Alzheimer Disease: Lin P

Christensen DD, Lin P. · Neuropsychiatric Institute, University of Utah School of Medicine, Salt Lake City, UT USA. · J Fam Pract. · Pubmed #18664338 No free full text.

Abstract: With the "baby boomers" entering retirement and beyond and the life expectancy of the entire population increasing, the burden of Alzheimer's Disease (AD) grows alarmingly greater. Over 5 million people in the United States currently have AD, and that number could triple by 2050. The financial impact of caring for these patients is substantial. Estimates of direct and indirect costs are as high as $148 billion per year. In addition to its substantial economic impact, AD has devastating effects on patients and their families. Alzheimer's disease begins with gradual memory loss and progresses to personality change, behavioral disturbance, loss of executive function, and loss of the ability to perform basic activities of daily living, including eating, walking, dressing, and grooming. These impairments strain families and caregivers and create challenges to the care and safety of the patient as well as threaten the health and well-being of the caregiver. As the number of patients diagnosed with AD increases, there is an ever-growing need for early diagnosis, which often is first observed in the primary care setting. While AD cannot be reversed or stopped, disease progression can be delayed and quality of life enhanced with early diagnosis and treatment. Early and accurate diagnosis has become increasingly important and will become even more so with the anticipated new generation of medications. Though several consensus statements on diagnosis and treatment of AD have been developed, few primary care physicians routinely follow evidence-based guidelines in their clinical practices. A 2006 survey conducted by the American Academy of Family Physicians identified a moderate to high level of need for education on AD in a majority of respondents. This article illustrates the primary care management of AD beginning with diagnosis and concluding with autopsy. Enhancing diagnostic and treatment skills in primary care will promote earlier diagnosis, improved patient management, and ongoing research into this increasingly important dilemma of aging.

Geldmacher DS, Frolich L, Doody RS, Erkinjuntti T, Vellas B, Jones RW, Banerjee S, Lin P, Sano M. · Memory Disorders Program, Department of Neurology, University of Virginia, Box 800394, Charlottesville, Virginia 22908, USA. · J Nutr Health Aging. · Pubmed #17066215 No free full text.

Abstract: Alzheimer's disease (AD) is a progressive degenerative disease that warrants active management to delay or slow progression of its symptoms. The symptoms of AD encompass behavior and daily function as well as cognition, so clinicians should take a global view in the assessment of treatment success. Because there is currently no cure for AD, one cannot expect an initial cognitive improvement observed in the first few months of therapy to be sustained indefinitely. However, one should expect that the patient who is treated early and persistently with medication for AD will show less evidence of behavioral, functional, and cognitive deterioration over a period of time than one would expect in the absence of pharmacotherapy. Thus, treatment success includes not only short-term improvement of symptoms but also less decline over the long term. Determination of treatment success therefore also requires awareness of the typical progression of untreated AD. In this article we review the natural history of AD and evidence for the effectiveness of the treatments indicated for AD: donepezil, galantamine, rivastigmine, and memantine.

Lin P, Li F, Zhang YW, Huang H, Tong G, Farquhar MG, Xu H. · Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, California 92037, USA. · J Neurochem. · Pubmed #17348862 No free full text.

Abstract: Calnuc, a Golgi calcium binding protein, plays a key role in the constitution of calcium storage. Abnormal calcium homeostasis has been linked to Alzheimer's disease (AD). Excessive production and/or accumulation of beta-amyloid (Abeta) peptides that are proteolytically derived from the beta-amyloid precursor protein (APP) have been linked to the pathogenesis of AD. APP has also been indicated to play multiple physiological functions. In this study, we demonstrate that calnuc interacts with APP through direct binding to the carboxyl-terminal region of APP, possibly in a calcium-sensitive manner. Immunofluorescence study revealed that the two proteins co-localize in the Golgi in both cultured cells and mouse brains. Over-expression of calnuc in neuroblastoma cells significantly reduces the level of endogenous APP. Conversely, down-regulation of calnuc by siRNA increases cellular levels of APP. Additionally, we show that over-expression of calnuc down-regulates the APP mRNA level and inhibits APP biosynthesis, which in turn results in a parallel reduction of APP proteolytic metabolites, sAPP, CTFs and Abeta. Furthermore, we found that the level of calnuc was significantly decreased in the brain of AD patients as compared with that of age-matched non-AD controls. Our results suggest a novel function of calnuc in modulating the levels of APP and its proteolytic metabolites, which may further affect the patho/physiological functions of APP including AD pathogenesis.