New Jefferson State Grant Focused on Early Detection, Prevention of Alzheimer’s and Caregiver Relief

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How can a family tell if a loved one is in the beginning stages of Alzheimer’s disease? Are there changes individuals can make in their lifestyle to reduce or perhaps delay the effects of the disease? What can caregivers do to lessen their burden?

These are some of the questions Thomas Jefferson University investigators hope to answer. Sam Gandy, M.D., Ph.D., is principal investigator of a four-year, $3.5 million grant from the Pennsylvania Department of Health to support a Center of Excellence on Neurodegenerative Diseases at the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia. The health research grant is awarded from Pennsylvania’s share of the national tobacco settlement.

The new Jefferson center, co-directed by Barry Rovner, M.D. and Laura N. Gitlin, Ph.D., will work in collaboration with the Philadelphia Corporation for Aging to conduct several research projects, each focusing on a different aspect of Alzheimer’s disease. The researchers plan, for example, to test innovative screening methods to identify dementia in a racially and economically diverse population. They also are going to examine the effectiveness of an in-home skills training program for caregivers to see if it can help delay patients from going to nursing homes and help reduce the stress on the caregiver.

“The disease goes on for five to 15 years of intense stress for the family, especially the primary caregiver,” says Dr. Gandy, director of the Farber Institute for Neurosciences and professor of neurology and biochemistry and molecular pharmacology at Jefferson Medical College of Thomas Jefferson University.

“Available medications are inadequate, making it imperative that caregivers be trained in how best to create an environment conducive to the care of someone with Alzheimer’s.”

Alzheimer’s disease is a major public health cost for the nation and particularly for Pennsylvania, which has a large elderly population. Alzheimer’s and related disorders cost an average of $80,000 a year per patient, and $25 million per year overall in Pennsylvania. The costs will rise to an estimated $40 million a year by 2050.

“The unique aspect of this project is the focus on developing a convenient diagnostic test that many caregivers and case workers can administer, and on training caregivers in non-drug related strategies that can help keep patients at home longer prior to nursing home placement,” says Dr. Gandy.

The researchers would also like to identify lifestyle factors in the development of Alzheimer’s, and how modifying them – changing dietary cholesterol, for example – might affect the course of the disease, in addition to measuring objective biological markers of stress and of disease risk, such as the buildup of sticky amyloid in the brain.

Dr. Rovner, director of Clinical Alzheimer’s Disease Research at the Farber Institute for Neurosciences at Thomas Jefferson University and professor of psychiatry and neurology at Jefferson Medical College, will direct the development and testing of the diagnostic tool. He and his group are developing a new screening tool combining cognitive tests assessing patient memory, orientation, language, and other abilities with a questionnaire given to family members. “Making a diagnosis as soon as possible is important now because there are clinical trials for drugs aimed at the early stages of disease,” Dr. Gandy says. “We need people to be diagnosed early to have the best chances of responding.”

“Our sense is that Alzheimer’s may be under-recognized in some communities,” says Christine Arenson, M.D., director of geriatric medicine in the Department of Family Medicine at Jefferson Medical College of Thomas Jefferson University, who is working with Dr. Rovner to both develop and validate the screening tool.

Dr. Gitlin, director of the Center for Applied Research on Aging and Health, and professor in the Department of Occupational Therapy at the Jefferson College of Health Professions at Thomas Jefferson University, will direct the randomized trial of the home-based skills training program for caregivers. Building on her previous work in this area, she plans to test whether such a program can help reduce troublesome behaviors in Alzheimer’s patients by teaching families problem-solving skills, how to engage the patient in meaningful activities and minimize triggers of behaviors and at the same time manage their own stress.

“An innovative feature of this randomized controlled trial is that the intervention will be tested in a real community setting so that if it is effective, it can easily be translated into the aging network,” she says. They will be working closely with the Philadelphia Corporation for Aging (PCA). 

Dr. Gitlin and her colleagues are developing a “risk screen” that PCA care managers will use to identify family caregivers who are at risk for placing their family member in a nursing home and who might benefit from the research. Individuals will be referred for participation in the study to receive either the innovative treatment or educational materials.

On the biological side, the researchers are developing a database of ethnically diverse individuals, with special emphasis on the African-American population. They are looking for markers of disease risk and stress in both patient and caregiver at two different points in the program.

“This project represents our growing understanding of the disease and mobilizing the health-care and academic systems to tackle the problem,” Dr. Gandy says.

Farber Institute for Neurosciences at Thomas Jefferson University is a multidisciplinary neurosciences research center established through a $10 million gift by the Farber Family Foundation, Inc., in 2001. It is initially focusing its efforts on basic and clinical research in a number of key areas, including Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS) and other neurodegenerative disorders.