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Friday, February 13, 2009
The Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study was funded by the Posit Science Corporation, which owns the rights to the Brain Fitness Program, tested in the study.
Elizabeth Zelinski, PhD, of the USC Davis School of Gerontology and Glenn Smith, PhD, of the Mayo Clinic were principal investigators on the study, published with colleagues from the University of California, San Francisco, Stanford, and California State University, Los Angeles.
Of the 487 healthy adults over the age of 65 who participated in a randomized controlled trial, half used the Brain Fitness Program for 40 hours over the course of eight weeks. The Brain Fitness Program consists of six audio exercises done on a computer, and is intended to "retrain the brain to discriminate fine distinctions in sound, and do it in a way that keeps the user engaged," Zelinski explained.
The other half of participants spent an equal amount of time learning from educational DVDs followed by quizzes.
Those who trained on the Brain Fitness Program were twice as fast in processing information with an average improvement in response time of 131 percent. The active control group did not show statistically significant gains, the researchers found.
According to the researchers, participants who used the Brain Fitness Program also scored as well as those ten years younger, on average, on memory and attention tests for which they did not train.
Many participants also reported significant improvements in everyday cognitive activities such as remembering names or understanding conversations in noisy restaurants.
"The changes we saw in the experimental group were remarkable — and significantly larger than the gains in the control group," Zelinski said. "From a researcher's point of view, this was very impressive because people got better at the tasks trained, [and] those improvements generalized to standardized measures of memory and people noticed improvements in their lives. What this means is that cognitive decline is no longer an inevitable part of aging. Doing properly designed cognitive activities can enhance our abilities as we age."
"This study has profound personal and public implications for aging baby boomers and their parents," said Joe Coughlin, PhD, Director of the AgeLab at the Massachusetts Institute Technology. "This means boomers may now have tools for a future that is not their grandfather's old age. It also impacts most aspects of independent living – from aging-in-place to transportation to all the great and little things that we call life. This is big news for aging and for all of us."
The multi-site IMPACT study is the largest study ever of a commercially available brain-training program.
Wednesday, February 11, 2009
By Ravi Samuel - email@example.com ; The Psychotherapy Clinic, 26/
Cognitive rehabilitation (CR) is a specialized treatment procedure to develop the cognition affected by internal or external injury to the brain. The process of cognitive rehabilitation involves assessment of cognitive functions, goal setting, and applying appropriate cognitive exercises to improve the cognitive function. There are two types of CR: Restorative rehabilitation and Compensatory rehabilitation. The CR therapist will make a comprehensive assessment of the impairment and design appropriate cognitive exercises. Studies on the effi cacy of CR for brain damage have shown two extremes; one opinion was CR has a positive effect on the patients cognitive functioning and the other opinion was that CR has no effect on the cognitive functioning. This case study examines the dynamics and relevance of CR in reversible and progressive brain injury. It was observed that in reversible condition CR improves cognition and thereby
functional ability. In progressive conditions like Alzheimer’s disease (AD), CR improves the cognition marginally and thereby improves functional ability and also reduces Behavioral and Psychological Symptoms in Dementia (BPSD).
Cognitive rehabilitation (CR) is a specialized treatment procedure to develop the cognition affected by internal or external injury to the brain. This is based on the theory proposed by Luria that the recovery of function can occur through new learned connections established through cognitive retraining exercises. The process of cognitive rehabilitation involves assessment of cognitive functions, goal setting, and applying appropriate cognitive exercise to improve the cognitive function.
There are two types of CR: Restorative rehabilitation and Compensatory rehabilitation. Restorative rehabilitation is to enable the person to develop the lost function through specialized computerized and manual cognitive exercises.
Compensatory rehabilitation helps the patient to develop use of aids and tools to overcome the impairment. For example, people with poor memory can have a small slip to write down what they need to remember.
The brain needs specific exercises to enable it to regain the lost function after injury; in case of internal event like stroke or external accident like head Injury. CR is normally done after the patient medically stabilizes. CR is also beneficial for people who have developed their brain functioning in a faulty manner due to poor supervision in learning during childhood.
CR therapist will make a comprehensive assessment of the impairment and select appropriate cognitive exercises. For example if a person suffers from severe memory difficulties, the exercises will start with simple exercises like learning five randomly selected words and then recalling as many times during the day. And with the development of the brain; the difficulty and complexity of the exercises will be increased like asking the patient to learn three new words. Initially CR is done through manual exercises and computerized programme with assistance of the therapist. The therapist will enable the patient to perform exercises in areas in which they have difficulty. After the patient develops confidence over their performance in doing the exercises, they will be encouraged to do cognitive exercises at home.
Studies on the efficacy of CR for brain injury have shown two extremes; one opinion was CR has a positive effect on the patients cognitive functioning[4,5] and the other opinion was that CR has no effect on the Cognitive Functioning.[6,7] This case study examines the dynamics and relevance of CR in reversible and progressive brain injury.
Mr. S aged 39 years, working as manager of a multi national company was referred by a Psychiatrist for CR. He was a heavy smoker and also had the habit of drinking alcohol occasionally. One and half years ago, he had severe myocardialinfarction and consequent hypoxia, resulting in severe brain injury, leading to severe cognitive impairment.
His Mini Mental Status Examination (MMSE) score was 10/30; in orientation, he was not able to give the date, day, month, house number, street and pin code, in memoryrecall he was able to recall only one word and in Language and Praxia he was not able to name objects and construct diagrams. On clinical evaluation, he had very severe memory impairment; he was not able to remember what happened five minutes ago, he did not know the names of his family members and friends, the company he worked, etc. He had poor orientation towards month, date, day, year, place, and time of the day. Though he was a postgraduate he was not able to read and write any language. His new learning ability was absent. He was dependent on his spouse to perform his Activities of Daily Living (ADL) and was always foundclinging to her. He was not able to plan and execute any ADL on his own.
The Psychiatrist did not find any psychiatric disorder so prescribed Aricep 10 mg to improve his cognition and referred him for CR.
Cognitive rehabilitation was done in his residence for forty minutes, twice a week for six months period. In the beginning of CR therapy, the focus was on memory and orientation. Since his memory was severely affected, the exercises were towards recall of major life events, work assignments and social events. On the basis of restorative principle to facilitate repetitive learning, a big chart with date, day, month, and year was given to him and was asked to inform the details to the carer thrice daily. The therapist during the sessions taught him to use a calendar to find the details, he was made to strike out the past month and date. This enabled him to use compensatory techniques instead of pleading ignorance and not incorporating the day and month concept in his thinking. To enable him to improve his memory to wards past life events, information was gathered from the family members and detailed account of his past was repeatedly narrated to him by the therapist. After two months of cognitive exercises, there was an improvement in his memory in terms of remembering five life events.Considering the improvement, his cognitive exercises were increased in complexity to enable higher level of stimulation to the brain. The memory exercises involved recalling names of friends and family members, his orientation towards the date and day was poor, so an orientation card was given to him with the year, date, month, and day. Unfortunately, he never bothered to carry it with him or tried to register theinformation. So the carer was requested to repeatedly use details of day, month, and date in her conversation.
After six months of providing details of his life events and facilitated recall exercises of life events, he was able to give additional details of the events narrated to him. Repeated exercises brought considerable improvement in his memory; he was able to remember the name of the therapist, the name of the hospital, the nature of the therapy and why he had to do the exercises repeatedly. The carer reported that as his cognitive functions developed improvements were noticed in his behavior; his expressions of anger were
replaced by courtesy and politeness.
The MMSE improved to 15/30; in orientation, he was able to give the date, day, month, and year, he was able to recall one word in the memory test. He was able to identify people whom he meets everyday. Patient was also observed to share social courtesies with visitors. He was able to independently engage himself with television or CD player without clinging to his wife.
Mr. N aged 68 years, with history of diabetes mellitus was brought by his wife for the complaint of progressive memory loss, word finding difficulty, inability to read and write and searching for belongings all the time.
His MMSE score was 15/30; he had total disorientation, was able to repeat only two words immediately and was not able to remember any words in memory recall exercise. In word fluency test, he was able to recollect five names of animals in one minute, which was suggestive of poverty of words to facilitate conversations. On clinical behavior assessment, he was found to be withdrawn, avoided talking to his family members, kept searching for his misplaced belongings all the time. Patient’s wife was found to be extremely critical of the patient, which made him all the more nervous about his performance.
Mr. N had insidious onset of the current illness three years ago, after detailed evaluation the Psychiatrist diagnosed Alzheimer’s disease (AD) with co-morbid depressive features. He prescribed rivastigmine 3 mg twice daily and decided not to start pharmacotherapy for his depressive features.
Cognitive rehabilitation exercise was provided in out patient facility once a week for forty minutes each session for six months period. Considering the progressive decline in AD very limited cognitive rehabilitation goals were set to improve his orientation, memory and word recall. To improve his speech and memory Mr. N was encouraged to speak on favorite topics of his choice. He was very much interested in religion and music, he felt encouraged to talk more and more on the subject. To improve word recall the therapist made the patient repeat after him 20 commonly used words in everyday life. Though he repeated the words, he was not able to remember and incorporate it in his speech. So the exercise was modified from words to sentences and were repeated over two week’s time every day. After repeated learning for two weeks, he was able to use some of the words in his conversation.To help him to be oriented towards the day and month, based on restorative principle he was made to relearn the day and month, but even after three weeks of repeated learning patient was not able to register the month and day.
So the orientation was modified towards his immediate surroundings. In the house, he was requested to name the objects in the room. He had difficulty in naming things which he does not use like computer, printer, but was able toname familiar objects. Instead of leaving him on his own in the house, a schedule was made incorporating activities like watching television, talking with his wife and daughter. Patient’s wife was counseled to talk about her frustrations during therapy sessions and not be irritable and critical of the patient as it will inhibit his performance.
His MMSE score on post assessment was 13/30 after six months. After six months of twice a week cognitiverehabilitation there was no improvement in his score, instead there was deterioration in his orientation, immediate recall and naming objects, patient showed orientation to rooms in the house, was able to keep all his belongings in one place which stopped his endless searching habit. He also helpedhis wife by participating in cooking and his communicationwith family members improved.
The present case studies, observed improvement in the cognitive functioning as reported by Gatz et al. and Spector.[1,2] In progressive conditions like AD, though CR does not reverse the cognitive impairment, marginallyimproving the cognition for a short period can reduce Behavioural and Psychological Symptoms in Dementia (BPSD). Also short term developments are also important to maintain the well-being of the patient, particularly in progressive degenerative disorder like dementia.In the learning process, the therapist compensating by his performance for the patient’s cognitive impairment can lead to faster learning. Reading loud the detailed account of incidents, the sentences commonly used, enabled the patients to relearn the material. Similarly, for orientation, the therapist saying once in every ten minutes the day, date, month, year, and season facilitates orientation.
Life circumstances can influence development of cognitive symptoms and that may in turn lead to BPSD. As in Case II, because of critical spouse, patient reduced his speech got isolated, withdrawn, and asocial. And that presumably lead to under usage of language faculty in the brain, which lead to word finding difficulty and poor sentence construction. Modifying life circumstances by counselling the patient and carer, we can avoid ‘induced’ cognitive impairment and BPSD.
I wish to thank Dr. Judith Jager of CENNOR, Jewish Medical College, Glen Oaks,
1. Luria AR. Restoration of Function after brain injury.
Books; 1963. p. 5-10.
2. Alladi S,
techniques. Neurol India 2002;50:S102-8.
3. Sohlberg M, Mateer C. Current perspectives in cognitive rehabilitation.
Introduction to cognitive rehabilitation theory and practice.
4. Spector A, Thorgrimsen L, Woods B, Royan L, Davies S, Butterworth
M, et al. EfÞ cacy of an evidence-based cognitive stimulation therapy
programme for people with dementia: Randomised controlled trial. Br J
5. Gatz M, Fiske A, Fox L, Kaskie B, Kasl-Godley JE, McCallum TJ, et al.
Empirically validated psychological treatments for older adults. J Mental
Health Aging 1998;4:45-8.
6. Zarit SH, Zarit JM, Reever KE. Memory training for severe memory loss:
Effects on senile dementia patients and their families. Gerontologist
7. Barry D. Jordan, MD. Cognitive rehabilitation following traumatic brain
injury. JAMA 2000;283:3123-4.
8. Clare L, Woods B. A role of cognitive rehabilitation in dementia care.
Neuropsychol Rehabil 2001;11:93-6.
Courtesy: 'Indian Journal of Psychiatry' 50(4), Oct-Dec 2008
The All India Institute of Medical Sciences (AIIMS), Indian Academy of Geriatrics (IAG), and IAG – Delhi Chapter are pleased to announce the International Congress on Gerontology and Geriatric Medicine 2009 (ICGGM 2009) for the advancement of health care systems for older people in India at the All India Institute of Medical Sciences, a premier health care Institute in the capital city of New Delhi. We are organizing the International Congress to sensitize and reorient medical practitioners and other health care partners in India and neighboring regions on the 26th, 27th and 28th February, 2009 with a commitment to improve old age care and bring Gerontology and Geriatrics to the mainstream in India. The Congress has a special focus on the use of assistive technology towards a comfortable and independent old age, establishing models of long term care in India, besides looking at musculoskeletal disorders in old age and needs of older victims in disaster situations. We have designed special workshops to address areas of social security for older people and improve intergenerational bonding between children and older people
It will be our privilege to have you with us for the Congress. Regular updates and details of the ICGGM may be accessed from our Website www.oldagesolutions.org. The brochures, fliers, registration forms and abstract submission forms may also be accessed at the website. I seek your guidance, suggestions, blessings and help in organizing this event. We would be grateful if you would help us to popularize the event through your own network and help us in popularizing the Congress.
Please do let me know if it would be possible for you to participate in this event at my email id firstname.lastname@example.org. We would be grateful if you could disseminate this information among colleagues and friends and encourage them to respond, contribute ideas and participate.
Dr.Ashish Goel (Organizing Secretary)
SRA, (Geriatrics) Medicine, AIIMS, ND 29
C2/403, Janak Puri, New Delhi 58 INDIA
S.V.T. COLLEGE OF HOME SCIENCE (Autonomous) S.N.D.T. Women’s University, held an UGC CPE sponsored International Conference on “Multidisciplinary Approach to Healthy & Participatory Ageing” from 22nd to 24th JANUARY, 2009, at ISKCON Auditorium,
The participating organizations for this conference were
Around 400 delegates consisting of academicians, students, researchers from the different fields of human development, psychology, nutrition, social work, related to the field of Gerontology across India and a few from abroad participated during the three-day event to discuss the areas related to Senior Citizens. Many representatives of Senior citizen organizations also participated in this conference.
In the Inaugural program, the keynote address ‘Towards Multi-disciplinary Approach – Going Beyond Physical Science’ was delivered by Dr. S. D. Gokhale (President, International Longevity Centre,
The inaugural ceremony was followed by the inauguration of photo exhibition and poster presentation. Later the students of SVT College of Home Science enthralled the audience with the rich cultural programme.
The delegates of this conference enriched their existing knowledge with the different presentations on various topics from a galaxy of National and International invited speakers who are stalwarts in the field of gerontology like Mrs. Irene Hoskins (President, International Federation of Ageing,
Various topics like Global Ageing Innovations in Policy & Practice, Role of NGOs in Population Ageing, Cardiovascular & Respiratory Rehabilitation – Emerging Issues, Special Housing for Elderly, Think Elderly: Designing Products for Elderly, Quality Ageing – Psychological Issues. Dementia Care – Emerging Issues and Newer Interventions, Family as Carer – the Changing Scenario, Ageing & Cognitive Impairment, Nutrition and Health Benefits of Soy in Human Nutrition, Menopause and Ageing, Personality Characteristics and Well-being of Older Adults, Intergenerational Relationships: Issues and Challenges, Nutrition, Health, and Ageing‘Active Ageing and Economic Security for Elderly, Research in Population Ageing, Use of Electro Stimulation for Incontinence, Issues of the Elderly Women etc were covered very effectively by the different topics.
There were about 22 oral paper presentations made by different researchers during this 3-day conference. About 14 posters presentations on varying topics related to ageing were also another highlight of this conference.
The concluding session was panel discussion on the theme ‘Healthy Ageing’ chaired by Dr. Vibhuti Patel and the panellists were Mr. Sailesh Mishra (Silver Innings), Dr. Sesikaran (NIN,
The conference came up with the following recommendations:-
• There is a need to raise awareness of and creating a common understanding of the concept of healthy ageing.
• Sensitize the society that concept of Healthy ageing goes beyond physical health.
• Quality Ageing should be part of Syllabus of School, College and University.
• Research in Areas of Widows, Disabled, Fragile older adults & Unorganised Sector should be encouraged. Networking for sharing of Research on Ageing should be promoted.
• Need for more well planned low-cost interventions for older adults.
• Need to develop supportive environment in terms of specially designed houses, medical infrastructure, NGO’s and services for the elderly.
• Need for more qualified care-givers for the elderly- Training programmes for caregivers need to be strengthened.
• Government must be cautious while giving the additional responsibility of Geriatric care to the anganwadi worker who is already overloaded.
Dr.Suja Koshy : email@example.com
Sunday, February 8, 2009
Although capitalism has brought prosperity and increased political power to China, it has also caused the weakening of a traditional society that had collectivism and strong family ties at its heart.
The study by Durham University and the University of Reading, published in Ageing and Society, examined in detail two surveys of Chinese people aged 60 years and over in 1992 and 2000 (1). The percentage of older people who said they were lonely has doubled from about 16% in 1992 to 30% in 2000.
While loneliness can severely impact a person’s quality of life, it can also be a triggering factor for mental health issues. The findings suggest that policy makers in China need to take urgent action to assess what is needed to improve the quality of life for its 140 million older people, who collectively amount to the largest older population in the world.
The Durham and Reading University study suggests potential causes for loneliness include a widespread move since the late1970s from highly collectivised communities, where several generations lived under one roof in close proximity to their neighbours, to communities dominated by the nuclear family, many living in impersonal city apartment blocks.
Under the collectivised system in rural areas, communes, brigades and teams were not only responsible for agricultural production but many other community affairs, meaning a high level of social interaction for all.
In today’s economic climate, sons and daughters are more likely to have moved long distances from the country to the city or from one city to another in search of work, often leaving their parents behind. They can work long hours, juggling childcare with the demands of full-time work, and although they send money home, visits can be infrequent. The single-child policy means that older people are increasingly left without a selection of offspring for company and care in their old age.
Lead study author Dr Keming Yang, a Durham University sociologist who hails from China’s third largest city, Tianjin, said: “While economic development has brought many benefits for China, such as money, increased political power and better standards of living, loneliness is one of its negative effects.
“Mao has been roundly criticised for many aspects of his leadership but - like it or not - the way the society was structured at the time effectively provided opportunities for a high level of social interaction, either good or bad.
“There was a lack of competition and a slower pace of life where people had more control over their schedule. Members of the community tended to attend long meetings where they would talk to others about not merely business but personal issues as well.”
But the study authors point out that more detailed research is needed to obtain a more accurate picture outlining the extent of the loneliness problem: Dr Yang added: “While concentrating on economic advancement it is easy to ignore the wider social effects of a richer but more competitive society.
“Experience of capitalist societies to date suggests it is very likely that many other sections of the population, especially young people who are under huge amounts of pressure at school and home, are feeling the same sense of isolation.”
Co-author Professor Christina Victor, of the University of Reading, said: “Levels of loneliness in China are now comparable, or higher than, those observed in Western Europe; therefore, this is not just a problem seen in developed countries.”
Dr Yang said a potential solution for the Chinese authorities to tackle loneliness in the old was to ensure the local community played a greater role in engaging older people in social and group activities, although this would require some financial support.
Thursday, February 5, 2009
Caregiving for a parent may stretch the budget as well as your endurance -- that is, if you aren’t aware of scores of federal, state and even local government programs.
Access to assistance is as close as your computer, and, in most cases, you can apply online. Start by accessing two sites:
www.Govbenefits.gov - Gather up all the information you can on your parent’s health, disability, income, wealth (as in property owned), whether a military veteran, education level and more. Access this site and answer every question that you can. Then, push the button and, within minutes, the site will respond with a list, details and access information for many, even scores, of beneficial government programs, supplements and/or services.
www.Benefitscheckup.org - This non-profit site will ask many of the same questions but may report added programs, details and contacts.
Here is a guide to the top 10 programs everyone who is caring for an aging parent should know about:
There is more to Medicare than just the Part A hospital and Part B medical insurance coverage. If your parent is 65 or older and collecting Social Security, the insurance premiums are deducted from monthly benefits. Part D prescription drug coverage is subsidized by Medicare through payments to private company insurers who then fund an average of 90 percent of the cost of prescription drugs. If your parent is considered low income, receiving only Social Security, Medicare may subsidize all but about $10 of the monthly premiums. Ask and you may find a great cost saving for your parent.
Medicare: www.medicare.gov Medicare Part D: www.medicare.gov/pdphome.asp
2. Social Security
If your parent’s Social Security benefits were earned based on lower-paying jobs, and if the benefits are the only source of income, there may be a larger monthly benefit available by applying for its Supplemental Security Income (SSI) program. The program may be operated federally or in conjunction with your state government. The welfare-based Medicaid program is also administered through the Social Security Administration, though the operation may be directed by your state government.
3. Administration on Aging (AoA)
The AoA administers many national programs and services for elders, including health insurance counseling, legal assistance, protection from elder abuse and long-term care. The banner on the website has a link to Elders and Families, your starting point. This section also offers a specific link and service For Caregivers (see the left hand column.)
4. Department of Veterans Affairs (VA)
If your parent is a military veteran and has a service-related disability, you may be able to apply for an increase in benefits, particularly if the disability has worsened over time. If he or she needs continuing medical care because of the disability, an application for medical benefits, hospitalization and prescription drugs may be submitted. There are several types and levels of VA disability compensation and pension programs. The VA has been slow in processing claims the past few years, but there is continuing pressure by Congress and the Administration to speed up its service.
The Health Insurance Portability and Accountability Act of 1966 provides your parent privacy of his or her medical records. It is a regulation and restriction program on health care providers. The protection should be of concern to you and other family members because, unless your parent signs a form designating each of you as approved to discuss your medical concerns with the physician, he or she cannot do such, even if you prove your family connection. Better sooner than later, access the HIPAA website for the information and forms, or secure the forms from a physician, and file copies with every health care professional involved in your parent’s care.
6. United States Department of Justice
If your parent has a disability, particularly with physical movement, learn about the Americans With Disability Act administered by the U.S. Department of Justice. Its website offers briefings and cost-free publications on the regulations to grant universal access to the disabled.
7. Food and Drug Administration
Your parent is probably taking five to as many as 10 different prescription drugs, perhaps prescribed by different doctors. As caregiver, you should be aware of every one of the drugs, know its mission in the body and, particularly the side effects and conflicts with other medications. The federal Food and Drug Administration offers a giant database on every drug approved by the agency, listing active ingredients, purpose or mission of the medication, dosing recommendations and the side effects and conflicts.
www.fda.gov/cder/index.html(At the top right hand on the opening page, click the link to Drugs@FDA)
8. Your U.S. Senator
Every senator has a staff specialist on elder affairs, programs and services, probably in major cities of your state plus in Washington, D.C. The staff person can both advise and advocate for benefits or services for your parent. Know that bureaucrats listen immediately to an aide for a United States Senator.
Click the Senators link.
9. Your Congressional Representative
Most Representatives in the United States Congress also have staff specialists on elder affairs, programs and services and can provide both information and advocacy.
www.house.gov(Click the Representatives by State link)
10. Area Agency on Aging
There is a federally-mandated Area Agency on Aging in your county or city. This agency is staffed by professionals who know every elder program and service, including available funding sources, in your area. Staff is often aided by volunteers who serve as drivers for transport and Meals-on-Wheels, for respite services and other duties. Gather up the same information you collected for the two sites detailing the national, and even state, programs for which your parent may qualify and make an appointment to meet with a counselor at the Area Agency on Aging. The staff person can advise regarding programs and qualifications and even help prepare the necessary applications and documentation. Often, the counselor will even call a recommended agency, program or service to advise that your application is headed their way. Access your Area Agency on Aging through your telephone book and call the office for an appointment, at which time you should also ask if they have a website that you can access in advance of an in-person visit.
Use these resources and you may gain a world of vital information as well as increased income and services for your parent. And you just may find your caregiving less stressful and demanding.
By Leonard J. Hansen a recognized as the pioneer journalist and author writing to, for and about mature adults, founding, publishing and editing Senior World newspapers and a syndicated newspaper columnists. He has received 106 professional awards and fellowships for his journalistic and creative work. Access his website at: www.lenhansen.com
Wednesday, February 4, 2009
Given these figures, the potential for Alzheimer's drugs seems to be huge. Surprisingly, a very low amount of research is going into developing new drugs for the disease, which usually affects people over 70 years and is characterised by memory loss, impaired judgment, loss of language skills, and behavioural disturbances. Alzheimer's disease currently poses the biggest unmet medical need in neurology.
According to statistics, the market for Alzheimer's drugs, which was at $3 billion in 2006, is expected to exceed $5 billion by 2012. Even then, pharma players are not going deep into the disease to discover new chemical entities (NCEs) or new biological entities (NBEs), which when developed can become novel drugs.
P N Renjen, senior consultant (neurology) at Indraprastha Apollo Hospital, says, "Alzheimer's is a degenerative disease of the nervous system. There is no drug that can reverse such degeneration of the nervous system." The medicines available now can be used only for mild to moderate Alzheimer's.
Among these are Pfizer's Aricept, Novartis' Exelon, Johnson & Johnson's Razadyne, and Forest Laboratories' Namenda. Ranbaxy, Sun Pharma, Teva, Dr Reddy's Laboratories, among others, sell generic versions of Alzheimer's drugs.
Sanjay Saxena, senior consultant (neurology) at Fortis Hospital, Noida, says, "There is no treatment available for severe forms of the disease. Clinical trials are being conducted to find out whether stem cell therapy can be used for treating Alzheimer's, but in most cases patients with severe forms of the disease end up in old-age centres." Bhavin Shah, a research analyst at Dolat Capital Market, feels if any company manages to develop an effective novel medicine for Alzheimer's, the drug can become a blockbuster with gross sales of over $1 billion.
But Indian firms such as Piramal Life Sciences, Glenmark Pharmaceuticals, Wockhardt, Dr Reddy's Labs, Lupin Pharmaceuticals, Sun Pharma Advanced Research Company and Biocon, which have several NCE and a few NBEs in their portfolios, have been focusing on areas like cancer, diabetes, chronic obstructive pulmonary disorder (COPD), etc. Globally, GlaxoSmithKline (GSK), Wyeth, Roche have Alzheimer's molecules.
But in India, the only one to have ventured into this highly complex segment is the Rs 120-crore Suven Life Sciences. The Hyderabad-based firm has a few molecules in Alzheimer's, one of which will enter phase II in June this year. Venkat Jasti, the vice chairman and CEO of Suven, says competition in the disease is low and so, its potential is greater.
However, companies shy away from research into it because it involves the central nervous system (CNS), a highly complex area. Bino Pathiparampil, an analyst at equity firm IIFL, agrees. "In areas such as diabetes or cancer, it is easy to conduct animal trials. However, in CNS, you cannot make out a lot from animal studies. It's tough, so companies don't like to venture into it," Pathiparampil says.
It is clear to me now that my mother was suffering from MCI long before she entered what is now considered the early stage of Alzheimer's. There was a period of more than two years when my mother was beginning to evidence behaviors that had me worried. For example, my mother was "scuffing her feet" on the ground while walking. She said things like "its about time you called me", when I had talked to her only a couple of days earlier. My mother started to talk incessantly about money. She started to get mean. All of these behaviors were new and different.
Every time I would bring this up to friends or family they would all say the same thing, "she is getting old". For a while I bought into this. Or maybe I wanted to believe it. But another thing was clear, I was getting worried and it was on my mind all the time. I guess you could say I went from being somewhat worried, to very worried, and finally I reached the point where the pain in my stomach drove me to take action.
During this entire period my mother who lived by herself, carried on normal conversations with friends, carried out all her everyday activities like grocery shopping, played bingo, and even drove a car. All her friends, who saw her on a daily basis, assured me she was fine.
When I couldn't take it any more and got on the scene I found out quickly how bad things had gotten. Unbeknowst to any of us my mother had driven a car over a parking lot abutment, through a hedge, over the lawn, and then circled around a sidewalk and put the car in its designated slot. Her neighbors thought it was funny and were more interested in discussing how clever she was to get the car back across the lawn, around trees and into her parking space. No one from her condominium association thought to call us. They fixed the problem and it didn't cost her a cent.
A physician's assistant at my mother's doctor's office told me that a year earlier my mother had come storming into the office for her appointment. When they tried to explain to her that she had been in earlier in that day and had the appointment she became agitated. So agitated that they had to sedate her and put her in room until she calmed down. No one thought to call us. I went to this same doctor with my mother for several months when I first came to Florida. He thought my mother was getting old.
My mother had a credit card bill of more than $3,000 that she claimed was not hers. She was certain that someone in the family had stolen her card and was using it. It turned out my mother thought it was her bank debit card. As a result, when she received her monthly banking statement it appeared everything was in order. It turned out she was getting money from the ATM with the credit card and buying lottery tickets as often as 3-4 times per day. This explained how my mother came to believe she was a big winner in the "scratch off" lottery. She was buying 100s of dollars of scratch off tickets each week. It took me some time to figure this out. It finally dawned on me when she kept saying over and over each day I want to get some scratch off lottery tickets. We had already gotten the tickets and she was the one who purchased them.
Soon, I'll write about the importance of early detection and all the potential medical benefits that come with early detection of Alzheimer's and dementia.
In the meantime, if you hear these words, "she is just getting old", you might consider a simple memory test to determine if your loved one is in an early stage of dementia, suffering from mild cognitive impairment, or worse.
Mrinal Gore ‘Paaniwali Bai’ A pioneer and visionary
Influenced by Mahatma Gandhi’s Quit India exhortation as a youngster, Mrinal Gore (born 1928) chucked in a promising career in medicine to devote herself to organizing the poor and the disenfranchised. For more than half a century, she has been involved with a series of organizations and leading protests both on the streets and in the corridors of power, focusing on women’s rights, civil rights, communal harmony, and trade union activities. She was fortunate to have had extremely enlightened parents: her father was a professor of physics at Mumbai’s Elphinstone College, and her mother came from a family of intellectuals. Of her six other siblings, three went on to become doctors and two engineers … It is said: Mrinal Gore’s sacrifice of her medical career for lifelong social activism was one of a kind with post independence idealism and the establishment of a democratic superstructure of governance.
Known as a political reformer, Mrinal Gore was a member of the Bombay Municipal Corporation. As a politician, she constantly brought into focus the woes of the common woman, earning the admiration of the masses. For her vociferous protests against water shortages in the city she was called Mumbai’s ‘Paaniwali Bai’. She had won the election with the largest margin of votes ever in Maharashtra.
A Socialist State leader, (she) was a Member of Parliament, Member of State Legislature and Mumbai Municipal Corporation, uninterruptedly from 1961 to 1990. A staunch supporter for Women’s empowerment and is in public life as a socialist since 1948.
She works for Swadhar and for the Keshav Gore Smarak Trust KGST .
It was during a family vacation to the nearby town of Palghar that Mrinal came in contact with the Rashtriya Seva Dal RSD , a voluntary organization connected with the Indian National Congress. At the time, India’s freedom struggle was at its height, and the atmosphere was charged by Mahatma Gandhi’s Quit India exhortation.
Mrinal had taken up medicine for her higher studies, and although a brilliant student, she decided to drop her academic career in favor of devoting herself to organizing the poor and the disenfranchised. She had passed the first MBBS examinations with flying colors, but in 1947, the year of Independence, Mrinal departed medical college, choosing to become a fulltimer with the RSD, organizing housewives for sociopolitical work.
She spent a year with the Congress, leaving in 1948 with a group of Socialist youngsters who decided to form the Socialist Party, which became a critical thorn in the Congress party’s flesh. The same year, Mrinal married Socialist leader Keshav “Bandhu” Gore. The two were from different castes and were breaking the prevalent caste taboo by marrying. The Gores lived and worked in Goregaon, a rural area that has now become part of suburban Mumbai.
In 1950, Mrinal joined the Goregaon Mahila Mandal as its secretary. The Mahila Mandal worked for the uplift of women in the area; in 1951, the organization put in place the Family Planning Center under Mrinal’s guidance. She was a step ahead of the Indian government, which introduced its family planning programs only in 1952.
In 1952, Mrinal and Keshav had a daughter. A year later, Mrinal was back and active again and was elected to the Village Council. In 1954-55, the couple also participated in the Goa liberation movement from the Portuguese, and the movement for the establishment of the linguistic state of Maharashtra. She organized a series of protest rallies with women satyagrahis for the Sayukta Maharashtra Movement, occasionally being jailed. Mrinal also resigned from the Village Council around this time with many others who were part of representative bodies in Maharashtra, on the issue of the Sayukta Maharashtra Movement.
Keshav died in 1958. Mrinal and other colleagues of Keshav’s set up the Keshav Gore Smarak Trust, which supports community-centered activities and social awareness campaigns and actions. This was the year that Mrinal became actively involved with civic rights, among them water and toilets for people in hutment’s and shantytowns.
She also questioned civic planning that ignored the needs of the poor, and opposed the state authorities and builders’ lobby which work together to demolish slums. Over the years, she has succeeded in rehabilitating thousands of people in pucca houses on government-allotted land.
In 1961, when she was elected to the Bombay Municipal Corporation (BMC), Mrinal began a long, arduous struggle to get waterlines and adequate water quota for poor and lower-middle class people. She campaigned tirelessly and organized people’s protests, pointing out that while the poor lacked adequate drinking water, the elite had constant running water, enough for their swimming pools. Finally, she forced the BMC to hand over an extra pipeline and install booster pumps.
The campaign stuck her with the sobriquet “Paaniwali bai” (literally, water-woman). Mrinal also organized a conference on water in Goregaon in 1962, followed by a siege of the BMC commissioner; meanwhile, the struggle for water and toilets in slums and shantytowns, and housing for the poor, continued apace.
In 1972, Mrinal was elected to the Maharashtra Legislative Assembly on a Socialist Party ticket. She raised issues of atrocities on marginalized farmers, indigenous people, Dalits, and women. Indira Gandhi’s power was cresting. After the India-Pakistan war and the formation of Bangladesh in 1971, prices of essential commodities rocketed up; shortages of foodgrains and kerosene were created thanks to the government’s policy of compulsory rationing; blackmarketing took root and came to stay.
Mrinal was at the forefront in setting up in September 1972 the Anti-Price Rise Committee, which mobilized the largest-ever turnout of women since the Independence movement. A whole arsenal of peaceful devices was used for protests, which carried on for two or three years. In the meantime, Mrinal also worked with other Socialists, succeeding in getting the government to focus on drought conditions in rural Maharashtra and chalk out a plan for the drought-affected.
In 1975, Indira Gandhi imposed the much-reviled internal Emergency. Constitutional rights were withdrawn, and strict censorship became routine. Mrinal went underground to guide a women’s protest against the Emergency. She was arrested in December that year and jailed, initially in solitary confinement and then with women who were seriously mentally unwell.
The Emergency was withdrawn in 1977. Mrinal was elected to Parliament with the highest margin of votes in the entire state of Maharashtra on the ticket of the Janata Party, a merger of four anti-Emergency parties. When the merger crashed in 1979.Mrinal lost the elections, but continued engaging with public issues, especially housing for the poor.
Around this time she became involved with women’s groups and participated in protests against rape and dowry. In 1983, she established Swadhar, a support center for women victims of domestic violence, and the Committee for Action Against Atrocities on Women. The Shramjeevi Mahila Sangh was also organized during those days, expressly for women employees who were not taking part, for various reasons, in the activities of the common union.
In 1985, Mrinal was again elected to the Maharashtra Legislative Assembly. Her most notable legislative action was introducing a Bill to prevent sex determination tests that directly led to female foeticide. The government agreed to ban these tests through a resolution in 1986.
In 1988, Mrinal was operated upon for breast cancer and could not resume work until the 1990s. By this time, a number of Socialist groupings were becoming worried about the barging of multinational corporations into the country. It became an issue close to Mrinal’s heart: she protested strongly the entry of US giant Enron in the power sector. She was involved in the Narmada Dam people’s displacement issue and the scientifically-unexamined raising of the dam’s height. Mrinal expressed her staunch support of the Narmada valley’s indigenous peoples’ rights and traveled extensively through the affected areas.
From 2000, Mrinal has only been sporadically involved, although she continues to provide guidance to her many projects. She celebrated her 75th birthday in June 2008 and has been slowed by health concerns, but remains mentally agile. Some of her main concerns, at the moment, are the Hindu-Muslim communal divide, fundamentalism, and the politics of hatred.
Mrinal has the knack of involving the community directly in her causes. She uses an imaginative range of nonviolent protest methods - marches, sit-ins, public fasting, and face-offs with the authorities - to draw people into working for themselves. She does not see the issues of Dalits, women, workers, farmers, and indigenous communities as separate problems, but as part of a whole that deserves a pluralistic and inclusive problem-solving approach.
A pioneer and visionary, Mrinal Gore is truly a leader and will always remain one.
Keshav Gore Smarak Nidhi
Smriti, Aarey Road
Near Abhi Goregaonkar School
Mumbai - 400062
Email : firstname.lastname@example.org
Atal Bihari Vajpayee: A man of the masses and a multi-faceted personality
Shri Vajpayee was Prime Minister of India from May 16-31, 1996 and a second time from March 19, 1998 to May 13, 2004. With his swearing-in as Prime Minister, he has been the only Prime Minister since Jawaharlal Nehru to occupy the office of the Prime Minister of India through three successive mandates. Shri Vajpayee has also been the first Prime Minister since Smt. Indira Gandhi to lead his party to victory in successive elections.
Born on December 25, 1924 at Gwalior, Madhya Pradesh to Shri Krishna Bihari Vajpayee and Smt. Krishna Devi, Shri Vajpayee brings with him a long parliamentary experience spanning over four decades. He has been a Member of Parliament since 1957. He was elected to the 5th, 6th and 7th Lok Sabha and again to the 10th, 11th 12th and 13th Lok Sabha and to Rajya Sabha in 1962 and 1986. He has again been elected to Parliament from Lucknow in Uttar Pradesh for the fifth time consecutively. He is the only parliamentarian elected from four different States at different times namely - UP, Gujarat, MP and Delhi.
Elected leader of the National Democratic Alliance, which is a pre-election coming together of political parties from different regions of the country and which enjoyed a comfortable backing and support of the elected Members of the 13th Lok Sabha, Shri Vajpayee was earlier elected leader of his own Bharatiya Janata Party (BJP) parliamentary party which has also again emerged as the single largest party in the 13th Lok Sabha as was the case in the 12th Lok Sabha.
Educated at Victoria (now Laxmi Bai) College, Gwalior and DAV College, Kanpur, Uttar Pradesh, Shri Vajpayee holds an M.A (Political Science) degree and has many literary, artistic and scientific accomplishments to his credit. He edited Rashtradharma (a Hindi monthly), Panchjanya (a Hindi weekly) and the dailies Swadesh and Veer Arjun. His published works include "Meri Sansadiya Yatra" (in four volumes), "Meri Ikkyavan Kavitayen", "Sankalp Kaal", "Shakti-se-Shanti", "Four Decades in Parliament" (speeches in three volumes), 1957-95, "Lok Sabha mein Atalji" (a collection of speeches); Mrityu Ya Hatya", "Amar Balidan", "Kaidi Kaviraj Ki Kundalian" (a collection of poems written in jail during Emergency); "New Dimensions of India's Foreign Policy" (a collection of speeches delivered as External Affairs Minister during 1977-79); "Jan Sangh Aur Mussalman"; "Sansad Mein Teen Dashak" (Hindi) (speeches in Parliament - 1957-1992 - three volumes; and "Amar Aag Hai" (a collection of poems) 1994.
Shri Vajpayee has participated in various social and cultural activities. He has been a Member of the National Integration Council since 1961. Some of his other associations include - (i) President, All India Station Masters and Assistant Station Masters Association (1965-70); (ii) Pandit Deendayal Upadhyay Smarak Samiti (1968-84); (iii) Deen Dayal Dham, Farah, Mathura, U.P; and (iv) Janmabhomi Smarak Samiti, 1969 onwards.
Founder-member of the erstwhile Jana Sangh (1951), President, Bharatiya Jana Sangh (1968-1973), leader of the Jana Sangh parliamentary party (1955-1977) and a founder-member of the Janata Party (1977-1980), Shri Vajpayee was President, BJP (1980-1986) and the leader of BJP parliamentary party during 1980-1984, 1986 and 1993-1996. He was Leader of the Opposition throughout the term of the 11th Lok Sabha. Earlier, he was India's External Affairs Minister in the Morarji Desai Government from March 24, 1977 to July 28, 1979.
Widely respected within the country and abroad as a statesman of the genre of Pt. Jawaharlal Nehru, Shri Vajpayee's 1998-99 stint as Prime Minister has been characterised as 'one year of courage of conviction'. It was during this period that India entered a select group of nations following a series of successful nuclear tests at Pokharan in May 1998. The bus journey to Pakistan in February 1999 was widely acclaimed for starting a new era of negotiations to resolve the outstanding problems of the sub-continent. India's honesty made an impact on the world community. Later, when this gesture of friendship turned out to be a betrayal of faith in Kargil, Shri Vajpayee was also hailed for his successful handling of the situation in repulsing back the intruders from the Indian soil. It was during Shri Vajpayee's 1998-99 tenure that despite a global recession, India achieved 5.8 per cent GDP growth, which was higher than the previous year. Higher agricultural production and increase in foreign exchange reserves during this period were indicative of a forward-looking economy responding to the needs of the people. "We must grow faster. We simply have no other alternative" has been Shri Vajpayee's slogan focussing particularly on economic empowerment of the rural poor. The bold decisions taken by his Government for strengthening rural economy, building a strong infrastructure and revitalising the human development programmes, fully demonstrated his Government's commitment to a strong and self-reliant nation to meet the challenges of the next millennium to make India an economic power in the 21st century. Speaking from the ramparts of the Red Fort on the occasion of 52nd Independence Day, he had said, "I have a vision of India : an India free of hunger and fear, an India free of illiteracy and want."
Shri Vajpayee has served on a number of important Committees of Parliament. He was Chairman, Committee on Government Assurances (1966-67); Chairman, Public Accounts Committee (1967-70); Member, General Purposes Committee (1986); Member, House Committee and Member, Business Advisory Committee, Rajya Sabha (1988-90); Chairman, Committee on Petitions, Rajya Sabha (1990-91); Chairman, Public Accounts Committee, Lok Sabha (1991-93); Chairman, Standing Committee on External Affairs (1993-96).
Shri Vajpayee participated in the freedom struggle and went to jail in 1942. He was detained during Emergency in 1975-77.
Widely travelled, Shri Vajpayee has been taking a keen interest in international affairs, upliftment of Scheduled Castes and Scheduled Tribes, women and child welfare. Some of his travels abroad include visits such as - Member, Parliamentary Goodwill Mission to East Africa, 1965; Parliamentary Delegation to Australia, 1967; European Parliament, 1983; Canada, 1987; Indian delegation to Commonwealth Parliamentary Association meetings held in Canada, 1966 and 1994, Zambia, 1980, Isle of Man 1984, Indian delegation to Inter-Parliamentary Union Conference, Japan, 1974; Sri Lanka, 1975; Switzerland, 1984; Indian Delegation to the UN General Assembly, 1988, 1990, 1991, 1992, 1993 and 1994; Leader, Indian Delegation to the Human Rights Commission Conference, Geneva, 1993.
Shri Vajpayee was conferred Padma Vibhushan in 1992 in recognition of his services to the nation. He was also conferred the Lokmanya Tilak Puruskar and the Bharat Ratna Pt. Govind Ballabh Pant Award for the Best Parliamentarian, both in 1994. Earlier, the Kanpur University honoured him with an Honorary Doctorate of Philosophy in 1993.
Well known and respected for his love for poetry and as an eloquent speaker, Shri Vajpayee is known to be a voracious reader. He is fond of Indian music and dance.
True to his name, Atalji is an eminent national leader, Most respected Politician in India, an erudite politician, a selfless social worker, forceful orator, poet and literature, journalist and indeed a multi-faceted personality…Atalji articulates the aspirations of the masses… his works ever echo total commitment to nationalism.
Though he is not keeping well for some time but he keeps himself busy writing poetry.
Lok Sabha Mein Atalji (a collection of speeches); Mrityu Ya Hatya, Amar Balidan, Kaidi Kavirai Ki Kundalian (a collection of poems written in jail during Emergency); New Dimensions of India's Foreign Policy (a collection of speeches delivered as External Affairs Minister during 1977-79); Jana Sangh Aur Musalman; Three Decades in Parliament (Speeches in three volumes); Amar Aag Hai(a collection of poems) 1994; Meri Ekyavan Kavitayen; Four Decades in Parliament (English)-4 Volumes of Speeches in Parliament, 1957-95
Literary, Artistic and Scientific Accomplishments:
Editor, (i) Rashtra-Dharma-monthly (ii) Panchajanya-weekly;
Swadesh and Veer Arjun, both dailies
Favourite Pastime and Recreation:
Reading, writing, traveling and cooking