POST TRAUMATIC STRESS DISORDER ASSOCIATED WITH HIGHER ALZHEIMER'S, DEMENTIA RISK

Though discoveries about Alzheimer's disease risk factors are often in the news, adults do not know about the relationship between Alzheimer's disease risk and heart health, nor that physical activity can be protective against dementia, according to new research reported at the Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna.

An additional study reported at ICAD 2009 shows higher Alzheimer's risk in veterans with post-traumatic stress disorder (PTSD).

"Your brain plays a critical role in almost everything you do: thinking, feeling, remembering, working, and playing – even sleeping," said Maria Carrillo, PhD, Director of Medical & Scientific Relations at the Alzheimer's Association. "The good news is that we now know there's a lot you can do to help keep your brain healthier as you age. These steps might also reduce your risk of developing Alzheimer's disease or another dementia."

"There's a strong and credible association between heart health and brain health. If people learn about and do some simple lifestyle modifications, such as being more physically active and eating a brain healthy diet, it could have an enormous impact on our nation's public health and the cost of healthcare," Carrillo added.

Adults Show a Poor Understanding of Alzheimer's Link to Heart Health Risk Factors

Colleen E. Jackson, M.S., a doctoral student in Clinical Psychology at the University of Connecticut, and colleagues conducted an anonymous online survey of 690 adults to measure "dementia literacy," that is, their knowledge and beliefs that may assist in the recognition, management, or prevention of Alzheimer's.

Mean age of the population was 50 years, the range was 30-85 years; 76% of respondents were female. Ninety-four percent (94%) of participants were from the United States, with the remaining 6% from other English-speaking countries. The sample was relatively wealthy, with 18% of respondents making more than $200,000 per year at the peak of their careers, and well-educated, with 87% of respondents having completed at least 1-3 years of college.

The researchers found that 64% of study participants incorrectly indicated no association between Alzheimer's and obesity or high blood pressure. Sixty-six percent (66%) did not know that high stress is a risk factor for dementia, and 34% did not know that physical exercise is a protective factor.

On the positive side, nearly all study participants (94%) correctly indicated that Alzheimer's is not normal aging, and is not completely based on genetics.

"Our data suggest that American adults have limited knowledge and a poor understanding of factors that have been demonstrated to increase risk for Alzheimer's, such as obesity, high blood pressure, and other heart health risk factors," Jackson said. "They also didn't know much about protective factors against Alzheimer's, such as physical exercise, relative to the strength of the available research evidence."

"We need more education programs and opportunities, across all demographic groups, focusing on behaviors that modify your risk for developing Alzheimer's disease," Jackson added.

PTSD Linked to Nearly Double Dementia Risk in Veterans

Post-traumatic stress disorder (PTSD) is common among veterans returning from combat and there is some evidence that it may be associated with reduced cognitive function. However, no study has yet investigated if PTSD increases the risk of developing dementia.

To address this emerging issue, Kristine Yaffe, MD, Professor of Psychiatry, Neurology and Epidemiology and Associate Chair of Research for the Department of Psychiatry at the University of California, San Francisco, and Chief of Geriatric Psychiatry and Director of the Memory Disorders Clinic at the San Francisco VA Medical Center, and colleagues sought to determine if PTSD is associated with risk of developing dementia among older veterans in the U.S. receiving treatment in veterans' medical centers.

They studied 181,093 veterans aged 55 years and older without dementia (53,155 veterans diagnosed with PTSD and 127,938 veterans without PTSD) using data from the Department of Veterans Affairs National Patient Care Database. Mean baseline age of the veterans was 68.8 years and 97% were male. They followed the veterans from 2001 through 2007, including tracking whether they were diagnosed with Alzheimer's/dementia.

The researchers found that veterans with PTSD in the study developed new cases of dementia at a rate of 10.6% over the seven years of follow-up; those without PTSD had a rate of 6.6%. (Note: This is updated data from the researcher, which is why it differs from the attached abstract.) Even after adjusting for demographics, and medical and psychiatric comorbidities, PTSD patients in this study were still nearly twice as likely to develop incident dementia compared to veterans without PTSD (HR = 1.8, 95% CI 1.7-1.9). Results were similar when they excluded those with a history of traumatic brain injury, substance abuse or depression.

"It is critical to follow patients with PTSD, and evaluate them early for dementia," Yaffe said.

"Further research is needed to fully understand what links these two important disorders. With that knowledge we may be able to find ways to reduce the increased risk of dementia associated with PTSD."

(Source: ScienceDaily, July 24, 2009)

A 'HEART HEALTHY' DIET & ONGOING, MODERATE PHYSICAL ACTIVITY MAY PROTECT AGAINST COGNITIVE DECLINE AS WE AGE

Eating a "heart healthy" diet and maintaining or increasing participation in moderate physical activity may help preserve our memory and thinking abilities as we age, according to new research reported at the recent Alzheimer's Association 2009 International Conference on Alzheimer's Disease (ICAD 2009) in Vienna.

"We can't do anything about aging or family history, but research continues to show us that there are lifestyle decisions we all can make to keep our brains healthier, and that also may lower our risk of memory decline as we age," said William Thies, PhD, Chief Medical & Scientific Officer at the Alzheimer's Association.

Dietary Approaches to Stop Hypertension (DASH) Eating Pattern May Reduce Age-Related Cognitive Decline

The Dietary Approaches to Stop Hypertension (DASH) Diet is often recommended by physicians to people with high blood pressure or pre-hypertension. The DASH Diet Eating Plan has been proven to lower blood pressure in studies sponsored by the National Institutes of Health. High blood pressure is considered a risk factor for Alzheimer's and Dementia.

Heidi Wengreen, RD, PhD, Assistant Professor of Nutrition at Utah State University, and colleagues examined associations between how closely people adhered to the DASH Diet and risk of cognitive decline and dementia among older participants in the Cache County Study on Memory, Health and Aging.

In 1995, 3,831 study participants 65 years of age or older completed a survey that included a food frequency questionnaire and cognitive assessment. Cognitive function was checked again during four assessments over 11 years using the Modified Mini-Mental State examination (3MS), which is graded on a 100 point scale. A DASH diet adherence score was created based on consumption levels of nine food-group/nutrient components -- fruit, vegetables, nut/legumes, whole grains, low-fat dairy, sodium, sweets, non-fish meat, and fish. Participants were ranked by DASH score into five groups, or quintiles.

The researchers found that higher DASH scores were associated with higher scores for cognitive functioning at the beginning of the study and over time. Those in the highest quintile scored 1.42 points higher at baseline and 1.81 points higher after 11 years on the 3MS than did those in the lowest quintile of the DASH score (p-values <0.001).

They also found that four of the nine food-group/nutrient components used to create the DASH score were independently associated with 3MS scores - vegetables, whole grains, low-fat dairy, nut/legumes. The scientists created a diet adherence score based on just these four components which they then tested for association with changes in cognitive abilities on the 3MS. Those in the highest quintile scored 1.72 points higher at baseline and 3.73 points higher after 11 years than did those in the lowest quintile of the four-component score (p-values <0.001).

"Our results suggest that including whole grains, vegetables, low-fat dairy foods, and nuts in one's diet may offer benefits for cognition in late life," Wengreen said. "However, we need more research before we can confidently say how much of these foods to include in your diet to experience some benefit."

CLOSE RELATIONSHIP WITH CAREGIVERS SLOWS ALZHEIMER'S

(Source: Alzheimer's Association: Special issue on ICAD and Alzheimer Research. http://www.alzheimersweekly.com/Caregivers/close-relationship-with-caregivers-slows-alzheimers-a550.html)

Higher levels of closeness to ones caregiver were significantly associated with a slower decline, especially in persons with spouse caregivers.

A group of Utah State University researchers and colleagues at Johns Hopkins University, Duke University and Boston University have demonstrated that the rate of clinical progression of dementia may be slowed by a close relationship with one's caregiver. The findings will be published in the September 2009 issue of "The Journals of Gerontology Series B: Psychological Sciences and Social Sciences" by Oxford Journals

The research study "Caregiver Recipient Closeness and Symptom Progression in Alzheimer Disease. The Cache County Dementia Progression Study," started in 2002 and monitored 167 participants with Alzheimer's disease for three years. The study, funded by the National Institutes of Health, measured the cognitive and functional status of the participants and the caregiver-reported relationship of the participants. It was found that higher levels of closeness to ones caregiver were significantly associated with a slower decline in both cognitive and functional domains, especially in persons with spouse caregivers.

USU Researchers involved in the study are Maria Norton, Associate Professor of Family, Consumer and Human Development and Principal Investigator for the Cache County Memory Study, the population wide project from which persons with dementia were identified; JoAnn Tschanz, Associate Professor of Psychology and Director of the Cache County Dementia Progression Study; and Kathy Piercy, Associate Professor of Family, Consumer and Human Development; and Chris Corcoran, Associate Professor of Mathematics and Statistics.

"This is the first study to demonstrate that, in addition to medications that help slow the progression of the disease, there are non-pharmacologic factors in the caregiving environment that may also help to extend functional abilities and quality of life for the person with dementia," Norton said. "Considering the aging of the 'Baby Boomer' generation, finding ways to reduce risk for development of dementia and slowing the rate of decline in affected individuals are urgent public health priorities."

The researchers will now focus on finding the kind of caregiver activities that may promote the longevity and quality of brain function for those suffering from dementia. The new focus may lead to interventions that will enhance the care-giving relationship and help slow the decline caused by Alzheimer's disease.

USU has collaborated with Duke University and Johns Hopkins University since 1994 when it began the Cache County Memory Study. The study is funded by the National Institute on Aging and has followed an initial cohort of more than 5,000 persons aged 65 and older to study the genetic and environmental factors that affect risk for development of Alzheimer's Disease and other dementias. Persons identified with dementia by the Cache County Memory Study are then monitored by the Cache County Dementia Progression Study.

The Cache County Memory Study follows individuals to the point of dementia onset to study what factors affect risk of developing the disease. The Dementia Progression Study is focused on what factors affect the rate of progression of the disease once it has started.

"The extraordinary participation rate (90 percent of the entire eligible population) and unusual longevity of the population in Cache County, Utah (the U.S. county with the highest longevity, based on 1990 Census), have made our university and its setting an ideal place for such a large-scale epidemiologic study," Norton said.

Norton has been involved in managing the study since its inception in 1994 and has been the local director of the project since 2001.

A DAILY TIPPLE CUTS DEMENTIA RISK FOR HEALTHY ELDERLY

One or two alcoholic beverages a day may reduce an elderly person’s risk of developing dementia by almost 40 percent, a study presented at the recent International Conference on Alzheimer’s Disease in Vienna found (ICAD).

The results show people aged 75 years and older reap the same benefits from alcohol as their middle-aged counterparts, the researchers said. They asked more than 3,000 adults how often they drank and examined them every six months for up to six years for signs of memory loss or mental decline.

The findings aren’t a free pass for drinking among the elderly, the results showed. People who were already showing signs of memory problems deteriorated significantly faster if they drank alcohol, and the more they consumed the worse the symptoms became. Heavy drinkers, defined as those consuming more than 14 drinks a week, were almost twice as likely to develop dementia, researchers said.

“If you’re already drinking, you don’t need to cut back if you’re cognitively healthy, but we don’t have enough information to recommend you start drinking,” Kaycee Sink, Assistant Professor of Medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, said during a press conference. “The benefits increase as people move from mild to moderate levels of drinking, and then start to decline.”

Range of Benefits:

Alcohol has a range of benefits, such as boosting good cholesterol, preventing blood platelets from clotting and prompting the production of chemicals that help memory, Sink said. When older people show signs of dementia, the benefits may be outweighed by the toxic effects of drinking, she said, emphasizing that the theory is unproven. Heavy drinking is associated with a range of problems, including smaller brain volumes and vitamin deficiencies, she said.

The study divided the group into four categories: those who abstained, light drinkers who had one to seven beverages a week, moderate drinkers at eight to 14 weekly drinks and heavy consumers who had more than 14 every week.

The participants had an average age of almost 80 years and most, 43 percent, didn’t drink at all. One-third took a drink a few times a week, while the rest were moderate or heavy drinkers.

The moderate drinkers were most likely to benefit from their alcohol habits, with the risk of developing dementia lowered by 37 percent, according to the study.

“It’s a nuanced message, and we need to take some care with that, especially given the large number of people with mild cognitive impairment that remain undiagnosed,” William Thies, Chief Medical and Scientific Officer of the Alzheimer’s Association, said in an interview. “Still, people are comforted by the fact that a drink or two a day is ok.”

(Source: Bloomberg, July 13, 2009)

NEW TESTS MAY HELP SPOT EARLY-STAGE ALZHEIMER'S

New tests assessing brain changes and body chemistry are showing promise at diagnosing Alzheimer's disease in its earliest stages, aiding the search for new drugs, Researchers said at the recent Alzheimer's Association's annual International Conference on Alzheimer's Disease (ICAD).

In one study, Irish Researchers found scans measuring brain volume and a combination of memory tests accurately identified nearly 95 percent of people who had progressed from mild cognitive impairment to early Alzheimer's disease.

In another study, U.S. Researchers found that a type of brain scan that measures glucose combined with low scores on memory tests was a strong predictor of disease progression.

The findings, presented at an Alzheimer's Association meeting in Vienna, Austria, are some of the first from a five-year, $60 million study aimed at identifying brain changes that signal the advance of Alzheimer's disease.

"The idea is if there could be biological markers identified that tracked what was going on in the brain, this would give you a better idea of whether a drug was having a biological effect," Neil Buckholtz, who heads the U.S. National Institute on Aging's Alzheimer's Disease Neuroimaging Initiative, or ADNI, said in a telephone interview.

The study, which is funded with U.S. government and industry funds, involves more than 800 people looking at brain structure and biological changes such as in spinal fluids that could signal disease progression.

Despite decades of research, doctors still have few effective treatments for Alzheimer's disease, a mind-robbing form of dementia that affects more than 26 million people globally and is expected to reach 100 million by 2050.

CHEAPER TRIALS

Only an autopsy revealing the disease's hallmark plaques and tangles in the brain can offer a definitive Alzheimer's diagnosis. Short of that, Doctors use Neurological and Memory Tests. Because they are subjective, drug companies must run large, costly trials to show their drugs work.

"Biomarkers may lead to cheaper trials," Buckholtz said.

In the Irish study, Michael Ewers of Trinity College Dublin and colleagues studied 345 participants in the ADNI study with mild cognitive impairment, a precursor to Alzheimer's.

They looked at an array of tests and found three memory tests plus MRI measurements of brain volume in the left hippocampus - a region closely linked to memory - were most predictive of disease progression.

In a separate study, Susan Landau of the University of California, Berkeley used data on 85 patients and found positron emission tomography scans that measure glucose in the brain and poor memory recall were strong predictors. People who did poorly on these measures were 15 times more likely to progress to Alzheimer's within two years.

Buckholtz expects many more studies to come from the ADNI study. "The idea is we are trying to define the best biomarkers or combination of biomarkers that will allow us to assess progress," he said.

In another study presented at the meeting, a Team at Duke University in North Carolina led by Dr. Allen Roses found that a gene called TOMM40 raises Alzheimer's risk.

The gene predicted the age of Alzheimer's development within a five- to seven-year window in people over 60. It is closely linked to another Alzheimer's gene called ApoE4.

"It now looks fairly clear that there are two major genes -- APOE4 and TOMM40 - and together they account an estimated 85-90 percent of the genetic effect," Roses said.

(Source: Reuters, July 14, 2009)

LANGUAGE 'PREDICTS DEMENTIA RISK'

People with superior language skills early in life may be less likely to develop Alzheimer's disease decades later, research suggests.

A Team from Johns Hopkins University studied the brains of 38 Catholic nuns after death.

They found those with good language skills early in life were less likely to have memory problems - even if their brains showed signs of dementia damage.

The study appears online in the Journal Neurology.

Dementia is linked to the formation of protein plaques and nerve cell tangles in the brain.

But scientists remain puzzled about why these signs of damage produce dementia symptoms in some people, but not others.

The Researchers focused on nuns who were part of an ongoing clinical study.

They divided the women into those with memory problems and signs of dementia damage in the brain, and those whose memory was unaffected regardless of whether or not they showed signs of dementia damage.

And they also analysed essays that 14 of the women wrote as they entered the convent in their late teens or early 20s, assessing them for complexity of language and grammar.

The study showed that language scores were 20% higher in women without memory problems than those with signs of a malfunctioning memory.

The grammar score did not show any difference between the two groups.

Lead Researcher Dr Juan Troncoso said: "Despite the small number of participants in this portion of the study, the finding is a fascinating one."

"Our results show that an intellectual ability test in the early 20s may predict the likelihood of remaining cognitively normal five or six decades later, even in the presence of a large amount of Alzheimer's disease pathology."

Brain Cell Growth

The study also found that brain cells were largest in women who retained a normal memory despite showing signs of disease in their brains.

The Researchers said this suggested that a growth in brain cells might be part of the body's early response to the onset of dementia, and this might help to prevent memory impairment.

Dr Troncoso said: "Perhaps mental abilities at age 20 are indicative of a brain that will be better able to cope with diseases later in life."

Dr Susanne Sorensen, Head of Research at the Alzheimer's Society, said: "It is interesting that the nuns in the study with better language skills in their youth avoided memory problems in later life."

"However, the research is in a very small, select group and it would be difficult to say at this stage if language skills could really predict dementia."

Rebecca Wood, Chief Executive of the Alzheimer's Research Trust, said: "One possible implication of this study is that an intellectual ability test in the early 20s may predict the likelihood of remaining cognitively normal five or six decades later.

"However, prominent exceptions exist, including Authors like Terry Pratchett and Iris Murdoch, who developed dementia despite their linguistic brilliance."

(Source: BBC News, July 8, 2009)

STATINS MIGHT STAVE OFF ALZHEIMER'S

Treatment with a cholesterol-lowering drug might protect against Alzheimer's disease, new research suggests.

Scientists have long known that nerve cells in people with Alzheimer's die prematurely because they are strongly overstimulated, a process called excitotoxicity.

Theorizing that the cholesterol drug lovastatin might ward off cell death, researchers at the University of Groningen, The Netherlands, conducted animal experiments in which they administered lovastatin (Altoprev, Mevacor) to overstimulated nerve cells. Lovastatin is a first-generation member of a class of drugs, statins, that has revolutionized the treatment of high cholesterol.

Lovastatin did indeed prevent cell death and, just as important, blocked the loss of memory that accompanies excitotoxicity, according to the lead scientist on the project, Amalia Dolga. Earlier, Dolga had shown that statins seem to stimulate the protective capacity of tumor necrosis factor, a key player in the brain's immune response. In addition, some researchers have speculated that high cholesterol might be a risk factor for Alzheimer's, suggesting that lowering cholesterol could be beneficial.

The findings are in the June Issue of the Journal of Alzheimer's Disease.

The degenerative disease attacks brain cells and ruins memory and thinking.

No cure has been found, but treatments have been shown to improve a person's quality of life.

(Source: HealthDay, June 30, 2009)

HEART DISORDER ALZHEIMER'S LINK

A common heart disorder has been linked to a raised risk of Alzheimer's disease by US researchers.

Atrial fibrillation causes the heart to beat chaotically, increasing the risk of blood clots and, if the condition is left untreated, stroke.

It has previously been linked to some types of dementia - but not Alzheimer's, the most common form.

The study based on more than 37,000 patients found atrial fibrillation patients under the age of 70 had a 187% greater risk of all types of dementia compared with the general population.

But their specific risk of Alzheimer's disease was also up - by 130%. However, the overall risk of Alzheimer's for all patients remained low.

The Researchers said previous studies have shown that patients with atrial fibrillation are at higher risk for some types of dementia, including vascular dementia. But to their knowledge, this is the first large-population study to clearly show that having atrial fibrillation puts patients at greater risk for developing Alzheimer's disease.

Alzheimer's, which accounts for up to 80% of all dementia cases, is known to be linked to age and genetics.

It has long been suspected that poor heart health may also play a role.

Various Theories

The Researchers said more research was needed to explain why atrial fibrillation may raise the risk of Alzheimer's.

They put forward several theories for a possible link. They suspect atrial fibrillation damages the small blood vessels, potentially reducing blood flow to the brain.

Alternatively, the condition is linked to tiny micro-strokes, the damage from which may accumulate over time, making Alzheimer's more likely.

Thirdly, atrial fibrillation is associated with a general increase in inflammation throughout the body, again a possible risk factor for Alzheimer's.

Now that they've established this link, their focus will be to see if early treatment of atrial fibrillation can prevent dementia or the development of Alzheimer's disease.

Rebecca Wood, Chief Executive of the Alzheimer's Research Trust, said: "If research helps us understand the relationship between the two conditions, we will be in a better position to develop desperately needed new treatments."

"We can all lower our dementia risk by maintaining a balanced diet and taking regular exercise, which is also good advice for protecting your heart."

Alasdair Little, cardiac nurse at the British Heart Foundation, said: "This is an interesting study which adds weight to previous data indicating a link between atrial fibrillation - a common disturbance of heart rhythm - and dementia.

"The risk factors for heart disease and dementia are very similar so it is not surprising that in some people they co-exist.

"Further research into both conditions is needed to understand whether there is a causal link between the two."

Details of the study were presented to the Heart Rhythm Society in Boston.

(Source: BBC NEWS, 15 May 2009: http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/8051800.stm)

WARNING SIGNS : A NEW TEST TO PREDICT ALZHEIMER'S

Researchers at the University of California, San Francisco (UCSF), and the University of Pittsburgh have developed the first screening tool that can help predict whether elderly patients are at low, moderate or high risk of developing dementia. The new test takes into account characteristic risk factors for dementia, including advanced age and the presence of genes associated with Alzheimer's, but also relies on lesser-known contributors such as patients' body weight and alcohol-drinking habits.

Detecting the earliest signs of memory loss and dementia - the broader category of age-related conditions of mental decline, up to 80% of which are Alzheimer's - has always been a major goal of researchers. While there is no cure for Alzheimer's, the earlier patients are diagnosed, the sooner they can make lifestyle changes that may help slow the progression of the neurodegenerative disorder. But so far, no test has proven dependable enough to help patients predict their true risk; even the presence of genes known to be associated with Alzheimer's does not reliably lead to the disease.

To date, the only other major screening tool for Alzheimer's was developed by Finnish scientists in 2006. However, that screen is targeted toward a younger population and designed to identify the highest-risk individuals in midlife. But considering how many factors may intervene between midlife and the 60s - the decade in which Alzheimer's typically sets in - Deborah Barnes, a Professor of Psychiatry at UCSF, says she wanted to develop a screen for the older population more likely to be at immediate risk of the disease.

"It's important to figure out who is at high risk and low risk, so that as we develop tools for prevention, we can try to target our prevention efforts at people with the highest risk for developing dementia," says Barnes, Lead Author of the new report published today in the Journal Neurology.

Barnes and her colleagues studied 3,375 patients age 65 years or older who were enrolled in a study analyzing heart disease and cognition. Researchers recorded which of the patients developed dementia in the six-year study period, then isolated the risk factors that appeared to make dementia more likely. Many factors were considered: age, genetic risk factors, mental health status, depression, physical fitness, alcohol consumption, fine motor skills and social support. In the end, only a handful of factors, arranged on a 15-point scale, emerged as being highly predictive of dementia.

Volunteers who scored eight points or higher on the index - which includes older age, worse cognitive function, some heart disease risk factors and the presence of genes linked to Alzheimer's - were at high risk of developing dementia within six years; 56% of these high scorers showed serious mental decline by the end of the study period. Of those scoring lower on the index, deemed at moderate or low risk, 23% were diagnosed with dementia.

Many of the risk factors included in the new screen are familiar: advanced age and the presence of Alzheimer's genes (which are associated with the growth of fatty plaques and tangles in the brain that gum up neural connections), for example, have long been clearly linked to dementia. Even heart disease risk factors are somewhat expected, since recent studies show that the same conditions that boost the risk of heart attack, such as high cholesterol, hypertension and atherosclerosis, may also raise the risk of dementia; the theory is that whatever is causing fat deposits in heart vessels may also contribute to fat and protein deposits in the Alzheimer's brain.

But some of the elements in the index were more surprising. The research team found, for instance, that patients who were underweight, did not drink alcohol and took longer to put on and button a shirt were also at high risk for dementia. Barnes speculates that fine motor skills, such as those required to button a shirt, may be one of the first things to suffer as neural connections in the brain succumb to dementia. As for the alcohol connection, she suggests that people who drink alcohol may simply be healthier overall and therefore less vulnerable than others to mental decline. "It's possible that someone who is still enjoying a glass of wine each day is in better health," Barnes says.

But she warns that it's too early to encourage elderly patients to start drinking in order to stave off senior moments. "Since alcohol is contraindicated with so many medications today, sicker people who are taking medications may have had to cut alcohol out," she says.

Still, the screening tool may be extremely useful in prompting high-risk people to start doing whatever they can to protect themselves from future memory loss. "This study has taken a number of earlier findings on risk factors and combined them into a fairly impressive predictor of risk," says Dr. Ralph Nixon, vice chair of the Medical and Scientific Advisory Council for the Alzheimer's Association. The new index accurately predicts dementia in 81% of cases. (The midlife tool predicts dementia accurately 78% of the time.)

So, what should high scorers do? For one, they can build a rich social network of friends and family, and engage aggressively in ways that challenge their mental as well as physical capabilities. "I truly believe that a lifestyle that incorporates greater socialization and greater use of the mind is what is most important for reducing risk of Alzheimer's," says Nixon, who is also Director of the Center of Excellence on Brain Aging at New York University Langone Medical Center. And if this screen can inform more people about their risk of developing dementia - and encourage younger folks to start taking precautions early - perhaps they will be able to prevent the disorder from occurring in the first place.


(Source: Time, May 14, 2009)
http://news.yahoo.com/s/time/20090514/hl_time/08599189803400/print

DELIRIUM EPISODES COULD HASTEN ALZHEIMER'S-LINKED DECLINE

The delirium sometimes experienced by people with Alzheimer's who are hospitalized might accelerate their cognitive decline, a new study shows.

Researchers found that people with Alzheimer's who had an episode of delirium while in the hospital had a rate of cognitive decline that was three times faster than that of those who didn't experience delirium.

"From a clinical standpoint, this study suggests that over 12 months, patients with AD [Alzheimer's disease] who become delirious experience the equivalent of an 18-month decline compared to those who do not experience delirium," the study's authors wrote.

What might an 18-month decline in cognitive ability signify for the average person with Alzheimer's? That can vary depending upon the individual, according to Dr. Tamara D. Fong, an Instructor of Neurology at Harvard Medical School and the Study's Lead Author.

For example, someone who is mildly forgetful about the details of a conversation might not, 18 months later, be able to drive, balance a check book or recognize relatives not frequently seen.

But there was good news in the findings as well.

"Delirium is preventable, so we can actually design an intervention for a disease for which we have no cure at the present time," she said. Prevention strategies would probably involve multiple components, including such things as making sure people with Alzheimer's who are hospitalized have their glasses and hearing aides on so that they remain as oriented as possible and keeping them out of the hospital by foregoing elective surgeries.

Further training about delirium for hospital staff also might help. "Delirium is sometimes hard to diagnose and probably is under-recognized, even in a hospital setting," she said.

The study, published in the May 5 issue of Neurology, compared the speed of cognitive decline among 408 people with Alzheimer's, 72 of whom developed delirium during the course of their illness.

Delirium is a state of extreme confusion that occurs suddenly and can be short-lived or more long-term. It usually develops in the context of infections, hospital surgeries and medication changes.

This could put the value of elective surgery for people with Alzheimer's into question, she said, adding that further research might be needed to evaluate the risk/benefit ratio. Also, because surgery and anesthesia remain big risk factors for delirium, it might be better to rely on an epidural rather than general anesthesia for people with Alzheimer's who have hip replacement surgery.

Dr. Gary Kennedy, Director of Geriatric Psychiatry at Montefiore Medical Center in New York City, speculated that better control over anesthesia might boost the safety of elective surgeries for people with Alzheimer's. This implies that if you're especially vigilant about preventing delirium, maybe those elective hospitalizations are a bit safer after all.

Some sleep medications, antihistamines and antibiotics as well as anesthetics also have been associated with higher risk for delirium, Fong added.

Kennedy is hopeful that future research will look at the difference between people with Alzheimer's who are hospitalized for elective procedures, such as hip or knee replacement, and those who are hospitalized via the emergency room because of an illness. That distinction might help clarify what impact illness has on the development of delirium.

(Source: HealthDay News, May 6, 2009)

BRAIN SCANS SUPPORT COGNITIVE RESERVE THEORY FOR PREVENTING ALZHEIMER'S

Education may provide mental reserves that help to keep the brain agile into old age. Those are the findings of a new study from researchers at Washington University School of Medicine in St. Louis.

Other studies have shown similar correlations between years of education and risk of Alzheimer’s disease. But the current study suggested that even those individuals whose brains appeared “scarred” by Alzheimer’s could still be cognitively normal, especially if they had received more years of formal education.

The Researchers found that seniors with the most years of formal education scored higher on tests of memory, learning and thinking compared to those who spent the least time in school. In fact, many of the highly educated individuals who did well on the memory tests were shown by imaging tests to have the same kind of damage seen in the brains of those with Alzheimer’s disease. The findings were published in the Archives of Neurology, one of the medical journals from the American Medical Association.

The findings support the cognitive reserve theory, which refers to the brain’s ability to nurture healthy brain cells and connections between them. As people age, diseases like Alzheimer’s ravage the brain with the buildup of toxic proteins that form plaques and tangles. But according to the cognitive reserve theory, if enough healthy brain cells and brain cell connections remain, people can escape symptoms like memory loss and disordered thinking that are typical of Alzheimer’s disease.

Education is thought to boost cognitive reserve. Intellectual challenges to the brain early in life from schoolwork are thought to build brain cells and enrich the connections between them, effects that may be maintained into later years.

Earlier studies of normal aging have found that higher levels of educational attainment were associated with less cognitive and functional decline. And having few years of formal education has also been linked to an increased risk of Alzheimer’s. A study last year from Finland found, for example, that teenage dropouts were at higher risk of developing Alzheimer’s years later than those who got their diplomas and continued with further study.

Intellectually stimulating careers and hobbies, like learning a new language, playing a musical instrument or doing crossword puzzles or word games, build extra brainpower. Healthier brain cells and connections may help compensate for the rise in Alzhiemer’s-like brain changes that accompany normal aging.

What the Study Showed:

In the study, Catherine M. Roe, Ph.D., and Colleagues at Washington University studied nearly 200 seniors (mean age 67) over a five-year period. Thirty-seven had a diagnosis of Alzheimer’s disease, while 161 had no signs of dementia.

The Researchers injected the study participants with a radioactive substance called Pittsburgh compound B, and then scanned their brains using an advanced imaging technique called positron emission tomography, or PET. The imaging agent, developed by Scientists at the University of Pittsburgh Medical Center, indicates brain areas damaged by Alzheimer’s by attaching to deposits of beta-amyloid, the toxic protein that builds up and forms plaques in the brains of those with the disease.

In the study, certain individuals’ brains absorbed the most Pittsburgh compound B, an indication that their brains were riddled with the greatest numbers of beta-amyloid plaques. But the more years of education that they had, the less likely they were to perform poorly on memory and thinking tests. In other words, their education seemed to protect them against the memory loss and other sympt oms of Alzheimer’s disease.

“The results support the hypothesis that cognitive reserve influences the association between Alzheimer’s disease pathological burden and cognition,” the Authors wrote.

It is thought that symptoms of Alzheimer’s would eventually emerge as beta-amyloid plaques continue to accumulate, even in the most highly educated people. But for many seniors, living into their 70s and 80s sharp as a tack, education and mental stimulation is thought to strengthen cognitive reserve and possibly protect against Alzheimer’s. And many people will die of other causes before the effects of Alzheimer’s become evident.

Further testing of individuals living into old age will allow Researchers to continue to test this theory. In the meantime, stay in school, turn off the TV, and do crossword puzzles or word games to help stimulate and maintain the brain.

(Source: Alzinfo.org, The Alzheimer's Information Site, 13 April 2009)
a href='http://www.alzinfo.org/newsarticle/anmviewer.asp?a=345'>Brain Scans Support Cognitive Reserve Theory for Preventing Alzheimer’s

READING, CRAFTS HELP KEEP THE BRAIN YOUNG

More good news on the neurobics front: Reading books, playing games or engaging in computer activities or crafts like pottery or quilting helps keep the brain young into old age, according to a new report. And while reading was good for the brain, watching too much TV seemed to be bad for it.

The findings, to be presented at the American Academy of Neurology’s 61st Annual Meeting in Seattle in late April, add to a growing body of evidence that mental challenges, or “neurobics,” like crossword puzzles and word games help keep memory and thinking sharp.

The research, from the Mayo Clinic in Rochester, Minn., involved a random sampling of 1,321 men and women in their 70s and 80s. Among the participants, 197 had mild cognitive impairment, a form of memory loss that sometimes precedes Alzheimer’s disease. The remainder had no memory problems.

Both groups filled out questionnaires about their everyday activities during the previous year. They also answered questions about what they engaged in during middle age, when they were in their 50s and 60s.

The researchers found that during the later years, those who regularly engaged in mentally-stimulating tasks like reading, crafts and computer activities were 30 to 50 percent less likely to suffer from serious memory loss compared to people who did not do those activities. People who watched television for less than seven hours a day as seniors were 50 percent less likely to develop memory loss than people who watched TV for more than seven hours a day.

People who participated in social activities and read magazines during middle age were about 40 percent less likely to develop memory loss than their less social peers or those who read less frequently.

“This study is exciting because it demonstrates that aging does not need to be a passive process,” said study author Yonas Geda, M.D., M.Sc., a Neuropsychiatrist at the Mayo Clinic. “By simply engaging in cognitive exercise, you can protect against future memory loss.”

The Researchers warned that these kinds of studies, which depend on participants’ recall of long past events, can be unreliable. But a growing body of evidence points to the benefits of mental stimulation in helping to ward off memory loss. Such activities may help to preserve and strengthen connections between brain cells in areas of the brain critical for memory.

(Source: Alzinfo.org Newsletter, 13 April 2009)
a href='http://www.alzinfo.org/newsarticle/anmviewer.asp?a=346'>Reading, Crafts Help Keep the Brain Young

10 TIPS FOR KEEPING THE BRAIN SHARP INTO 2009

One piece of excellent news in the past year was that brain health seems to be improving among older Americans. A large national survey from the University of Michigan found that over a 10-year-period ending in 2002, memory loss and thinking problems were down significantly among seniors aged 70 and up, from 12.2 percent to 8.7 percent. That’s a change that translates into hundreds of thousands of men and women, though Alzheimer’s is still a top concern for millions worldwide.

Researchers aren’t sure why the decrease in cognitive impairment is occurring, but they suspect that a better educated and more affluent older generation that is less likely to smoke and more likely to eat better and get regular exercise may be helping to keep the brain young. Here’s a roundup of ALZinfo.org's Wellness and Prevention stories from the past year that may help set the tone for a brain-healthy new year.

1. Stay Mentally Challenged
Seniors who engage in reading books or newspapers, doing crossword puzzles and word or card games, or who attend adult education classes may be more likely to ward off Alzheimer's as they age. Researchers at Columbia University in New York found that participation in intellectual and social activities among seniors was associated with fewer cases of Alzheimer's disease.

2. Practice Good Waist Management
Having a thick middle in the middle years increases the risk of developing Alzheimer's disease, a study of more than 6,500 adults from Northern California found. Belly fat, in particular, may be bad for the brain. Having a large abdomen increased the risk of dementia regardless of whether someone was normal weight, overweight or obese.

3. Work It
Another study, from Duke University, found that having a job that challenges the intellect may help to keep the mind sharp into old age. And the more complex the job, the better memory and thinking skills held up after retirement. The jobs that proved most beneficial included careers like law, medicine and journalism. But any tasks that required complex organization, decision-making and multi-tasking boosted brain function late into life.

4. Stay in School
Research continues to show that the more years of formal education someone has, the lower the risk of Alzheimer's disease. Most recently, investigators in Italy showed that men and women who had many years of schooling and who went on to work in demanding jobs were much more likely stay mentally alert into old age. Even though their brains had many of the changes typical of Alzheimer's disease, education seemed to protect them against memory loss and problems with thinking.

5. Maintain an Active Social Life
Men and women who remained socially connected with friends and family as they aged had sharper memories, a study from the Harvard School of Public Health reported. The findings add to a growing body of evidence that active social engagement is key to keeping the brain fit and lowering the risk of Alzheimer's among the elderly.

6. Walk for the Brain
Seniors who regularly took walks and engaged in other forms of moderate exercise had a lower risk of developing vascular dementia, a form of memory loss tied to poor blood flow in the brain. Vascular dementia is the second most common form of dementia, after Alzheimer's disease, and affects a large segment of the senior population. Poor blood flow may also aggravate the memory loss and symptoms of Alzheimer's disease.

7. Keep Cholesterol in Check
Scientists still aren’t sure whether statins, the popular cholesterol-lowering drugs that are prescribed for heart disease, help protect against Alzheimer's disease. But they do know that having high cholesterol, at midlife or in later years, can raise the risk of Alzheimer's and other forms of dementia. And statin drugs are proven fighters against heart attacks and strokes. To help keep cholesterol in check, eat a heart-healthy diet and exercise regularly, and see your doctor to see if you could benefit from a statin medication.

8. Control Blood Pressure
Getting blood pressure under control, an important step for reducing heart disease and stroke, may also help reduce rates of Alzheimer's as well. And it’s never too late. New findings show that for seniors in their 80s and 90s, lowering blood pressure with antihypertensive medications was good for the brain.

9. Pass the Fish
Once again, research showed that eating tuna and other types of oily fish like salmon, mackerel and anchovies may help lower the risk of memory decline and stroke in healthy older adults. Fish that was baked or broiled, but not fried, appeared to benefit the brain.

10. Surf the Web
Finally, searching the Internet may be good for the brain. Researchers at the University of California, Los Angeles, found that surfing the Web triggers key centers in the brain involved in decision-making and complex reasoning and was better for the brain than reading a book. So whether you turn to the Web to
e-mail friends, read up on the latest Alzheimer's disease research, or join the discussion groups at ALZinfo.org, keep coming back for a brain-healthy 2009.

(Source: http://www.alzinfo.org/alzheimers-distribution/article-10tipsforkeepingbrainsharp.asp)

HAVING A PARENT WITH DEMENTIA MAY AFFECT MEMORY IN MIDLIFE

If your mother or father has Alzheimer’s disease, you may be at increased risk of memory problems in middle age, according to a new report. The findings are to be presented at the American Academy of Neurology’s 61st Annual Meeting in Seattle this spring.

Researchers at Boston University analzyed data from the Framingham Heart Study, a long-running study of people living in Massaschusetts. They gathered data on 715 children of the original study, looking at such factors as memory, thinking abilities, and brain volume. They also tested for a gene called APOE-E4, which is known to increase the risk of developing Alzheimer’s late in life. Their average age was 59.

One group of 282 people had one or both parents with Alzheimer’s disease or another form of dementia. The parents of the remaining 433 did not have an Alzheimer’s diagnosis.

Among people who were carriers of the APOE-E4 gene, those who had parents with Alzheimer’s disease or another form of dementia were at two- to three-fold risk of performing poorly on verbal and visual memory tests compared to those who did not have a parent with Alzheimer’s.

“This result in people with parents who have Alzheimer’s disease is equivalent to about 15 years of brain aging,” said study author Stephanie Debette, M.D., Ph.D., of Boston University. “The effect was largely limited to those who have the APOE-E4 gene, which supports the idea that the gene is probably at least partially responsible for the transmission of Alzheimer’s disease risk between generations.”

The authors noted that despite the low scores on some aspects of the memory test, all the individuals were functioning normally and not everyone with the APOE-E4 gene scored poorly. They called for further testing to determine to what extent a family history of dementia, coupled with the presence of the APOE-E4 gene, really affects memory in middle age, and whether such memory problems may result in an increased risk of Alzheimer’s disease late in life.

(Source: http://www.alzinfo.org/newsarticle/templates/newstemplate.asp?articleid=343&zoneid=10)

EXERCISE CALMS AGITATION ASSOCIATED WITH DEMENTIA

In a pilot study, agitation and functioning improved in a group of elderly nursing home residents suffering from severe dementia when they engaged in just 30 minutes of supervised exercise three times a week.

Edris Aman, a second-year medical student at Saint Louis University School of Medicine in Missouri, who conducted the study, told Reuters Health: "Lots of people just assume that people with this kind of (severe) dementia cannot follow exercise instructions, but they can. It just takes more patience on the part of the exercise coordinator - me in this case."

Aman said his study is unique because it involved people suffering from severe dementia who were living in the "special needs" units of two nursing homes. The 50 study participants, whose average age was 79, performed 15 minutes of aerobic exercise and 15 minutes of weight lifting three times a week.

"Before and after" tests revealed that patients were far less agitated after completing the 3-week exercise program. They also showed significant improvement in their functional status - specifically, the distance they could walk in six minutes.

Aman, who presented his research at the annual meeting of the American Geriatrics Society, said there didn't seem to be an improvement in depression with exercise; however, this was a "very low dose of exercise," he said, and "there are a lot of studies that are emerging" that do show a benefit of exercise on depression.

The take-home message is that, exercise benefits all; even those with severe dementia can reap the benefits of exercise if people are patient enough.

Aman's study is currently "in press" at the Journal of the American Medical Directors Association.

(Source: Reuters Health, 30 April 2009)

STUDY : PAINKILLERS DO NOT PREVENT ALZHEIMER'S

Anti-inflammatory pain relievers such as Ibupofren (Advil, Motril) and naproxen (Aleve) may delay the onset of Alzheimer's but do not prevent it, according to a new medical study.

Earlier studies indicated that such nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, could protect against Alzheimer's, a degenerative disease linked to inflammation in the brain.

The new research, published in the April 22 online issue of Neurology, the Jurnal of the American Academy of Neurology, has shown the opposite effect, with NSAIDs increasing the risk of Alzheimer's by 66 percent.

The study involved 2,736 subjects with an average age of 75 who did not suffer dementia when enrolled. Followed over a period of 12 years, the group included 351 heavy users of ibuprofen or naproxen prior to enrollment, and 107 who became heavy users during the study.

At the end of the research, 476 patients had developed Alzheimer's or some form of dementia.

Researchers determined that heavy NSAIDs users had 66 percent greater chance of developing Alzheimer's or dementia than those with little or no NSAID use.

"A key difference between this study and most of those done earlier is that our participants were older," said study author John Breitner, of the Department of Veterans Affairs and the University of Washington in Seattle.

"It has been argued for some time that NSAID use delays the onset of Alzheimer's disease. It would follow that studies looking at younger people who use NSAIDs would show fewer cases of Alzheimer's, while in groups of older people there might be more cases, including those that would have occurred earlier if they had not been delayed," he added.

"This is one interpretation of the results, but other explanations are possible," Breitner cautioned, adding that further research was needed to understand why NSAIDs increased the risk of dementia.

Characterized by forgetfulness, agitation and dementia, Alzheimer's is caused by a massive loss of cells in several regions of the brain, driven by a buildup of plaques of amyloid protein. The disease occurs most frequently in old age.

An estimated 37 million people worldwide, including 5.3 million in the United States, live with dementia, with Alzheimer's disease causing the majority of cases, according to the World Health Organization (WHO).

With the aging of populations, this figure is projected to increase rapidly over the next 20 years.

(Source: AFP, 22 April 2009)

LOW BLOOD SUGAR A DEMENTIA RISK FOR DIABETICS

Older diabetics whose blood sugar drops to dangerously low levels have a higher risk of developing dementia, latest study from U.S. Researchers.

The study by Researchers at Kaiser Permanente in Oakland, California, suggests that aggressive blood sugar control resulting in blood sugar so low it requires a trip to the hospital may increase dementia risks in older adults with type 2 diabetes.

"We know that having blood sugar that is too high is not good," said Rachel Whitmer, a Kaiser research scientist whose study appears in the Journal of the American Medical Association.

"You want to keep that blood sugar at a good level, but you don't want to go too low," she said.

Several studies have found that diabetics have a higher risk of developing Alzheimer's disease. The most common form of dementia - than do the general population. And others have shown that diabetics who take insulin and pills to help control their disease have a lower Alzheimer's risk.

The very current issue here is balance of blood sugar control.

A number of things such as a missed meal can cause severe low blood sugar in diabetics, but the chief cause is too much insulin, which can happen in people who take insulin injections or with oral diabetes drugs such as sulfanylureas or glimepiride that cause the body to make more insulin.

The research study looked at more that two decades of data in more than 16,600 patients with type 2 diabetes.

The Research Team checked to see if prior episodes of low blood sugar that were severe enough to require a trip to the hospital were associated with a higher risk of dementia.

They found that compared with people who had no severe bouts of low blood sugar, diabetics with single or multiple episodes had higher dementia risks, and risk levels rose depending on the number of severe hypoglycemic episodes.

The study said in older patients with a history of one episode, they had a 26 percent greater risk of dementia. Patients with two episodes had a 115 percent greater risk of dementia. And patients with three or more episodes had a 160 percent greater risk of dementia.

The study offers more evidence that aggressive measures to control blood sugar can cause harm in elderly diabetics.

It follows three recent trials that found tight glycemic control could cause heart disease and death in some elderly diabetics.

The Research Team plan to look at dementia risks for people in the study who took glitazones - a class of drugs that help diabetics use insulin better. Drugs in this class include GlaxoSmithKline's Avandia or rosiglitazone and Takeda Pharmaceutical's Actos or pioglitazone.

Alzheimer's is the most common form of dementia among older people, affecting 5.2 million people in the United States, according to the Alzheimer's Association. Some 23.6 million Americans have diabetes, according to the American Diabetes Association.

(Source: Reuters, 14 April 2009)

FORGET BRAIN EXERCISE

Healthy older people shouldn't bother spending money on computer games and websites promising to ward off mental decline, according to the author of a review of scientific evidence for the benefits of these "Brain Exercise" Programmes.

"These marketed products don't confer any additional benefit over and above being socially and intellectually active in one's normal daily life," said Dr Peter J. Snyder of Lifespan Affiliated Hospitals in Rhode Island in the United States.

"There are somethings that we could be doing that have much more rigorous data to support their application."

Types of "Brain Training" are known to help people with memory problems function better, but their benefit for those who don't have measurable cognitive impairment isn't clear, Synder and his Team noted.

Meanwhile in an interview, Synder said the market for these products has swelled from US$2 million (RM) in 2005 to an estimated US$225 million this year.

To review evidence on the benefits of cognitive training for healthy older people, Snyder and his colleagues analyzed 10 randomized controlled trials of a variety of approaches, ranging from a popular computer-based programme to individualized piano lessons.

While there was some evidence that brain training helped people's immediate performance on tasks related to the training, there was no evidence that the effects could be generalized to other areas of mental function. Further, just half of the studies included extended follow-up, so evidence for long term benefits was slim.

The findings don't mean that brain training isn't helpful for people who have memory problems, nor are they definitive proof that brain exercise can't help keep healthy people's wits sharp.

But social and intellectual engagement in day-to-day life, from reading to grandchildren to doing crossword puzzles, is "probably just as effective or more effective" than any formal brain exercise programme, he said. Further, these activities are free.

Also, there is strong scientific evidence that being physically active every day preserves cognitive function. Because cardiovascular disease and Type 2 diabetes are both known to contribute to mental decline, exercising and taking other steps to maintain heart health and a healthy weight will help keep the brain healthy too.

(Source: NST, 12 April 2009 from Reuters)

ALZHEIMER'S AND THE WATER WE DRINK

Higher levels of aluminum in drinking water appear to increase people's risk of developing Alzheimer's disease, whereas higher levels of silica appear to decrease the risk, according to French investigators.

"Alzheimer's is a multifactorial disease, and aluminum concentrations in drinking water may have an effect on cognitive decline and Alzheimer's," said Dr Virginie Rondeau.

The results of some studies suggest that silica reduces the oral absorption of aluminum or increases the excretion of this metal.

Rondeau, at the Institute National de la Sante et de la Recherche Medicale in Bordeaux, and her colleagues examined associations between exposure to aluminum or silica from drinking water and the risk of cognitive decline, dementia, and Alzheimer's among elderly subjects followed for 15 years.

Daily aluminum intake of at least 0.1 milligramme was associated with greater cognitive decline during the course of the study.

Subjects with a high daily aluminum intake had a 2.26-fold increased risk of dementia, the Researchers noted. On the other hand, for every 10 milligramme per-day intake of silica, the odds of developing dementia dropped by 11 percent.

(Source: NST, 12 April 2009 from Reuters)

MORE EVIDENCE LINKS DIABETES TO ALZHEIMER'S RISK

You've heard that diabetes hurts your heart, your eyes, your kidneys. New research indicates a more ominous link: That diabetes increases the risk of getting Alzheimer's disease and may speed dementia once it strikes.

Doctors long suspected diabetes damaged blood vessels that supply the brain. It now seems even more insidious, that the damage may start before someone is diagnosed with full-blown diabetes, back when the body is gradually losing its ability to regulate blood sugar.

In fact, the lines are blurring between what specialists call "vascular dementia" and scarier classic Alzheimer's disease. Whatever it's labeled, there's reason enough to safeguard your brain by fighting diabetes and heart-related risks.

"Right now we can't do much about the Alzheimer's disease pathology," those sticky plaques that clog patients' brains, says Dr. Yaakov Stern, an Alzheimer's specialist at Columbia University Medical Center. But, "if you could control these vascular conditions, you might slow the course of the disease."

The link has staggering societal implications: More than 5 million Americans have Alzheimer's, and cases already are projected to skyrocket in the next two decades as the population ages. The question is how much the simultaneous obesity-fueled epidemic of Type 2 diabetes may worsen that toll.

There are about 18 million Type 2 diabetics who are considered to have at least two to three times a non-diabetic's risk of developing Alzheimer's. Still, Type 2 diabetes often leads to heart disease and other conditions that kill before Alzheimer's typically strikes, in the 70s.

Don't panic if you're diabetic, stresses Dr. Ralph Nixon of New York University, vice chairman of the Alzheimer's Association's scientific advisory council. Genetics still are the prime risk factor for dementia.

"It by no means means that you're going to develop Alzheimer's disease, and certainly many people with Alzheimer's don't have diabetes," he cautions.

But the latest research strengthens the link, and has scientists asking if diabetes and its related "metabolic syndrome" increase risk solely by spurring brain changes that underlie Alzheimer's - or if they add an extra layer of injury to an already struggling brain, what Nixon calls "essentially a two-hit situation."

Among the findings:

Brain functioning subtly slows as Type 2 diabetics' blood-sugar rises, well before people have any obvious memory problems.

In a major national study, doctors gave a battery of cognitive tests to nearly 3,000 diabetics. Every 1 percentage point increase in their A1C score — an average of glucose control over a few months — meant small but meaningful drops in memory, the ability to multitask, and other cognitive tasks, Wake Forest University scientists wrote last month in the journal Diabetes Care.

The government-funded study is testing whether better treatment to lower those A1C scores in turn improves brain function.

At Columbia, Stern is co-directing a powerful study: Hundreds of aging New York City residents agreed to regular testing while they were still healthy, allowing scientists to catch the earliest signs of dementia. Stern tracked yearly changes in 156 who developed Alzheimer's, and found that those who had a history of diabetes and high cholesterol worsened faster, he reports this month in a special issue of Archives of Neurology dedicated to the link.

Type 2 diabetes occurs as a result of insulin resistance, as the body gradually loses sensitivity to this hormone that's essential for turning blood sugar into energy. A similar effect in the brain helps explain the dementia link, Dr. Suzanne Craft of the Veterans Affairs Puget Sound Health Care System concludes in a research review also published in that journal. Insulin influences memory in a variety of ways, and an insulin-resistant body in turn affects brain cells' insulin-related activity.

Other factors such as brain inflammation and cell-damaging oxidative stress may play a role, too. But clearly more affected is a silent dysfunction of glucose control, not something that suddenly begins after diabetes is diagnosed.

"You want to think of it more as a continuum than just whether or not you have diabetes," Stern says.

While scientists sort out exactly what's going on, the research does point to some common-sense protections: If you have diabetes, closely follow your doctor's advice for controlling it. Try to lower high cholesterol and blood pressure that can harm the brain's blood supply and exacerbate memory problems.

And if you're still healthy, Nixon advises "hedging your bets against Alzheimer's" with the same steps that help prevent both diabetes and heart disease - A Good Diet and Plenty of Exercise.

(Source: AP, 17 March 2009)