• This page looks at the legal and regulatory issues associated with Alzheimer’s disease as well as National Alzheimer’s Project Act (NAPA).  The issues involve all levels of government (Executive branch, Congress, States, Laws, Regulation, Action/no-Action, Advocacy, Funding, and Leadership.

HR 647 Palliative Care and Hospice Education and Training Act (PCHETA) https://alzheimersabcs.com/2019/12/23/h-r-647-palliative-

  • PCHETA) needs to become law to address the future staff shortages in Hospice and Palliative Care. It would  provide in-depth and improved training for physicians, nurses, social workers, chaplains, pharmacists, and other allied specialties. It would create educational opportunities for healthcare careers through service commitments to the Dementia branch of needed care.  This is similar to the Geriatric Bill or Geriatric Academy recommended in the book “ABC’S of ALZHEIMER’S DISEASE: ASHARED REALITY by ME and MY SHADOWDICARE & MEDICAID

The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is insufficient to conclude that the use of positron emission tomography (PET) amyloid-beta (Aβ) imaging is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member for Medicare beneficiaries with dementia or neurodegenerative disease, and thus PET Aβ imaging is not covered under §1862(a)(1)(A) of the Social Security Act (“the Act”).

image1-17The Centers for Medicare & Medicaid Services (CMS) has determined that the evidence is insufficient to conclude that the use of positron emission tomography (PET) amyloid-beta (Aβ) imaging is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member for Medicare beneficiaries with dementia or neurodegenerative disease, and thus PET Aβ imaging is not covered under §1862(a)(1)(A) of the Social Security Act (“the Act”).

The brain is the most complex and magnificent organ in the human body. This page offers a motivated person the opportunity for learning an overview understanding of the brain through articles and blogs.BIG DATA AND OMICS

Omics refers to a field of study in biology ending in -omics, such as genomics, proteomics or metabolomics.  A related suffix -ome is used to address the objects of a study along with fields, such as the genome, proteome or metabolome respectively.  Past research indicated the complexity of AD along with identifying amyloid beta and tau protein as the main AD targets.  With increase knowledge and  technology, basic research is now exploring the network pathways leading to neuro-degeneration.  This network methodology has identified the involvement of additional proteins, along with the brain’s immune system playing a role through inflammation and microglia cells of the brain’s immune system.

A report from Seyfriend et al., 2017  tracked alterations in how individual proteins and networks of proteins were turned or off in brain tissue from 129 volunteers who progressed from symptom-free to the earliest and later stages of Alzheimer’s.  Using network modeling approaches to analyze large-scale data, they identified changes that may influence Alzheimer’s before symptoms appear, such as increased activity of protein networks linked to inflammation.  This multi-network analysis revealed proteins and disease-specific pathways involved in the etiology (study of cause) , initiation, and progression of AD.  The report identified 10 proteins correlated to both AD and asymptomatic volunteers, mainly associated with inflammation.  Could the next AD target be the role of the brain’s immune system?

GENETICS  (Reprogramming human cells to stem cells and beyond) 

An exciting new addition to the Alzheimer’s research toolbox builds on breakthroughs of several years ago showing that adult human skin cells can be converted, or “reprogrammed,” to a type of stem cell called induced pluripotent stem cells (iPSCs). The iPSCs can, in turn, be converted to make other cells, like neurons, so laboratories can directly study human cell biology and disease processes in living human cells, something not previously possible for brain cells.

Understanding the genetic, molecular, and cellular mechanisms underlying Alzheimer’s will be enhanced by studying Alzheimer’s in living cells. This reprogramming of human cells to model Alzheimer’s and aging holds great promise, as well as many unknowns, and is an example of scientific advances with the capacity to produce dramatic breakthroughs.

A new initiative will seek to stimulate basic research on human cell models of Alzheimer’s in three areas: a)  Develop human iPSCs as cell models to study Alzheimer’s pathophysiology b)  Explore the impact of age on the development of Alzheimer’s in iPSC models to potentially  investigate early disease events and late-stage features of Alzheimer’s; c) •         Establish functional genotype-phenotype relationships of genes or genetic variants (mutations) suspected of altering the risk of Alzheimer’s

The iPSCs cell is used during pregnancy to develop the brain’s neurons and is eliminated prior to birth.  This development offers tremendous opportunity for laboratory research.

FY 2019 NAPA BUDGET ITEMS

This article highlights selected studies/initiatives from the FY 2019 National Alzheimer’s Project Act (NAPA) budget submital.  Bruce comments are in italics.

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