Scientists Discover New Computerized Linguistic Approach to Detect Alzheimer’s Disease

Newswise, December 14, 2015– Researchers have discovered how to diagnose Alzheimer’s disease with more than 82 per cent accuracy by evaluating the interplay between four linguistic factors; and developing automated technology to detect these impairments.

The study, led by Dr. Frank Rudzicz, Scientist, Toronto Rehabilitation Institute (TR), UHN, is published in the December issue of the Journal of Alzheimer’s Disease.

The method and automated application of the assessment is proven to be more accurate than the current initial assessment tool used by health-care professionals. It can also provide an objective diagnostic rating for dementia.

Based on the analysis, it was determined that four collective dimensions of speech are indicative of dementia: semantic impairment, such as using overly simple words; acoustic impairment, such as speaking more slowly; syntactic impairment, such as using less complex grammar; and information impairment, such as not clearly identifying the main aspects of a picture.

“Previous to our study, language factors were connected to Alzheimer’s disease, but often only related to delayed memory or a person’s ability to follow instructions,” says Dr. Rudzicz, who is also Assistant Professor, Department of Computer Science, University of Toronto, and a Network Investigator with the AGE-WELL Network of Centres of Excellence.

“This study characterizes the diversity of language impairments experienced by people with Alzheimer’s disease, and our automated detection algorithm takes this into account.”

Dr. Rudzicz further adds, “the driving force that makes this analysis so accurate is the large number of measurements, behind the scenes, that are precisely and automatically detected from speech using our software. An advantage of this technology is that it is repeatable – it’s not susceptible to the sort of perceptual differences or biases that can occur between humans.”

In this study, the researchers examined speech samples (including audio files) from a database of patients diagnosed with possible or probable Alzheimer’s disease and additional samples from 97 control subjects.

“Every caregiver knows that people with dementia have good days and bad days - we can tell this by talking to them, because speech is a rich source of information on the brain’s cognitive function,” says Dr. Jed Meltzer, neurorehabilitation scientist, Rotman Research Institute at Baycrest Health Sciences, and co-author of the study.

“These methods offer a way to assess speech quantitatively and objectively, so we can use them to test interventions such as novel drugs and brain stimulation.”

“The demand on the health-care system to support Alzheimer’s disease will continue to grow rapidly,” says Dr. Rudzicz. “Our automated approach will provide an opportunity to give people easier, more cost-effective and accurate access to initial dementia screening.”

The researchers will now begin testing the automated screening technology with current patients and control subjects to validate the approach. Dr. Rudzicz is also partnering with the University of Toronto and industry to commercialize the technology through a start-up company called WinterLight Labs.

This study was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC), the Alzheimer’s Association, and the Alzheimer’s Society.

About Toronto Rehabilitation Institute

As the world-leading rehabilitation research centre, Toronto Rehabilitation Institute is revolutionizing rehabilitation by helping people overcome the challenges of disabling injury, illness or age related health conditions to live active, healthier, more independent lives. It integrates innovative patient care, ground breaking research and diverse education to build healthier communities and advance the role of rehabilitation in the health system. Toronto Rehab, along with Toronto Western, Toronto General and Princess Margaret Hospitals, is a member of the University Health Network and is affiliated with the University of Toronto. www.uhn.ca

Stress in Older People Increases Risk for Pre-Alzheimer’s Condition

Newswise, December 14, 2015--Feeling stressed out increases the likelihood that elderly people will develop mild cognitive impairment—often a prelude to full-blown Alzheimer’s disease.

In a new study, scientists at Albert Einstein College of Medicine and Montefiore Health System found that highly stressed participants were more than twice as likely to become impaired than those who were not. Because stress is treatable, the results suggest that detecting and treating stress in older people might help delay or even prevent the onset of Alzheimer’s. The findings were published online in Alzheimer Disease & Associated Disorders.

Each year, approximately 470,000 Americans are diagnosed with Alzheimer’s dementia. Many of them first experience mild cognitive impairment—a pre-dementia condition that significantly increases the risk of developing Alzheimer’s in the following months or years. This study looked at the connection between chronic stress and “amnestic mild cognitive impairment” (aMCI), the most common type of MCI, which is primarily characterized by memory loss.

“Our study provides strong evidence that perceived stress increases the likelihood that an older person will develop aMCI,” said Richard Lipton, M.D., senior author of the study, vice chair of neurology at Einstein and Montefiore, and professor in the Saul R. Korey Department of Neurology and the Edwin S. Lowe Chair of Neurology at Einstein. "Fortunately, perceived stress is a modifiable risk factor for cognitive impairment, making it a potential target for treatment."

“Perceived stress reflects the daily hassles we all experience, as well as the way we appraise and cope with these events,” said study first author, Mindy Katz, M.P.H., senior associate in the Saul R. Korey Department of Neurology at Einstein.

“Perceived stress can be altered by mindfulness-based stress reduction, cognitive-behavioral therapies and stress-reducing drugs. These interventions may postpone or even prevent an individual’s cognitive decline.”

The researchers studied data collected from 507 people enrolled in the Einstein Aging Study (EAS), a community-based cohort of older adults. Since 1993, the EAS has systematically recruited adults 70 and over who live in Bronx County, NY.

Participants undergo annual assessments that include clinical evaluations, a neuropsychological battery of tests, psychosocial measures, medical history, assessments of daily-living activities and reports (by participants and those close to them) of memory and other cognitive complaints.

Starting in 2005, the EAS began assessing stress using the Perceived Stress Scale (PSS).

This widely used 14-item measure of psychological stress was designed to be sensitive to chronic stress (due to ongoing life circumstances, possible future events and other causes) perceived over the previous month. PSS scores range from 0 to 56, with higher scores indicating greater perceived stress.

The diagnosis of aMCI was based on standardized clinical criteria including the results of recall tests and reports of forgetfulness from the participants or from others. All 507 enrollees were free of aMCI or dementia at their initial PSS assessment and subsequently underwent at least one annual follow-up evaluation. They were followed for an average of 3.6 years.

Seventy-one of the 507 participants were diagnosed with aMCI during the study. The greater the participants’ stress level, the greater their risk for developing aMCI: for every 5 point increase in their PSS scores, their risk of developing aMCI increased by 30 percent. Similar results were obtained when participants were divided into five groups (quintiles) based on their PSS scores.

Participants in the highest-stress quintile (high stress) were nearly 2.5 times more likely to develop aMCI than were people in the remaining four quintiles combined (low stress). When comparing the two groups, participants in the high-stress group were more likely to be female and have less education and higher levels of depression.

To confirm that stress was independently increasing risk for aMCI in this study, the researchers assessed whether depression—which increases the risk for stress as well as for cognitive impairment and Alzheimer’s disease—might have influenced the results.

They found that depression did not significantly affect the relationship observed between stress and the onset of aMCI. Similarly, stress’s impact on cognitive status was unaffected if participants possessed at least one e4 allele of the APOE gene, which increases their risk for developing late-onset Alzheimer’s.

The study is titled “Influence of perceived stress on incident amnestic mild cognitive impairment: Results from the Einstein Aging Study.”

In addition to Dr. Lipton and Ms. Katz, other Einstein-Montefiore authors were Carol Derby, Ph.D., Cuiling Wang, Ph.D., Ali Ezzati, M.D., Molly Zimmerman, Ph.D., and Jessica Zwerling, M.D., M.S. Martin Sliwinski, Ph.D., of Pennsylvania State University also contributed to the study.

The research was funded by the National Institutes of Health, the National Center for Advancing Translational Sciences, the Leonard and Sylvia Marx Foundation and the Czap Foundation. The authors report no conflicts of interest.

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About Albert Einstein College of Medicine
Albert Einstein College of Medicine is one of the nation’s premier centers for research, medical education and clinical investigation. During the 2015-2016 academic year, Einstein is home to 731 M.D. students, 193 Ph.D.students, 106 students in the combined M.D./Ph.D. program, and 278 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2015, Einstein received $148 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center—Einstein’s founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.

About Montefiore Health System
Montefiore Health System is a premier academic health system and the University Hospital for Albert Einstein College of Medicine. Combining nationally-recognized clinical excellence with a population health perspective that focuses on the comprehensive needs of the communities it serves, Montefiore delivers coordinated, compassionate, science-driven care where, when and how patients need it most. Montefiore consists of seven hospitals and an extended care facility with a total of 2,455 beds, a School of Nursing, and state-of-the-art primary and specialty care provided through a network of more than 150 locations across the region, including the largest school health program in the nation and a home health program. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals." Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The health system derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit www.montefiorehealthsystem.org. Follow us on Twitter; like us on Facebook; view us on YouTube.

Can Slow Walking Speed in Elderly Signal Alzheimer’s Disease Hallmarks?

Newswise, December 8, 2015 – How fast elderly people walk may be related to the amount of amyloid they have built up in their brains, even if they don’t yet have symptoms of Alzheimer’s disease, according to a study published in the December 2, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.

 

The study involved 128 people with an average age of 76 who did not have dementia but were considered at high risk for developing it because they had some concerns about their memory. 

The participants had positron emission tomography (PET) scans of their brains to measure amyloid plaques in the brain. These plaques consist of dense deposits of a protein called beta amyloid, and their progressive buildup in the brain has been associated with the development of Alzheimer’s disease. 

Of the participants, 48 percent had a level of amyloid often associated with dementia.

Participants were also tested on thinking and memory skills and how well they could complete everyday activities. A total of 46 percent of the participants had mild cognitive impairment, which can be a precursor to the dementia that occurs in Alzheimer’s disease.

Walking speed was measured with a standard test that times people on how fast they can walk about 13 feet at their usual pace. The average walking speed was 3.48 feet per second. All but two of the participants tested in the normal range of walking speed.

The researchers found an association between slow walking speed and amyloid in several areas of the brain, including the putamen, a key region involved in motor function. 

The researchers compared how fast people walked both with and without taking into account the amount of amyloid and found that the amyloid level accounted for up to 9 percent of the difference in walking speed.

The relationship between amyloid levels and walking speed did not change when researchers took into account age, education level, or amount of memory problems.

“It’s possible that having subtle walking disturbances in addition to memory concerns may signal Alzheimer’s disease, even before people show any clinical symptoms,” said study author Natalia del Campo, PhD, of the Gerontopole and the Centre of Excellence in Neurodegeneration of Toulouse (University Hospital Toulouse) in France.

Del Campo noted that the study looked only at a snapshot in time and does not prove that amyloid plaques cause the slowdown in walking speed; it shows the association. She also noted there are many other causes of slow walking in older adults.

The study was based on a larger trial called the Multidomain Alzheimer Preventive Trial, which was supported by the French Ministry of Health and Pierre Fabre Research Institute. 

The imaging was supported by Avid Radiopharmaceuticals/Eli Lilly and Company. Biological sample collection was supported by Exhonit Therapeutics. The promotion of the study was supported by the University Hospital in Toulouse.

To learn more about Alzheimer’s disease, please visit www.aan.com/patients.

The American Academy of Neurology, an association of more than 28,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. 

A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

How Can I Tell if She’s Lying? Sarcasm, white lies and teasing can be difficult to identify for those with certain disorders – new video inventory developed at McGill may help

Newswise, December 1, 2015— When she says she loves my new haircut is she telling the truth or being sarcastic? The answer isn’t always obvious.

Especially for men.

Or for those who suffer from diseases like Alzheimer’s or Parkinson’s, or neurodevelopmental conditions such as Autism spectrum disorder. For people with these problems, any form of non-literal speech such as sarcasm, teasing or ‘white lies’ can be very confusing. 

A new video inventory of examples of these forms of indirect speech developed at McGill should help in the diagnosis and clinical testing of those with disorders of this kind.

A ‘truth bias’ underlies much social interaction

“We tend to believe that people tell the truth most of the time,” says Kathrin Rothermich, from McGill’s School of Communication Disorders, who has recently published a paper about the research in PLoS ONE. 

“So sarcasm and white lies seem to go against a basic understanding of what ‘should’ be happening in conversation. This may be part of what makes them so difficult to recognize for some.”

Rothermich has spent the past two years creating and testing the Relational Inference and Social Communication (RISC) video inventory that she and her colleague Marc Pell developed. 

These 926 videos feature short, scripted scenes with four actors interacting in different relationships (as romantic partners, as friends, as colleagues, or as boss/employee).

In each exchange, the actors were asked to convey one specific intention through their speech and actions: to be sincere, to tell ‘white lies’, to tease, or to be sarcastic. 

Rothermich then tested the videos on a group of healthy participants to see whether they were able to identify the speakers’ intentions, and to get feedback about which vocal and facial cues had helped them identify what was going on.

Sarcasm is especially hard to recognize

Participants were generally well able to identify the speakers’ intention either when one of the actors was teasing someone else or when they were telling the truth. 

What proved to be more difficult, and particularly so for men, was identifying when someone was being sarcastic. It was only when sarcasm was used in relationships between friends that participants were better able to recognize it.

“We discovered that the actors found it hardest to perform the scripts where they were being asked to tease one another,” says Rothermich. 

“This may be because teasing doesn’t always fit easily or logically into a conversation. One of the things that some actors did was to speak with exaggerated or fake accents when they were teasing, which is something that other researchers have also reported.”

The researchers believe that this video inventory will provide a useful tool for future research on social cognition, inter-personal communication and the interpretation of a speaker’s intentions in both healthy adult and clinical populations.

Nurses Help Tracheostomy Patients Regain Speech

Article in Critical Care Nurse describes nursing assessments and interventions to help patients regain the ability to speak after a tracheostomy

Newswise, December 1, 2015— Tracheostomies are among the most common procedures performed in critically ill patients, and various methods are available to help patients with tracheostomies regain the ability to speak, according to an article in the December issue of Critical Care Nurse (CCN).

The article, “Restoring Speech to Tracheostomy Patients,” provides an overview of nursing assessments and interventions to help patients regain the ability to speak after a tracheostomy.

Critical care nurses work as part of an interdisciplinary team that includes respiratory therapists, speech pathologists, advanced practice nurses and physicians to coordinate care and develop a patient-specific communication plan, which is essential to the goal of voice restoration.

Lead author Linda L. Morris, PhD, APN, CCNS, FCCM, is a tracheostomy specialist/consultant and associate professor of clinical anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago. 

The co-editor/author of the 2010 edition of “Tracheostomies: The Complete Guide,” she also serves on the board of directors for the Global Tracheostomy Collaborative.

“Losing the ability to speak after a tracheostomy adds to the stress, fear and frustration of being critically ill,” she said. “Restoring speech to a patient after a tracheostomy allows them to more fully and effectively express their needs and wishes, participate in their plan of care and converse with their loved ones and caregivers.”

Speaking after a tracheostomy depends on having an adequate supply of air reach the vocal cords with a minimum of resistance, and the tracheostomy tube itself is an important factor related to phonation, or the ability to make sound with one’s vocal cords. 

Changing the type of tube, as well as its diameter or length, can help avoid complications and lead to greater success in phonation.

The article summarizes different approaches to restore phonation in patients with a tracheostomy, including special considerations related to nursing interventions. 

The methods vary, depending on whether the patient is spontaneously breathing, being treated with intermittent mechanical ventilation or is fully ventilator dependent.

“An essential component of successfully helping a patient regain the ability to speak is to determine which option or options are most appropriate, and nurses need to be aware of all the options available,” Morris said.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org/.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 105,000 and can be accessed at http://ccn.aacnjournals.org/.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than 500,000 acute and critical care nurses and includes more than 225 chapters worldwide. 

The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. www.aacn.org; www.facebook.com/aacnface; www.twitter.com/aacnme

Senior Patients Treated in Van Equipped as Dentist’s Office

Newswise, December 1, 2015 — Students and faculty at Case Western Reserve University’s School of Dental Medicine are treating seniors in a dentist’s office on wheels—a 38-foot van, in fact, renovated to provide full-service oral care.

“There’s almost no difference between our van and a traditional dentist’s office,” said Nicole Harris, a visiting assistant professor in the dental school’s Department of Community Dentistry.

Dental students, under supervision of faculty, provide, oral exams, digital X-rays, cleanings, fillings, dentures, extractions and cancer screenings on the van for many patients who haven’t visited a dentist in years.

The "Lifelong Smiles" van is driven and parked outside nursing homes and assisted-living facilities for residents to come aboard. In addition, two portable dental chairs are set up in facilities for those patients who cannot get on the van.

“There’s a perception it’s more difficult to treat seniors, which has kept many dentists in their comfort zones, avoiding these patients,” said James Lalumandier, chair and professor in the dental school’s Department of Community Dentistry. “We want to reverse that—and need to—given our current and future dental needs.”

The van is the centerpiece of a new dental school initiative known as the Geriatric Dental Program, which was created, in part, as a response to changing demographics nationally, said Lalumandier.

The nation’s senior population—ages 65 and older—is expected to surpass 72 million by 2030—more than double the number from 2000, according to the U.S. Department of Health and Human Services.

“Often, underserved elderly populations cannot go out and get care on their own. So we’re building a model where we go to them,” said Suparna A. Mahalaha, a visiting assistant professor in the Department of Community Dentistry and co-director of its new Geriatric Dental Program, along with Harris.

“At the same time, by providing students experience with older patients, we’re planting a seed in them to serve seniors during their careers.”

Soon, medical, nursing and social work students at Case Western Reserve also will accompany dental students in assessing patients in facilities where the van is parked, as part of an emphasis on increasing interdisciplinary training in the health sciences.

“It used to be people just lost their teeth. In today’s world, seniors are retaining a good portion of their teeth and need specialized care that’s in fitting with their overall medical histories,” said Lalumandier.

“Across the health sciences, students are opening their eyes to the idea that oral health is key to a patient’s complete wellbeing.”

The Ohio Department of Health donated the vehicle to the university after reviewing competing proposals from across the state. Funds for the van’s overhaul were provided by the McGregor Foundation, the Dental Trade Alliance Foundation and others

Study Offers Insights to How Ovarian Cancer Grows – and Potential to Stop It

Findings support cancer stem cell model, with exceptions

Study offers insights to how ovarian cancer grows – and potential to stop it...

Findings support cancer stem cell model, with exception

Newswise, December 1, 2015 — Can any cancer cell form another tumor, or is it only select cancer stem cells that give rise to new cancer cells? The answer, a new study finds, is both.

Researchers at the University of Michigan Comprehensive Cancer Center looked at human ovarian cancer cells and found that for the most part the cancer cells generate offspring in a predictable and organized fashion: mother cancer cells produced daughter cells and the daughter cells produced granddaughter cells. The grandmother cells are the rare cancer stem cells that can initiate cancer recurrence and the granddaughter cells are the bulk tumor cells.

But in rare exceptions, the daughter cells gave rise to the stem-like grandmother cells.

The question of whether cancer cells divide in a patterned fashion or randomly has been hotly debated.

“Like any nature/nurture question, the answer is always both. In general we observed that cancer cells do not divide randomly. Just like in normal biology, we saw the pattern of stem cells giving rise to daughter cells. But within that hierarchy, we saw rare exceptions that went against the hierarchy,” says senior study author Ronald J. Buckanovich, M.D., Ph.D., associate professor of internal medicine at the University of Michigan Medical School.

“This is very significant for how you design cancer therapies. These stem-like cells are the really critical therapeutic targets, but the non-stem cells need to be addressed as well,” he adds.

The researchers also found that a protein called BMP2 increased the growth of the cancer stem cells and decreased the growth of the granddaughter cells, or the bulk tumor cells. 

It’s like a conversation between the two types of cells: When there are too many granddaughter cells, they trigger BMP2 to increase the number of stem cells. The non-stem cells are helping to support the growth of the stem cells to maintain an equilibrium within the tumor.

“BMP2 tells the cancer to make more grandmothers and stop making granddaughters. So there are fewer bulk cells. But there are more of the aggressive, chemotherapy-resistant cells that have the ability to create new tumors,” Buckanovich says.

When the researcher blocked BMP2, it reduced the ability of the cancer cells to make new stem cells. But blocking BMP2 promotes the growth of the granddaughter bulk cells. 

The challenge is to target the BMP2 inhibitor to the cancer stem cells only. This type of treatment is not currently available to patients. Researchers are examining ways to deliver an inhibitor only to the stem cells.

The study, which is published in PNAS, is unique because it looked at human tissue, rather than mouse models. The cancer researchers tapped into a microfluidic device designed by Euisik Yoon’s group at the University of Michigan College of Engineering. 

The device enabled the cells to be separated and studied individually over time in a manner that would not be possible with traditional methods.

“We could watch cancer cells divide in real time, actually track and watch who’s the mother and who’s the daughter,” Buckanovich says. “This device allowed us to study human cells instead of mouse models. We believe it is the first instance to define a cancer hierarchy using cells from patients.”

Additional authors: Yunjung Choi, Patrick Neal Ingram, Kun Yang, Lan Coffman, Mangala Iyengar, Shoumei Bai, Dafydd Thomas, Euisik Yoon

Funding: Ovarian Cancer Research Fund, National Institutes of Health grants DP200440377 and P30 CA046592

Disclosure: None