A small study suggests that the apathy shown by many Alzheimer's patients may not simply be due to memory or language problems, but to a decreased ability to experience emotions. The seven patients were asked to rate pictures of positive and negative scenes (such as babies and spiders) by putting a mark closer or further to either a happy face or a sad face emoticon. Closeness to the face indicated the strength of the emotion felt. Although most of the time the Alzheimer’s patients placed their mark in the appropriate direction, they did make more inappropriate choices than the control group, and typically also gave less intense judgments.

Both comprehension problems and depression were ruled out. A lower emotional response may result from damage to brain areas that produce neurotransmitters, which typically occurs early in Alzheimer’s. It may be that medication to replace or increase these neurotransmitters would improve emotional experience.

This finding is a warning that apathy should not be automatically taken to mean that the patient is depressed. The researchers, enabled by the small size of the study, tested more thoroughly for depression than is usually the case in large studies. It may be that in these studies, this apathy has often been confounded with depression — which may explain the inconsistencies in the research into depression and Alzheimer’s (see the news item just previous to this).

The finding may also help caregivers understand that any emotional indifference is not ‘personal’.

Confirming previous research, a study involving 270 Alzheimer’s patients has found that larger head size was associated with better performance on memory and thinking tests, even when there was an equivalent degree of brain damage. The findings are consistent with the theory of cognitive reserve. They also point to the importance of brain development early in life, since the brain reaches 93% of its final size at age six, and while partly determined by genes, brain growth is also influenced by nutrition, infections, and brain injuries.

Part of the Women's Health Initiative study looking at the effect of hormone therapy on thinking and memory in postmenopausal women, involving over 1400 women, has found those who had high blood pressure at the start of the study (eight years earlier) had significantly higher amounts of white matter lesions. Damage to white matter seems to be an independent risk factor for dementia. The finding adds to evidence suggesting that preventing hypertension helps protect against dementia. High blood pressure is common in the U.S. — of the nearly 99,000 women enrolled in the WHI study, 37.8% had hypertension. You can watch the researcher discussing the findings at http://www.eurekalert.org/multimedia/pub/19494.php?from=152110

A study involving 511 older adults (average age 78) has found that 11.6% of those with very mild or mild Alzheimer’s (43% of the participants) had mental lapses, compared to only 2 of the 295 without Alzheimer’s. Those with mental lapses also tended to have more severe Alzheimer’s. Although mental lapses are characteristic of dementia with Lewy bodies, this is the first study to look at them in connection with Alzheimer’s. Having mental lapses was defined as having three or four of the following symptoms:

• Feeling drowsy or lethargic all the time or several times per day despite getting enough sleep the night before
• Sleeping two or more hours before 7 p.m.
• Having times when the person's flow of ideas seems disorganized, unclear, or not logical
• Staring into space for long periods

Loss of memory and problems with judgment in dementia patients can cause difficulties in relation to eating and nutrition; these problems in turn can lead to poor quality of life, pressure ulcers and infections. A study used two different step-by-step training programs to help dementia patients regain eating skills. Three institutions, involving 85 patients, were assigned to one of three programs: spaced retrieval training; Montessori-based training; control. Training consisted of three 30-40 min sessions per week, for 8 weeks. Both training programs resulted in significantly improved feeding skills, however the Montessori group needed more physical and verbal assistance. Nutritional status was significantly higher in the spaced-retrieval group compared to the control.