Alzheimers

Alzheimer's & other dementias

Friends, family detect early Alzheimer's signs better than traditional tests

October, 2010

Cognitive tests only test you at a particular moment in time; early signs of Alzheimer's are more evident in declines in everyday behavior that are most visible to other people.

Confirming earlier research, a study involving 257 older adults (average age 75) has found that a two-minute questionnaire filled out by a close friend or family member is more accurate that standard cognitive tests in detecting early signs of Alzheimer’s.

The AD8 asks questions about changes in everyday activities:

  • Problems with judgment, such as bad financial decisions;
  • Reduced interest in hobbies and other activities;
  • Repeating of questions, stories or statements;
  • Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
  • Forgetting the month or year;
  • Difficulty handling complicated financial affairs, such as balancing a checkbook;
  • Difficulty remembering appointments; and
  • Consistent problems with thinking and memory.

Problems with two or more of these are grounds for further evaluation. The study found those with AD8 scores of 2 or more were very significantly more likely to have early biomarkers of Alzheimer’s (abnormal Pittsburgh compound B binding and cerebrospinal fluid biomarkers), and was better at detecting early stages of dementia than the MMSE. The AD8 has now been validated in several languages and is used in clinics around the world.

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Low levels of omega-3 fatty acid may contribute to Alzheimer’s

October, 2010

A finding that the livers of Alzheimer’s patients have an impaired ability to make the omega-3 fatty acid DHA may suggest a new approach.

Low levels of DHA, an omega-3 fatty acid, have been found in the brains of those with Alzheimer's disease, but the reason has not been known. A new study has found that lower levels of DHA in the liver (where most brain DHA is manufactured) were correlated with greater cognitive problems in the Alzheimer’s patients. Moreover, comparison of postmortem livers from Alzheimer’s patients and controls found reduced expression of a protein that converts a precursor acid into DHA, meaning the liver was less able to make DHA from food.

The findings may explain why clinical trials in which Alzheimer's patients are given omega-3 fatty acids have had mixed results. They also suggest that it might be possible to identify at-risk persons using specific blood tests, and perhaps delay the development of Alzheimer’s with a chemically enhanced form of DHA.

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Career choice may determine where frontotemporal dementia begins

October, 2010
  • An international review of patients with frontotemporal dementia has revealed that the area of the brain first affected tends to be the hemisphere least used in the individual’s occupation.

A review of brain imaging and occupation data from 588 patients diagnosed with frontotemporal dementia has found that among the dementias affecting those 65 years and younger, FTD is as common as Alzheimer's disease. The study also found that the side of the brain first attacked (unlike Alzheimer’s, FTD typically begins with tissue loss in one hemisphere) is influenced by the person’s occupation.

Using occupation scores that reflect the type of skills emphasized, they found that patients with professions rated highly for verbal skills, such as school principals, had greater tissue loss on the right side of the brain, whereas those rated low for verbal skills, such as flight engineers, had greater tissue loss on the left side of the brain. This effect was expressed most clearly in the temporal lobes of the brain. In other words, the side of the brain least used in the patient's professional life was apparently the first attacked.

These findings are in keeping with the theory of cognitive reserve, but may be due to some asymmetry in the brain that both inclines them to a particular occupational path and renders the relatively deficient hemisphere more vulnerable in later life.

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Deep Brain Stimulation shows promise for patients with Alzheimer's

September, 2010

A safety trial has shown that Deep Brain Stimulation is safe for those with mild Alzheimer’s, and may slow cognitive decline.

A pilot study involving six patients with mild Alzheimer’s has shown using Deep Brain Stimulation (DBS) is safe and may help improve memory, or at least slow decline. Patients received continuous stimulation for 12 months, between 2005 and 2008. Impaired glucose utilization in the temporal and parietal lobes was dramatically reversed early in the treatment, and maintained after the year of continuous stimulation. Performance on cognitive tests showed possible improvement and/or slowing in the rate of cognitive decline at 6 and 12 months in three of the six patients.

The principal aim of this pilot study was to assess the safety of the procedure, and it is now hoped to move on to a larger study to assess its effectiveness. Anyone interested in more information about participating in the next phase should visit: http://www.uhn.on.ca/Focus_of_Care/KNC/Functional_Neurosurgery/research.asp.

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Vitamin B supplements could delay onset of Alzheimer's

September, 2010
  • Vitamin B supplements markedly reduced brain atrophy in older adults with MCI, offering hope that they may be effective in delaying the development of Alzheimer’s.

A two-year study involving 271 older adults (70+) with mild cognitive impairment has found that the rate of brain atrophy in those taking folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d) and vitamin B6 (20 mg/d), was significantly slower than in those taking a placebo, with those taking the supplements experiencing on average 30% less brain atrophy. Higher rates of atrophy were associated with lower cognitive performance. Moreover those who with the highest levels of homocysteine at the beginning of the trial benefited the most, with 50% less brain shrinkage. High levels of homocysteine are a risk factor for Alzheimer’s, and folate, B12 and B6 help regulate it.

The finding that atrophy can be slowed in those with MCI offers hope that the treatment could delay the development of Alzheimer’s, since MCI is a major risk factor for Alzheimer’s, and faster brain atrophy is typical of those who go on to develop Alzheimer’s.

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Stress in middle age could contribute to later dementia

September, 2010

A long-running study of Swedish women has revealed that dementia risk is greater in those who experienced periods of stress in middle age.

Data from a 35-year study of women from Gothenburg in Sweden has revealed that the risk of dementia was about 65% higher in women who reported repeated periods of stress in middle age than in those who did not. The risk increased with number of periods of stress, with women who reported stress on all three occasions they were asked (1968, 1974 and 1980) having more than double the risk of dementia. Stress was defined as a sense of irritation, tension, nervousness, anxiety, fear or sleeping problems lasting a month or more due to work, health, family or other problems. Of the 1462 women in the sample used, 11% developed dementia, 65% of which was Alzheimer’s and 25% vascular dementia.

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Post-traumatic stress disorder increases dementia risk

September, 2010

A very large study has found that military veterans with PTSD were twice as likely to develop dementia in old age, compared to vets without PTSD.

A study involving over 180,000 older veterans (average age 68.8 at study start), of whom 29% had PTSD, has revealed that those with PTSD had a significantly greater risk of developing dementia. Over the seven years of the study, 10.6% of the veterans with PTSD developed dementia compared to 6.6% of those without PTSD. When age was used as the time scale, the risk for those with PTSD was more than double. Results were similar when those with a history of head injury, substance abuse, or clinical depression, were excluded.

One possibility for the link is that the stress induced by PTSD contributes to the development of dementia.

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Healthy diet could slow or reverse early effects of Alzheimer's disease

August, 2010

A mouse study demonstrates that the right diet can reverse Alzheimer’s damage in the early stages.

Following on from previous research with mice that demonstrated that a diet rich in methionine could increase the risk of developing Alzheimer's Disease through its effect on homocysteine levels, a new study has found that these effects were reversible if the mice then switched to a healthier diet. The mice, after five months on a methionine-rich diet, were divided into two groups, with one group continuing the diet and the second switching to the healthy diet for an additional two months. The cognitive impairment, and the build-up in amyloid plaques, was completely reversed after two months.

Methionine is an amino acid typically found in red meats, fish, beans, eggs, garlic, lentils, onions, yogurt and seeds. I note, however, that most of the items in this list are usually considered healthy! Fish, in particular, has been shown in a number of studies to reduce the risk of Alzheimer’s. The point is that methionine in itself is an essential amino acid and necessary for a healthy brain, but this indicates that, as with many foods, moderation is important. Clearly a balance is required; equally clearly, we still haven’t quite worked out the ‘perfect’ Alzheimer’s-prevention diet. Nevertheless, this study is welcome in demonstrating that diet can have such an effect on the brain, and adds to our knowledge of what makes a good diet for staving off dementia.

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Music aids Alzheimer's patients in remembering new information

August, 2010

A small study has found that music can help patients with Alzheimer's disease recognize verbal information.

The study involved 13 patients and 14 controls, who listened to either spoken lyrics or lyrics sung with full musical accompaniment while reading the printed lyrics on a screen. The 40 lyrics were four-line excerpts of children’s songs, all characterized by having simple, unrepeated lyrics, repetitive melodies, and a perfect end-rhyme scheme for the four lines. The participants were then given these 40 lyrics mixed in with 40 other similar lyrics, and asked whether they had heard it earlier. Alzheimer’s patients were markedly more likely to recognize those they had heard sung (40% compared to 28% of the spoken). Interestingly, the controls showed no difference, although of course their performance was considerably better (77% and 74%).

It may be that setting new information, such as simple instructions, to music might help Alzheimer’s patients remember it.

On a side note, a recent study found that classical music (four short pieces by different composers) affected the heart rates of people in a vegetative state in the same way as they did those of healthy listeners, suggesting that music affects emotion at very deep level. (see http://www.newscientist.com/article/dn19123-classical-music-moves-the-he...)

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Special care plan does not slow decline in patients with Alzheimer's

August, 2010

A large French study has found no evidence that special care plans for dementia patients improve the outcomes.

A study involving over 1100 patients with mild to moderate Alzheimer's disease at 50 French clinics has revealed that receiving a comprehensive care plan involving regular 6-monthly assessments (with standardised guidelines for the management of problems) produced no benefits compared to receiving the usual care (an annual consultation). After two years, there was no significant difference in functional decline between the two groups, and no difference in the risk of being admitted to an institution or death. While this argues against guideline-based interventions for dementia care (widely recommended), it may be that the treatment received by both groups was superior to that received by those who do not attend a specialized memory clinic. It remains to be seen whether the findings would be different for patients being treated in general practice.

It should also be noted that this study only measured the effects on daily activities, institutionalization, and death. A number of studies have found improvements in specific behaviors (eg, reduced behavioral problems, reduced agitation, or improved quality of life) as a result of particular care programs. The fact that, in this case, interventions were more frequent early in the study compared to later, suggests that the care plan may not have been all that easy to implement.

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