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Nurturing Equality in the Face of Forgetfulness: Health Equity and Alzheimer’s Disease

Health Inequalities arise when barriers hinder individuals and communities from accessing optimal conditions for reaching their full potential. It distinguishes inequities from health disparities, which are differences in health status linked to social or demographic factors. Health Equity involves valuing everyone equally, optimizing conditions across various life stages, and collaborating with different sectors to address factors influencing health, such as employment, housing, education, healthcare, public safety, and food access. Notably, the passage acknowledges racism as a factor influencing the distribution of these social determinants.

According to the Centers for Disease Control and Prevention (CDC), addressing disparities necessitates national leadership to involve diverse stakeholders, coordinate federal entities and nonfederal partners, advocate for effective policies, and ensure accountability. The CDC and its collaborators can utilize the report’s findings to heighten awareness of vulnerable groups. Additionally, the insights can motivate increased interventions at state, tribal, and local levels to tackle health disparities and inequalities effectively.

Also, Healthy People 2030 offers diverse strategies for attaining health equity. A pivotal aspect in realizing the overarching vision of enhancing the health and well-being of all is the targeted addressing of health disparities. Consequently, disparity ratios are being formulated to evaluate data on disparities for population-based core objectives, utilizing demographic group data available at a specific time point.

In Alzheimer’s disease, achieving health equity gains significant importance. Factors such as income, education, and access to health care can create disparities in diagnosis, treatment, and support services. We address all disparities so that patients and caregivers have equal opportunities for early detection, quality care, and support services regardless of their background. This approach is crucial for creating an inclusive society where everyone can age with dignity and receive the necessary assistance in managing the challenges posed by Alzheimer’s disease.

https://www.apha.org/Topics-and-Issues/Health-Equity
https://www.cdc.gov/minorityhealth/CHDIReport.html
https://health.gov/healthypeople/objectives-and-data/about-disparities-data
https://www.nimhd.nih.gov/resources/understanding-health-disparities/health-equity.html

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Medicare Agrees to Cover PET Scans: Great News for Diagnosis and Treatment of Alzheimer’s Disease.

The Centers for Medicare and Medicaid Services (CMS) have recently announced a significant expansion in Medicare coverage for amyloid Positron Emission Tomography (PET) scans for diagnosing Alzheimer’s disease, which is set to take effect in 2024.

This is a significant development in medical imaging technology, particularly PET scans, which have opened new avenues for understanding and managing Alzheimer’s disease. PET scans are a crucial tool in diagnosing Alzheimer’s, as they provide detailed images of the brain’s activity and abnormalities. In particular, Florbetapir, a tracer used in PET imaging for Alzheimer’s, binds to beta-amyloid plaques. A small amount of this tracer is injected into the patient’s bloodstream during a PET scan. As it travels to the brain, the PET scanner detects the emitted positrons, creating a detailed map of beta-amyloid plaque distribution. This imaging technique enables physicians to visualize and quantify the presence of beta-amyloid plaques, aiding in the early detection of Alzheimer’s disease.

Early diagnosis is essential as it helps implement appropriate interventions, including lifestyle changes, medication, and support for patients and their families. Moreover, PET scans also play a crucial role in guiding treatment strategies for Alzheimer’s patients. By providing a comprehensive understanding of the disease’s progression and severity, PET imaging assists healthcare professionals in tailoring personalized treatment plans. With the expansion of Medicare coverage for amyloid PET scans, more patients will have access to this diagnostic tool, leading to early detection and better management of Alzheimer’s disease. This is a significant step made by the CMS in Alzheimer’s research. It paves way for better better patient care and improved outcomes in the future.

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Unraveling the Connection: Exploring the Relationship Between Gut Microbiome Profiles and Alzheimer’s Disease

In recent years, the gut-brain axis has emerged as a fascinating area of research, opening new avenues to understand the intricate connections between our gastrointestinal system and cognitive health. One of the most intriguing findings in this field is the potential link between gut microbiome profiles and Alzheimer’s disease, a progressive neurodegenerative disorder affecting millions worldwide with synaptic dysfunction and cognitive decline. In this post, I delve into the latest scientific insights exploring the intricate relationship between the gut microbiome and Alzheimer’s disease.

The gut-brain axis is directly connected to the central nervous system (CNS) with the gastrointestinal tract. This communication occurs through neural, immune, and hormonal pathways, emphasizing the profound impact of gut health on cognitive function and vice versa.

Gut Microbiome and Alzheimer’s Disease: Recent studies have explored the composition and functionality of the gut microbiome in individuals with Alzheimer’s disease, revealing intriguing patterns. The gut microbiome contains trillions of microorganisms in the digestive system, including bacteria, viruses, fungi, and archaea.

Microbial Diversity: Research indicates that individuals with Alzheimer’s disease often exhibit altered gut microbial diversity compared to healthy counterparts. Reduced microbial diversity has been linked to various health issues, suggesting a potential role in neurodegenerative processes.

Inflammatory Pathways: Inflammation plays a crucial role in the progression of Alzheimer’s disease. The gut microbiome influences systemic inflammation, and dysbiosis (imbalances in microbial communities) may contribute to the inflammatory cascade implicated in Alzheimer’s pathology.

Metabolite Production: Microorganisms in the gut produce a variety of metabolites, some of which can influence brain health. Short-chain fatty acids (SCFAs) are among the metabolites that may have neuroprotective effects, potentially influencing Alzheimer’s disease progression.

Blood-Brain Barrier Integrity: The gut microbiome can degrade the blood-brain barrier (BBB), a crucial barrier protecting the brain from harmful substances. Dysbiosis may compromise BBB function, allowing the entry of inflammatory molecules that exacerbate neurodegenerative processes.

Future Implications and Therapeutic Potential: Understanding the link between gut microbiome profiles and Alzheimer’s disease opens new doors for potential therapeutic interventions. Modulating the gut microbiome through diet, prebiotics, probiotics, and fecal microbiota transplantation are active research areas aiming to harness the symbiotic relationship between gut health and cognitive function.

Practical Tips for Enhancing your gut Health:

  • Eat a variety of foods including Fiber and Probiotic-Rich foods. For example, eat a lot of yogurt, miso, sauerkraut, kefir, and kimchi. Also, include prebiotic foods like garlic, onions, leeks, asparagus, and bananas are rich in prebiotics.
  • Drink enough water to prevent constipation.
  • Reduce processed and sugary foods and excessive sugar intake eat whole, unprocessed foods instead.
  • Limit alcohol intake to avoid disrupttion to the gut microbiome.
  • Do regular exercise has been linked to a diverse and beneficial gut microbiome.
  • Get a good sleep between seven to nine hours per night.
  • Practice stress management activities, including meditation, deep breathing exercises, or yoga into your routine.
  • Avoid Overuse of Antibiotics:
  • Ask a healthcare professional about dietary supplements in the form of probiotic supplements or other nutritional supplements that may be recommended.
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Harmony in Healing: The Transformative Power of Music to Calm Anxiety and Depression

Introduction:

In the symphony of life, where emotions often dance to their unpredictable rhythm, one universal melody has emerged as a powerful force for healing — music. Beyond its enchanting notes and beats, music has proven to be a therapeutic remedy for those grappling with anxiety and depression. This article explores the profound benefits of music in alleviating the burdens of the mind, offering solace in sound waves.

The Science Behind Music and Mood:

 Listening to music releases the dopamine hormone, the “feel-good” neurotransmitter, reducing stress and promoting a sense of pleasure. Additionally, music has the remarkable ability to modulate the level of cortisol in the body, which is the hormone associated with stress, thereby creating a calming effect on the anxious mind.

Anxiety Soothing Sounds:

Specific genres and styles of music are particularly effective in calming anxiety. Classical music, with its harmonious compositions, has a serene quality that can transport listeners to a tranquil state. Nature sounds, and ambient music emulates the calming sounds of the environment, providing a therapeutic escape from the chaos of daily life.

The Rhythmic Prescription for Depression:

Depression often brings with it a heavy burden that can feel insurmountable. With its rhythmic cadence, music acts as a balm for the soul. Upbeat and uplifting tunes can elevate mood by encouraging the brain to produce more serotonin, which helps overall well-being and good mood.

Personalized Playlist Therapy:

One of the beauty of music’s therapeutic benefits lies in its personalization. Creating a playlist tailored to individual preferences allows a tailored approach to mental well-being. Whether it’s the nostalgic tunes from the past or the latest hits, a curated playlist can be a reliable companion on the journey to mental wellness.

Musical Meditation and Mindfulness:

Music is a gateway to mindfulness, offering a focus point for those seeking solace. Incorporating musical meditation into daily routines fosters a sense of presence and calm, guiding individuals away from the relentless grip of anxiety and depression.

The Universal Language of Connection:

Beyond its impact, music is a universal language, connecting people across cultures, ages, and backgrounds. Group music-making activities, such as singing in choirs or participating in drum circles, provide a sense of community and support, fostering a shared journey toward healing.

Conclusion:

In the vast tapestry of therapeutic interventions for anxiety and depression, music is a melody feeds the soul. The harmony in healing that music offers is invaluable. As we navigate the ebbs and flows of life, let the transformative power of music guide us toward a symphony of serenity and mental well-being.

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Breakthrough treatment: Locanemab is approved to treat early-onset Alzheimer’s disease

According to the Alzheimer’s Drug Discovery Foundation and the article published in the New England Journal of Medicine, the United States Food and Drug Administration (FDA) has approved Locanemab (Leqembi) as a new treatment to treat early onset Alzheimer’s disease. The approval came through the accelerated pathway for critical medical needs based on strong clinical evidence from randomized trials.

Phase 3 of the ongoing trial shows evidence of slow cognitive decline among users of Locanemab after 18 months. In addition, results from the study show a significant reduction in Amyloid Plaques in the brain of Locanemab users compared to those on placebo.

As with every trial, there are concerns about the adverse effects of such a new medication. Therefore, additional information on the safety and efficacy of the drug is warranted from longer trials.

Sources:

1. Alzheimer’s Drug Discovery Foundation

2. Lecanemab in Early Alzheimer’s Disease, The New England Journal of Medicine

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What is the Alzheimer’s Dementia Continuum?

…several findings suggest a possible reversal of AD-type MCI with carefully administered behavioral therapy, including brain-stimulating exercises.

Alzheimer’s disease (AD) is the prodromal stage of Dementia. Imagine the disease as a continuum, beginning with Mild Cognitive Impairment (MCI) to possible/probable AD, and ultimately Dementia, the end-stage. Not all healthy people will have MCI, and not all MCI will result in AD. However, there is research evidence that a substantial proportion of people with AD-type MCI will progress to AD and subsequently Dementia. On the other hand, several findings suggest a possible reversal of AD-type MCI with carefully administered behavioral therapy, including brain-stimulating exercises. In addition to a good diet (the Mediterranean diet preferred), a minimum of 30 minutes of daily exercise, social connectedness (community groups, family, friends), and brain-stimulating exercises have been associated with possible reversal or delay of AD-type Dementia.

The figure below gives a clear overview of the Alzheimer’s disease Dementia continuum.

Overview of Alzheimer’s disease Dementia continuum. Image source: https://www.alz.org/

Below, I provide a list of websites where you can try out different brain-stimulating exercises:

BRAINGLE: Braingle is a place to solve puzzles, brush up on your trivia, play games and give your brain a workout.

brainHQ: American Association of Retired Persons (AARP) brain training exercise.

JigZone: Online Jigsaw Puzzles

Lumosity: Personalized brain training.

WholisticResearch: Brain exercises to improve cognitive performance and memory retention.

For additional information on Alzheimer’s disease and Dementia, visit https://www.alz.org/.

There is hope, even when your brain tells you there isn’t.

John Green

The value I provide with my expertise in behavioral health.

I am Dr. Sylvester Orimaye, PhD, MPH. DBH-C. As the Founder and Director of the Behavioral Health Outcomes and Artificial Intelligence Laboratory, I wanted to briefly overview what I do in behavioral health. As a data scientist and behavioral health researcher, I am particularly interested in early screening of behavioral health problems so patients can access timely interventions before their illnesses get severe. This process can potentially save substantial healthcare costs and decrease the need for emergency room visits or hospitalization.

More importantly, I am using my expertise in Artificial Intelligence to create screening technologies that guarantee accuracy and effectiveness in identifying behavioral health problems. This idea will revolutionize the way we diagnose and treat behavioral health problems.

Finally, as a researcher and someone with expertise in behavioral health, I intend to contribute to and enhance patient-centered care, manage population health, improve reporting, and support value-based payments in healthcare and community-based services for individuals with behavioral health disorders, particularly those with depression, mild cognitive impairment, and Alzheimer’s disease.

Patient Care and Implicit Biases

Suppose you have ever attempted the Harvard Implicit Association Test (IAT). In that case, you will realize it shows implicit biases or an unexpected inclination towards a particular category of interest that may often contradict your beliefs or expectations. Nevertheless, the IAT emerged as a valuable instrument for unearthing unconscious biases that may not align with our convictions.

Navigating through professional responsibilities laden with ethical considerations, I have always been vigilant about addressing both conscious and unconscious biases. However, the IAT underscored the intricate nature of these biases, penetrating even the subconscious layers of our attitudes. Implicit attitudes towards race/ethnicity, disability, gender, age, sexual orientation, national origin, veteran status, obesity, addiction, and homelessness can significantly influence clinical judgment. The intricacies and limitations in understanding these multifaceted factors often contribute to these biases, highlighting the need for continued introspection.

In healthcare, where the stakes are high, and patient well-being is paramount, acknowledging the influence of implicit biases becomes a critical aspect of delivering equitable and patient-centered care. Understanding that these biases impact clinical judgment necessitates a nuanced approach to patient interactions. It calls for recognizing patients’ diverse backgrounds, experiences, and identities in healthcare.


The path forward lies in fostering a healthcare environment where patients are treated as care recipients and active contributors to their well-being. Contextualizing care, active listening, and involving patients in decision-making become indispensable practices in mitigating the impact of implicit biases. Education emerges as a key catalyst for change, equipping healthcare professionals with the knowledge and awareness needed to navigate the complex landscape of human diversity.

As we strive for positive health outcomes, we must view patient care as a collaborative effort, transcending the boundaries of bias. The journey toward unbiased healthcare is ongoing, requiring commitment, self-reflection, and a collective dedication to dismantling ingrained prejudices. By embracing this ethos, we can pave the way for a healthcare system that not only recognizes the existence of implicit biases but actively works towards mitigating their impact to improve patient well-being.

You can take the Harvard Implicit Association Test here.

Deterioration in language can predict early symptoms of Alzheimer’s Dementia.

In a recent study, an independent linguistic battery comprising only the language components or subtests of popular neuropsychological batteries showed a better clinical detection for MCI-AD than using an exhaustive battery of test.

Mild Cognitive Impairment due to Alzheimer’s disease (MCI-AD) is a precursor to Alzheimer’s disease (AD). It is characterized by a cognitive decline usually associated with aging or AD. However, some of the profound characteristics of MCI-AD are the gradual degrading of cognitive speech functions, which is often affected long before the diagnosis of MCI-AD. Research has shown that neurodegenerative disease such as MCI-AD deteriorates nerve cells that control cognitive speech and language processes, affecting an individual’s ability to make effective verbal utterances. As a result, the need for early detection of MCI-AD using linguistic biomarkers has grown. However, it is still prevalent to diagnose MCI-AD utilizing a combination of neuropsychological batteries and a doctor’s longitudinal observation of the individual. In a recent study, an independent linguistic battery comprising only the language components or subtests of popular neuropsychological batteries showed a better clinical detection for MCI-AD than using an exhaustive battery of tests. As confirmed by the study, the figures below compare the underlying patterns of the linguistic components and risk factors of MCI-AD and healthy control groups.

Three Key Qualities a Doctor of Behavioral Health must have

While many primary care physicians mainly focus on treating the pathological causes of diseases, it is eminent that other psychosocial aspects of diseases are also considered as part of a holistic treatment plan – an aspect of medical care often handled by behavioral health providers.

The primary care model of medicine is increasingly modified to allow medical and behavioral health providers to work collaboratively in an integrative manner by going through different stages of integration. Many primary care physicians mainly focus on treating the pathological causes of diseases. However, it is eminent that other psychosocial aspects of conditions are also considered as part of a holistic treatment plan – an aspect of medical care often handled by behavioral health providers. The emergent nature of integrative medicine creates an avenue for behavioral health providers to give complementary and alternative medical care alongside other medical providers contributing to less negative impacts on clinical care, overall better health outcomes, and satisfaction for patients. This emergent model is termed the Biodyne model of health care.

For this reasons, I state below the three key qualities that a Doctor of Behavioral Health must have:

1. Be a team player

For a successful medical and behavioral integrative healthcare model, both medical and behavioral health providers would function as a team of providers in a physically integrated space to implement a single and holistic patient care plan. The integrated physical space would allow for structural integration of knowledge across different disciplines of medicine and promote collaboration among the leadership of the medical care team. The team would be connected via a shared electronic medical records (EMR) system providing access to medical diagnosis and instructions from different care team members. More importantly, each of the integrated medical care providers would understand the roles and contributions of other providers towards a better healthcare delivery for a patient. Both the medical care team and the patient would see a vivid clinical structure to give a comprehensive healthcare delivery for the patient as a whole. The integrated care team would include the patient, primary care provider, behavioral health provider, care manager, clinical nurse, pharmacist, and other medical specialists.

2. Be interdisciplinary

In addition to the medical education honed by a behavioral health provider, interdisciplinary skills are often essential and contribute to positive patient outcomes. The acquired interdisciplinary skills would help improve the overall quality of life and educate patients on the underlying risk factors for different behavioral health problems. Therefore, a Doctor of Behavioral Health should develop a certain level of understanding in public health, psychopharmacology, health informatics, health economics, and health care finance. More importantly, the provider must have a good sense of the population you are serving (e.g., demographic information relating to women, racial/ethnic groups, and underserved people).

3. Be adaptable

Although the integrated medical and behavioral healthcare delivery model promises better health outcomes for the patient, there are fundamental challenges to its implementation. Notably, changes to the existing primary care structure relating to leadership, culture, interpersonal relationships, and patient care workflow are potential challenges to integrated health care. In addition, in some cases, a behavioral health provider may need time to adjust to different care models or transfer trust among an existing network of providers. As such, the provider must be ready to transition through the coordinated, co-located, and fully integrated stages of the integrated medical and behavioral health care model.

The links below provide more information about the Doctor of Behavioral health and the integrated health care model:

1. International Foundation of Integrated Care

2. The Cummins Graduate Institute

“In any given moment, we have two options: to step forward into growth or to step back into safety.”

Abraham Maslow