More information about the link between BMI and Alzheimer's

Two new studies find that people with a low BMI are at greater risk of mortality and those with early stage Alzheimer's have a lower BMI.

Article from the ABC News :

Low BMI Linked to Alzheimer's and Death After Surgery

Maintaining a low Body Mass Index, or BMI, has long been considered a healthy practice for the general population, but two new studies have suggested links between low BMI and serious health conditions.

The first study, published in the Journal Neurology found that older people in the earliest stages of Alzheimer's disease are more likely to have lower BMI.

"The earliest stages of Alzheimer's are associated with some metabolic dysfunction, as evidence with the differences in BMI," said Dr. Jeffrey Burns, lead author of the study and Director of the Alzheimer and Memory Program at University of Kansas Medical Center. "We saw the relationship between Alzheimer's markers with body composition with low BMI in people in the earliest stages of the disease, both in people with mild cognitive impairment and in people without functional problems."

While Burns said he does not have the evidence to support whether low BMI puts people at risk of cognitive impairment or cognitive impairment may contribute to lower BMI, he said it goes beyond simple changes in one's ability to remember to eat.

"It reflects there is a systemic response to an underlying problem," said Burns. "We think of Alzheimer's as classically a brain disease, but now there's evidence that there are measurable changes going on in the body."

BMI is a number calculated from a person's height and weight that is meant to indicate body fatness in most people. According to the Centers for Disease Control and Prevention, 18.5 and below is considered underweight. Normal weight ranges from 18.5 to 24.9. Overweight spans from 25 to 29.9 and obese is considered 30 and above.

Researchers analyzed more than 500 patients with Alzheimer's biomarkers through advanced brain imaging techniques and cerebrospinal fluid. The biomarkers are often present years before symptoms set in. Study participants included people without any memory problems and those with mild cognitive impairment.

While the link between later-life low body mass and Alzheimer's disease has been fairly established by previous research publications, William Thies, Chief Medical and Scientific Officer of the Alzheimer's Association, said this study appears to extend this relationship to the earliest stages of Alzheimer's pathology through the biomarker findings.

Interestingly, prior research has shown that middle-aged people who are overweight or obese (higher BMIs) are at greater risk of developing Alzheimer's disease.

"It appears that mid-life high BMI and later life lower BMI are both related to Alzheimer's disease," said Thies. "Perhaps the mid-life findings are due to exacerbation of vascular risk by high BMI. The later-life linkage between low BMI and Alzheimer's may come about as the result of the earliest changes of Alzheimer's disease and result in a lowering of appetite, among other things."

While Burns said they are currently conducting studies that look deeper into metabolic changes in the body and brain, Thies said further research on early-stage symptoms is expansive and expensive.

"Without more money being invested in basic Alzheimer's disease research studies, we will never know the real relationship between BMI, age, and Alzheimer's disease," said Thies. "We must see, and quite soon, a greater commitment to Alzheimer's disease research at the federal level, and from industry, and from the American public."

In the second study, low BMI was spotlighted as increasing risk of death within 30 days of surgery. The research, published in the Archives of Surgery, found that, of the nearly 190,000 patients included in the study, 1.7 percent of them died within 30 days of surgery. Deaths among patients with a BMI less than 23.1 were twice that of patients with a BMI of 35.3 or higher.

"Patients with low body mass index are at significantly higher risk of death with 30 days after following general and vascular surgical procedures," said Dr. George Stukenborg, Associate Professor of Public Health Sciences at University of Virginia's School of Medicine. "Low BMI should be taken into account as an important risk factor for risk of death within 30 days of the procedure."

Oddly, patients in the heavier BMI groups did not have "a statistically significant mortality risk," said Stukenborg.

Patients who underwent laparatomy, or a procedure involving a large incision through the abdominal wall, were at highest risk of death after surgery, compared with other operations.

Stukenborg said the research does not disclose why BMI is a risk factor for death, but experts say the higher amount of deaths could be among the frail and elderly, not the young, thin and healthy. Stukenborg said he and his colleagues plan to investigate reasons for the increased risk in upcoming studies.

(Source: By Mikaela Conley, ABC World News, 27 November 2011)

Medications and Patients with Alzheimer’s Disease – What to Avoid

Doctors are often asked whether there are any medications that someone with Alzheimer’s disease should avoid. Patients with Alzheimer’s disease may need medicines to treat symptoms of the disease, as well as for other health problems such as bladder incontinence, mood disturbances, high blood pressure, etc… However, when a person takes many medications, there is an increased risk of adverse effects, including confusion, mood swings, sleepiness, and worsening memory problems. Some medications can worsen symptoms of Alzheimer’s disease and should be avoided, if at all possible.

Sedatives and Sleep Aids:
Some sedatives or hypnotics, such as benzodiazepines and barbiturates, can cause drowsiness, confusion, increased cognitive impairment, slowed reaction, and worsening balance leading to falls. Sleep aids usually have the same effects. Examples of sedatives to avoid include the benzodiazepines diazepam (Valium), lorazepam (Aivan), temazepam(Restoril), triazolam (Halcion), and sleep aids zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata).

Antidepressants:

Certain antidepressants, such as the older tricyclic antidepressants amitriptyline (Elavil), nortriptyline (Pamelor), andimipramine (Tofranil), can cause sedation and worsening cognition. The tricyclic antidepressants have anticholinergic effects, meaning that they can further suppress the activity of acetylcholine, one of the main brain cell messenger chemicals whose activity is reduced by Alzheimer’s disease. For low mood and irritability in patients with Alzheimer’s, the SSRI (selective serotonin reuptake inhibitor) antidepressants including citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and the SARI (serotonin antagonist reuptake inhibitor) such as trazodone (Desyrel) can be considered instead.

Antipsychotics:

Antipychotics are sometimes given to treat behavioral symptoms such as agitation, aggressiveness, hallucinations and delusions. However, both the older antipsychotic drugs such as haloperidol (Haldol) and the newer atypical antipsychotics such as resperidone (Risperdal), olanzepine (Zyprexa) can cause serious side effects including sedation, confusion, and sometimes Parkinsonian-like symptoms. Studies have shown that both atypical and older antipsychoticsare associated with increased risk of death in elderly dementia patients. These drugs should not be used routinely, and if needed, the minimum dosage should be used for the minimum amount of time, under careful supervision of an experienced clinician.

Patients and caregivers should also be cautious of over the counter medicine containing diphenhydramine (Benadryl). Diphenhydramine is an antihistamine that tends to make people drowsy. It also has anticholinergic effects that may result in confusion and worsening cognition. Diphenhydramine is found in sleep aids such as Compoz, Nytol, Sominex, Unisom, and also in “night time” or “pm” version of popular pain relievers, cold and sinus remedies.

In essence, patients with Alzheimer’s disease are particularly vulnerable to side effects from various medications. It is best to consult with your doctors and pharmacists to learn about the benefits and potential adverse effects of any new treatment therapy, including seemingly benign over the counter remedies.

Source: Gaby T. Thai, M.D., 19 April 2011
http://www.alz.uci.edu/medications-and-patients-with-alzheimer%E2%8...

Stress and Its Influence on Alzheimer’s Disease

Aging is an inevitable journey for everyone, and includes many obstacles and different paths to take. How we live our lives can have enormous impact on whether we grow old gracefully, or succumb along the way. Good physical health, through diet and exercise, will allow people to remain active well into their twilight years, but as lifespan increases it is also important to take care of and maintain brain health as well. Fortunately, it appears that what is good for the heart is also good for the brain, and thus by keeping active, both physically and mentally, and maintaining a healthy diet rich in omega 3 fatty acids, a person can have the best chance of aging successfully, and avoid both heart disease and brain disease.

The major brain disease of the elderly is Alzheimer’s disease. It affects 1 in 20 people aged 65 and over, and its incidence increases with age such that around half of people aged 85 and over have the disease. Alzheimer’s disease is a devastating disorder that robs a person of their memories and cognitive abilities, rendering them unable to recognize family members, or care for themselves. But what is it that causes Alzheimer’s disease? Why do some people develop Alzheimer’s disease and not others? By asking, and then understanding these questions, we, as scientists, can develop therapies and strategies to help people avoid developing the disease in old age.

Here within UCI MIND, we have devoted considerable resources to identifying the causes of Alzheimer’s disease, and finding ways to circumvent these causes. We have identified how the stress hormone cortisol can play a role in the development of Alzheimer’s disease. Cortisol is a steroid hormone that is produced in the adrenal gland in response to times of stress. In the short term, following a stressful experience, cortisol levels rapidly increase in the blood stream, and its presence is helpful – improving short-term memory formation and adapting the body’s physiology to deal with the situation effectively. However, long-term stress leads to prolonged elevated levels of cortisol within the blood stream, which can have serious deleterious effects.

It was found, over twenty years ago, that patients with Alzheimer’s disease had elevated levels of cortisol in their blood streams, compared to healthy patients. This elevation correlated with the degree of memory impairments that the patients had and appeared early on in the disease progression. We were interested in whether or not these early increases in circulating cortisol could be contributing to the development of Alzheimer’s disease, by leading to the pathologies that are found in the AD brain. It is the accumulation of sticky proteins in the brain, leading to a loss of neuronal function, which underlies the dementia and memory loss seen in Alzheimer’s disease. Typically 2 sticky proteins are present in the Alzheimer’s disease brain – the first is the amyloid-beta peptide(Ab), which stick together in between neurons and form the extracellular plaques. The second sticky protein is known as tau, which becomes modified in the Alzheimer’s disease brain causing it to stick together inside neurons and disrupting normal neuronal function. The net result of these sticky proteins is a cascade of events leading to widespread synaptic and neuronal loss in the brain, which causes the dementia and memory loss.

Relax! Avoid stress...

We showed that cells treated with cortisol produced dramatically larger amounts of this Ab peptide – which can accumulate to form the Ab plaques. In order to test whether increased cortisol could have a similar effect in animals and by extension people we turned to a genetically altered mouse, which had been engineered to develop Alzheimer’s disease pathology in its brain as it aged. We took young animals, before they were old enough to have Alzheimer’s disease pathology, and we injected them with a rodent equivalent of cortisol every day for 1 week. After just a single week we looked inside the brains of these animals and found that levels of both Ab peptide and tau protein were tremendously elevated. This showed us that increase in circulating cortisol in humans is able to increase the pathology present in the brain – and thus could make people develop Alzheimer’s disease faster.

So how can we use these findings to help people reduce their risk of developing Alzheimer’s disease in old age? Firstly, cortisol levels are increased by stress – a study has also shown that people with stressful lives are around 2-3 times more likely to develop Alzheimer’s disease than others. So avoiding stress is paramount. In addition, these results can be used by scientists to develop drugs to block either the production of cortisol, or to prevent its effects once it is produced. This could lead to a slowing of the disease if it proves successful.

Stress reduction, combined with a healthy lifestyle and diet will help people age successfully and avoid disease.

(Source:http://www.alz.uci.edu/stress-and-its-influence-on-alzheimer%e2%80%99s-disease/)

(SAT)10DEC11 Talk On "Laughter Yoga" & Exercise Session, Organized By ADFM KL-PJ Alzheimer's Caregivers Support Group

Dear All,

Karen Sze Tho, Certified Laughter Yoga Teacher, will be conducting a Talk on “Laughter Yoga” and Exercise Session for our Caregivers and Members.

Date : Saturday, 10 December
Venue : ADFM PJ Daycare Centre. No. 6, Lorong 11/8E, Section 11, 46200 PJ
Time:

2:00pm : Registration
2:30pm : Introduction by CLY Teacher, Karen Sze Tho
2:50pm : Exercise Session
3:50pm : Sharing Session
4:10pm : Light Refreshments

Laughter Yoga was first introduced to Johor Bahru (JB) in 2008 and since then has been much sought after in Malaysia and Singapore.

Karen will give an introduction on understanding the basic concept, philosophy of Laughter Yoga and what happens in a LY session, techniques of how to laugh all by yourself and the Multiple Health Benefits.

Speaker’s Profile

Karen Sze Tho is a Certified Laughter Yoga Teacher (CLYT) trained by the Founder of the Laughter Yoga Movement, Dr . Madan Kataria in Bangalore, India in January 2010.

Karen's passion with LY started in 2001 when she saw an episode of LY on National Geographic on TV. It was only in 2010 that she had the opportunity to learn from the Master.

Since her Certification, Karen has conducted numerous LY sessions with senior citizens, training academies, children’s homes, companies and at events.

Confirm your registration (on first- come first-served basis):
1. Email jenny@adfm.org.my / Tel: 03-7956 2008/7958 3008 / SMS 016- 608 2513 / Fax 03-7960 8482
2. Christine at 03 - 2260 3158.

Come, have fun and experience this simple, easy & light-hearted exercise

JOIN THE ADFM NATIONAL ALZHEIMER’S CAREGIVERS NETWORK
Your National Platform for The Caregivers Community
SIGN UP, Click at : “http://admalaysia.ning.com/main/authorization/signUp”
(If you do not have an Email Account, contact us at Tel: 03-7956 2008 / 7968 3008)

Advanced-Stage Dementia & Hospice Care

CBS News - Gertrude Buckley was a beauty with brains - one of Milwaukee's first female real estate brokers. But around her 80th birthday, her family began noticing odd behavior.

"Her checkbook was a mess. She wrote checks for very much the wrong amount," said Paula Tishel, Buckley's daughter. "She completely denied that she had any memory loss. 'That's ridiculous,' is what she would say."

Buckley is now 93 years old, with advanced dementia. A controversial new study finds her illness is as deadly as cancer and, therefore, its victims should be offered hospice care to spare them from futile and frightening procedures, reports CBS News medical correspondent Jon LaPook.

"Far too many patients experienced distressing symptoms like pain and shortness of breath and received burdensome interventions of questionable benefit in the final days of life," Dr. Susan Mitchell said.

But how do you know when someone is in the final days of life?

Researchers found patients with late-stage dementia - those who speak fewer than six words at a time and are completely dependent - lived on average only 16 months. And about 40 percent were in pain.


Advanced dementia has the same poor prognosis as terminal cancer. But only about 18 percent of family members say this has been explained to them by doctors.

Those who did were far less likely to allow extraordinary measures like feeding tubes and emergency room visits.

"If you're someone who doesn't understand who is doing this or why they're doing it, it's going to feel almost like an assault," said Dr. Greg Sachs of the Indiana University School of Medicine's Center for Aging Research, said of the medical procedures conducted on dementia patients.

Sachs watched his own grandmother suffer through aggressive treatments right up until she died.

He's among a growing number of doctors who advocate hospice care to comfort patients such as Gertrude Buckley. Medicare has covered hospice care since the 1990s but is used on only one in 10 patients with advanced dementia.

"Certainly I'm not advocating sending grandma off on an ice floe," Sachs said. "It's a misconception people either get aggressive care or they get neglected or they get put to death. People actually have a right to aggressive palliative care. They need someone who is responsive to their pain."

Because Buckley left no advanced care instructions, her daughter has been left guessing about her mother's wishes.

"I know that she wouldn't want to be in pain, nobody would. I don't want her to be frightened. I opted not to do anything that was uncomfortable to her but just to make sure that she was really well taken care of and stimulated and comfortable."

Experts stress the goal of hospice care for patients with advanced dementia is hot to hasten their death, it's to make their last days as comfortable as possible.

Watch Video - Advance Dementia-Managing the Burden ...

(Source: Latest Alzheimer's Weekly and Dementia Weekly Newsletter)

The New Alzheimer's Tangles: Tau, Neurofilaments and Vimentin

Scientists from the National Institutes of Health in the United States have made an important discovery that should forever change the scope and direction of Alzheimer's research. Specifically, they have discovered that the protein tangles which are a hallmark of the disease involve at least three different proteins rather than just one. The discovery of these additional proteins, called neurofilaments and vimentin, should help scientists better understand the biology and progression of the disease as well as provide additional drug discovery targets. This discovery was published in the November 2011 issue of the FASEB Journal.

"Since neurofilaments are the predominant protein in nerve cells, our study suggests that we should refocus our research on the biology of these filamentous proteins in an effort to understand how they are normally regulated and deregulated in response to human aging," said Harish C. Pant, Ph.D., a senior researcher involved in the work from the Cytoskeletal Regulatory Protein Section of the Laboratory of Neurochemistry at the National Institute of Neurological Disorders and Stroke at the National Institutes of Health in Bethesda, Maryland.

To make their discovery, Pant and colleagues identified normal and abnormal proteins present in autopsy samples of the brains of Alzheimer's disease victims. Then they isolated and purified the tangles (which are knots of abnormally aggregated filaments that fill and compromise nerve cells) from the autopsy samples and compared their protein composition to age- and post mortem-matched samples of brains from patients who died of other causes, such as accidents. Through a combination of improved instrumentation and informatics, it was possible to resolve the mixture of proteins successfully and identify the novel Alzheimer's disease proteins. Previous research suggested that only one protein, called "tau," is present in these tangles.

"This is a breakthrough of great importance: tau is not the only target," said Gerald Weissmann, M.D., Editor-in-Chief of the FASEB Journal. "Before this discovery, we approached these tangles as if they were woven of one piece of string. Now we know that there are at least three proteins involved, we're much closer to untangling the Alzheimer's web. Without question, discoveries like this bring us closer than ever to advanced Alzheimer's treatments, and it is a good example of why NIH funding is among the best investments our nation can make toward improving health and well being.

(Source: Latest Alzheimer's Weekly and Dementia Weekly Newsletter)

The drugs we take are getting more advanced and more popular ... and yet we're getting sicker. What's the answer?

6 Lifestyle Changes That Work

Statin drugs, diabetic medications and other pharmaceuticals...

The drugs we take are getting more advanced and more popular .. and yet we’re getting sicker. What’s the answer?
Below excerpts from Dr. Loretta Friedman.

Metabolic syndrome is a constellation of interrelated risk factors that appear to promote the development of heart disease. Metabolic syndrome is characterized by:

- Abdominal Obesity (an abundance of fat around your middle)
- Insulin Resistance (Type II diabetes, coming on later in life)
- Excess Stress Hypertension.

Sounds rare? Not so much. At least one in five people suffer from Metabolic Syndrome. Some studies estimate as much as 25% of the population is suffering from this.

Let's take all this in. Why is this so important?

Because for the last 20 years, the pharmaceutical industry has been coming up with better drugs for diabetes and hypertension and Americans are getting worse, not better.

The medical doctors write the prescriptions and patients are only getting more ill. Why?

People take their insulin and go out and eat every fast food that crosses their path. They take their high blood pressure meds or their heart drugs and the support them by being a couch potato all day, every day.

Here is the bitter pill: The medications don’t work without Life Style Changes. Better yet, you might not even need your medications after Life Style Changes. Get off your butt and help yourself. You might be able to get off your medications.

National Heart, Lung and Blood Institute (NHLBI) Director Elizabeth G. Nabel, M.D., said, “This statement should serve as an alert to physicians that it is vitally important to identify and treat the growing number of people with metabolic syndrome. For individuals with this syndrome, lifestyle treatment…is the primary therapy for lowering their risk factors and reducing the long-term risk for heart disease.”

Helping patients adopt a therapeutic lifestyle is the first and possibly the most important therapy doctors can use to treat many chronic health problems.

As a patient, finding someone who can guide you through this is terribly important.

Consider a few facts:

1. 91% of type II diabetes cases could be prevented by the adoption of healthy habits and lifestyle choices.

2. The National Institutes of Health (NIH) say that lifestyle changes are the most important and cost effective way to lower cholesterol (and not putting the world on statin drugs or other medications.

3. Lifestyle changes are now recommended as the “First Line Therapy” for the major chronic diseases in our society:

Heart Disease
Stroke
Diabetes
Cancer
Arthritis Osteoporosis
Alzheimer’s disease

4. Lifestyle choices are also the key to many symptoms that are not classified as diseases:

Fatigue
Stress-Related Symptoms
Hormonal Imbalances

All these can be helped.

The American Diabetes Association reports that approximately 2200 new cases of diabetes are reported in the US every day. According to estimates from the National Institutes of Health, over 50 million Americans have “Metabolic Syndrome”, a disorder that is directly responsible for America’s unusually large population of Type 2 Diabetics.

What are the key lifestyle changes you should make?
Here are the six steps to a new, therapeutic lifestyle.

6-Step Therapeutic Life Style Program
A regular program of aerobic, strength training and flexibility exercises has been shown to increase vitality and reduce the risk for disease.

1. Knowledge

A healthy lifestyle starts with the knowledge to make an informed decision that impacts your health every day.

2. Balanced Eating
Balanced eating habits have a direct influence on excess insulin production, body composition, and disease prevention.

3. Regular Activity/Exercise

A regular program of aerobic, strength training and flexibility exercises has been shown to reverse insulin resistance, increase vitality and reduce the risk for disease.

4. Appropriate Nutritional Supplementation
Incorporating a foundational nutritional program with targeted nutrients that help to prevent and/or treat specific conditions is an essential part of the therapeutic life style program.

5. Stress Management

For optimal health, regular stress management programs help keep insulin and other hormonal levels balanced, improving vitality.

6. Sleep

Sleep is crucial for the proper functioning of the mind and body. Quality and depth of sleep is of primary importance. Although the amount of sleep individuals need varies, most people should get 7-8 hours per night.

Summing Up:
If you are reaching for that medication to solve your woes, here is my advice:

- Think past the pill.
- Try eating a nutritious diet.
- Get a solid night's sleep.
- Get a little regular exericise.
- Take the right nutritional supplements

You may be AMAZED at what this does to even the most serious maladies you are suffering from.

Watch Video ...

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Recommended reading are:
1. Walk the Walk


A recent study shows that regular walking protects the aging brain. Even moderate exercise helps ward off Alzheimer's and dementia.

2. Recognize A Stroke - Prevent Dementia


The article details a new, related research breakthrough. The video explains how to quickly identify a stroke and what it is. Watch Video ...

3. Hypertension Usually Goes Undetected


Treatment of hypertension might be a key factor in the prevention of dementias such as Alzheimer's. However, a large proportion of people with hypertension are not even diagnosed or treated.

(Source: Alzheimer's Weekly and Dementia Weekly Newsletter)