Director of the Vanderbilt Memory & Alzheimer’s Center and head of the Jefferson Laboratory on Cognitive Aging, Angela Jefferson, PhD, had her grandmothers on her mind when she and her team presented findings at the 2015 Alzheimer’s Association International Conference (AAIC) this summer in Washington, D.C.

Jefferson first encountered Alzheimer’s disease while growing up in Virginia. The clinical neuropsychologist’s beloved maternal grandmother began losing her memory when Jefferson was only 13. As the disease progressed, Jefferson witnessed both her grandmother’s decline and the heavy toll the burden of care took on her parents. Following her maternal grandmother’s death, Jefferson’s paternal grandmother succumbed to the disease, as well.

These events dramatically shaped the course of Jefferson’s professional life, leading her to study neuropsychology and pursue a career in clinical research with a focus on unhealthy cognitive aging. Her work deals with a variety of conditions – from mild cognitive impairment (MCI) to various forms of dementia, including Alzheimer’s. During her more than 15 years in the field, Jefferson has received numerous NIH and NIA research awards and amassed an impressive publishing record. She was serving as the associate director of Boston University Alzheimer’s Center when Vanderbilt offered her the directorship of its new center in 2012.

The CDC lists Alzheimer’s disease as the sixth leading cause of death in the United States. It is the only one of the top 10 causes of death that cannot be prevented, cured or slowed. The most current CDC statistics state Alzheimer’s kills nearly 85,000 Americans annually, but many medical professionals believe the actual number of Alzheimer’s deaths is vastly underreported.

The Alzheimer’s Association cites studies that estimate the annual number of Alzheimer’s deaths nationally at 700,000. The dramatic discrepancy between this figure and the CDC figure is most likely due to Alzheimer’s patients dying from complications such as infections with the underlying condition going unrecognized or unrecorded.

While the debate on mortality rates continues, there is universal agreement that the number of Alzheimer’s cases will continue to rise as the baby boom generation ages, impacting America’s families, the healthcare system and U.S. economy. These concerns have created enormous urgency to better understand the origin and progress of the disease, seek new treatments, and search for breakthroughs.

“Some of the most important advances are presented at the annual Alzheimer’s International Conference,” Jefferson said. “It’s the largest meeting of its kind in the world, ideal for promoting the high-impact work we’re doing at Vanderbilt.”

The meeting’s most prestigious presentations are “paper talks,” 15-minute summaries of specific research projects and results. The team from the Vanderbilt Memory & Cognitive Aging Center presented three such talks, two of which Jefferson discussed with Nashville Medical News.

Jefferson presented “Clinical Staging of Mild Cognitive Impairment Severity Yields Neuropsychological, Neuroimaging, and Genetic Susceptibility Differences Among Subtypes: The Vanderbilt Memory & Aging Project,” on which she was the lead author. “Mild cognitive impairment occurs in older adults, for a variety of reasons,” Jefferson said. “Patients can stabilize, get better, or get worse.” MCI often precedes the onset of Alzheimer’s and is considered a classic warning sign.

“Alzheimer’s has been staged for some time,” Jefferson continued. “MCI has not.”

Without much proof, medical professionals have tended to separate MCI into two stages. Jefferson’s team created a three-stage model (early, middle, late) and assessed its validity through neuropsychological, neuroimaging and genetic susceptibility differences. Neuropsychological tests validated the three-stage model, while imaging revealed corresponding structural differences in white and grey matter and genetic susceptibility, suggesting more precise staging of MCI might correspond to both. These results clear the way for further research of the three-stage model.

Katherine Gifford, PsyD, is a neuropsychology fellow at the Vanderbilt Center. She was the lead author and AAIC presenter of “Development of a Subjective Cognitive Decline Questionnaire Using Item Response Theory.” Subjective Cognitive Decline (SCD) is the self-reporting of possible cognitive issues to physicians by patients. Like MCI, SCD has been noted as a potential early marker of unhealthy brain aging.

The Vanderbilt team developed and tested a standardized methodology for measuring the complaint, employing latent variable modeling to select an ideal list of SCD questions. Participants included cognitively normal individuals and MCI patients from the Vanderbilt Memory & Alzheimer’s Center registry.

Participants took a 196-item survey consisting of commonly administered SCD questions and items culled from the National Alzheimer’s Coordinating Center’s database. Computer modeling was used to eliminate low-information and redundant items. More than two-thirds of the questions were eliminated, creating a simple, powerful screening tool.

“Our team really boiled it down to the essentials,” Jefferson said. Initial positive results justify additional research to determine the accuracy and reliability of the questionnaire as an effective tool.

Jefferson and her colleagues know the long shadow Alzheimer’s casts. Years after losing her grandmothers to the disease, Jefferson carries on the struggle to stop their killer in its tracks.

RELATED LINKS:

Vanderbilt Memory & Alzheimer’s Center: https://www.mc.vanderbilt.edu/root/vumc.php?site=mac

Angela Jefferson, PhD: http://www.mc.vanderbilt.edu/root/vumc.php?site=jeffersonlab&doc=38288

Katherine Gifford, PsyD: https://www.mc.vanderbilt.edu/root/vumc.php?site=mac&doc=38521

Alzheimer’s Association: http://www.alz.org,

2015 Alzheimer’s Association International Conference (AAIC): https://www.alz.org/aaic/portal/overview.asp