November 14, 2008
NIH Podcast Episode #0071
Balintfy: Welcome to the 71st episode of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health—the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode a series of reports related to aging. November is Alzheimer’s Disease Awareness Month, so we'll follow-up with our last episode and feature another expert from the National Institute on Aging. But first how the brain changes as we age. That's next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Brain's Reward Circuit Activity Mostly Ebbs as We Age
Balintfy: While the National Institute on Aging here at the NIH leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life, research at other institutes also make advances in this area. For example, National Institute of Mental Health researchers have found that the brain's reward-circuit activity mostly ebbs as we age. Dr. Karen Berman at NIMH, explains the importance of this discovery.
Berman: One of the big challenges that we all face is aging and aging gracefully, successfully and happily. And I think something that many people as they age fear the most is having something wrong with their brains. Either a dementia of some type or being depressed or not being able to enjoy life.
Balintfy: The NIMH study demonstrated for the first time in living humans how the activity of dopamine, a key messenger chemical in the middle of the brain, affects reward-related circuitry at the front of the brain—and how this changes as we age.
Berman: What we did in this study was to use powerful brain imaging techniques, two different types of brain imaging techniques. One that measures the dopamine in the brain, and the other that measures the brain's function.
Balintfy: Dr. Berman explains that dopamine in the brain is very important for things like motivation, happiness, experiencing rewards, and helping carry out plans.
Berman: So this is a very important chemical in the brain. And it has been shown that the receptors in the brain for dopamine decrease with age. So that's the first thing that we measured. We also measured the function of the brain as it responds to either anticipating getting a reward or actually getting one.
Balintfy: Dr. Berman and colleagues scanned 60-year-olds and 20-year-olds while they viewed a slot machine-like game on a computer screen. Moment-to-moment brain activity was monitored by functional magnetic resonance imaging. Then the researchers also used a positron emission tomography scanner to measure dopamine. Compared to the young participants, older participants showed less activity in brain motivation hubs.
Berman: So this study showed that as we age the way our brains process pleasurable events actually changes. That's actually the first time that this has even been done in older folks. And we feel that this is very important data that will help us not only to understand when aging is not so successful, but other disorders of this reward-related circuitry such as in schizophrenia, in Parkinson’s disease, in drug addiction.
Balintfy: Dr. Berman adds that just keeping the brain active can help.
Berman: I think something that people can do is keep active, be involved in many activities and actually keep this circuit active in the brain.
Balintfy: For more information on the study, visit www.nimh.nih.gov.
Alzheimer's Disease: Unraveling the Mystery
Balintfy: Now, as promised, more about Alzheimer’s Disease. Last episode, we talked to Dr. Laurie Ryan at the National Institute on Aging. In this report, we talk to one of her colleagues about a new information resource and the importance of clinical trials. A newly-updated book called Alzheimer’s Disease: Unraveling the Mystery is now available from the National Institute on Aging. It answers a variety of questions about the disease.
Morrison-Bogorad: Especially those about how it can be cured or treated.
Balintfy: Dr. Marcelle Morrison-Bogorad, Director of the Division of Neuroscience at the NIA, says the book explains what the healthy brain is like, and more.
Morrison-Bogorad: It focuses on how Alzheimer’s changes the brain. It talks about current research, and puts a human face on AD research, and addresses the needs of caregivers.
Balintfy: Dr. Morrison-Bogorad emphasizes that the book is also a great resource to help the public understand the importance of clinical trials.
Morrison-Bogorad: Clinical trials are really the only way we have of finding out whether a drug that people thought that might be useful in treating AD, is actually going to work or not.
Balintfy: She adds that clinical trials also give patients the chance for treatment at the best facilities, and to have access to researchers knowledgeable about the disease. Yet more patients are needed for Alzheimer’s disease clinical trials.
Morrison-Bogorad: Most of our clinical trials have trouble recruiting because the numbers we need are so large. And having difficulties recruiting can add to the cost and add to the time of the trial. So if you want to do anything for Alzheimer’s research, try to enroll in a clinical trial. It's really very important.
Balintfy: Dr. Morrison-Bogorad points out that trials typically require thousands of people. To learn more about clinical trials and to get the latest on Alzheimer’s disease, order the publication: Alzheimer’s Disease: Unraveling the Mystery. It is available online at www.nia.nih.gov/alzheimers, or by calling 1-800-438-4380. Stay tuned, we'll have a few more notes from Dr. Morrison-Bogorad after this break. You're listening to NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
AD Clinical Trials
Balintfy: Before the break, we featured some quotes from Dr. Morrison-Bogorad at the National Institute on Aging. But those soundbites were from a longer conversation. For Alzheimer’s Disease Awareness Month, here's some more from that interview. We had asked Dr. Morrison-Bogorad, why are clinical trials so important to Alzheimer’s Disease research?
Morrison-Bogorad: They're a way of testing people, giving them either a drug or a placebo, an inert substance, and the wonderful thing about clinical trials is that neither the doctor nor the patient know, usually, whether they're getting the placebo or the drug. So this is a very formal way of testing whether a drug works or not, without bias. And it's really the climax of research that goes into what Alzheimer’s is and how we might address it. So it is vital to moving AD research forward.
Balintfy: What are some concrete ways that clinical trials can help people?
Morrison-Bogorad: Not only can clinical trials, hopefully, help to distinguish which drugs might work and also which ones do not, they also give you the chance for treatment at the best facilities and to have access to wonderful researchers who know a lot about the disease. So you get a benefit both potentially if the drug works, and also the benefit of participation in good clinical care.
Balintfy: What are some other important things to know about clinical trials?
Morrison-Bogorad: They take place in a variety of settings. Clinical trials are always on drugs that are FDA approved. They range from small preliminary trials to very large scale trials that are the culmination of years of work. When you sing up for a trial, you'll be told a lot about what the trial is for and you'll be asked to sign a consent form that tells you what the trial is for and lets you know what some of the possible side effects might be. There are a lot of reasons that you or your family member might not be eligible for a particular trial, perhaps you have another condition, perhaps you're on a drug that they don't want to you use in a trail, perhaps you're too old or too young. But the major point is don't be discouraged. If you apply for inclusion in a trial and you are not chosen, try again. It's really important that we get as many volunteers for these trials as possible so Alzheimer’s research can move forward as quickly as it can. That will help you, your family, and it will help the millions of people that are at the moment going to develop Alzheimer’s in the future.
Balintfy: Can you tell me more about what kind of people are needed for clinical trials and AD research?
Morrison-Bogorad: It depends on the trial. One of the differences in clinical trials is in the type of person they want to test. Many trials test people who have early to mid-stage Alzheimer’s disease. That's probably the most common. But there are some trials that look at an earlier stage called mild cognitive impairment which often leads to Alzheimer's disease. And possibly the most uncommon type of trial is a trial on healthy volunteers.
Balintfy: What do you think is especially important for people to remember about clinical trials?
Morrison-Bogorad: The point that's so necessary is that if a person or a doctor knows that they're getting the drug, then that can influence the way they person reacts of the way the doctor thinks they reacting. It's just human nature. And so the only way to really button down whether the drug is having an effect or not is to double blind and let neither the person nor the doctor know what's happening.
Balintfy: Is it also worth emphasizing that anyone participating in a trial is getting the best treatment available at a minimum.
Morrison-Bogorad: Oh, you're absolutely right. I think that's a really good point. In fact, that's something that we notice in clinical trials that even the people who are getting the placebo, the patients, sometimes don't do as badly over time as they were predicted to, and that might well be because they're getting good care and they're getting care. And that's very important to the way a person feels about themselves; it's another form of the placebo effect. I think that getting access to care and good treatment is very important.
Balintfy: Thanks to Dr. Marcelle Morrison-Bogorad, Director of the Division of Neuroscience at the National Institute on Aging. She recommends getting more information on clinical trials for Alzheimer's disease by visiting www.nia.nih.gov/alzheimers, or by calling 1-800-438-4380.
NIHSeniorHealth Website Featuring Parkinson's Disease
Balintfy: Another good source of information for older adults, also from the National Institute on Aging, is the NIH Senior Health website, at www.nihseniorhealth.gov. In this next report, we hear from Wally Akinso how there's new information there on Parkenson's disease.
Akinso: Parkinson's disease occurs most often among the elderly and the risk increases with age.
Sieber: The onset of Parkinson's disease occurs at an average age of 60 years old.
Akinso: Dr. Beth-Anne Sieber is the Program Director in the Neurodegeneration Group at the National Institute of Neurological Disorders and Stroke.
Sieber: It's not a part of normal aging. It's a separate disease that tends to occur more often in the elderly.
Akinso: Older adults now can visit NIHSeniorHealth.gov to learn more about Parkinson's disease. Dr. Sieber talks about what the visitors can find.
Sieber: They can find out the definition of Parkinson's disease; what the disease actually manifest as. There's information on symptoms of the disease and how it's diagnosed by the neurological experts. There's great information on treatment and research currently ongoing in Parkinson's disease. There's a very helpful section on frequently asked questions. And finally they can link out to Medline plus for further information on the disease and additional contacts.
Akinso: Parkinson's disease is caused by the loss of brain cells that produce dopamine, a chemical that helps coordinate and control muscle activity. The four main symptoms of the disease are trembling, stiffness, slowness of movement, and impaired balance. Dr. Sieber says the new Parkinson's information on the website is an excellent resource for older adults who want to learn more about the disease.
Sieber: I hope we can serve as a starting point to provide information to seniors and their families. It's a great entry point into learning about the disease.
Akinso: Dr. Seiber says currently, there is no cure for the disease, but ongoing research provides new information about causes, symptoms and treatment options. The NIH Senior Health website was jointly developed by the National Institute on Aging and the National Library of Medicine for older adults and their families. Once again the website is www.NIHSeniorHealth.gov. This is Wally Akinso at the National Institutes of Health Bethesda, Maryland.
Balintfy: Thank you Wally. And that's it for this episode of NIH Research Radio. Please join us again in two weeks. Our next edition will be available for download on or about Friday, November 28—that's the day after Thanksgiving. For now, I'm your host, Joe Balintfy. Thanks for listening. NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.