Could diabetes medications help the mind?

Research in the last few years  has raised the possibility that Alzheimer’s memory loss could be due to a novel third form of diabetes, according to an Oct. 2 Northwestern University press release.

Scientists at the university claim to have discovered why brain insulin signaling--crucial for memory formation--would stop working in Alzheimer’s disease. They have shown that a toxic protein that builds up in the brains of Alzheimer’s patients removes insulin receptors from nerve cells, leaving those neurons insulin resistant, the release stated. (The protein, known to attack memory-forming synapses, is called an ADDL for “amyloid ß-derived diffusible ligand.”)

Groundbreaking: With other research showing that the brain’s insulin levels and related receptors are lower in individuals with Alzheimer’s’ disease, the Northwestern study supports the emerging idea of Alzheimer’s being a “type 3” diabetes, the university said.

New Drug Treatment Possibilities On The Horizon

These new findings have led researchers to take another look at drugs that treat diabetic patients. Researchers believe the drugs may protect neurons from ADDLs and improve insulin signaling in individuals with Alzheimer’s, the release stated.

How it works: In the brain, insulin and insulin receptors are crucial for learning and memory. When insulin binds to a receptor at a synapse, it turns on a mechanism necessary for nerve cells to survive and memories to form. And the fact that Alzheimer’s disease may in part be caused by insulin resistance in the brain has scientists asking how that process gets initiated, the university reported.

“We found the binding of ADDLs to synapses somehow prevents insulin receptors from accumulating at the synapses where they are needed,” said William L. Klein, professor of neurobiology and physiology in the Weinberg College of Arts and Sciences, who led the research team. “Instead, they are piling up where they are made, in the cell body, near the nucleus. Insulin cannot reach receptors there. This finding is the first molecular evidence as to why nerve cells should become insulin resistant in Alzheimer’s disease.”

In prior research, Klein and his colleagues found that ADDLs bind specifically at synapses, initiating synapse function deterioration and causing changes in synapse composition and shape. Now Klein and his team have shown that ADDLs from the surface membrane of nerve cells are removing the molecules that make memories at synapses (insulin receptors).

“We’re dealing with a fundamental new connection between two fields, diabetes and Alzheimer’s disease, and the implication is for therapeutics. We want to find ways to make those insulin receptors themselves resistant to the impact of ADDLs. And that might not be so difficult.”

The hope: “With proper research and development the drug arsenal for type 2 diabetes, in which individuals become insulin resistant, may be translated to Alzheimer’s treatment,” said Klein. “I think such drugs could supercede currently available Alzheimer’s drugs.”

Note: The National Institutes of Health, the Human Frontier Science Program and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico of Brazil supported the research. The study is published online by the FASEB Journal at www.fasebj.org. 

In other news…

• Part D Or Part B? Know Who’s Covering Chemotherapy Drugs

Beneficiaries can expect to continue to jump through Part D’s administrative appeals hoops when prescription drug plans deny coverage of needed drugs.

Spotlight: A cancer patient who claims that her Medicare Advantage plan improperly classified her chemotherapy drugs must first exhaust her administrative remedies under Medicare before she can seek judicial review of her claims. That decision was handed down last month from a federal district court in Florida (Masey v. Humana Inc., M.D. Fla. No. 06-1713).

Reasoning: In cases in which a party’s claims are “inextricably intertwined” with a claim for Medicare benefits, judicial review is not available until the party has presented his claims to the Department of Health and Human Services and run through all options in the administrative appeal process, wrote Judge Elizabeth Jenkins, wiring for the District Court for the Middle District of Florida on Aug. 16.

Darly Masey alleged in the case that Humana breached its Medicare Advantage contract when it classified her chemotherapy drugs as covered by Part D rather than Part B. Part B would have covered 100 percent of the associated costs, but Masey incurred “thousands of dollars” in drug expenses under Part D.

• Reporting a nursing home’s inadequate care can give the whistleblower a share of the recovery costs. That’s what happened in the case of Ciena Healthcare Management Inc. of Southfiled, MI, according to an article in the Aug. 21 edition of The Detroit News.

The nursing home company will pay $1.2 million to settle a civil lawsuit alleging it improperly billed Medicaid and Medicare for inadequate care at four Detroit-area nursing homes--and former director of nursing at the St. James Nursing Center, Denise Hubbard, will receive a share of both the federal and state awards, Detroit News said. That will total to about $174,000, which covers Hubbard’s legal fees, the nursing director’s lawyer, Robin West said.

Under federal law, citizens like Hubbard, who report fraud in federal programs, are entitled to receive 15 to 25 percent of the amount the government recovers, Detroit News said.