Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Tuesday, August 1, 2017

Karlawish: The Way Forward in Alzheimer's Disease

Your doctor should be closely following this since YOU are likely to get dementia/Alzheimers. Or is your doctor fucking incompetent like the stroke associations and stroke hospitals?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research.   July 2013.

Karlawish: The Way Forward in Alzheimer's Disease

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Following several failed trials, what is the way forward in Alzheimer's disease? Learning from mistakes and focusing on prevention, answers Jason Karlawish, MD, professor of medicine, medical ethics and health policy, and neurology at the University of Pennsylvania Perelman School of Medicine and co-director of the Penn Memory Center, in this exclusive MedPage Today video.
A transcript of his remarks follows.
The way forward is more research, but it's research that has to be smart and learns from those failures. For example, it's only been in the last few years that Alzheimer's disease trials have, as routine eligibility criteria, the need to have evidence of the disease as shown by a biomarker, in particular a biomarker of amyloid. Early studies of drugs such as solanezumab that were targeting individuals with Alzheimer's disease dementia, we discover that in fact about 20% of the patients didn't have sufficient amyloid to meet the criteria for having Alzheimer's disease.
Well, now that we are using those markers as eligibility criteria, we're better able to target the drug through the disease. Fast-forward to the results of EXPEDITION 3, which used amyloid as an eligibility criteria: that drug didn't work as well, but the trends and the measures of cognition and function were generally favorable towards some sort of effect. So, now we have to explore issues around dosing of the drug.
That's a very specific example, but the point is that our failures are teaching us something and we're learning. The United States has a national plan for Alzheimer's disease and goal number one of that plan is to discover an effective treatment or a preventive therapy by 2025.
Prevention is a tall order. If taken literally, it means you take a treatment before you have any signs or symptoms of the disease and the treatment prevents you from ever developing those signs and symptoms. Will we achieve that by 2025 in Alzheimer's? I think it's unlikely. It's a complicated disease. There are many pathologies involved on top of an aging brain. But I think the signals from our studies are telling us that we may be able to slow down the decline seen over time in people who have Alzheimer's pathology, and delay the time before people lose the capacity to do their daily activities like managing their money or driving.
I think that's a reasonable hope. Some patients may respond very well to these therapies, some patients may not respond at all. But I think we can expect in the future that it will be a disease that is under our control.
Of course, we also have to understand that this disease sits upon an aging brain. Aging neurons don't work as well and we have to be thoughtful about what might be some interventions -- both therapeutic drugs, as well as lifestyle -- that can preserve our aging brain.
Finally, though, I think the key message is this. We're not going to drag our way out of this problem. We're going to have to learn how to live with cognitive impairment, and live well.

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