The Week: LMTX slows Alzheimer's progression - but it doesn't work on everyone and experts are urging caution
LMTX is taken twice a day in tablet form. In the trial, it was used to treat 891 patients with mild to moderate Alzheimer's for 18 months, with the results presented at a conference in Toronto, Canada. It is the first time a major drug trial has targeted tau tangles – abnormal clumps of protein that disrupt brain function – instead of beta-amyloid, a different type of protein that forms plaques as it accumulates in the brain, the New Scientist reports.
The discovery was hailed by many, with the US Alzheimer's Association describing it as "a significant event" in the history of dementia research. "In a field that has been plagued by consistent failures of novel drug candidates in late-stage clinical trials and where there has been no practical therapeutic advance for over a decade, I am excited," said Dr Serge Gauthier, the director of the Alzheimer's Disease Research Unit at McGill University, Canada.Others, however, have urged caution. Alzheimer's Research UK's Dr David Reynolds said he was concerned LMTX appeared not to work alongside other medications. "The data suggests it is slowing down the disease, but the important caveat is these small numbers," he said. "It is encouraging, but we need more data and will have to run a study with it as just a monotherapy [on its own]," he added. "It will still be years from reaching patients, even assuming it works."
Dr Rachelle Doody, the director of the Alzheimer's disease and Memory Disorders Center at Baylor College of Medicine in Texas, was even more pessimistic. "To present it to the public now as a promising approach seems unjustified," she told the New York Times.
A two part paper published recently in Age & Ageing, the scientific journal of the British Geriatrics Society, reveals that pain profiling in older patients has the potential to improve quality of life, and help target resources to those most at risk of disability. The study also found that the use of new pain profiles, which took into account the impact of pain and its subjective nature, might enable better management of pain, and more accurate predictions of healthcare utilisation among older people.
The research, ‘Understanding pain among older persons’ examines pain profiles in older patients, and their ability to predict disability, quality of life and help manage healthcare resources. The study, which was conducted by the University of Limerick in Ireland, highlights the fact that pain is a widely recognised problem in older people, and a common reason for enduring long-term disability. The data for the study was gathered from 8,171 respondents, aged 50 and over, living in a community setting. 65% reported not often being troubled by pain. Of the 2,896 respondents often troubled by pain, four pain profiles were identified using questions such as ‘does the pain make it difficult for you to do your usual activities?’, ‘do you have a number of pain sites?’ and ‘are you taking medication to control the pain?’.
It is with profound sadness that the BGS shares the news that our member, Dr Kate Granger has passed away over the weekend.
Kate was only 34 when she died, having battled cancer since 2011.
Kate became well known to BGS members when, during the course of her very difficult treatments, she encountered health professionals who failed to introduce themselves when dealing with her. 'I felt like I was just a diseased body', she said in both the books she wrote about her experiences. These books, entitled 'The Other Side of the Story' and 'The Bright Side' chronicled her journey through the health system. The proceeds from the sale of the books were donated to charity. In all, she raised £250k for charity.
Speaking of her achievements, Chris Pointon, Kate's husband said that although Kate's death at the age of 34 was cruel, 'in those 34 years, she made a huge difference. She didn't think she had achieved a lot in her life but her legacy will remain for many, many years to come and we have many ambassadors across the globe that will make sure the names Kage Granger and 'hello my name is' will always be remembered'.
When Kate addressed the BGS spring conference in 2014, she thought she had only months to live, but her determination to drive her 'hellomynameis' social media campaign sustained her for two more years. Her renown grew steadily over that time. Apart from being awarded the BGS President's Medal (the only one ever awarded to a trainee - as she was at the time), she was recognised in the Honours list with an MBE, and she was, for several years running, named by the HSJ, as being one of the most inspirational young leaders of our time. This accolade is borne out by Felicity Jones, past medical students' representative on the BGS Trainees' Council who said after she met Kate: 'Whilst helping with the microphones [at the BGS Spring meeting in 2014], I found myself chatting to Dr Kate Granger, who is rightly seen as one of the most inspiring doctors of our time, before she gave a powerful speech about the use of social media and the importance of compassion in medicine. Having long admired Kate and being a wholehearted supporter of these messages, it was amazing to meet her, and to see many others in the audience also deeply affected by her speech.'
Our heartfelt condolences to Chris, Kate's family and to many BGS members who grew close to Kate and who will have been deeply affected by her passing. Geriatric Medicine is the richer for having had her in the speciality and the BGS was fortunate to have had her as a member. She will be long remembered and sorely missed.
See: Kate Granger inspired all of us in the NHS to be more compassionate (Guardian)
Recent publicity around the NHS Protect report on assaults on NHS staff over a 5 yr period focused on the finding that over 75 yr olds were frequently involved in such assaults (“perpetrators”) and substantially failed to identify the common underlying cause- that is delirium or behavioural and psychiatric symptoms of dementia.
Stigmatising and blaming older people in this way is extremely unhelpful.
We link here to two resources- blogs by Dr James Wood and Dr Duncan Forsyth which “call out” the media for the pejorative way in which the NHS Protect report was interpreted, and which summarise the 2014 NICE guidelines on the prevention, identification and management of dementia.
There are a number of guidelines and videos linked from James’s blog which staff members can use as teaching aids- they are added below, with a link to the NICE guidelines.
We still have a long way to go in the understanding of one of the commonest complications of acute hospital admission in older people. The reports in both print, on-line, TV and radio indicated complete misunderstanding by journalists of the condition. Nor can we accept the implicit ageism of these articles which fail so completely to understand the distressing nature of delirium to the patient, their family and staff and which instead offer only blame to the older person suffering the illness.
Let’s redouble our efforts to ensure that in all of our hospitals the nature of delirium is understood and that we are spreading the word- it’s preventable and treatable.
https://www.youtube.com/watch?v=BPfZgBmcQB8&feature=youtu.be by Mani Krishnan (@psychinformatic)
With approximately 500,000 instances of elder abuse occurring each year in the UK we are constantly seeking ways in which we can combat elder abuse. As many of you know, Action on Elder Abuse provides direct support through our helpline and EARS scheme and reaches many more through our awareness raising activities and policy work.
AEA has three upcoming running events that are commencing later on in the year and it invites you to take up the opportunity to fundraise for Action on Elder Abuse and help to put a stop to abuse of our older people throughout the UK.
Are you ready to make a difference? Whether or not you have ever considered taking part in fundraising for charity why not take the plunge this year? It doesn’t matter if you have never run before, or feel that it would be a struggle to raise the money because the AEA team will be on hand with training tips and fundraising ideas.
NICE has published two new resources to support the implementation of the guideline on Older people with social care needs and multiple long-term conditions
This resource will help you to implement one of the key guideline recommendations - that older people with social care needs and multiple long-term conditions have a ‘single, named care coordinator who acts as their first point of contact’. Drawing on the discussions from 3 focus groups facilitated by Age UK Sutton, which involved older people living in their own homes and in a care home, it presents the expectations that older people have of this role.
Tailored resource - ‘Just one person’: the named care coordinator role from the perspective of older people
NICE held a roundtable event in January 2016 to identify how the guideline can be used. This report summarises the discussion, and sets out practical examples and ideas to implement best practice. You can use the report to see how others are implementing the guideline and to get ideas for how you might use the guideline to improve local practice..
Making progress on personal joined up support: report of a roundtable discussion
Both resources were developed the NICE Collaborating Centre for Social Care (NCCSC), a partnership led by SCIE.
Independent: Many might have welcomed the latest reports that a cure for Alzheimer’s could be just around the corner, to scrub the disease from the planet for once and for all. Currently, patients’ options are limited to treatments that reduce memory loss by replacing neurotransmitters eaten away by the condition. Now, researchers working in the US – where over $1.3 billion has already been spent on investigating dementia – believe that they have developed a “breakthrough” vaccine which uses the immune system’s antibodies to attack proteins believed to cause Alzheimer’s disease.
Following tests on mice, experts from the Institute for Molecular Medicine and the University of California, Irvine published a paper on a vaccine that targets both beta-amyloid and tau proteins linked to the disease.
“If we are successful in pre-clinical trials, in three to five years we could be well on the way to one of the most important developments in recent medical history,” Flinders University School of Medicine Professor Nikolai Petrovsky, and co-author of the study published in Nature’s 'Scientific Reports' journal, recently said.
It certainly sounds revolutionary – particularly to those desperately afraid of the disease. But experts working in a field where only 0.4 per cent of the almost 250 potential treatments for dementia tested between 2002 and 2012 have been successful are cautious to celebrate. Some even warn that harnessing the immune system against Alzheimer’s could be dangerous.
This NICE guideline covers the planning and delivery of person-centred care for older people living in their own homes (known as home care or domiciliary care). It aims to promote older people's independence and to ensure safe and consistently high quality home care services. The Care Quality Commission uses NICE guidelines as evidence to inform the inspection process.
Recommendations (click here for more detail)
- ensuring care is person centred
- providing information about care and support options
- planning and reviewing home care and support
- delivering home care, including recommendations on the length home care visits
- joint working between health and social care
- ensuring safety and safeguarding people using home care services
- recruiting, training and supporting home care workers