WHAT IS APHASIA: WORD JUMBLES IN ALZHEIMER'S DISEASE

Aphasia (ah-FA-ze-ah) is a language disorder that affects a person’s ability to communicate. "Aphasia" is a general term used to refer to deficits in language functions, such as speaking, understanding what others are saying, and naming common objects. It is caused by damage to the portions of the brain that are responsible for language.

Aphasia is not a disease, but a symptom of brain damage. The type and severity of language dysfunction in Alzheimer's disease is somewhat random, as it depends on the precise location and extent of the damaged brain tissue.

Alzheimer's Disease (AD) & Aphasia

Alzheimer's disease symptoms fall into two categories:

ü   Cognitive (Intellectual) Symptoms

ü   Psychiatric Symptoms

The Cognitive Symptoms include "The 4 Cognitive 'A's of Alzheimer's Disease". These are:

·                Aphasia

·                Apraxia

·                Agnosia

·                Amnesia

4 Types of Aphasia:

Generally, aphasia can be divided into four broad categories:

1.   Expressive Aphasia involves difficulty in conveying thoughts through speech or writing. The persons know what they want to say, but cannot find the words they need. Expressive aphasia may be non-fluent, in which case a person has trouble:

Ø   Finding the right words

Ø   Saying more than one word or phrase at a time

Ø   Speaking overall 

Another kind of expressive aphasia is fluent aphasia. Persons who have fluent aphasia may be able to put many words together. But what they say may not make sense. They are often unaware that they are not making sense.

2.   Receptive Aphasia involves difficulty understanding spoken or written language. The person hears the voice or sees the print but cannot make sense of the words.

3.   Anomic or Amnesia Aphasia is the least severe form of aphasia. In this type of aphasia, the person has difficulty in using the correct names for particular objects, people, places, or events.

4.   Global Aphasia results from severe and extensive damage to the language areas of the brain.  The person loses almost all language function, both comprehension and expression. They cannot speak or understand speech, nor can read or write.

Therapy:

Language Therapy can help and should be tailored to the individual needs of the person. Rehabilitation with a speech pathologist involves extensive exercises in which the persons read, write, follow directions, and repeat what they hear. Computer-aided therapy may supplement standard language therapy.

Care Tips:

There are simple ways to keep distractions and noise down, such as:

ü   Turn off background music, news or TV.

ü   Move to a quieter room.

Always assume that the person with aphasia is listening and understanding. Talk in adult language, never make them feel like children. 

If they cannot understand you, do not shout. Unless the person also has a hearing problem, shouting will not help. Make eye contact when talking to them.

When asking questions:

·                Ask yes/no questions.

·                Give clear choices for possible answers. Do not offer too many choices.

·                Visual cues help.

When giving instructions:

Ø   Break them down into small, simple steps.

Ø   Allow time for the person to understand. Sometimes this can be a lot longer than you expect.

Ø   If frustrated, consider switching activities.

Encourage a person with aphasia to communicate in other ways, such as:

v   Pictures

v   Pointing

v    Hand gestures

It may help everyone to have a book of pictures or words about common topics or people. This can make communication a lot easier.

Generally, it is a good idea to keep them involved in conversations. Check to make sure they understand, without pushing too hard or causing more frustration.

Do not correct when they remember a thing incorrectly.

When leaving anyone with speech problems by themselves, make sure they have ID with:

ü   Contact information of family members or caregivers.

ü   An explanation of their speech problem and basics on communicating.

Questions for your Doctor or Nurse:

Take a few minutes to write your own questions for the next time you see your healthcare provider:

ü   How long will I need therapy?

ü   Will my aphasia go away?

ü   How can I find a stroke or aphasia support group?

Care Tips:

How can family, friends and caregivers help?

A person with aphasia and family members will need the help and support of a doctor, counsellor and speech pathologist. It's a good idea for family and friends to:

Ø   Be open about the problem so people can understand.

Ø   Set up a daily routine for the person with aphasia that includes rest and time to practice skills.

Ø   Use sentences that are short and to the point.

Ø   Stand where the person with aphasia can see you.

Ø   Treat the person as an adult, keeping him or her involved in all possible routines. No one likes to be ignored. Include the person in your conversation.

Ø   Help the person with aphasia cope with feelings of frustration and depression.

Ø   Be patient with the person with aphasia. Give them the time they need to try to speak and get their point across to you. This respects their dignity.

Ø   Talk to your doctor, nurse or other healthcare professionals.

(Source:  Alzheimer’s and Dementia Weekly, 8 December 2015)

How Alzheimer’s Progresses Through the Brain

Alzheimer's Disease Symptoms result from physical changes in the brain. While the cause of these changes remains somewhat of a mystery and has yet to be thoroughly proven, researchers have a leading theory of how the Alzheimer's disease progresses. Here’s an explanation, in brief. 

In a healthy brain, certain chemical processes ensure the proper functioning of neurons. One is the processing of amyloid precursor protein (APP) that is attached to the outer membrane of nerve cells. An enzyme called alpha-secretase cuts off a section of the protein; then another enzyme, gamma-secretase, snips a second portion and releases APP from the cell’s membrane. 

These APP fragments are then broken down and removed from the brain. Another process involves the microtubules, which carry nutrients through the nerve cells to keep them functioning normally. Tau protein helps to maintain the physical structure of microtubules. 

The Plaques and Tangles of Alzheimer's.  But when these processes go awry, a different enzyme, beta-secretase, cuts shorter APP fragments from the nerve cell membrane.  These smaller pieces are more resistant to breakdown and tend to clump together in toxic clusters called oligomers; eventually, the oligomers collect into larger beta-amyloid plaques that interfere with nerve cell functioning. 

Within neurons, abnormal tau strands separate from the microtubules and cause the microtubules to fall apart, crippling the transport of nutrients and destroying nerve cells. Loose tau threads join together to form knotted strands inside neurons.  Called neurofibrillary tangles, they cause further neuron destruction. 

In the early stages of Alzheimer's, plaques and tangles form in brain areas responsible for learning, thinking, and planning - in particular, the hippocampus. This is why forgetfulness, disorientation and verbal repetition are often among the earliest signs of Alzheimer's.  As nerve cell destruction spreads, more brain areas are affected, especially the cerebral cortex, responsible for language, reasoning and judgment. Speaking skills become impaired and emotional outbursts grow more frequent. 

When large areas of nerve cells die off in the advanced Alzheimer's stage, brain sections atrophy and the whole brain shrinks to as much as three quarters of its original size.  People with Alzheimer's lose most of their ability to communicate, walk and care for themselves.  

(Sources:  John Hopkins Health Alert, posted in Memory on 14 January, 2013)

Alzheimer's Diagnosis: More Tests Improve Chance Of Early Detection

Two or three tests are better than one, when it comes to predicting the onset of Alzheimer's disease, a new study suggests. 

The research, published in the Journal Radiology, shows that using more than one diagnostic test could better predict which people with mild cognitive impairment will go on to develop Alzheimer's disease. 

"Misdiagnosis in very early stages of Alzheimer's is a significant problem, as there are more than 100 conditions that can mimic the disease. In people with mild memory complaints, our accuracy is barely better than chance," study researcher P. Murali Doraiswamy, MBBS, professor of psychiatry and medicine at Duke Medicine, said in a statement. "Given that the definitive gold standard for diagnosing Alzheimer's is autopsy, we need a better way to look into the brain." 

The study, conducted by Duke Medicine researchers, included 97 people with mild cognitive impairment who were part of the Alzheimer's Disease Neuroimaging Initiative. Researchers had the study participants undergo the typical diagnostic procedures for Alzhiemer's - which includes cognitive testing -- as well as three other diagnostic tests. They included magnetic resonance imagine (MRI), cerebrospinal fluid analysis and fluorine 18 fluorodeoxyglucose positron emission tomography (also known as FDG-PET). 

The study participants were followed for up to four years. Researchers found that the rate of misdiagnosis was highest when the study participants only received the typical cognitive testing - 41.3 percent. However, that percentage went down with each additional test the person was given, with the lowest percentage of misdiagnosis occurring when all three tests were administered - 28.4 percent. 

And of all the tests, the FDG-PET seemed to add the most diagnostic value, the researchers noted. 

According to the Alzheimer's Association, the earlier memory loss conditions are discovered, the better. That's because doctors are then able to know which medications to prescribe - and not to prescribe - early on, and patients can be aware of potential safety issues that may crop up.

(Source:  Huffpost Healthy Living, 21 January 2013)

BERRIES ARE GOOD FOR THE BRAIN

Older women who regularly ate blueberries and strawberries had slower rates of cognitive decline than those who ate berries infrequently, a new study found. The findings, part of the large and on- going Nurses’ Health Study, were published in the Annals of Neurology.

The study analysed results from some 16,000 women who had completed extensive questionnaires about the foods they ate, beginning in middle age and then every four years thereafter. They also underwent tests of memory and thinking skills every two years, starting at age 70.

Over the next four years, the researchers found, those women who ate the most strawberries and blueberries had the lowest rates of memory decline. The greatest benefit occurred in women who ate at least one serving of blueberries or at least two servings of strawberries per week. Including berries in your regular diet, the researchers estimated, was associated with a delay in cognitive aging of up to two-and-a-half years.

"Among women who consumed two or more servings of strawberries and blueberries each week, we saw a modest reduction in memory decline,” said study author Dr Elizabeth Devore, a researcher at Harvard Medical School. “This effect appears to be attainable with relatively simple dietary modifications."

Berries are rich in health-promoting flavonoids, the pigments that give them their colour. Flavonoids are also found in other fruits and vegetables, as well as herbs, grains, legumes and nuts at well. In the study, total flavonoid intake was also associated with less declining in brain function.

The authors noted that there is "substantial biologic evidence" to support a diet rich in berries and other foods rich in flavonoids in protecting the brain. Several flavonoids have been to reduce levels of inflammation, which scientists increasingly link to Alzheimer’s and other forms of dementia. Flavonoids are also potent antioxidants, which prevent cell damage from the reactive forms of oxygen known as free radicals, and have been shown to have other protective effects on brain cells as well.

Dietary studies can be unreliable, experts caution that, since people may not fill our food surveys accurately, and it can be difficult to tease out the cause-and-effect relationship between what we eat and the many factors that contribute to sound health. But "what makes our study unique is the amount of data we analysed over such a long period of time,” said Dr. Devore. “No other berry study has been conducted on such a large scale."

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Elizabeth E. Devore ScD, Jae Hee Kang ScD, Monique M. B. Breteler MD, PhD, Francine Grodstein ScD: “Dietary intakes of berries and flavonoids in relation to cognitive decline.” Annals of Neurology Online, 25 April 2012.

If Dementia Causes Sleep Problems

Sleep problems are common in people with dementia, but there are things caregivers can do to help their charges get a peaceful night's rest.

The American Academy of Family Physicians mentions these tips to help people with dementia sleep better:

•  Create a consistent bedtime routine and morning wake time.
•  Create obvious ways to tell the time of day, such as placing clocks in visible areas and     opening blinds.
•  Limit the amount of caffeine, sugar and junk food in the person's diet.
•  Encourage daily exercise early in the day.
•  Cut down on napping.
•  Create a peaceful bedroom environment.
•  Make sure to control any pain.

(Source:  MedicineNet.com, January 2013)

Dementia, Late-Life Depression May Be Linked

Older people with depression may be more likely to experience mild mental impairment or dementia than their peers, Dutch researchers report.

In a study of nearly 2,200 Medicare recipients aged 65 and older, researchers led by Dr. Edo Richard of the University of Amsterdam examined the association between late-life depression and dementia and thinking/memory difficulties known as mild cognitive impairment (MCI).

The study, published online Dec. 31 in the Journal Archives of Neurology, found that people with depression were 40 percent more likely to have mild mental impairment and more than twice as likely to have full-blown dementia. Although depression also was linked to greater risk for incident dementia, it was not associated with incident problems with thinking and memory.

The study authors said those with both mild cognitive impairment and depression were at increased risk for developing dementia, particularly vascular dementia. They noted, however, that these patients were not at greater risk for Alzheimer's disease, the most common form of dementia.

"Our finding ... suggests that depression develops with the transition from normal cognition to dementia," the authors wrote in a journal news release.

Depression affects between 3 percent and 63 percent of people with mild cognitive impairment. Previous studies have found that those with a history of depression are at greater risk for dementia. The researchers added that there is no clear explanation for the link between late-life depression and cognitive impairment, and their study does not establish a direct cause-and-effect relationship.

(Source:  MedicineNet.com, 4 January 2013)

Loneliness Increases Dementia Risk Among the Elderly

People who feel lonely are significantly more likely to develop clinical dementia over a period of 3 years compared with those who do not feel lonely, a Dutch study of the elderly suggests.

Tjalling Jan Holwerda, ARKIN Mental Health Care and the Vrije Universiteit Medical Centre, Amsterdam, the Netherlands, and multicenter Dutch colleagues found that after adjustment for other risk factors for dementia, older individuals who expressed feelings of loneliness had a significantly greater risk of developing clinical dementia over a 3-year follow-up period than individuals who did not harbor such feelings.

In contrast, social isolation, not or no longer being married, and not having social support were not associated with a higher risk for dementia in multivariate analysis.

"Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life," investigators observe. "And [loneliness] can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention."

The study was published online December 10 in the Journal of Neurology, Neurosurgery and Psychiatry.

AMSTEL Study

For the study, investigators tested the association between social isolation, defined as living alone, being unmarried or without social support; feelings of loneliness; and incident dementia in 2173 community-living older individuals who were without dementia and who were involved in the Amsterdam Study of the Elderly (AMSTEL).

At baseline and again at follow-up 3 years later, all participants underwent a home assessment that included questions on sociodemographic items.

Participants were also assessed using the Geriatric Mental State Examination along with a structured psychiatric interview and diagnostic algorithm in the form of the Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT).

A diagnosis of clinical dementia was defined as having GMS AGECAT scores of level 3 or higher.

"Of the participants living alone at baseline, 9.3% had developed dementia at 3 years follow-up compared with 5.6% of participants living with others (P = .001)," the authors note.

Among those who were not or who were no longer married, 9.2% had developed dementia at follow-up compared with 5.3% of those who were married (P = .001), they add.

Of those without social support, 5.6% had developed dementia at follow-up compared with 11.4% of those receiving social support (P = .000).

Slightly more than 13% of participants who expressed feelings of loneliness at baseline also met criteria for dementia 3 years later compared with 5.7% of those who expressed no such feelings, a 64% greater risk of developing clinical dementia after multivariate analysis (odds ratio [OR], 1.64; 95% confidence interval, 1.05 - 2.56; P = .000).

Bivariate Analysis showed that those who lived alone as well as those who were not or were no longer married had a higher risk of meeting criteria for dementia 3 years later compared with participants living with others and those who were married.

In contrast, Bivariate Analysis indicated that not having social support was associated with a lower risk of having dementia at follow-up.

Table: Risk for Dementia by Living Situation

Category                            Risk for Dementia (OR)

Living alone                        2.52

Living with others                1.67

Not/no longer married          2.24

Married                              2.31

Not receiving social support  2.03

Receiving social support       2.47

"Further research is needed to investigate whether cognitive deterioration and dementia are a consequence of feelings of loneliness or whether feelings of loneliness are a behavioural reaction to diminished cognition," the authors observe.

They add that to develop a better understanding of how loneliness may affect the development of dementia, "we need to know whether [these feelings] are a signal of a prodromal stage of dementia or a direct result of neurodegenerative pathology affecting social skills."

The study was funded by grants from the Netherlands Health Research Promotion Programme and the Netherlands Foundation for Mental Health. The authors have disclosed no relevant financial relationships.

J Neurol Neurosurg Psychiatry. Published online December 10, 2012. Abstract.

(Source:  Medscape Medical News, 18 December 2013)

Alzheimer’s Diagnosis Presents New Challenge For ‘Bravest Man In The Universe’

"I got a story I want to tell

Gather round me

Gather round me boys and girls"

—Bobby Womack, "The Bravest Man in the Universe," June 2012

He's survived two different types of cancer (colon and prostate), and toured while suffering from two collapsed lungs and pneumonia. Now, Singer/Songwriter, Bobby Womack, faces a newer, deadlier challenge: Alzheimer's disease.

At age 68, the man who inspired Jimi Hendrix and has worked with a pantheon of musical legends—from the Rolling Stones and Elvis Presley, to Aretha Franklin and the Gorillaz—has been diagnosed with early stage Alzheimer's, reports the British Broadcasting Corporation (BBC).

A Disease of Loss

"I once was lost,

But now I'm found

When I bear up so high,

I always know how to come down…"

—Bobby Womack, "The Bravest Man in the Universe," June 2012

Womack visited a doctor after he started having trouble remembering the names of his colleagues and the words to his songs.

"How can I not remember songs that I wrote? That's frustrating," Womack told BBC reporter Giles Peterson.

Alzheimer's memory loss typically follows a particular pattern—referred to as "first-in, last out…last in, first out."

The disease first robs a person of their short-term recall (what they did a few hours ago, the names of new acquaintances). Eventually childhood and young adult memories are also affected. The timetable varies from person to person; some individuals experience rapid deterioration of their recollections, while others may decline over a number of years.

Dealing with pain by pursuing passions

"The bravest man in the Universe

Is the one who has forgiven first

Yeah, shame on me, shame on you,

It's up to us,

What we say and what we do."

—Bobby Womack, "The Bravest Man in the Universe," June 2012

Following in the footsteps of other luminaries recently diagnosed with dementia (Glen Campbell, Pat Summit), Womack refuses to surrender his passion for music to Alzheimer's.

Along with seeking support from a network of reliable family and friends, experts agree that continuing to pursue the activities that they have a passion for is a key to helping a person cope with an Alzheimer's diagnosis and can help keep their minds sharp for as long as possible.

"With the support of many good doctors, my family, and all of my wonderful fans, I will continue to write, and perform and bring good music to the people for as long as I can," the recent Rock and Roll Hall of Fame inductee told CNN reporters.

Really, one should expect nothing less from the man whose latest album, entitled, "The Bravest Man in the Universe," gained critical acclaim in 2012 as a soul-moving work of lyrical art.

(Source:  AgingCare.com, 7 January 2013)

Amyvid® Now Available To Diagnose Alzheimer’s

Beta-almyloid plaque is a marker for Alzheimer's Disease and for a number of years, the only way to find it was through a brain biopsy or an autopsy. Now a new test has been approved to help doctors diagnose the disease.

It's been an emotional day for 73-year-old Hilda McIntosh. Her son- a psychiatrist- started noticing mental changes in his mom about a year ago and wanted to have her checked for Alzheimer's Disease.

"Her memory isn't quite the same, she is repeating stories and becoming more forgetful," said Hilda's son.

Along with other exams, she also got a PET scan with a recently FDA-approved radioactive dye called Amyvid.

Dr. Rajan Agarwal of Abington PET/CT of Willow Grove says the dye travels through the bloodstream to the brain. If there are amyloid plaques, the dye will bind to them.

"This is the first scan of all the scans out there that actually looks for Beta-almyloid deposits in the brain," said Dr. Agarwal.

Simply because amyloid plaques are detected, doesn't necessarily mean the patient has Alzheimer's. This is just one piece of the puzzle but it does give doctors more confidence in diagnosing the disease.

"This would just help us determine if their cognitive impairment could be related to amyloid deposits in the brain, which might be related to Alzheimer's," said Dr. Agarwal.

Dr. Agarwal says if other tests also point to Alzheimer's, then medication can be started early to slow its progression.
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The scans can also help advance research to find better treatments. This is something Hilda would like to see for the millions of people and their families affected with the disease.

"It's so painful. I would like to be a part of helping in any small way to find answers and bring this to some better level than it is today," she said.

There was other good news for Hilda - her scans were negative which means it's highly unlikely she has Alzheimer's Disease.

Regarding the new testing, the dye was just approved in April and it could start being used at more centers soon.

It's important to note that it is not a screening tool. It won't predict Alzheimer's but it can help lead to a more accurate diagnosis.

(Source : Alzheimer's & Dementia Weekly, 3 June 12 -10 June 2012)

Tips from A Professor with Dementia

I am a retired physician and an Emeritus Professor of Medicine. I also have Alzheimer's disease.

Before my diagnosis, I was certainly familiar with the disease, having seen patients with Alzheimer's over the years in my internal medicine practice. But I was slow to suspect my own affliction.

Now that I've been diagnosed, I can trace my problems back some 10 years, to when I was 76. I had been chairing a monthly program in medical ethics, and I knew most of the speakers and found it easy and enjoyable to introduce them. Then, suddenly, I found I had to rely on prepared material to make the introductions. I started to forget names, though never faces. These kinds of lapses are common in aging brains, so it was easy for me to write them off to "senior moments"...

Since my improvement, I have developed a list of insights I'd like to share with others facing memory problems:

• Carry a small book and write notes whenever there's something you want to recall later.

• When you cannot remember a name, make a joke and ask the person to repeat it, then write it down.

• Read books.

• Take walks.

• If you cannot walk, exercise in bed.

• Draw and paint.

• Garden, if you can.

• Do puzzles and games.

• Do Try new things.

• Organize your day.

• Learn to prepare food, eat, dress, wash and go to bed in an efficient way.

• Eat a healthful diet that includes fish twice a week, fruits and vegetables and omega-3 fatty acids.

• A reliable and good-humored book on a serious subject is "The Memory Bible" by Dr. Gary Small.

Don't withdraw from your friends and your family. This is advice I had to learn the hard way. Afraid of being pitied, I tried to keep my condition a secret, and that meant pulling away from people I cared about. But now that I've decided to be open, I've been gratified to see how accepting people are and how willing to assist.

For the full-length story, go to The Los Angeles Times.

(Source : Alzheimer's & Dementia Weekly, 3 June 2012 - 10 June 2012)

Is Coconut Oil Effective For Alzheimer Disease?

(Source : Medscape, 30 May 2012)

Response from Gayle Nicholas Scott, PharmD, Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia.

Coconut oil and a related medical food, Axona® (Accera, Inc; Broomfield, Colorado), are being promoted as treatments for Alzheimer disease (AD). Obtained from the kernel of the coconut palm (Cocos nucifera),[1] coconut oil contains medium-chain fatty acids, predominately lauric acid but also caprylic, myristic, and palmitic acids. Medium-chain triglycerides are the esterified form of medium-chain fatty acids; the terms are often used interchangeably.[2] The active ingredient of Axona is caprylic triglyceride. In the published research available, the product is called AC-1202.[3-5]

Proponents claim that coconut oil and Axona provide ketones as an alternative to glucose for cerebral metabolic processes. Advocates of these treatments describe AD as "diabetes of the brain" and contend that the AD brain is better able to use ketones than glucose.[6] This theory is not widely accepted among AD clinicians and researchers,[7] but some speculate that ketogenesis might improve free radical-mediated pathologies associated with AD.[8]

Normally, metabolic energy comes from glucose. When glucose availability is reduced, the liver produces ketone bodies (primarily acetoacetate and beta-hydroxybutyric acid [beta-OHB]) as energy sources. Unlike the heart and skeletal muscle, the brain cannot use fatty acids as an energy source because it requires glucose or ketone bodies.[8]

Medium-chain triglycerides are more ketogenic than long-chain triglycerides, such as those in animal fat. Ketogenic diets, which are diets high in fat and low in carbohydrates and proteins, have been used since the time of Hippocrates for treatment of epilepsy; the mechanism is still unknown.[8] Ketogenic diets are still used in refractory epilepsy, but poor tolerance of the gastrointestinal side effects and dislike for the diet limit effectiveness.[9] Medium-chain triglyceride diets are better tolerated than classic ketogenic diets, which include more long-chain triglycerides. Because medium-chain triglycerides are highly ketogenic, patients can consume more carbohydrates, making the diet more palatable.[8]

Several theories have been proposed for beneficial effects of ketones in AD, including prevention of amyloid plaques, reduction of proinflammatory mediators associated with neurodegeneration, and a neurotrophic effect of cerebral ketone metabolism.[10] Studies with encouraging results using ketogenic diets in AD have been published.[10-13] In a 6-week clinical study of 23 elderly patients with mild cognitive dysfunction, a diet very low in carbohydrates, which increased ketone levels, improved memory function better than a high-carbohydrate diet.[10] In another preliminary clinical study of 20 persons with AD or mild cognitive impairment, administration of a medium-chain triglyceride beverage was associated with improvement on some cognitive measurements in response to acute elevation of beta-OHB levels 90 minutes after treatment in 2 single-dose study visits, but only in patients without the apolipoprotein E gene (n = 9).[14]

A literature search for coconut oil and AD revealed no clinical studies. A search for the medical food Axona yielded 1 manufacturer-sponsored study and 2 substudies.[3-5] In a 90-day, randomized, double-blind phase 2 study, 152 persons diagnosed with mild to moderate AD received Axona10-20 g/daily or placebo. The primary endpoint was improvement on the AD Assessment Scale-Cognitive subscale (ADAS-Cog). At 45 days, patients receiving the study drug showed improvement on the ADAS-Cog, as noted in company advertising. However, scores were similar in both groups at day 90 and after a 2-week washout period on day 104. In patients without the apolipoprotein E gene, Axona was superior to placebo at both time points.[3]

According to the Alzheimer's Association, the manufacturer of Axona elected to market the product as a medical food rather than conducting phase 3 studies in a larger population to prove effectiveness. Medical foods do not require phase 3 studies.[15]

Both coconut oil and Axona are high in calories and saturated fat, but some research suggests that coconut oil neither increases weight nor adversely affects lipid levels.[2,16,17] Gastrointestinal adverse effects, particularly diarrhea, were frequent causes of discontinuation in the phase 2 study.[3] Coconut oil costs about $12 for 16 oz. Axona costs about $85 per month.

Currently, neither coconut oil nor Axona can be recommended for AD due to lack of credible effectiveness research. For patients or family members who insist on these products, suggest starting with a low dose and gradually increasing the dose to avoid adverse gastrointestinal effects. Healthcare providers should monitor for adverse effects and effectiveness and possibly increased lipid levels.