Abstract: The individual and social challenges created by population aging and especially the growing number of people labeled with dementia demand new innovative and comprehensive approaches. A broader integrative biology needs to replace reductionist, overly simplistic biomedical solutions that dominate today's scientific discourse, particularly with regards to cognitive aging. Alzheimer's disease is a heterogeneous syndrome characterized more fully at a system rather than molecular level. Coordinated scientific and community responses are needed including new attention to intergenerational relationships, innovative learning organizations, and empowering health practices. The Intergenerational School is a successful public charter school which provides learning opportunities for elementary school…children and adults of various ages, including those with dementia. InterWell is a planned primary care and public health practice to be associated with the school. Both represent innovations that balance the sciences and the humanities in address growing social challenges associated with changes in population demographics and climate.
Show more
Keywords: Dementia, Alzheimer's disease, intergenerational, social relationships, school-based health care
Abstract: Our paper on loss of neurons in the Nucleus Basalis of Meynert (now considered part of the cholinergic basal forebrain) in Alzheimer disease (AD) stimulated scientific interest in this little studied brain region. Our subsequent studies associated pathology in the basal forebrain with other dementias, such as Parkinson's disease, and with neurotransmitter receptor changes, such as in nicotinic receptors. We and many others worked to develop medications to treat AD through cholinergic mechanisms and eventually four cholinesterase inhibitors were approved. However the effect sizes of currently available drugs are modest and ethical issues in conducting research in dementia are challenging.…In Cleveland we came to focus on the goals of improving quality of life and the importance on non-pharmacological approaches to treatment. International efforts were organized to improve the efficiency of drug development and to focus on important cultural and pharmacoeconomic issues. Eventually I became concerned about the very way we conceive AD and related concepts like MCI (mild cognitive impairment). As the hundredth anniversary of the first case approaches I am helping to organize meetings to reflect deeply on what we have learned and how to imagine creating a more positive future for persons affected by what I used to call AD.
Show more
Keywords: Cholinergic basal forebrain, Alzheimer disease, neuropathology, drug development, quality of life, bioethics, cognitive science
National Institute of Health and Clinical Excellence Decision Processes Supported by UK High Court: The Debate about the Value of Alzheimer's Disease Drugs Continues
Abstract: U.S. Food and Drug Administration–s (FDA) approval of aducanumab (Aduhelm® in the US) as a treatment for mild cognitive impairment of the Alzheimer type and Alzheimer–s disease has raised such major concerns about efficacy, safety, FDA processes, and regulatory capture that Biogen–s license to market this biologic should be immediately withdrawn. Aducanumab has not demonstrated benefit to patients, failed to meet regulatory guidelines, and is likely to cause both individual and societal harm.
Keywords: Accelerated approval, aducanumab, Alzheimer’s disease, clinical trials, FDA