Hispanics and Alzheimer’s Disease

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According to the Alzheimer’s Association the number of Hispanics afflicted with Alzheimer’s and related dementias is expected to increase in the U.S. by 2050. Join Dr. Alfred Kazniak, Director of the Arizona Alzheimer’s Disease Consortium Core at the University of Arizona and Dr. Eric Reiman, Director of the Alzheimer’s Disease Research Program at Banner Good Samaritan Medical Center in Phoenix who are members of a state lab that addresses Alzheimer’s disease in Hispanics. Web site: Arizona Alzheimer’s Disease Consortium

José Cárdenas:
Tonight on "Horizonte", the new Medicare drug plan, federal immigration reform bill proposals, and the war in Iraq are just some of the issues U.S. Congressman Ed Pastor will talk about when he joins us in the studio. And, it's a disease without a cure. You'll hear about a statewide outreach effort and a federally funded study to learn more about Hispanics and Alzheimer's disease in Arizona. These topics coming up next on "Horizonte".

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>> José Cárdenas:
I'm José Cárdenas. Welcome to "Horizonte". President Bush came to the valley Monday to talk about his new Medicare plan. Under the plan, more than 40 million people on Medicare will be able to have prescription drug coverage. Here to talk about this plan and several other topics is Congressman Ed Pastor. Thank you for joining us on "Horizonte".

>> Ed Pastor:
Thank you very much.

>> José Cárdenas:
You're about to go back to Washington, you've been on recess for five weeks. Tell us what you have been doing during that time period.

>> Ed Pastor:
Well, when you're at the district work period, you catch up on some of the work. I visited TGEN, to talk about some of the equipment needs they're going to need where federal funding has assisted. We visited children's hospital because there are two programs, healthy start and reading programs so that we can increase reading in the very young years of children, so we use the doctors to do that, encourage it. I went to a number of schools, had a chance to visit some schools and I had a trip to the Baltic states, Sweden and Finland.

>> José Cárdenas:
What were you doing there?

>> Ed Pastor:
They both have nuclear reactors and they are dealing with the problem of storing their spent fuel. Here in the United States, it's a problem for us. At Palo Verde the spent rods are being stored in water pools to cool off. That's probably the safest storage you have today. They treat their nuclear waste in different steps. Eventually they're going to house them in copper casings surrounding by iron ore casings. Interesting to see how they deal with it.

>> José Cárdenas:
This may be an alternative for us here?

>> Ed Pastor:
It could be. I think if we look to nuclear fuel as, for the future, the future youth we have to deal with how we deal with spent fuels. We're trying to find out what other countries do. The country I'm more impressed with is France. They recycle their fuel, about 80% of the rod that's used is recyclable. So they take a different view of it. Hopefully, we'll do some research on that.

>>José Cárdenas:
Closer to home, president bush was here to talk about the Medicare program. What can you tell us about that?

>> Ed Pastor:
That's going to start January 1st. If the people who qualify are not enrolled by May 2006, there will be penalties. We need to inform the public what is happening. The very, very poor will probably benefit by it. People who have a little bit of a pension plan along with Social Security, they get up to about 2500 of expenses and then there's a gap. Until they get about $6,000 worth of expenses, so there's a gap which they call a doughnut. I think that's where most of our senior citizens are going to fall. So the drug benefit is not going to be a benefit to many because they're going to fall in between and not get what we thought would be the fairest way -- the Democrats-- having the benefit to go through the cycle, to help with the drug expense benefit, so you would be helped with your drug benefits whether you start at zero or 10,000 a year you would be helped throughout that cycle.

>> José Cárdenas:
President Bush was here to talk about that plan, but he ended up talking a fair amount of the time about immigration issue, which are pretty hot in Arizona right now. What's your reaction to the state of emergency declared by Governors Napolitano and Richardson?

>> Ed Pastor:
I'm glad to get it, because both governors have been accused of not doing anything. The state legislature, you hear some of the leadership of the Arizona legislature saying they're not doing anything. They said if the federal government is not going to deal with the problem -- and that's where it belongs, the federal government -- then we're going to claim an emergency and that would allow resources to go to the border. I think they did the right thing. It's interesting what happened in California and Texas because they have similar problems but they have Republican governors. I don't know what they're going to do.

>>José Cárdenas:
The suggestion has been that actions such as this perhaps have given Democrats the edge on immigration issues. Do you agree?

>> Ed Pastor:
I think immigration reform is a bipartisan issue. I think the bill that is most reasonable, McCain and Kennedy, in a bipartisan manner introducing in the Senate. Arizona members Jim Kolbe and Jeff Flake from Arizona along with Luis Gutierrez and myself, and other Democrats supporting it. I don't think anybody is trying to get the heads up, it's just that we need to solve it and it has to get solved in the federal government.

>>José Cárdenas :
Is that one of the first things that Congress will tackle when you get back next week?

>> Ed Pastor:
We were told when we were leaving the first of August that the speaker wanted to deal with immigration. I don't know what he means by that. Are we going to take up the McCain-Kennedy bill for debate? I would welcome that. Are we going to deal with the Dream Act? I would welcome that. Are we going to deal with the Ag bill in terms of how we deal with farm workers that have been here? That's something we welcome. We don't know what the leadership, the Republican Congress is going to bring forth. I can tell you, it takes 218 votes to pass a bill. That's the magic number, 218. Right now, there are at least 200 Democrats in the house and probably 40 Republicans that would vote for immigration reform and the Dream Act and would vote for the Ag bill. The likelihood would also vote for the McCain-Kennedy bill. The numbers are there to do it but the political will is not.

>>José Cárdenas:
Can speaking of the Dream Act, the students avoided deportation recently, but their status is still up in the air?

>> Ed Pastor:
Well, it will be up in the air if the immigration people decide to appeal the ruling of the immigration judge. And I would hope that they would concur with the judge and settle the case for these four young students. Basically, the judge said they were profiled. The questions they were asked and they were the only ones that were profiled so they were profiled and possibly there constitutional rights are violated. It only stands to those four students. I would hope the immigration people would not appeal and let them continue their life here.

>> José Cárdenas:
Another subject the president talked about while here was the war in Iraq. Is it your sense that support is slipping in Congress?

>> Ed Pastor:
You now have a number of Republicans, conservative Republicans saying that their needs to be a plan of withdrawal. If you look at the polls, almost all the polls show that 70% of the American public disagrees with the president and how this conflict is being carried out. I think the hurricane is going to show that in terms of National Guard, that it's going to show in dealing with the hurricane that the National Guard units are pretty much depleted in Mississippi and Louisiana, that they're going to go out to other states and they're going to find that the trucks, the big trucks that you need, are in Iraq, because shortage of armament is a real concern. One of the issues is this. In Iraq, we have 40% of the troops are reserves or National Guard. And many of them now have been called two or three times. We are now to the limit of legally requiring that category to be called up. So 40% now are coming up, and your armament is in short supply. You have read in newspapers where the generals are saying there will be reduction in forces this spring. So I will see and you will see probably a gradual pullout once the constitution is ratified and the elections in December. I think this administration is going to claim victory. They don't want to go in 2006 into congressional elections.

>> José Cárdenas:
Another impact of hurricane Katrina will be a further spike in gas prices.

>> Ed Pastor:
Right.

>>José Cárdenas:
What can we expect there?

>> Ed Pastor:
The administration is going to open up the petroleum reserves and make that available, but whether or not we can refine them fast enough, I don't know what refineries are going to be able to take that capacity and the volume. I made a comment that right now we get 40% of our crude from Minnesota. What we ought to do, rather than have Reverend Roberts claim who he wants assassinated, maybe we should call him in, have him address a joint session of Congress, give him a medal and ask him to pump more oil. If you're doing 40%, why don't you get it to 60%? It follows supply and demand. So we need to deal with those countries that can provide more crude oil.

>>José Cárdenas:
We have less than a minute left. When you get back to Washington, the newspapers and airwaves will be dominated by the confirmation hearing for Judge Roberts.

>> Ed Pastor:
I think he is going to get confirmed. The issue is how long it will take. Democrats are asking for additional information. They will probably get some. I think when everything is said and done he will be confirmed.

>>José Cárdenas:
Was the Hispanic caucus disappointed it wasn't Gonzalez?

>> Ed Pastor:
Well, I think some of the members were hoping it would be Gonzalez, to have the first Latino Supreme Court Justice. I think Laura Bush was disappointed because she was pushing for a woman. So I think there's enough disappointment to go along.

>> José Cárdenas:
Congressman, have a safe trip back to Washington.

>> Ed Pastor:
Thank you, Jose.

>> José Cárdenas:
According to a report in the May issue of Archives of Neurology, researchers concluded that Latinos in the United States develop their first symptoms of Alzheimer's disease at a younger age than non-Latinos. Also, the Alzheimer's association says the number of Hispanics with Alzheimer's is expected to increase by the year 2050. This has sparked concern and a statewide effort to bring awareness and a better understanding of Alzheimer's disease among Latinos. Here is a look at what some of the statewide outreach effort is all about.

>> Dr. Marilyn Albert:
Alzheimer's disease is a disease that affects the brain. It causes gradual progressive damage in nerve cells in the brain and it means over time people have less and less ability to think normally. The reason people are thinking and talking so much about the disease today is that it's more common as people get older and so we're looking at increasingly vast numbers of people who are going to be affected by Alzheimer's disease unless we can do something about it.

>> Scott Gardner:
There are a number of victims by this. The patient, obviously, the individual with the disease. There is the caregiver. The caregiver is entrenched with the person with the disease, 24 hours a day, 365 days a year. It's their sole responsibility.

>> Dr. Eric M. Reiman:
Alzheimer's affects about 80,000 citizens in Arizona and currently costs about $4 billion in their health care needs. By the time today's adults become senior citizens, that number is expected to quadruple, affecting more than a quarter of a million individuals in the state and costing more than $16 billion to care for their needs.

>> Dr. Zaven Khachaturian:
This disease, unlike any other, involves the most important organism in the body, which is the brain. The brain is who we are. Essentially, you're losing who you are. The disease costs the country $100 billion a year and the only way we're going to solve the problem is through research.

>> José Cárdenas:
With us to talk more about Alzheimer's disease and a federally funded study for Hispanics is Dr. Eric Reiman. Dr. Reiman is the director of the Alzheimer's disease research program at the banner Good Samaritan hospital in Phoenix. Also here to talk more about the Latino outreach effort is Dr. Alfred Kaszniak. Dr. Kaszniak is the director Of the Arizona Alzheimer's disease consortium education core. He is also the head of the psychology department at the University of Arizona. Gentlemen, thank you for joining us on "Horizonte". Dr. Reiman, we heard a figure in the video package of $100 billion a year impact in the United States. What are we talking about in terms of Arizona and can you elaborate on what this means?

>> Dr. Eric M. Reiman:
It's a terrible problem not just a problem for the affected person and their family members but a growing financial problem for our communities. We believe there are about 80,000 affected individuals in Arizona. We believe, as the video described, that those numbers are going to increase over the next 40 to 50 years by a factor of four. By a factor of six in our Latino populations. In the United States, those numbers will add up to a cost of more than three-quarters of a trillion dollars per year. We have an urgent need to find a way not just to stop the progression but to prevent the onset of the disorder.

>> José Cárdenas:
As I understand, Arizona is a leader in this area, not simply because, as some might assume, we have a significant elderly population but also we have a unique combination of resources. Can you tell us more about that?

>> Dr. Eric M. Reiman:
We have remarkable scientific and organizational resources. Leaders from 8 institutions in our state, more than 100 researchers have made remarkable contributions to help us understand some of the risk factors and molecular mechanisms that lead to the development of the disorder, providing targets against which we can name new treatments. They suggested some promising new treatments and they have developed some promising ways to evaluate, identify which treatments are effective in the shortest possible time. What we have been able to do with our Arizona Alzheimer's Disease consortium, with support from the state and the federal government, is bring researchers from different institutions together to address their problems in a more fundamental way.

>> José Cárdenas:
Dr. Kaszniak, how long have you been involved in this effort?

>> Dr. Alfred Kaszniak
: I've been involved in Alzheimer's disease about 32 years.

>>José Cárdenas:
We heard a lot about some differences for Latinos, earlier onset and apparently a significant increase by 2050. What's going on there? What are we talking about?

>> Dr. Alfred Kaszniak:
First of all, part of the increase is the increase of Latino individuals in the United States. That accounts for a part of that projection.

>> José Cárdenas:
So better record keeping?

>> Dr. Alfred Kaszniak:
Right. And a second aspect is, with an earlier age of onset, given the fact that the incidence of Alzheimer's disease doubles about every five years, that results in greater numbers of Latinos developing the illness.

>> José Cárdenas:
Why double?

>> Dr. Alfred Kaszniak:
It's not clear what the mechanisms that relate to age are. It may be changes in the immune system, other age related changes.

>> José Cárdenas:
Dr. Reiman, what with other minority groups? We've heard about Latinos. Are there other differences that are of significance?

>> Dr. Eric M. Reiman:
It's very important as we learn more about the disorder to find out the extent to which the factors that contribute are relevant to other groups. For instance, we have been studying a common gene that increases a person's susceptibility to Alzheimer's disease. We know that it increases a Caucasian person's risk for developing the disorder. It doesn't seem to have that same risk in individuals of African descent. And we're very interested in determining the extent to which it is a factor for the risk for Alzheimer's disease in our Latino communities.

>> José Cárdenas:
As I understand it, we have two major efforts underway. Dr. Kaszniak, I wanted to talk to you about the other one, but can you talk about the other study that you're involved in?

>> Dr. Eric M. Reiman:
Sure. In partnership with our collaborators at the Mayo Clinic, at Banner, we have been using brain-imaging techniques to detect and track the brain changes that may be associated with risk for developing Alzheimer's disease many decades before the onset of memory and thinking problems. We are developing a way to test future prevention therapies without having to wait many years to determine whether and when people develop memory and thinking problems. We would like to do now, having detected those changes, almost five decades before the onset of memory and thinking problems, is to see if we can find the same changes in carriers of the susceptibility gene before they have any memory, thinking problems at all.

>> José Cárdenas:
How are you going about this in terms of organizing the study?

>> Dr. Eric M. Reiman:
Right now we're enrolling members of the Latino community between 47 and 68 years of age. I think you have a phone number that people can call to find out about their suitability for participating in the study. If they are eligible, we would like to provide a battery of memory and thinking tests and follow individuals and perhaps brain imaging studies. As part of our larger effort, there are other studies those individuals might be interested in participating in, as well.

>> José Cárdenas:
We'll have the number up later in the program. Dr. Kaszniak, the outreach effort to Latinos, is that impacted by cultural differences?

>> Dr. Alfred Kaszniak:
Absolutely. In any effort to reach out to communities that had been underserved and underrepresented in research, I think the first thing one has to do is consider why that is. Why is it that individuals have not been enrolled in studies previously? I think a part of the answer is there has not been sufficient cultural sensitivities, about what matters to them and what concerns do they have in coming to the sorts of places where research is conducted.

>> José Cárdenas:
Can you give me an example of what you have encountered in that area?

>> Dr. Alfred Kaszniak:
For one example with Latino individuals in this region, family is a very, very important factor. Very often the individual afflicted by the illness or at risk is not the only person that one needs to consult with, it's really the entire family that makes the decision about whether someone is going to get involved in something like research or come even to the attention of a professional for diagnosis.

>> José Cárdenas:
I know have you some Spanish language materials. In what other ways are you reaching out to the Latino community?

>> Dr. Alfred Kaszniak:
We have been organizing particular education efforts to better train physicians to be more culturally sensitive and be more aware of some of the risk factors so they can better serve Latino individuals. We have been doing a variety of educational efforts at professional meetings aimed toward the same kinds of goals and organizing a number of community educational events where we bring individuals in areas where a large number of individuals reside to try to provide the every day person with some of what we know at the present time.

>> José Cárdenas:
This may be a sign of my own onset of Alzheimer's. Did you say how young it is that Latinos are contracting Alzheimer's as compared to the population at large?

>> Dr. Alfred Kaszniak:
The average age of onset, and as I said it increases with age, but overall the average age of onset is in the middle 70s. For Latino individuals, it is in the middle to earlier 60s.

>>José Cárdenas:
Dr. Reiman, what kind of funding are we talking about? And what are you getting and do you have enough?

>> Dr. Eric M. Reiman:
We could always use funding, but we in Arizona have a unique opportunity to find a way to stop the progression and prevent the onset of Alzheimer's disease. We have a unique opportunity to do it before we lose a generation along the way. We have received generous funding from participating institutions and the government, but we think we can take this to the next level to really make a difference in eradicating the disorder. Meantime, we are committed to helping to identify and address the needs of our underserved, understudied Latino communities and also the American Indian communities here in Arizona.

>>José Cárdenas: Is there a particular impact on them as relates to Alzheimer's?

>> Dr. Eric M. Reiman: We know very little about the risk of Alzheimer's disease in our American Indian communities. Some of the thinking tests that we use may not be of special relevance to some of those communities. We need to be able to study the condition well. Meantime, there is increasing suggestion that certain cardiovascular risk factors and lifestyle changes, including diabetes, and obesity, higher cholesterol levels may contribute to the risks of the disorder. To the extent members of the community are at risk for such conditions as diabetes that contribute to the risk, as well.

>> José Cárdenas:
And we know that among Latinos and Native Americans diabetes is a bigger problem than the population at large. But Dr. Kaszniak is that a sufficient reason to focus on a particular population? Alzheimer's affects everybody, from President Regan on down. Why should we be focusing on particular ethnic groups and spending these precious research dollars that way?

>> Dr. Alfred Kaszniak:
I think of greatest importance is the possibility that different groups either because of small differences in their genetics or because of the contribution to differences in lifestyle may respond differently to treatments. We don't want to have a treatment that's developed based upon primarily only Anglo individuals and find out later after it's approved and put into place that it doesn't work for other groups.

>>José Cárdenas:
When are we going to see results for the studies?

>> Dr. Alfred Kaszniak:
There are, in addition to our own consortium and the federally funded Alzheimer's center in Arizona, there are others across the country that are actively working on these questions. It's hard to give a precise estimate about when we're going to have a cure, when we're going to have prevention. I can say over my own lifetime of research in this area, the rapidity of progress has been enormous within the last 10 years.

>>José Cárdenas:
Dr. Reiman, I'm going to give you the last word. Do you want to give us your opinion as to when we're going to see a cure? You've got 30 seconds.

>> Dr. Eric M. Reiman:
I think there's been more scientific progress in the study of this disorder and the development of promising ways to treat and prevent it. It's my hope that we might be able to find a way to prevent the disorder within the next decade, but we need to be able to identify and address some of the challenges along the way.

>>José Cárdenas:
Gentlemen, best of luck on your research and thank you for joining us on Horizonte.

>> Dr. Alfred Kaszniak:
Thank you.

>> José Cárdenas:
If you want to find out more about the study or on Latinos and Alzheimer's research, just call the Positron Emission Topography or "PET" research center at banner good Samaritan medical center at 602-239-2083. We also have a link set up on our website www.az.pbs.org, just lick on "Horizonte" and then look at the upper left-hand side of the screen. That's "Horizonte" for tonight. Thank you for joining us. I'm José Cárdenas. Have a good evening.

Dr. Eric Reiman: Director, Alzheimer's disease Research Program, Banner Good Samaritan hospital;

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