Alzheimer's Disease vs. Alzheimer's Diseases: Clinical and Pathological Heterogeneity in the Manifestations of Alzheimer's Disease

1.5 CE Credits

Presented by:
Eric Edward Smith, MD, MPH, FRCPC, FAHA
Associate Professor of Neurology
Katthy Taylor Chair in Vascular Dementia
Cumming School of Medicine, University of Calgary

Alzheimer's disease is well known as the commonest neuropathology of dementia. The hallmark of Alzheimer's disease is neuropathological accumulation of senile plaques and neurofibrillary tangles, leading to medial temporal atrophy and impairments in episodic memory that subsequently progress to global impairments. However, a decade of research has identified atypical presentations of Alzheimer's disease, marked by initial focal degeneration outside the medial temporal lobe and presenting with abnormalities in behavior, language, or visuospatial function. Additionally, it is now recognized that pure Alzheimer's disease is the exception, and Alzheimer's disease with one or more co-pathologies is the rule. These co-pathologies also alter the course and clinical presentation of Alzheimer's disease.

After the webinar, participants will be able to:

  1. Discuss the classification of atypical Alzheimer's disease.
  2. List diagnostic criteria for atypical Alzheimer's disease.
  3. Describe the clinical, cognitive, and behavioral features of atypical Alzheimer's disease.
  4. Describe the most common comorbid neuropathologies in Alzheimer's disease patients and their clinical features.

Target Audience: Clinical psychologists and neuropsychologists

Instructional Level: Intermediate (Basic clinical knowledge of AD pathology and clinical neuropsychology is assumed)

About Eric Edward Smith, M.D.
Dr. Eric Smith is Associate Professor of Neurology, Radiology and Community Health Sciences at the University of Calgary, where he directs the Cognitive Neurosciences Clinic and is a member of the Calgary Stroke Program. He holds the endowed Katthy Taylor Chair in Vascular Dementia at the University of Calgary. Dr. Smith’s research uses neuroimaging to investigate the risk factors for, and consequences of, cerebral small vessel disease in healthy populations and in patients with mild cognitive impairment or cerebral amyloid angiopathy. He leads the Vascular Cognitive Impairment team of Canada’s national research strategy for dementia, the Canadian Consortium on Neurodegeneration in Aging.

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Chronic Traumatic Encephalopathy (CTE): What We Think We Know and What We Need to Know Next

1.5 CE Credits

Presented by:
Robert A. Stern, Ph.D.
Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology
Clinical Core Director, BU Alzheimer’s Disease Center
Director of Clinical Research, BU CTE Center
Boston University School of Medicine

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease found in individuals with a history of exposure to repetitive head impacts (RHI), such as former American football players and boxers. Referred to as “punch drunk” or dementia pugilistica since the early 20th century, the term “CTE” has been used since the 1950s to describe the clinical and neuropathological changes seen in individuals with RHI exposure. However, it is only in the past 8-10 years that CTE has received increased attention due to a growing number of deceased former NFL players being diagnosed with the disease postmortem. The tremendous growth in media attention to CTE, however, has outpaced the growth in scientific understanding of CTE. As with other neurodegenerative diseases, at this time CTE can only be diagnosed by neuropathological examination. However, provisional clinical research diagnostic criteria have been proposed and studies are underway to develop neuroimaging and fluid biomarkers to detect and diagnose CTE during life. This webinar will provide an overview of what is currently known about CTE, as well as current and future directions in research.

After the webinar, participants will be able to:

  1. Describe the neuropathological and clinical features of chronic traumatic encephalopathy (CTE).
  2. Describe the possible fluid and neuroimaging biomarkers for CTE.
  3. Explain the current limitations of making a clinical diagnosis of CTE.

Target Audience: The target audience includes practicing neuropsychologists and clinical neuroscience researchers, as well as advanced trainees.

Instructional Level: Intermediate

Robert A. Stern, Ph.D. received his PhD in Clinical Psychology from the University of Rhode Island. He completed his predoctoral internship training under Dr. Edith Kaplan at the Boston VA Medical Center and his post-doctoral fellowship at the University of North Carolina School of Medicine. He is currently Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology at Boston University (BU) School of Medicine, where he is also Director of the Clinical Core of the NIH-funded BU Alzheimer’s Disease Center, and Director of Clinical Research for the BU Chronic Traumatic Encephalopathy (CTE) Center.  A major focus of his research involves the long-term effects of repetitive head impacts in athletes, including the neurodegenerative disease, CTE.  He is the lead co-principal investigator of a $16 million NIH grant for a multi-center, longitudinal study to develop methods of diagnosing CTE during life as well as examining potential risk factors of the disease. Dr. Stern’s other current major area of funded research involves the diagnosis and treatment of Alzheimer’s disease. He has published on various aspects of cognitive assessment and is the senior author of the Neuropsychological Assessment Battery (NAB), as well as the Boston Qualitative Scoring System for the Rey-Osterreith Complex Figure.  He has received numerous NIH and other national grants and he is a Fellow of both the NAN and the American Neuropsychiatric Association. Dr. Stern has over 175 peer-reviewed publications, is on several journal editorial boards, and is the co-editor of two upcoming books: Sports Neurology (part of the Handbook in Clinical Neurology series published by Elsevier), and The Oxford Handbook of Adult Cognitive Disorders. He is a member of the medical advisory boards of several biotech/pharma companies as well as the Mackey-White Health and Safety Committee of the NFL Players Association and the Medical Scientific Committee for the NCAA Student-Athlete Concussion Injury Litigation.

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Frontotemporal Dementia: The Behavioral Phenotype

1.5 CE Credits

Presented by:
Bruce L. Miller, M.D.
Director, Memory and Aging Center
University of California San Francisco

In this 90-minute presentation, Dr. Bruce Miller, director of the UC San Francisco Memory and Aging Center, will introduce the clinical syndromes of frontotemporal dementia (FTD) and discuss why it is such a highly prevalent and diagnosable disorder. He will detail the different cognitive and behavioral symptoms associated with FTD and relate them to the underlying networks and disease pathology. He will present the neuropsychological profile and testing approach for evaluating patients with FTD. He will provide a detailed look at reward, crime and emotion in patients with FTD, and how they differ from patients with Alzheimer’s disease and other degenerative and non-degenerative disorders. He will also describe the current symptomatic treatments and investigative directions for potentially disease-modifying therapies that are likely to emerge in the coming decade.

After the webinar, participants will be able to:

  1. Explain how frontotemporal dementia is evaluated in the clinic.
  2. Describe the basic biology of frontotemporal dementia, including genetics and pathology.
  3. Discuss the latest research into therapies for frontotemporal dementia.

Target Audience: This webinar is targeted for an audience of professional neuropsychologists who may or may not work in aging and neurodegenerative disease.

Instructional Level: This webinar will present predominantly advanced data and information for health care providers with some intermediate material.

Bruce L. Miller, M.D. holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at the University of California, San Francisco (UCSF). He directs the busy UCSF dementia center where patients in the San Francisco Bay Area and beyond receive comprehensive clinical evaluations. His goal is the delivery of model care to all of the patients who enter the clinical and research programs at the UCSF Memory and Aging Center MAC). 

Dr. Miller is a behavioral neurologist focused on dementia with special interests in brain and behavior relationships as well as the genetic and molecular underpinnings of disease. His work in frontotemporal dementia (FTD) emphasizes both the behavioral and emotional deficits that characterize these patients, while simultaneously noting the visual creativity that can emerge in the setting of FTD. He is the principal investigator of the NIH-sponsored Alzheimer’s Disease Research Center (ADRC) and program project on FTD called Frontotemporal Dementia: Genes, Imaging and Emotions. He oversees a healthy aging program, which includes an artist-in-residence program. He helps lead two philanthropy-funded research consortia, the Tau Consortium and the Consortium for Frontotemporal Research, focused on developing treatments for tau and progranulin disorders, respectively. Additionally, he is a director for the Global Brain Health Institute, which works to reduce the scale and impact of dementia around the world by training and supporting a new generation of leaders to translate research evidence into effective policy and practice. Dr. Miller teaches extensively, runs the Behavioral Neurology Fellowship at UCSF, and oversees visits of more than 50 foreign scholars every year.

Dr. Miller has received many awards, including the Potamkin Award from the American Academy of Neurology, the Raymond Adams Award from the American Neurological Association, the Gene D. Cohen Research Award in Creativity and Aging from the National Center for Creative Aging, the UCSF Academic Senate Distinction in Mentoring Award and the Wallace Wilson Distinguished Alumni Award from the University of British Columbia. Dr. Miller is the current President of the International Society for Frontotemporal Dementias (ISFTD), and in 2016, he was elected to the National Academy of Medicine. He has authored The Human Frontal Lobes, The Behavioral Neurology of Neurology, Frontotemporal Dementia and over 700 other publications regarding dementia. He has been featured in Fortune magazine and the New York Times, as well as on Charlie Rose, PBS NewsHour and other media. For more than three decades, Dr. Miller has been the scientific director for the philanthropic organization The John Douglas French Alzheimer’s Foundation, a private philanthropic organization that funds basic science research in Alzheimer’s disease.

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Limbic-predominant Age-related TDP-43 Encephalopathy (LATE): A common pathology of the oldest old

1.5 CE Credit

 

Presented by:
Caitlin Shannon Latimer, MD, PhD
University of Washington, Seattle WA


This course will introduce the recently defined “Limbic-predominant Age-related TDP-43 Encephalopathy (LATE)” including both the clinical and neuropathologic manifestations.  The course will begin with some historical perspective on TDP-43 as a pathologic protein in neurodegenerative disease, starting with its initial association with frontotemporal lobar degeneration (FTLD) and motor neuron disease (MND) and culminating with the recent studies describing its pervasiveness in the brains of the oldest-old and its intersection with Alzheimer’s disease (AD).  The pathology and diagnostic approach will be described and compared with that of FTLD and MND, particularly focusing on the debate as to whether LATE is a distinct entity or on a continuum with these other TDP-43 proteinopathies. Finally, we will discuss the clinical consequences of LATE, including the clinicopathologic correlation, the potential impact on diagnosis and patient management, and the effects on research efforts to understand AD pathophysiology, particularly genetic studies (GWAS) and clinical trials.

 

After the webinar, participants will be able to:
1. Compare the brain regions most commonly affected in LATE, FTLD, and MND and explain the clinical similarities and differences between these three entities.
2. Recognize the clinical associations of LATE and describe the clinical overlap with AD.
3. Discuss the challenges in making a diagnosis of LATE and the potential consequences for both treatment and research in neurodegenerative disease.

Target Audience: An audience of professional neuropsychologists who may or may not work in aging and neurodegenerative disease.

Instructional Level: Intermediate - Assumes a basic understanding of dementia syndromes but a very limited understanding of the underlying neuropathology.   

Dr. Latimer is an acting instructor and neuropathologist in the division of Neuropathology at the University of Washington with a research focus on the mechanisms of resistance and resilience to Alzheimer’s disease. She completed her combined MD PhD at the University of Kentucky followed by residency and fellowship in anatomic pathology and neuropathology at the University of Washington. As a co-investigator in the University of Washington Neuropathology Core she has participated in the neuropathologic evaluation of human brain tissue from several iconic autopsy cohorts, including the Nun study, the Honolulu Aging Asians study, and the Adult Changes in Thought Study.  Her recent work has specifically focused on defining the role of TDP-43 in the neuropathology of age-related neurodegenerative disease, both through observations in human post-mortem tissue and through models of proteotoxicity.

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Medication Overuse and Implications for Dementia

1.5 CE Credits

Presented by:
Laura A. Hart, PharmD, MS, BCPS, BCGP
Assistant Clinical Professor
University of California, San Diego 
Skaggs School of Pharmacy and Pharmaceutical Sciences


This presentation will review the evidence linking commonly used medications with risk of dementia. Medications discussed will include benzodiazepines, anticholinergics, and proton pump inhibitors. The presentation will also describe risks of medication use in patients with dementia and provide strategies to optimize medication use in this patient population. Participants will have the opportunity to apply the concepts learned through a patient case.

After the session, participants will be able to:

1. Describe evidence linking commonly used medications with dementia risk, with a focus on benzodiazepines, anticholinergics, and proton pump inhibitors.
2. Optimize medication safety in a patient with dementia.
3. Given a patient case, evaluate medications that could be potentially changed to reduce risk of cognitive impairment.

Target Audience:  Neuropsychologists across the career span
Instructional Level:  Intermediate
 

Laura Hart
is an Assistant Clinical Professor at the University of California, San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) in the Division of Clinical Pharmacy. Prior to joining the faculty at SSPPS in September 2018, she completed a specialty residency and research fellowship in Geriatric Pharmacotherapy and served as an instructor in the Doctor of Pharmacy program at the University of Washington School of Pharmacy in Seattle, Washington. As part of her postgraduate training, she earned a Master of Science degree in Pharmaceutical Outcomes Research and Policy. Her research focuses in geriatrics, aiming to optimize medication use in older adults. In particular, her research has used pharmacoepidemiologic methods to examine risks and patterns of medication use in older adults. Her research to date has focused in the areas of dementia, central nervous system-active medications, falls. She is also interested in the implementation and evaluation of innovative pharmacy practice models in the care of older adults.

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Sleep and Cognition in Neurodegenerative Disease

1.5 CE Credits

Presented by:
Amy Amara, M.D., Ph.D.
University of Alabama at Birmingham
School of Medicine/Joint Health Services Foundation Faculty


 





Sleep dysfunction and cognitive decline are common features of neurodegenerative diseases such as Parkinson’s disease and Alzheimer’s disease. Additionally, sleep disruption can negatively influence cognitive performance, even in healthy adults. This webinar will include an overview of normal sleep architecture, descriptions of common sleep disorders in older adults at risk for neurodegenerative disease, and information about the relationship between sleep and cognition in neurodegenerative disease.

After the webinar, participants will be able to: 
1. Describe normal sleep architecture
2. Discuss common sleep disorders experienced by persons with neurodegenerative disease
3. Analyze the relationships between sleep and cognition in neurodegenerative disease

Target Audience: Clinical and Research Neuropsychologists
Instructional Level: Introductory

Dr. Amy Amara
is a physician scientist at the University of Alabama at Birmingham, Department of Neurology. She has fellowship training in both Movement Disorders and Sleep Medicine, with a particular interest in sleep dysfunction and other non-motor symptoms in patients with Parkinson’s disease (PD). Her main research focus includes investigation of non-pharmacological interventions, such as exercise, to improve sleep, cognition, vigilance, and safety in these patients.

 
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The Neuropsychology (Broadly Conceived) of MSA, PSP, and CBD

1.5 CE Credits

Presented by:
Adam Gerstenecker, Ph.D. 
Assistant Professor of Neurology
Division of Neuropsychology
The University of Alabama at Birmingham

The primary objective of this presentation will be to review the cognitive and behavioral features of the different atypical parkinsonian syndromes in which motor symptoms dominate early clinical symptomatology: multiple systems atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The impact of cognitive and behavioral deficits on quality of life, associations between neuropsychological and neuropsychiatric findings and brain imaging, and cognitive and behavioral symptom management are also discussed. Information included in this presentation was acquired through review of the available MSA, PSP, and CBD literature, with emphasis given to studies investigating the cognitive and behavioral features of the syndromes.

After the webinar, participants will be able to:

  1. Describe the neuropsychological features of MSA, PSP, and CBD.
  2. Explain the impact of neuropsychological features on quality of life in MSA, PSP, and CBD.
  3. Describe the current strategies for symptom management in MSA, PSP, and CBD.

Target Audience: Clinicians and researchers interested in the cognitive, behavioral, and functional aspects of MSA, PSP, and CBD

Instructional Level: Intermediate

Adam Gerstenecker, Ph.D. is an Assistant Professor of Neurology at the University of Alabama at Birmingham (UAB). Dr. Gerstenecker has expertise in atypical parkinsonisms in both clinical and research settings. His research in PSP has been funded by NIH/NIA and CurePSP. He has published a number of peer-reviewed papers on the cognitive, behavioral, and functional features of PSP and authored review papers and book chapters on the neuropsychological aspects of atypical parkinsonian disorders.

 
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Risk and Protective Factors of Cognitive Aging in Older African Americans

1.5 CE Credits

Presented by
Lisa L. Barnes, PhD
Rush Alzheimer’s Disease Center and Department of Neurological Sciences
Rush University Medical Center

Older African Americans, a rapidly growing segment of the US population, bear a disproportionate burden of Alzheimer’s disease and cognitive impairment compared to non-Hispanic Whites, with some estimates suggesting that they may have more than a two-fold increased risk than their white counterparts. Recent studies have led to significant advances in our understanding of the underlying neurobiologic substrates and risk factors of Alzheimer’s disease. But because of challenges in recruitment of African Americans into research studies and a lack of clinical and biologic data in this population, knowledge of the drivers of the disparities has lagged behind. The ability to identify therapeutic targets and effective interventions for this population has become a public health imperative. This lecture will present data from longitudinal cohort studies conducted at Rush of older African Americans regarding how risk factors and protective markers influence cognitive aging.

After the session, participants will be able to:
Discuss evidence that suggests African Americans have greater risk of cognitive impairment and Alzheimer’s dementia.
Evaluate longitudinal studies of cognitive aging in older African Americans.
Identify risk and protective factors for cognitive decline in older African Americans.

Target Audience: Neuropsychologists and trainees
Instructional Level: Intermediate

Lisa L. Barnes, PhD is the Alla V. and Solomon Jesmer Endowed Professor of Gerontology and Geriatric Medicine, and a cognitive neuropsychologist within the Rush Alzheimer’s Disease Center at Rush University Medical Center in Chicago, IL. Dr. Barnes’ research focus is on the epidemiology of cognitive aging with an emphasis on understanding mechanisms of cognitive health disparities of chronic diseases of aging among older African Americans. As the Principal Investigator of the Minority Aging Research Study, known as MARS, a longitudinal clinical-pathologic study of more than 800 African Americans without dementia who have been followed for over 15 years, and the Clinical Core Leader of the African American Core of the Rush Alzheimer’s Disease Center, she is a leading expert on health disparities and minority aging. Dr. Barnes completed her BA in psychology from Clark Atlanta University, one of the Historically Black Colleges and Universities, and her PhD in biopsychology from the University of Michigan in Ann Arbor. Additionally, she completed a post-doctoral fellowship at the University of California, Davis in the field of cognitive neuroscience. She joined the Rush Alzheimer’s Disease Center as an assistant professor in July 1999. Dr. Barnes has made significant contributions to our understanding of cognitive aging, cognitive decline, and Alzheimer’s dementia in older African Americans. She has mentored numerous early career investigators, has published close to 200 peer-reviewed manuscripts, and has received a number of awards and honors from universities and community-based organizations throughout the US for her work in the African American community.

 
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Diagnosing Early Stage “Pre-clinical” Alzheimer’s Disease- Clinical Advances & Ethical Considerations

1 CE Credits

 
Presented by: 
Kathleen A. Welsh-Bohmer, PhD 
Professor, Departments of Psychiatry and Neurology
Duke University Health System
Director of Alzheimer’s Disease Interventional Trials
Duke Clinical Research Institute (DCRI)
& VP for Neurodegenerative Disorders at VeraSci


Description
Progress in understanding the biological expression of Alzheimer’s disease (AD) has led to the recent revision of the diagnostic criteria for the disease, which is defined by the biology present and, to a far lesser extent, the clinical phenomenology. These criteria recognize the full disease continuum and invite the possibility of arriving at an early diagnosis of AD when the condition is clinically silent and potentially at a point in the disease many years in advance of the emergence of any symptoms. Absent any effective treatment for either preventing the disease onset or slowing its rate of progression, a diagnosis of biomarker-determined preclinical (silent) AD poses a number of ethical considerations for the practicing clinician. In this session, we will: 1) review the recent advances in AD biomarkers and their implications for diagnosis and treatment; 2) consider the ethical issues that arise from an early diagnosis, including both the merits of early detection and the risks of having a diagnosis before symptoms have manifested; and, 3) conclude by discussing the implications of a biological diagnosis of AD for the practice of clinical neuropsychology, including the types of referral questions we might expect, the impact on our inferential approach, and the normative data we select.

After the session, participants will be able to:
Define the biomarkers used in diagnosing Alzheimer’s disease.
Explain the difference between diagnostic biomarkers and surrogate markers for measuring response to treatment.
Describe the ethical issues associated with an early biological diagnosis of Alzheimer’s disease.
Explain the impact of knowledge of AD biomarkers status on cognitive performance and psychological health.
List the types of referral questions clinical neuropsychologists can expect in the context of biologically defined Alzheimer’s disease.
Discuss the influences of AD biomarkers when drawing clinical inferences about normal or abnormal function.

Target Audience: Neuropsychologists and trainees
Instructional Level: Intermediate

Dr. Kathleen Welsh-Bohmer is a Professor of Psychiatry and Neurology at Duke University. Clinically trained as a neuropsychologist, her research activities have been focused around developing effective prevention and treatment strategies to delay the onset of cognitive disorders occurring in later life. She was the Principal Investigator of the Cache County Memory Study (2002-2013), an epidemiological study of an exceptionally long-lived population that established key environmental modifiers affecting Alzheimer’s disease onset and progression. Since 2006 she has directed the Joseph and Kathleen Bryan Alzheimer’s Center at Duke University, where she has led a large multidisciplinary team focused around the genetic determinants of Alzheimer’s disease and speeding drug discoveries to prevent and treat neurodegenerative diseases. She has served as the neuropsychology lead for the TOMMORROW program, a global clinical trial to delay the onset of mild cognitive impairment due to Alzheimer’s disease (Takeda Pharmaceutical Company). And very recently, she was appointed to the Duke Clinical Research Institute (DCRI), an academic clinical research organization, to oversee its interventional trials within the Alzheimer’s disease therapeutic area. Concurrently, she is leading science strategy for neurodegenerative disorders in VeraSci, a private company focused on improving the precision of endpoint measurements within clinical trial designs. The methods her team has been developing in collaboration with public and private partners help fill an information void in the measurement of preclinical dementias and has important implications for accelerating global clinical trials in Alzheimer’s disease prevention and in population health.
 
 
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