Alzheimer's patients speak brush in hand

Friday night in time to present the original exhibition hung on the walls of the nursing home, Dr. Philippe Sol spoke of Aristotle and "the cathartic power of art." In the wide corridor of the hospital, to contemplate the works produced by his patients, mostly suffering from neurodegenerative diseases, all doubt was lifted. Yes, painting, collage, drawing, essentially any form of artistic creation was undoubtedly a cleansing effect, both for the creator himself as one who admires the work.

The muscles are recovering on the road.
"Of course the art does not heal, but it improves the well-being and gives the patient the subject status," said the doctor who supports art therapy workshop and memory enlivened every Wednesday Gaia Cathy Louise Nurse in art therapy, and Annie Lambert. "The creation aid learning retention of memory, struggle against isolation and restore communication. When you put a pencil between the fingers of a patient with a neurodegenerative disease, muscle set off," adds there.

And the result, we can see now in the nursing home, is up. In the lobby, patients have compositions graphic artists and very precise patterns inspired by Aborigines, pastel landscapes, and finally, a table, like on the wall of a cave, everyone has put his imprint hand.

Diagnose Alzheimer's. Yes, but when?

In the detection of an incurable disease, the earlier is not necessarily better.

In late April the U.S., new guidelines for the diagnosis of Alzheimer's disease have identified a stage "preclinical" disease. It seems indeed that pathologies-especially symptomatic plaques that invade the brain-can be detected for years or decades, even before the patient begins to forget to feed her cat or becomes unable to remember his name.

The news reignited a debate that has raged in recent months: not only possible cure, some believe that early diagnosis of Alzheimer's disease would only fill doctors sadistic, masochistic patients and certain commercial interests . Their fear is that the pharmaceutical industry do take the opportunity to sell snake oil to a customer as important as desperate, not to mention insurance companies and employers, who could use this information against patients.

Others, however, argue that early diagnosis also has its interests. It could, for example, inspire you to do this last trip to Antarctica that you have so long delayed, or to make you more diligent at the gym (although inconclusive, some research has shown that exercise slow physical deterioration of the brain).

History further complicate things, we must know that the "biomarkers" that appear at an early diagnosis would not necessarily have symptoms. For reasons still unclear, some brains seem to function very well despite the plates, while others succumb more easily.

Very often, patients die from causes any other, before the plates do not really damage. Given the many gaps in our knowledge at present, the guidelines insist that the tests are not used for medical research (the idea is that by studying the first manifestations of the disease, can be in understand the genesis and eventually find treatments preventing the onset of symptoms).

This does not, however, some fear that soon the biomarkers are used to test patients 'normal'. What implications are there to diagnose a terminal illness in apparently healthy people?

Doctors, patients, and bioethicists falling over on this issue for years. At all times, diseases were announced by unpleasant symptoms, obvious. You knew you were not going well because you vomited in jet, you had a headache or your unbearable wounds were purulent.

To some extent, we still rely on these signs of illness, but increasingly by laboratory results that we learn when we are sick or likely to be. And if being diagnosed disease may be a relief when one is suffering from a mysterious illness, it looks more like a sentence if you feel perfectly healthy.

Take the example of the genes BRCA 1 and 2, discovered in mid-1990. Some mutations in these genes greatly increase the risk of breast and ovarian cancer. Masha Gessen, who was tested positive, reported his experience with distance and humor for Slate and in his book Blood Matters. In this case, patients can at least do something, although options are often grim: Goshen, for example, chose a double mastectomy as a preventive measure.

For comparison, the Huntington's disease, degenerative neurological disorder causing involuntary movements and dementia (often leading to suicide), is more like Alzheimer's disease. If a parent has the misfortune to suffer from this incurable disease, the risk that you have your turn is 50%. Symptoms do not usually appear until 40-50 years, but genetic testing of presymptomatic testing have been available for years.

The discovery of the genetic marker for Huntington's disease in 1983 has raised important ethical issues about screening, most of which resemble those confronting us today. The tests are not infallible, the misdiagnosis represented a real threat. There was also concern that people testing positive are encouraged not to children. And what about the psychological impact of diagnosis? The first rule in medicine is to "do no harm", one can legitimately expect that the announcement of a new disturbing also is contrary to this precept.

Before the test becomes widely available, medical staff working with patients and family members to put some conditions on its use. Several patient advocacy groups had established rules establishing the patient's right to refuse the test and to maintain some confidentiality.

People at risk met a genetic counselor, a psychologist and geneticist for advice and guidance. This preparation could take up to 2 years. Patients were encouraged to imagine their reactions to different situations and, ultimately, to digest the results (in the United States, persons undergoing testing for BRCA genes as frequently consult a genetic counselor).

Over the years, researchers have examined the impact of tests and have identified both the advantages and disadvantages. As expected, the positive result depression, anxiety, isolation, fear for their job prospects and regret having learned a difficult future awaited them. But there are also good sides: the end of uncertainty unbearable, a stronger bond with parents also tested positive and the ability to focus on the important things in life. Those who learn they do not feel the change, of course, terribly relieved.

Yet, despite these similarities, Alzheimer's disease is different from Huntington's chorea by several fundamental aspects. Huntington's disease is a rare disease that only affects about 30,000 Americans. Alzheimer's disease in regards to the current 5.4 million and this figure is expected to reach 13.5 million by 2050. Given these figures, the cost incurred in preclinical testing and individual counseling for anyone at risk would be astronomical. In addition, patients often have a long and normal life before plunging into the hell of the disease. The challenge of early diagnosis is simply not as high as for Huntington's disease.

At present, given the uncertain relationship between biomarkers and dementia, early diagnosis seems quite unhelpful. As recalled by the new guidelines, the greatest risk factor for Alzheimer's disease is an age-and you do not have brain MRI or lumbar puncture to know that you are old. Similarly, at some point, even if you avoided Alzheimer's, nothing says that you will escape to another form of dementia. In the end we are all "biomarqués" for the death and decline.

Rebecca Tuhus-Dubrow

Translated by Yann Champion

A new blood test could detect Alzheimer's, according to researchers

TORONTO - Canadian researchers have developed a blood test that could one day help diagnose Alzheimer's disease, even at the very beginning, providing a longer period for use of drugs to slow its progression.

Scientists have spent years trying to devise a definitive test for Alzheimer's disease, a form of progressive dementia that can not currently be confirmed by analysis of brain tissue after death.

Researchers at the McGill University Health Centre (MUHC) but have created a test that measures the levels of DHEA in the blood or the rate of a hormone naturally produced by the body and has anti-aging.

"Our clinical studies demonstrate that a non-invasive blood test, based on a biochemical process could be successfully used to diagnose Alzheimer's early in the disease and distinguish it from other types of dementia," said Vassilios Papadopoulos, director of the Research Institute of the MUHC.

The test requires the execution of a chemical reaction called oxidation, in a blood sample. Oxidation causes the production of DHEA, or dehydroepiandrosterone.

Dr. Papadopoulos said that additional quantities of this steroid should be produced from a precursor of DHEA, which is present in the blood, although researchers have not yet identified what it is.

In a study published in the edition of this month's Journal of Alzheime'rs Disease, researchers detail how they tested blood samples of 86 persons.

About half of them were likely to suffer from Alzheimer's disease, according to cognitive and clinical symptoms, while an equal number of people served healthy control group chosen because of their age and sex .

Exposed to oxidation, the blood of healthy individuals showed higher levels of DHEA indicating that the precursor was present unidentified. The chemical reaction has not triggered a significant increase in DHEA levels in the blood of patients with Alzheimer's disease.

In patients affected by a severe form of the disease, no increase in DHEA levels was detected, said on Wednesday, Papadopoulos, in an interview from Montreal. "If you look at patients with mild or moderate forms of Alzheimer's, you'll find a little, but not at the same level as in a normal patient."

In addition, he says, there is a clear correlation between the inability to produce DHEA via oxidation in the blood and the level of cognitive impairment found in patients.

"We showed we could, accurately and repeatedly detect Alzheimer's disease with small samples of blood. This test was also used to establish different diagnoses in the early stages of the disease, indicating that it can be used as a method to diagnose the disease when it starts to grow. "

Dr. Papadopoulos and his team began to collect more blood samples - they already have nearly 400 other patients with Alzheimer's - and will recruit an equal number of subjects cognitively healthy for a broader study of their test, to see if they can reproduce the initial results.

Papadopoulos believes that there is still a lot of steps before such a test can be distributed on the market and used to detect the devastating and potentially fatal disease among the population.

If the test proves effective tool for Alzheimer's disease, it could also be used in clinical studies to test whether experimental drugs have an effect.

Dr. Papadopoulos also explains that people often wonder about the usefulness, for one, learned that she suffers from Alzheimer's, then there is no cure or medicine that can effectively stop the disease.

"I think the best answer is to go back in time," he replied, noting that breast cancer was almost always fatal 30 years ago, but there is now a high cure rate. 50 years ago, there was little to be done to slow the solidification of the arteries leading to heart attacks and stroke. But now, drugs such as statins can prevent or at least slow the damage to blood vessels.

A test to identify the disease is an essential first step to better identify when or Alzheimer's disease begins and what causes it to appear. "Then, treatment can be developed, treatments that take you back maybe not normal, but to help you stabilize, inhibit the progression of the disease."

In the future, a test based on DHEA could be one of many tests to diagnose Alzheimer's disease, the same way that blood is tested for various substances determining the risk of cardiovascular disease in a patient Papadopoulos says.

"I do not know if a patient of 50 years may have to pass a test like this. Time will tell if this is possible."

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