University Alzheimer Center Refunded for Five Years by the National Institutes of Health

We are pleased to announce that the University Alzheimer Center has been awarded a five year grant for $10.6 million dollars from the National Institutes of Health (NIH) under the leadership of our Center Directory, Dr. Karl Herrup. We are proud to be the only federally funded center in the state of Ohio, specifically designated by the National Institute on Aging as an Alzheimer's Disease Research Center. This grant is quite significant, for it demonstrates the strength of our Center, which has been funded through grants from the NIH since 1988. "It is particularly gratifying to me as a new Center Director to receive such a strong statement of endorsement from the National Institutes of Health for the new programs and initiatives that are outlined in our proposal. It also speaks clearly of the consistently strong reputation that our Center enjoys at the national and international level," Dr. Herrup said.

The mission of the University Alzheimer Center is to promote the best possible care to persons with Alzheimer's disease and other related disorders and their families through an integrated program of clinical services, research, and education. The grant will support a variety of core facilities whose purpose is to facilitate and encourage a variety of research activities. In addition, the grant also contains funds for four new independent research projects. In future editions of the "Research Register" we will be highlighting each core activity as well as the individual research projects. The University Alzheimer Center not only carries out memory and aging studies in Northeastern Ohio, but also collaborates with researchers across the country and throughout the world.

Our researchers and clinicians are at the forefront in providing help in the present and hope for the future for all those affected by Alzheimer's disease and related disorders: the persons affected, as well as their caregivers, family members, and friends. In our new funding cycle each of us here at the Center has recommitted him or herself to our work and to you, our volunteers, who are at the heart of our mission and who have made our success possible.

Alzheimer's Association Memory Walk 2000

Please join the University Alzheimer Center in supporting the Alzheimer's Association Memory Walk 2000! There are three locations to choose from:

• Sunday, October 8, Memory Walk-Run at the Cleveland Metroparks Zoo
• Sunday, October 8, Lorain County Memory Walk at the Woolybear Festival
• Saturday, October 14, Eastern Counties Memory Walk at Lake Erie College in Painesville

For additional information, call the Memory Walk Hotline: 1-800-441-3322 OR 216-721-8457

Alzheimer's Disease in the News

Dr. David Geldmacher, the Alzheimer Center's Clinical Director, responds to recent stories in the news about Alzheimer's disease research.

Headline: "Estrogen No Benefit in Alzheimer's Study." (The Plain Dealer, February 23, 2000)

Summary: University of California-Irvine researchers reported in the Journal of the American Medical Association that taking either low or high doses of estrogen daily for 12 months produced no sustained improvement compared to women who got an inactive pill. The study, supported by the National Institute of Aging, involved 120 women who had hysterectomies from 32 sites around the nation.

Response: This study illustrates the need for replication in scientific studies. Strong evidence had suggested that estrogen might delay or reduce the risk of Alzheimer's disease. However, when tested in people who already had Alzheimer's disease, it had no effect. How can this be? The early studies looked at hundreds of people over decades to find a small effect. In individuals, studied over one year, the effect is too small to measure, and therefore may not be clinically meaningful.

Headline: "Scanning Device May Aid Fight against Alzheimer's Disease" (The Plain Dealer, June 20, 2000)

Summary: Researchers reported in the Proceedings of the National Academy of Science that they have developed a molecule that can pass out of blood vessels into the brain to mark plaque buildups. Amyloid plaques, which appear in the brains of people with Alzheimer's disease, are believed to contribute to the decline of brain function. Presently, they can be confirmed only during an autopsy.

Response: This preliminary study reveals evidence that we may someday be able to see Alzheimer's plaques in the brain, in much the same way that we can see evidence for strokes. This research will be of greater value as more effective treatments become available.

Headline: "Study Finds Alzheimer's Indications Early in Life." The Wall Street Journal, August 17, 2000

Summary: A study published in the New England Journal of Medicine suggested that the brains of healthy people with the APOE4 gene, a genetic risk for Alzheimer's disease, have to work harder than normal to perform simple memory tasks long before any outward symptoms of the disease develop. Scientists at the University of California at Los Angeles scanned the brains of 30 people ages 47 to 82 who had tested normal on conventional memory tests while they recalled words memorized from a list. Those with the APOE4 gene produced scan signals that were about twice as strong and more widespread as those of other participants.

Response: We have long known that Alzheimer's disease probably begins in the brain many years before symptoms emerge. We also recognize that APOE4 is a risk factor to Alzheimer's disease. This study provides evidence that the APOE4 influence is felt before symptoms appear. Note, however, that none of the study participants developed Alzheimer's disease. This scan, therefore, cannot be considered a diagnostic test for Alzheimer's disease.

Autopsy Program Update

We extend our appreciation to all the families participating in our autopsy program. To date, 100 families have had an autopsy facilitated through our program, and another 131 families currently plan to have one. I would like to share some of the frequently asked questions with you:

Who signs the autopsy permit?

A spouse must sign the autopsy permit. If there is no surviving spouse, the permit must be signed by a family member in the following order name: adult children, parents, brothers or sisters, or any other relative if there are no surviving persons listed above. If there are no relatives, the estate executor may sign the permit.

What tissue is sampled during the autopsy?

Only brain tissue is autopsied. Older autopsy forms some of you may have list cerebral spinal fluid, eyes, and bone marrow. The forms are being changed. If you have already filled out the old forms, your form is still acceptable.

What happens when the person passes away at home?

Some families plan for the individual to be at home during the last days. In that case, it is important to make sure a MD will sign the death certificate. It is also a good idea to have a hospice service involved. They will take care of everything. If you do not have a plan in place, the coroner's office must be called and this will delay your plans for memorial services.

If an autopsy is planned, is it possible to also donate organs or donate a body to the medical school?

No, this process is too difficult to coordinate. It is important to know that the donation of the brain tissues for Alzheimer's disease is extremely valuable for learning about Alzheimer's disease and working toward finding a cure.

Are the results of the autopsy shared with families?

Yes. Four to six months after the autopsy, a feedback session is held with Dr. David Geldmacher, our Clinical Director, by telephone or in person. During this session, the autopsy report is explained in detail, a diagnosis is confirmed, and the family has an opportunity to ask any questions. The autopsy report is sent or given to the family and a physician if you designate one on the Release of Information Form.

We welcome your participation in the autopsy program. For questions, autopsy forms, or help filling out forms call Marcia Neundorfer at 216-844-6320 or email Marcia at mmn@po.cwru.edu. To page us at anytime, call 216-844-1000, and ask for beeper number 35755. Please stay on the line until I can answer the telephone.

Tips for Healthy Aging

Stay in contact with family and friends. Science is beginning to show that the support of friends and family helps people live healthier, happier, and longer lives. The company of other people and warm, loving relationships seems to protect the body from the effects of stress.

Thank you to all that have made their generous donations this year. We appreciate your kindness and thoughtfulness.

For information on making a donation to the University Alzheimer Center, please contact Joann Franko at 216-844-6412. If you would like to make a donation to our Center, checks should be made payable to the University Alzheimer Center and sent to the attention of Joann Franko, 12200 Fairhill Rd., Cleveland, OH 44120-1013. All donations are appreciated and will be acknowledged.