the disease, announced that research on Alzheimer's drugs is very difficult and costly, and that they will be ending these studies.
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A PROMISING DRUG-FREE TREATMENT: “NEUROFEEDBACK”
We have patients with whom we have achieved successful results with Neurofeedback, which helps reduce the negatively increased slow brain waves in Alzheimer's and strengthens connections, and which we use within the framework of evidence-based medicine in Attention Deficit Hyperactivity Disorder (ADHD). The electrical current disorder in ADHD is similar to that in Alzheimer's patients.
In a double-blind controlled study in 2007, Angelakis et al. showed that Neurofeedback training, which rewards the increase of the dominant alpha frequency, improved cognitive processing speed and executive functions in a small sample of normal aging individuals.
In 2009, Festa et al. at Brown University demonstrated the positive effect of Neurofeedback treatment in 26 normally aging individuals in a randomized controlled trial.
Mexican and Cuban researchers (Becerra et al.) demonstrated the positive effects of neurofeedback treatment in 56 normally aging individuals through a randomized placebo-comparative study.
In the United States, a 2009 dementia study by Berman et al. with 27 subjects showed that neurofeedback training significantly improved memory and some aspects of executive function compared to a waiting list control group, suggesting that neurofeedback could be a "possibly effective" treatment for dementia.
I also believe that QEEG NxLink neurometric analysis, which I use, is very helpful in diagnosis and in selecting neurofeedback treatment protocols, and I will discuss how some of our patients responded positively to neurofeedback in future articles.
NEW TREATMENT HOPE FOR ALZHEIMER'S DISEASE
Slowing down cognitive decline and functional and behavioral deterioration in Alzheimer's disease is crucial. Treatment interventions include both pharmacological and non-pharmacological methods, aimed at slowing disease progression and improving quality of life. Currently, the primary drug treatment thought to slow the progression of dementia is Donepezil. However, this slowdown lasts for a maximum of 6 months within a year.
In our clinic, we have observed that in some Alzheimer's patients whose brainwaves we record, the medications do not correct brainwaves but rather negatively affect them. This supports the need for personalized treatments. Neurofeedback (NF) studies have shown positive results in both normally aging individuals and in dementia, so we have applied it to our patients.
A 72-year-old male patient had been using Donepezil for two years after being diagnosed with Alzheimer's. He stated that the medication did not improve his attention and memory problems, and that his enjoyment of life, daily energy, and sexual energy had significantly decreased. When we examined brain waves under the influence of medication using the NxLink neurometric database, we observed a significant increase in slow theta waves, similar to those in Alzheimer's disease. The patient scored 30 out of 30 on the Brief State Examination Test (MSET). After discontinuing the medication and recording brain waves again 30 days later, we observed a decrease in theta waves. It was clear that the Done Peacock medication, given to improve symptoms, had significantly slowed the brain in this patient. When we repeated the MSET, the patient scored the same 30. With drug-free neurotransmitter treatment, the patient improved significantly and learned that he did not have Alzheimer's disease.
In a 79-year-old male patient diagnosed with Alzheimer's and given Done Peacock and Memantine for two years, we obtained a score of 15 out of 30 on the MSET. A score of 15 indicates a moderate degree of Alzheimer's.
When the patient arrived on medication, they were only able to form sentences using single words, their body movements were very slow, and they were completely dependent on care. They had significantly reduced the things they could do independently. Two days after we stopped all their medication, their family noticed that their movements had become faster, their speech had returned to two- or three-word sentences, and most importantly, for the first time in two years, they were able to wake up in the morning and prepare the table by themselves. This suggests that in some patients, it is necessary to temporarily discontinue medication and monitor them.
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Alzheimer's drugs receive FDA approval when they show a 1.8-point increase in KDMT (Kidney-to-Mouth Disease) compared to placebo. In this patient, I saw a 2-point improvement in KSMT 30 days after stopping the medication, bringing their score to 17. We have obtained similar results in many patients. This means that medication negatively affects some patients more than others. Some studies in the medical literature show that 3 years of using the Alzheimer's drug DoneZepil can create a 3.8-point increase in KDMT.
[Image caption:]
Using Neurofeedback, a drug-free brainwave regulation method, we were able to increase the KDMT (Knowledge, Experience, and Mood) score by an average of 6 points in 20 patients (9 Alzheimer's patients, 11 Vascular dementia) over an average of 3 months. Simultaneously, these patients experienced improved sleep problems, agitation issues, and increased enjoyment of life. The American Sleep Medicine Association declares that Biofeedback is effective in sleep disorders within the framework of evidence-based medicine.
We presented this study orally at the Euroasia Biological Psychiatry scientific meeting in Istanbul in May 2012. Of course, these are data we obtained in the clinic without placebo control. We decided to publish this to demonstrate its effectiveness in controlled studies. This study was published this month (June 2015) in the important scientific journal Clinical EEG and Neuroscience as the first clinical study in the world demonstrating its effectiveness in both Alzheimer's disease and vascular dementia.
QUANTITATIVE EEG (QEEG) ABNORMALITIES OF DEMENTIA
Earlier studies have shown that quantitative EEG (QEEG) abnormalities in dementia are associated with elevated delta and theta power (Duffy, F.H., 1984, Coburn, K.A., 1985, Prichep, L.S., 1994), decreased mean frequency (Saletu, B., 1991; Brenner, R.P., 71), decreased beta power (Soininen, H., 1981; Albert, M.S., 1990; Jackson & Snyder, 2008), decreased occipital dominant frequency (Prinz, P.N., 1989; Williamson, P.C., 1990), and decreased peak alpha frequency (Passant et al., 2005). (Chan et al., 2004).
The Value of QEEG in Clinical Psychiatry: According to the report by the Committee on Research of the American Neuropsychiatric Association (Coburn, 2006), QEEG provides the physician with a definitive laboratory test to differentiate diagnoses of several general neuropsychiatric disorders such as Alzheimer's disease and vascular dementia. (Hughes J.R, et al 1999, Prichep LS et al, 1992, John E. R. et al, 1987, 1989, 1991, 1992; Chabot et al, 1996).
QEEG NxLink neurometric analysis (E. Roy John) differentiates depression from Primary Degenerative Dementia
QEEG Nx-Link neurometric analysis can differentiate Alzheimer's and Vascular Dementia with high precision (91.9%-92.2%) and with high precision (95%), respectively.
QEEG Nx-Link neurometric analysis is a helpful tool that differentiates dementia (Alzheimer's dementia versus Vascular Dementia) and dementia versus depression with high precision (95%), and this can occur in the early or late stages of the disease.
EEG biofeedback (neurofeback) training to normalize abnormal EEG activities can improve memory, attention, orientation, and language scales.
1. Neurofeedback Treatment Guided by Quantitative EEG Neurometric Analysis in Dementia. How is Neurometric Analysis Important in the Treatment of Dementia and as a Biomarker?
In this study, 20 patients with dementia (9 with Alzheimer's type and 11 with vascular dementia) were treated with qEEG training. The Mini Mental Short Memory (MMSE) test, which assesses orientation, registration, attention, calculation, memory, language, and visuospatial abilities, was used as the primary outcome measure. The results showed an average increase of 6 points in MMSE scores in all patients, regardless of dementia type. This is the first time we have shown that the same modality is beneficial in both dementia groups. This study demonstrates that NF treatment is effective in this group regardless of the type of dementia present.
This is particularly important because medications for dementia are only effective in about 50% of patients and can have serious side effects in some patients.
Birks and Harvey reviewed 16 randomized controlled drug trials and showed that when comparing MMSE with placebo groups, Donepezil, a drug used in Alzheimer's, improved cognitive function by approximately 1.5 points after 24 weeks at both 5 and 10 mg/day doses, and by approximately 2 points after 52 weeks at the 10 mg/day dose (MMSE).
Wallin et al. published the results of 3 years of donepezil-based treatment in a routine clinical setting and reported an average change of 3.8 points in MMSE from baseline. Our results showed an average increase of 6 points in MMSE scores, and this change was observed over a treatment period of 1 to 6 months, regardless of the type of dementia. (Surmeli et al., 2016)
A problem we observed in the patients in this study is the use of multiple medications to address the different symptoms the patients might have, reflecting the real world.
Therefore, for cognitive decline, an antidementia medication, an antipsychotic for agitation, and an antidepressant to stabilize mood were prescribed by previous doctors.
Since this is a geriatric population, it is also highly likely that they are taking other medications for comorbid physiological problems (e.g., cardiovascular, hypertension, metabolic, etc.). In this way, all these medications increase the risk of side effects and place an unnecessary burden on an already delicate physiology.
In our study, we were able to discontinue all medications in all patients. Only one patient was given medication for a short period to monitor agitation. At the end of the study, none of the patients required medication, and all observed improvements continued during follow-up visits.
The patients' families noticed an improvement in their mood, anxiety, sleep problems, and agitation. According to the families, the patients became more involved in their daily lives and more productive. These findings were confirmed by us during follow-up interviews.
2. A dementia study with 27 subjects (Berman, M. H., 2009) showed that neurofeedback training significantly improved some aspects of memory and executive function compared to a waiting list control group, suggesting that neurofeedback could be a “possibly effective” treatment for dementia.
3. A recent double-blind controlled study showed that neurofeedback training rewarding an increase in dominant alpha frequency improved cognitive processing speed and executive function in a sample of normally aging elderly individuals. (Angelakis, et al., 2007)
4. Festa et al. at Brown University demonstrated the positive effect of neurofeedback treatment in 26 normally aging individuals using a randomized controlled trial (RCT). They presented their initial findings at the Cognitive Neuroscience Society Annual Meeting Program in 2009. http://stresstherapysolutions.com/kb/entry/41/
5. Researchers from Mexico and Cuba demonstrated the positive effect of neurofeedback treatment in 14 normally aging individuals using a randomized sham neurofeedback (placebo) versus neurofeedback controlled study (Becerra J. et al. 2011).
Predicting Alzheimer's Disease:
Psychiatrists Can Predict the Onset of Alzheimer's Disease with a New Test
March 1, 2006 - Using new software that analyzes EEG data and looks at differences between the right and left sides of the brain, psychiatrists can now better distinguish Alzheimer's disease from normal aging. Early diagnosis of Alzheimer's disease is crucial because new drugs can now slow the progression of the disease. This new method is better than MR or PET scans used for the same diagnosis.
More cheap and less invasive
NEW YORK – Alzheimer's disease is a devastating illness affecting 4 million Americans and their families. Do you want to know if you might develop Alzheimer's in the future? Now, a new addition to an old test can tell you and your relatives the likelihood of developing this mind-altering disease.
Beth Senicola and her sister Dianne Burke have a mother with Alzheimer's. They remember her as someone who loved to travel and be active. But now 94, their mother has been battling Alzheimer's for eight years. “The hardest part is seeing your mother and her not knowing who you are,” says Beth.
The two sisters are having a standard EEG, part of the new test, to predict whether they will develop Alzheimer's in the future.
According to Leslie Prichep, assistant director of the Brain Research Laboratory at the Department of Psychiatry at New York University School of Medicine, “We compare the numbers derived from the analysis to the numbers expected for that person’s age to move from the wavy lines to the description of events.”
Using computer software that converts EEG scans into numbers, psychiatrists can more easily distinguish normal aging from early signs of dementia. For example: the left and right sides of the EEG on the left are normal in size and shape, and similar regions resemble each other, implying the absence of dementia. But the right EEG shows significant differences between the left and right sides – indicating the possibility of future dementia. Prichep says this is noteworthy because there are now medications that stop or slow the progression of dementia. Beth is having the test done so that her children don’t go through what she went through. She wants to have the opportunity to change the future.
Currently, MRI and PET scans can detect future dementia, but these methods are both more invasive and more expensive. A seven-year NYU study revealed that the software has a 95% accuracy rate in detecting decline [in brain function]. Researchers are expanding the study by processing thousands of elderly patients' records in their databases through the new software.
HISTORY: A new study shows that the earliest signs of Alzheimer's, the time when the first signs of memory loss begin, can be screened more cheaply, without discomfort, and more easily with EEG combined with software. Early detection of the disease could give treatment a chance to slow down or stop the transition from memory loss to dementia.
HOW IT WORKS: An electroencephalogram (EEG) measures the electrical activity of the brain. Electrical signals from electrodes attached to the skin are recorded and analyzed by a computer. Because the electrical signals of brain cells are very weak, the instrument amplifies them more than a thousand times to be able to see the brain's electrical rhythms and patterns. To a non-expert, an EEG looks like a bunch of convoluted lines, but these lines are a mathematical description of how the strength and frequency of electrical signals change over time.
WHAT WAS FOUND: NYU researchers were able to identify which EEG lines are associated with normal aging and which indicate dementia and early Alzheimer's. Using this information, they developed computer software to help doctors see the same patterns. Their method can identify with 95% accuracy who will and will not experience a decline in brain function. For example, theta brainwaves were much more prominent in those at high risk of mental decline compared to those who will not, and this wave is particularly abnormal in the frontal parts of the brain. Theta brainwaves originate from the hippocampus, and this region is affected by dementia.
WHAT'S IN THE FUTURE: This new EEG method will likely become an important tool in assessing the likelihood of someone having Alzheimer's disease. But before that happens, NYU's results need to be replicated in larger studies with similar results so that the method can be validated for general use. This need for reproducibility and repeated testing is fundamental to the scientific method.
NOTE: After all validation studies of this method were completed, the software and its associated database were submitted to and approved by the U.S. Food and Drug Administration (FDA).
Source:
https://www.cbsnews.com/news/simple-test-may-spot-alzheimers/
http://weeksmd.com/2008/01/eeg-testing-can-predict-alzheimers-risk/
http://www.milliyet.com.tr/yazarlar/dr-tanju-surmeli/alzheimer-da-yeni-tedavi-umudu-1747221/
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