Brain Bodyguard

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David Geldmacher Makes Moves Against Alzheimer's

By Robin Sutton Anders and Eleanor Spicer Rice
Alzheimer’s disease affects millions of Americans and is the nation’s sixth leading cause of death. Alzheimer’s is marked by the accelerating death of brain cells, which means early detection is critical, says David Geldmacher, M.D., director of the UAB Division of Memory Disorders and Behavioral Neurology and Charles and Patsy Collat Professor of Neurology. Geldmacher, an expert on Alzheimer’s diagnosis and management, shares his latest research and reveals some common myths about the disease.

UAB Magazine:
Why is your research focused on the earliest stages of Alzheimer’s disease?
Geldmacher: We haven’t discovered a way to effectively make brain cells grow back. Once they’re lost, they’re gone forever. We need to intervene earlier, at the point when brain damage can be minimized. With modern technology, we can recognize biological changes in the brain before disabling levels of memory loss occur.

UAB Magazine:
What potential therapies are you testing in your lab?

We know one of the crucial features of Alzheimer’s is the abnormal accumulation of a normal protein called the amyloid peptide. Many of our treatments target that peptide. We look at medications that can prevent amyloid from forming, or that try to remove it once it has formed. We also look at medications that try to lessen amyloid’s toxic effects on brain cells. And we are testing medications that can potentially help affected brain cells work better or resist amyloid’s toxic effects.

UAB Magazine:
One of your goals is to boost the amount of clinical research in Alzheimer’s. Why is this so important?

Without a placebo-controlled trial, no new medicine can come to market. This is the bridge from the research labs to the doctor’s office. We need to know the drugs are safe and that they work in people—not just animals. The only way to do that is to test them in people who have volunteered.

UAB Magazine:
You are also focused on integrated care for patients with Alzheimer’s. What does that mean?

The Alzheimer’s disease process leads to less and less independence, and eventually people lose the ability to be mobile. They end up in their chairs or beds because their brains can’t follow through with purposeful mobility. Complications like blood clots in legs can end up causing death. Another common difficulty is people lose the know-how to eat and hydrate themselves.

We frequently find that the care a patient receives gets fragmented across physicians. Neurologists and psychiatrists prescribe medications that affect the patient while a primary care physician is helping to manage their blood pressure or diabetes. It’s difficult to keep patients and doctors in sync even though they’re all dealing with elements of the same illness. Communication is important.

Through the UAB Memory Disorders Clinic, members of our nursing staff can provide support and information. And we have a referral network within the UAB system with neurologists, geriatricians, speech therapists, psychologists, and other relevant specialists who can communicate with each other quickly and effectively. One of our goals is to strengthen the network of health-care providers who can work together to meet patients’ needs. An integrated care team that includes nursing, psychology, social work, and rehabilitation services like speech and occupational therapy can help people with Alzheimer’s disease maintain their highest levels of independence and daily function. I think that these services help maintain the highest possible quality of life for people with Alzheimer’s.

UAB Magazine:
Do you find that general practitioners have any misconceptions about Alzheimer’s?

There is still a common perception that there isn’t much we can do for people with Alzheimer’s. But we’re learning there are things we can do to help people maintain their well being through physical exercise, mental stimulation, and a healthy diet. Those three things may help to prevent the disease or slow it down. [See Geldmacher’s five tips on lifestyle choices that can affect Alzheimer’s.]
The other misconception is that disabling levels of memory loss are part of the aging process. That’s clearly not true. There’s growing evidence that treatment with our existing medications, such as cholinesterase inhibitors, has a meaningful long-term impact.

UAB Magazine:
What do you wish the public knew about Alzheimer’s?

It’s a biological disease, not a mental illness. It’s not a weakness or the fault of the person who developed it. For the vast majority of cases, we still don’t know what triggers the disease. It appears that there isn’t just one cause, but a series of interactions between genetics, lifestyle, small strokes, and concussions. When people have a certain combination of factors, which might differ from one person to the next,the disease shows up.

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Hot Topics: Advances in Parkinson's

What works and what doesn't work in Parkinson's? We asked four experts in the field for their take.  Their answers encompassed surgical interventions, levodopa as the "gold standard," managing disease, and the role of exercise. To see the full interview please click below:

High-intensity strength training shows benefit for Parkinson's patients

Researchers at the University of Alabama at Birmingham say that high-intensity strength training produced significant improvements in quality of life, mood and motor function in older patients with Parkinson’s disease. The findings were published Jan. 9 online in the Journal of Applied Physiology.  Fifteen subjects with moderate Parkinson’s underwent 16 weeks of high-intensity resistance training combined with interval training designed to simultaneously challenge strength, power, endurance, balance and mobility function. Before and after the 16 weeks, the subjects were compared to age-matched controls who did not have Parkinson’s and did not undergo the exercise regimen.

“We saw improvements in strength, muscle size and power, which we expected after rigorous weight training; but we also saw improvement in balance and muscle control,” said Marcas Bamman, Ph.D., professor in the Department of Cell, Developmental and Integrative Biology and lead author of the study. “We also saw improvement in cognition, mood and sense of well-being.”

Parkinson’s disease is a debilitating, neurodegenerative disease that dramatically affects mobility function and quality of life. Patients often experience weakness, low muscle power and fatigue.

Bamman, who heads the UAB Center for Exercise Medicine, devised a strenuous exercise regimen for the participants. Subjects performed three sets of eight to 12 repetitions of a variety of strength training exercises, such as leg or overhead presses, with a one-minute interval between sets for high-repetition, bodyweight exercises, such as lunges or pushups.

“We pushed these patients throughout the exercise period,” said Neil Kelly, M.A., a graduate student trainee and first author of the study. “We used a heart rate monitor to measure exercise intensity — keeping the heart rate high through the entire 40-minute session.”

Bamman says this was the first study of its kind to look at the biology of the muscles. Biopsies of muscle tissue were collected before and after the 16 weeks.

“We found favorable changes in skeletal muscle at the cellular and subcellular levels that are associated with improvements in motor function and physical capacity,” Bamman said. 

Physicians who treat Parkinson’s patients, such as UAB’s David Standaert, M.D., Ph.D., chair of the Department of Neurology, say they have long believed that exercise is beneficial to their patients.
Physicians who treat Parkinson’s patients, such as UAB’s David Standaert, M.D., Ph.D., chair of the Department of Neurology, say they have long believed that exercise is beneficial to their patients.

“What we do not know is what kind of exercise and how much exercise will prove best for individual patients with Parkinson’s,” Standaert said. “This study is concrete evidence that patients can benefit from an exercise program and can do so rapidly in only 16 weeks.”

Standaert says he hopes this study will open the door to a more complete understanding of the role of exercise in this patient population.

“My patients who participated in the study told me that they enjoyed the exercise regimen and that they saw distinct improvement in their health and physical condition,” he said. “Future studies should be able to help answer questions such as optimal frequency, intensity and type of exercise.”

Study participants showed significant improvement of six points on average on a measure called the Unified Parkinson’s Disease Rating Scale. On another measure, a seven-point fatigue scale, the group improved from a score above the clinical threshold for undue fatigue to a score below this threshold. 

A sit-to-stand test showed that, after strength training, participants dropped from requiring 90 percent of maximum muscle recruitment to rise to a standing position to just 60 percent, which put them on par with their same-age, non-Parkinson’s peers.

“These are all indications that strength training produced a major improvement in the ability to activate muscles, to generate power and to produce energy,” Bamman said, “all of which can contribute to improved quality of life and reduction of injury risk from falls.”

The study was funded by the UAB School of Medicine and the Department of Neurology, along with the UAB Center for Exercise Medicine. Bamman hopes the findings will pave the way for larger studies to define optimal exercise doses for Parkinson’s patients across the disease spectrum.

“This is the first step in an important direction to maximize the therapeutic benefits of exercise training for people with Parkinson’s disease,” he said.

Author: Bob Shepard - UAB Media Relations