A New Public Health Paradigm for Alzheimer's Disease Research

Garrett, Mario; Valle, Ramon

doi:10.15226/2374-6858/2/2/00117

Cited by 9 publications

(16 citation statements)

References 105 publications

(89 reference statements)

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“…This is a public health approach to the disease. [102] Ignoring these complexities will have radical social and scientific consequences. Consequences that were prophesied in 1911 when Perusini wrote: "of course, as usually happens when anatomo-pathological datum offers easy enticement, there will be more than one person who, on the basis of these findings will make the most useless and fanciful anatomo-psychic guesses, and those who amuse themselves with anatomically localizing the location of conscience, the will and related matters, would find a good playground, in which the tangles, for instance, might offer the most clear-cut explanation for the disorientation observed in the senile demented patient.…”

Section: Resultsmentioning

confidence: 99%

A century of confusion in researching Alzheimer’s disease

Garrett

Valle

2016

IJH

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More than a century ago Alois Alzheimer published a case study that later evolved into the Amyloid Cascade hypothesis-which assumes that increasing proliferation of plaques and tangles in the brain cause dementia. However, studies involving the removal of plaques-amyloid-β-in patients' brains resulted in worse cognitive performance, suggesting that plaques cannot solely be the disease. The search then focused on tau misfolded protein. But the evidence is uncertain. This paper suggests a critical history approach to understanding this confusion in Alzheimer's disease research. Confusion is related to variability in expression of the disease, inaccuracy of clinical diagnostic tools, the relationship to other diseases, and the increasing neurological variance among older adults. The final verdict is that there is an unclear relationship between the biology and the expression of the disease. Alzheimer's disease may in fact be the expression of another, yet unknown, disease. An often overlooked component in Alzheimer's disease is white matter in the brain. Although found to be negatively related to dementia and positively related to learning, white matter remains unexamined in most current research. Historical evidence suggests that this was not the case a century ago. This paper is grounded in historical observations that Alois Alzheimer and his contemporaries identified these criticisms a hundred years ago. By ignoring these criticisms today, we have ended in a research cul de sac. This paper argues for greater specificity of the definition of Alzheimer's disease and a broadening of the research focus to include the possible role of epigenetic changes, variance within older ages and brain plasticity. Only by broadening the scope of research and addressing this confusion directly can we move out of this research cul de sac and move closer to a cure.

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Section: Resultsmentioning

confidence: 99%

A century of confusion in researching Alzheimer’s disease

Garrett

Valle

2016

IJH

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“…Arnold Pick more than a century ago indicated that "a mosaic of circumscribed neuropsychological deficits" could cause dementia [31]. There are many events that we know cause dementia and/or Alzheimer's disease, including viral (HIV/AIDS, herpes simplex virus type I, varicella zoster virus, cytomegalovirus, Epstein-Barr virus), bacteria (syphilis and Lyme-disease/borrelia), parasites (toxoplasmosis, cryptococcosis, and neurocysticercosis), fungi (Candida collaborator), infections (possibly prions), and vascular (stroke, multiple-infarct dementia, hydrocephalus, injury, and brain tumors) [11,32]. There are other processes that either promote or delay the infection and the spread of infection, primarily through the blood-brain barrier [33], inflammation, vascular, white matter [34], and many other dynamic processes in the brain.…”

Section: The Causes Of Alzheimer's Diseasementioning

confidence: 99%

“…Protective factors include cognitive reserve and the capacity of the brain to absorb trauma (maybe including education, multilingual, exercise, diet, enriched environment in infancy) [36,37]. While factors that worsen resilience possibly includes behavior (alcohol, cigarette smoking, recreational drugs, concussion), environmental elements (possibly aluminum), and emotional trauma (divorce, death of a loved one, sexual, physical and emotional abuse, and depression) [11]. There are also cascading effects where one infection destroys or diminishes the ability of another system to protect the brain.…”

Section: The Causes Of Alzheimer's Diseasementioning

confidence: 99%

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The pitfalls of crowdfunding Alzheimer's disease research

Garrett¹

2019

Int Med

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With pharmaceutical companies' repeated failures at finding effective interventions for Alzheimer's disease, together with an increasing reliance on the growing federal funding for research, there is an emergent opportunity for financing alternate research through crowdfunding. Crowdfunding-where funding is obtained from small donations from a large group of people-has become a new source of funding for medical research. By understanding how the research community has evolved to study Alzheimer's disease the pitfalls of this strategy can be highlighted. Alzheimer's disease research is complex. From its inception in the early 1900s, Alzheimer's disease has been at the center of movement within psychiatry to define the disease on the basis of its biology. Recent emphasisthrough the DSM (Diagnostic and Statistical Manual of Mental Disorders), RDC (Research Diagnostic Criteria), RDoC (Research Domain Criteria) as well as the more recent Framework from the U.S. National Institute on Aging-have supported an exclusive emphasis on biology. But by excluding other aspects of the disease, such as its clinical expression, this research approach will be shown to be faulty and contradictory. So far, this approach has resulted in 100% failures. By examining the historical and financial circumstances of the industry centered on Alzheimer's disease a strong warning is given to the public to mistrust crowdfunding Alzheimer's disease research. A broader and more inclusive approach is likely to generate a better understanding of the disease and therefore hold better promise for understanding the disease in the long term. Such a nuanced approach competes badly with the more binary search for a cure and is less receptive to public support through crowdfunding.

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“…Thus, interest is quickly growing in generating non-pharmacological interventions for dementia in general and AD in particular. A shift to a broader approach is needed from today's prevailing AD intervention paradigm, which is too constrained around biological, genetic and chemical biomarkers (Garrett & Valle, 2015). Such narrowly focused view inhibits placing more emphasis on the allocation of sufficient financial and human resources for developing and implementing other important factors known to be possible paths to ameliorate the effects of this disease.…”

Section: Non-pharmacological Interventionsmentioning

confidence: 99%

A methodological framework for exploring the applicability of virtual reality in cognitive disabilities care

Betances¹,

Isabel²

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There is always going to be a reason why you can't do something, your job is toconstantly look for the reasons why you can achieve your dreams. Shannon Miller -7x Olympic Gymnast medallist AcknowledgmentsI would like to firstly express my sincere gratitude to my advisor ProfessorMaría Teresa Arredondo Waldmeyer for her continuous support of my PhD studies and related research, and for her inspiration, tenacity, and immense knowledge.In addition to my advisor, I thank Prof. María Fernanda Cabrera-Umpiérrez and Prof. Francisco J. García-Sánchez, not only for their insightful commentaries and supportive encouragement, but also for the helpful suggestions and revision recommendations which motivated me to extend the scope of my research work to wider perspectives.I also thank my former colleagues and present fellow teammates at LifeSTech for the stimulating discussions, help and advice, as well as for the interesting times we shared working and learning together at several projects during the last years.Last but not least, I thank my family and friends for supporting all my life goals and purposes, and for the patience shown while I was writing this thesis.ix AbstractHandling the care needs of people affected by Alzheimer's disease and related dementias (ADRD) represents nowadays a personal, familial and social challenge of enormous proportions, which poses an ever growing human and economic burden on the world's society in general. Information and communication technologies (ICT) have the potential to make a considerable impact to help revert this trend, especially through the use of advanced virtual reality (VR)-based computerized diagnostic and therapeutic cognitive interventions for people living with, or at risk of developing,ADRD. This doctoral thesis aims to facilitate the use of such VR-based interventions.To that end, it makes specific original contributions regarding: the categorization of VR systems particularly designed for ADRD; an analysis and assessment of the current relevance and impact of the 'brain training debate' involving commercial brain training products; an up-to-date critical description of the technical and scientific challenges faced today for the development of effective VR-based cognitive training tools; and finally, this thesis proposes a novel methodological design framework to provide guidance to researchers and developers with the design process of VR-based tools to address the care needs of people with ADRD. The framework is based on our previous critical analysis of the most recent knowledge available about VR cognitive interventions. The framework and its ensuing roadmap take into account, not only universal design principles, standard techniques and methodologies, but also addresses the specific aspects of accessibility and usability that are particular to the use VR-based platforms on patients with ADRD-associated cognitive impairments.x xi ResumenEl manejo de las necesidades de atención de las personas afectadas por la enfermedad de Alzheimer y demencias relacionadas (EADR)...

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A New Public Health Paradigm for Alzheimer's Disease Research

Cited by 9 publications

References 105 publications

A century of confusion in researching Alzheimer’s disease

A century of confusion in researching Alzheimer’s disease

The pitfalls of crowdfunding Alzheimer's disease research

A methodological framework for exploring the applicability of virtual reality in cognitive disabilities care

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