STUDY FINDS TREATING DEPRESSION LOWERS ALZHEIMER’S RISK

There is no one reason why some people get Alzheimer’s and others do not. Most scientists point to genetics and lifestyle as the main factors, but there are many subcategories within those factors that all play a part in overall risk: education level, sex, obesity, whether or not someone is a smoker or has high blood pressure, and age itself, among others. Some of these, like smoking, can be controlled; others, like genetics, are just the luck of the draw.

And then there’s depression, which a large body of research points to as a risk factor for Alzheimer’s. Older adults with depression have been identified as twice as likely to develop dementia, and 65 percent more likely to develop Alzheimer’s. People cannot control whether or not they’ll get depression, but they can treat it, which a new study says can help prevent how it affects Alzheimer’s risk.

According to a new study from Boston University School of Medicine, getting evaluated and treated for depression can improve or maintain cognitive function in patients with mild cognitive impairment (M.C.I.), which is considered to be the first stage of Alzheimer’s by most researchers. People with M.C.I. can still function in their day-to-day life, but tasks like paying bills or grocery shopping are noticeably harder.

Researchers looked at data from over 6,700 people with an average age of 72. The participants were evaluated at the beginning of the study for cognitive ability, then followed for two to 12 years.

While results showed that people who started as normal were more likely to progress to M.C.I. if they had depression, anxiety or other mood symptoms, one-third of those who had M.C.I. were able to go back to normal cognition, and those who reverted back had a reduction in depressive symptoms.

Researchers highlighted that successfully identifying and providing effective treatment for these neuropsychiatric symptoms, including depression, may potentially improve or maintain cognitive functioning in many older adults.

Researchers still don’t know if late-life depression causes dementia or contributes to it, or if it’s the other way around—those who are pre-symptomatic may experience depression as a result of changes in the brain that will lead to dementia.

It is highlighted that there are many possible explanations for these findings and further research is needed to address this important issue.

(Source:  Being Patient, 11 April 2018  – This study was published in the Journal of Alzheimer’s Disease.)

Can Vitamin E Prevent Alzheimer's?

Can Vitamin E Prevent Alzheimer's?   

      

The evidence:

While there is some evidence that vitamin E slows the progression of Alzheimer's, a recent trial the first large-scale trial to investigate whether antioxidants can prevent dementia found that neither vitamin E nor selenium (another antioxidant) was protective, whether used alone or in combination.

The study, published in JAMA Neurology in 2017, tested the effect of the two antioxidants on about 3,800 men who were at least 60 years old. Participants were divided into four groups, each took supplements or placebo for up to 15 years as follows: vitamin E (400 IU per day), selenium (200 micrograms per day), vitamin E plus selenium, or placebo. All participants were evaluated periodically for dementia, using screening tests and medical records.

Analysis showed that about the same percentage of each of the four groups – 4 percent developed dementia, indicating that neither supplement was protective.

The bottom line:

Don't waste your money on these supplements to prevent Alzheimer's.  A better investment in money and time would be to exercise regularly and follow a healthful diet to reduce your risk for cardiovascular disease. There is convincing evidence that these steps can also help reduce the risk for age-related cognitive decline.

(Source: UC Berkeley Health and Wellness Alerts, 12 December 2017)

How A Healthy Lifestyle Protects Memory

Scientists who study memory and other cognitive functions like to say that what's good for the body is good for the brain, too, and proof for that axiom continues to grow.

A wealth of research shows that people who eat right, stay trim, and follow other well-established healthy habits have the best shot at remaining sharp-witted as they grow older.

Recently, several clinical trials have provided even more powerful evidence that adopting a healthy lifestyle can protect your brain and reduce the risk for age-related cognitive problems.

The FINGER Study

A number of population studies have found that people who engage in regular exercise, eat a healthful diet, and keep mentally active (with mentally challenging activities, for instance) have a reduced risk for cognitive decline.

But an association between a behavior and a health outcome doesn't prove that one causes the other. For that level of evidence, scientists conduct clinical trials, randomly choosing one group of participants to receive a therapy or other intervention, then comparing their outcomes with other study participants who don't receive the treatment being studied.

To determine whether healthy habits truly benefit the brain, a team of scientists in Finland set up an experiment called the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (abbreviated as FINGER), which they reported on in The Lancet in 2016.

The study included 1,260 men and women aged 60 to 77 who were generally healthy, though many had risk factors closely linked to dementia, including high blood pressure and high cholesterol, which may both be improved through diet changes and exercise.

At the outset of the study, all subjects had their memory and other cognitive skills tested, and only those whose scores were average or slightly below average were invited to participate.

Half of the FINGER subjects were enrolled in a comprehensive program of lifestyle changes. They were encouraged to eat a healthful diet that included plenty of fruit, vegetables, and whole grains, but avoid sugary treats and artery-clogging fats.

Men and women in the active treatment group were asked to follow fitness regimens that included both aerobic exercise (such as walking or jogging) and strength training. They were also required to use computer-based cognitive-training programs three times a week.

The other half of the subjects in the FINGER study were given basic health advice and served as a control (or comparison) group.

After two years, all FINGER participants took a second battery of cognitive tests. Men and women who adopted lifestyle changes showed a 25 percent improvement in memory and other thinking abilities compared to subjects in the control group.

According to the authors, the FINGER study is the first long-term clinical trial to show that lifestyle changes can help prevent cognitive decline.

Obesity and other risk factors

In another 2016 study, published in the Journal of Clinical Endocrinology and Metabolism, Brazilian researchers focused specifically on the role of obesity, which studies have linked to an increased risk for dementia.

The authors of this study recruited 80 obese people aged 60 and older who had been diagnosed with mild cognitive impairment, which is a subtle, but noticeable age-related decline in thinking ability, and another known risk factor for dementia. Could shedding some pounds help protect these men and women from memory loss and other cognitive woes?

To find out, the researchers randomly chose half of the participants to receive weight-loss advice from a nutrition counselor. After one year, participants who lost even a modest amount of weight showed improvements in their overall cognitive capacities, ability to recall words, language skills, and executive function (or ability to focus attention and multi-task).

In addition to eating well and staying fit, keeping your brain busy may help stave off the loss of mental acuity, too, according to some studies, though most were small and the benefits of cognitive training remain controversial. On the other hand, one recent trial found evidence that seniors who become socially engaged may improve brain health.

As part of the ongoing Brain Health Study, researchers from the Bloomberg School of Public Health at Johns Hopkins performed magnetic resonance imaging (MRI) scans on the brains of 111 men and women aged 60 and older.

Next, about half of the subjects were assigned to work as volunteer tutors and teachers' aides in inner city kindergartens and elementary schools. The remaining men and women acted as a control group.

Two years later, a follow-up set of MRIs showed that men and women in the control group had experienced slight shrinking in several brain regions, including the hippocampus; loss of volume in the hippocampus has been linked to memory problems and an increased risk for Alzheimer's disease. Meanwhile, men and (to a lesser extent) women volunteers who worked in schools showed increased volume in this important brain region.

What you can do

There's plenty of proof that the same steps that reduce the risk for common diseases can also help keep your mind sound and functioning at a high level.

A major 2015 review by the Alzheimer's Association found convincing evidence that you can reduce the risk for age-related cognitive decline, and possibly dementia, by exercising regularly and taking steps to curb cardiovascular risk factors. That means watching your weight, avoiding or managing diabetes and high blood pressure, and not smoking.

Consuming a healthful diet and staying mentally engaged through learning may help, too.

There's really no downside to habits, so the only question that remains is: What are you waiting for?

(Source:  HealthAfter50)

Prevent Alzheimer’s? Yes, We Can! What did we learn at the Smith Lecture on Dementia?

Professor Emeritus A. David Smith of the University of Oxford has worked at the frontiers of neuroscience for more than 50 years.In particular he has been at the forefront of research into novel treatments and techniques for Alzheimer’s disease and dementia. 

A packed audience sat enthralled as Emeritus Professor A. David Smith (University of Oxford, UK) spoke of his research into novel treatments and techniques for Alzheimer’s disease and Dementia during the BRNZ Inaugural Public Lecture on 3 February 2016 sponsored by the Neurological Foundation and Brain Research New Zealand.

Then came this question from the audience:

“Can we prevent Alzheimer’s?”

“Yes, we can!” was Prof. Smith’s resounding reply.

Here’s How:

Prof. A. David Smith’s recommendations:

·                Stop smoking.

·                30 minutes of brisk exercise each day (enough to get you puffing and sweating).

·                If you have diabetes and/or high blood pressure, take drugs that effectively treat these.

·                Increase the Mediterranean elements of your diet, especially your 5+ a day of fruit and vegetables.

·                Eat fish once or more a week.

·                Watch your blood glucose.

·                Make sure your vitamin D and B12 status is good.

·                If you do have memory problems, get your homocysteine checked.  (Homocysteine is a common amino acid in your blood. You get it mostly from eating meat. High levels of it are linked to early development of heart disease. In fact, a high level of homocysteine is a risk factor for heart disease. It's associated with low levels of vitamins B6, B12, and folate, as well as renal disease.)

·                If it’s high, take B vitamins in consultation with your GP.

·                Keep mentally and socially active

Here’s Why

Prof. Smith cited, (among others), the Caerphilly Cohort Study.  Read the full study

Twenty-five years ago, 2,235 men between the ages of 45 and 59 agreed to take part in a longitudinal study.  They were tested again in 2013.

The group who had adopted these healthy behaviours:

·                Non-smoking

·                Consuming more than 3 portions of fruit / vegetables a day

·                Consuming less than 30% of calories as fat

·                Taking daily exercise

·                Drinking less than 3 units of alcohol per day

had a 64% lower risk of dementia.  It’s as simple as that!  (Visit the Neurological Foundation for a full coverage of Professor Smith’s presentation.)

Is Alzheimer’s inherited?

When asked if Alzheimer’s Disease is caused by our genes, Prof. Smith dispelled that myth.

‘Less than 1% of dementia cases are entirely genetic’.

About 20% of the population has common gene mutations (called susceptibility genes) which may slightly increase the risk of developing dementia, but in 99% of all cases, dementia does not have genetic causes.

Most common risk factors for dementia are NOT genetic. Here they are:

·                Age

·                Smoking

·                Mid-life high blood pressure, high cholesterol and obesity

·                Depression

·                Low social activity

·                Physical inactivity

·                Low education

·                Diabetes and high blood sugar

·                Low intake of omega-3 fatty acids

·                High blood homocysteine (due to low levels of B vitamins)

Here’s the best news! Dementia CAN be prevented.

Please find below links to an overview of Professor Smith's lecture on Dementia and his presentation.

1.   Click here for Professor Smith's presentation

2.   Click here for an overview of Professor Smith lecture

Science Note:

What’s the difference between Dementia and Alzheimer’s Disease?

Dementia is an umbrella term used to describe a group of conditions that affect how well our brains work.

The most common form of dementia is Alzheimer’s disease – which around two-thirds of people with dementia have.

The symptoms each person experiences depends on the parts of the brain that are affected. However, the most common dementia symptoms include changes in memory, thinking, behaviour, personality and emotions. These changes affect a person’s ability to perform everyday tasks and interfere with their everyday lives.

Why does Alzheimer’s affect people differently?

QUESTION: Both my mother and my father-in-law suffer from Alzheimer’s disease. We’re told that they both seem to be at about the same point in the physical progression of the disease. But my father-in-law has remained fairly lucid, while my mother is more confused and forgetful. What could account for this?

Harvard Medical School’s Adviser gives the answer:

ANSWER: The tremendous number of nerve cells and connections between cells in a healthy brain provide a seemingly infinite capacity for processing information. It also provides a margin of safety in case some cells are damaged. In Alzheimer’s disease, however, the wholesale destruction of nerve cells eliminates this safety net, especially in the brain areas involved in memory and cognition.

But as you’ve noted, the disease doesn’t always affect people in the same way or with similar severity. Consider two older people with the same amount of Alzheimer’s disease–related plaques and tangles in their brains. One person has some memory miscues now and then, but continues to lead a relatively normal life. The other has the severe loss of memory and other cognitive deficits that typify Alzheimer’s disease.

Why the difference? One explanation is that they had differing amounts of cognitive reserve. Cognitive reserve can protect you from the effects of Alzheimer’s and other diseases that affect the brain.

Cognitive reserve can be thought of as having two parts, hardware and software. The hardware consists of brain cells, or neurons, and connections between those brain cells, which are called synapses. The theory is that people with more brain cells and synapses at their disposal are better able to maintain cognitive functions even after important brain cells are damaged.

The software is the brain’s capacity for finding alternative circuits and neural networks if disease or injury is blocking the usual ones. People’s cognitive abilities can stay roughly the same if their brains are adept at these workarounds.

Brain reserve capacity — the term sometimes used for the hardware — is, in large part, genetically determined. But the human brain is capable of generating new synapses and neurons throughout life, and the input of stimulating experiences has been shown to alter brain structure.

There is plenty of research to back up this idea. Brain scans of people learning to juggle show increases in the size of brain structures linked with the visual processing of movement. MRIs of the brains of London taxi drivers have shown that they have larger-than-normal posterior hippocampi, an area of the brain involved in spatial memory.

Formal educational achievement is an important factor, but virtually any mentally challenging or engaging activity seems to have a positive effect on cognitive reserve.

Some research has found that crossword puzzles, Sudoku and other “brain exercise” activities have a narrow effect: That is, if you do Sudoku puzzles, you become better at doing Sudoku puzzles and little else.

But a study showed that Sudoku and other puzzles also made older people more open to trying new things, so there’s still much more to be learned in this area.

Physical activity may be just as important as mental activity for brain health and building up cognitive reserve. Dozens of studies have shown it to have a pronounced effect, and aerobic exercise that gets your heart rate up may be especially important.

Exercise seems to affect the brain directly, increasing the number of synapses and enhancing the action of neurotransmitters, the chemicals that make brain cell-to-brain cell communication possible. It also increases the production of brain-derived neurotrophic factor (BDNF), a “brain juice” protein that promotes the production of new brain cells and the survival of existing ones.

Physical activity also has indirect effects. If your heart and lungs are strong and healthy, more oxygen-rich blood will circulate to the brain. And exercise controls and reduces the risk of conditions like diabetes and high blood pressure that can put brain cells in harm’s way.

For the brain and the rest of the body, the wisdom of Hippocrates may be as true today as it was 2,400 years ago: That which is used develops that which is not used, wastes away.

Start your brain training today!

(Sources:  Memory Foundation, 8 April 2012, Neurological Foundation of New Zealand, 3 February 2016))

DO YOU HAVE MILD COGNITIVE IMPAIRMENT?

Mild cognitive impairment (MCI) falls somewhere between age-associated memory impairment and early dementia. People with mild cognitive impairment are more forgetful than normal for their age, but they don’t experience other cognitive problems associated with dementia, such as disorientation or confusion about routine activities. Routine tasks such as paying bills, shopping and meal preparation may become challenging but can still be performed. People with MCI may take more time doing these activities and they may make more mistakes. They are generally able to live independently but may be less active socially.

About one in five older adults has some type of MCI. In a 2010 study of nearly 2,000 people, about 16 percent of dementia-free people over age 70 were suffering from MCI. Men were more likely to suffer than women, although women may simply experience dementia at a later age. In the study, risk factors included being a carrier of the APOE ε4 gene (a known risk factor for late-onset Alzheimer’s disease), never having married and having less than nine years of education. In a 2011 study of nearly 1,300 women age 85 and older, 23 percent were diagnosed with MCI. The researchers recommend that women this age should be screened for cognitive problems.

The National Institute on Aging/Alzheimer’s Association workgroup has come up with new diagnostic guidelines for MCI due to Alzheimer’s disease. With MCI, people experience gradual cognitive decline due to Alzheimer’s-related brain changes. A person is thought to suffer from MCI if he or she meets the following criteria:

• A friend, family member, doctor or the person in question is concerned about a change in his or her cognition compared to the previous level.

• The person is experiencing more difficulties in one or more cognitive areas such as memory, attention and language than would be expected for his or her age or educational background. Difficulty learning and retaining new information is most common in MCI patients who develop Alzheimer’s-related dementia.

• The person is having trouble performing complex tasks such as paying bills, preparing a meal or shopping. He or she may take more time, be less efficient and make more mistakes than in the past. Still, he or she maintains his or her independence with minimal assistance.

• There’s no evidence of significant impairment in social or occupational functioning.

• There should be objective evidence of progressive cognitive decline over time. Cognitive testing can assess the degree of impairment. Scores for people with MCI are usually 1 to 1.5 standard deviations below the mean for their age and education level. Some formal cognitive tests that assess both immediate and delayed recall can help identify MCI patients who are likely to progress to Alzheimer’s dementia within a few years. Other tests can determine impairment in problem-solving, reasoning and language. Doctors may also assess a person’s cognitive function using informal techniques, like asking a patient to learn a street address and then remember it after a delay.

• Vascular, traumatic and medical illnesses that could explain the decline in cognition must be ruled out. The goal is to increase the likelihood that the underlying cause of MCI is probably Alzheimer’s.

• If a person is known to carry a genetic defect, such as a mutation in APP, PS-1 or PS-2, he or she most likely has MCI due to Alzheimer’s disease. Most of these carriers develop Alzheimer’s before age 65. A person who meets the diagnostic criteria for MCI and carries a variant of the Apolipoprotein E (APOE) gene is more likely to progress to Alzheimer’s dementia within a few years than someone without it.

Researchers have discovered that activities such as exercise and computer use may prevent MCI. In a 2010 Mayo Clinic study, adults between ages 70 and 90 who participated in moderate physical exercise like brisk walking or biking and used a computer were less likely to develop MCI. Another Mayo Clinic study found that consuming more heart-healthy mono- and polyunsaturated fats reduced the risk of MCI among people age 70 and older. These fatty acids—which are found in olive oil, nuts, seafood and vegetable oils—appear to prevent inflammation and reduce the risk of blood clots, stroke and heart disease.

Many experts believe that MCI may be an early warning sign of memory disorders later in life. Studies show that up to 15 percent of people with MCI progress to Alzheimer’s disease each year, compared with a rate of 1 to 2 percent a year for the general older population.

(Source:  Health After 50, 14 April 2016)

LIFESTYLE CHANGES ARE KEY TO EASING ALZHEIMER'S RISK

While medications have consistently failed to prevent Alzheimer's or significantly slow its progression, commonsense health activities can make a profound difference, a growing body of research shows.

"Health doesn't always come in the form of a pill," said Alan Lerner, Director of the Brain Health and Memory Center at University Hospitals Case Medical Center in Cleveland, and a Neurologist at Case Western Reserve University.

The combination of eating well, exercising, keeping mentally and socially engaged, and managing obesity, high blood pressure and diabetes can reduce someone's risk of memory decline, according to a new study from Finland. The study, presented Sunday at the Alzheimer's Association International Conference in Denmark, is the first to examine the impact of all four factors together; other studies have looked at pieces of healthy lifestyles, but not the combination.

"The routine things, the things that are simple, have turned out to be protective," said Yonas Geda, a Professor of Neurology and psychiatry at the Mayo Clinic in Scottsdale, Ariz., who was not involved in the Finnish study. "It keeps going back to the old advice from grandma."

In that study, 1,260 Finnish volunteers, ages 60-77, were divided into two groups – one that was encouraged to follow the four healthy lifestyle factors and the other that was given standard care.

At the end of the two-year study period, the group that paid extra attention to healthy eating, exercising, engagement and management of heart-health risk factors performed significantly better on tests of memory and other cognitive abilities than the control group. Researchers will follow both groups an additional seven years to see if the improvement continues.

Geda presented his own research at the conference, showing that exercise in midlife appears to be protective against dementia decades later. People who simply took an after-dinner stroll three times a week in their 50s and 60s were less likely to suffer memory problems in their 80s, according to the study.

He and his colleagues have also shown in past research that mental and social activities, such as reading books, going to Bible study, playing the piano and knitting can reduce the risk of memory loss, as can eating in moderation.

"This is really good news to society," said Geda, who has added an occasional after-dinner stroll to his own schedule. "Physical activity and mental activities are accessible to all people."

Another study, which Lerner led and presented at the conference, was the first to explore whether it is worthwhile to put dementia patients through the discomfort and expense of cataract surgery.

A group of 28 patients who had the surgery declined much more slowly than 14 people with similar vision problems who did not, the study found. The improvement was at least as large as the benefits seen with medication, he said.

"You don't stop being a person just because you have a dementia," Lerner said. "We find that really taking care of the whole person is very important, especially when it comes to sensory deprivation — if you don't perceive it, it's very difficult to remember it."

(Source:  USA Today, 14 July 2014)

ONE IN THREE ALZHEIMER'S CASES PREVENTABLE, SAYS RESEARCH

One in three cases of Alzheimer's disease worldwide is preventable, according to research from the University of Cambridge.

The main risk factors for the disease are a lack of exercise, smoking, depression and poor education, it says.

Previous research from 2011 put the estimate at one in two cases, but this new study takes into account overlapping risk factors.

Alzheimer's Research UK said age was still the biggest risk factor.

Writing in The Lancet Neurology, the Cambridge team analysed population-based data to work out the main seven risk factors for Alzheimer's disease.

These are:

·         Diabetes

·         Mid-life hypertension

·         Mid-life obesity

·         Physical inactivity

·         Depression

·         Smoking

·         Low educational attainment

They worked out that a third of Alzheimer's cases could be linked to lifestyle factors that could be modified, such as lack of exercise and smoking.

The researchers then looked at how reducing these factors could affect  the number of future Alzheimer's cases.  

They found that by reducing each risk factor by 10%, nearly nine million cases of the disease could be prevented by 2050.                                                     

In the UK, a 10% reduction in risk factors would reduce cases by 8.8%, or 200,000, by 2050, they calculated.

Current estimates suggest that more than 106 million people worldwide will be living with Alzheimer's by 2050 - more than three times the number affected in 2010.

Healthier old age

Professor Carol Brayne, from the Institute of Public Health at the University of Cambridge, said: "Although there is no single way to treat dementia, we may be able to take steps to reduce our risk of developing dementia at older ages.”

"We know what many of these factors are, and that they are often linked.”

"Simply tackling physical inactivity, for example, will reduce levels of obesity, hypertension and diabetes, and prevent some people from developing dementia.”

"As well as being healthier in old age in general, it's a win-win situation."

Dr Simon Ridley, Head of Research at charity Alzheimer's Research UK, said there was still much to discover about the disease.

"While age is the biggest risk factor for most cases of Alzheimer's, there are a number of lifestyle and general health factors that could increase or decrease a person's chances of developing the disease.”

"However, we still do not fully understand the mechanisms behind how these factors are related to the onset of Alzheimer's."

Investment

Dr Ridley said there were more than 820,000 people in the UK living with dementia, and an ageing population would lead to spiraling numbers being affected.

"As there is still no certain way to prevent Alzheimer's, research must continue to build the strongest evidence around health and environmental factors to help individuals reduce their risk."

He added: "This new study also highlights that many cases are not due to modifiable risk factors which underlines the need to drive investment into new treatment research."

Of the seven risk factors, the largest proportion of cases of Alzheimer's in the US, UK and the rest of Europe can be attributed to physical inactivity.

The study says about a third of the adult population in these countries are physically inactive.

Physical inactivity is also linked to increased risks of other health problems, such as cancers and cardiovascular diseases.

(Source:  BBC News Health, 14 July 2014)