LONGER LIVES, BETTER LIVING - WHY I’M DIGGING DEEP INTO ALZHEIMER'S

By Bill Gates, 13 November 2017

In every part of the world, people are living longer than they used to. Thanks to scientific advancements, fewer people die young from heart disease, cancer, and infectious diseases. It’s no longer unusual for a person to live well into their 80s and beyond. My dad will celebrate his 92nd birthday in a couple weeks, a milestone that was practically unimaginable when he was born.

This fact—that people are living longer than ever before—should always be a wonderful thing. But what happens when it’s not?

Investing In The Fight Against Alzheimer’s

The longer you live, the more likely you are to develop a chronic condition. Your risk of getting arthritis, Parkinson’s, or another non-infectious disease that diminishes your quality of life increases with each year. But of all the disorders that plague us late in life, one stands out as a particularly big threat to society: Alzheimer’s disease.

You have a nearly 50 percent chance of developing the disease if you live into your mid-80s. It is the only cause of death in the top 10 without any meaningful treatments that becomes more prevalent each year. That trend will likely continue as baby boomers age, which means that more families will watch their loved ones suffer from cognitive decline and slowly disappear. Despite this growing burden, scientists have yet to figure out what exactly causes Alzheimer’s or how to stop the disease from destroying the brain.

I first became interested in Alzheimer’s because of its costs—both emotional and economic—to families and healthcare systems. The financial burden of the disease is much easier to quantify. A person with Alzheimer’s or another form of dementia spends five times more every year out-of-pocket on healthcare than a senior without a neurodegenerative condition. Unlike those with many chronic diseases, people with Alzheimer’s incur long-term care costs as well as direct medical expenses. If you get the disease in your 60s or 70s, you might require expensive care for decades.

These costs represent one of the fastest growing burdens on healthcare systems in developed countries. According to the Alzheimer’s Association, Americans will spend $259 billion caring for those with Alzheimer’s and other dementias in 2017. Absent a major breakthrough, expenditures will continue to squeeze healthcare budgets in the years and decades to come. This is something that governments all over the world need to be thinking about, including in low- and middle-income countries where life expectancies are catching up to the global average and the number of people with dementia is on the rise.

The human cost of Alzheimer’s is much more difficult to put into numbers. It’s a terrible disease that devastates both those who have it and their loved ones. This is something I know a lot about, because men in my family have suffered from Alzheimer’s. I know how awful it is to watch people you love struggle as the disease robs them of their mental capacity, and there is nothing you can do about it. It feels a lot like you’re experiencing a gradual death of the person that you knew.

My family history isn’t the sole reason behind my interest in Alzheimer’s. But my personal experience has exposed me to how hopeless it feels when you or a loved one gets the disease. We’ve seen scientific innovation turn once-guaranteed killers like HIV into chronic illnesses that can be held in check with medication. I believe we can do the same (or better) with Alzheimer’s.

I’ve spent considerable time over the last year learning about the disease and the progress made to date. There’s a lot of amazing work being done in this field to delay Alzheimer’s and reduce its cognitive impact. What I’ve heard from researchers, academics, funders, and industry experts makes me hopeful that we can substantially alter the course of Alzheimer’s if we make progress in five areas:

·     We need to better understand how Alzheimer’s unfolds. The brain is a complicated    organ. Because it’s so difficult to study while patients are alive, we know very little about  how it ages normally and how Alzheimer’s disrupts that process. Our understanding of what happens in the brain is based largely on autopsies, which show only the late stages of the disease and don’t explain many of its lingering mysteries. For example, we don’t fully understand why you are more likely to get Alzheimer’s if you’re African American or Latino than if you’re white. If we’re going to make progress, we need a better grasp on its underlying causes and biology.

·       We need to detect and diagnose Alzheimer’s earlier. Since the only way to diagnose Alzheimer’s definitively is through an autopsy after death, it’s difficult to identify the disease definitively early in its progression. Cognitive tests exist but often have a high variance. If you didn’t sleep well the night before, that might skew your results. A more reliable, affordable, and accessible diagnostic—such as a blood test—would make it easier to see how Alzheimer’s progresses and track how effective new drugs are.

·       We need to better understand how Alzheimer’s unfolds. The brain is a complicated organ. Because it’s so difficult to study while patients are alive, we know very little about how it ages normally and how Alzheimer’s disrupts that process. Our understanding of what happens in the brain is based largely on autopsies, which show only the late stages of the disease and don’t explain many of its lingering mysteries. For example, we don’t fully understand why you are more likely to get Alzheimer’s if you’re African American or Latino than if you’re white. If we’re going to make progress, we need a better grasp on its underlying causes and biology.

·       We need to make it easier to get people enrolled in clinical trials. The pace of innovation is partly determined by how quickly we can do clinical trials. Since we don’t yet have a good understanding of the disease or a reliable diagnostic, it’s difficult to find qualified people early enough in the disease’s progression willing to participate. It can sometimes take years to enroll enough patients. If we could develop a process to pre-qualify participants and create efficient registries, we could start new trials more quickly.

·     We need to use data better. Every time a pharmaceutical company or a research lab does a study, they gather lots of information. We should compile this data in a common form, so that we get a better sense of how the disease progresses, how that progression is determined by gender and age, and how genetics determines your likelihood of getting Alzheimer’s. This would make it easier for researchers to look for patterns and identify new pathways for treatment.

By improving in each of these areas, I think we can develop an intervention that drastically reduces the impact of Alzheimer’s. There are plenty of reasons to be optimistic about our chances: our understanding of the brain and the disease is advancing a great deal. We’re already making progress—but we need to do more.

I want to support the brilliant minds doing this work. As a first step, I’ve invested $50 million in the Dementia Discovery Fund—a private fund working to diversify the clinical pipeline and identify new targets for treatment. Most of the major pharmaceutical companies continue to pursue the amyloid and tau pathways. DDF complements their work by supporting startups as they explore less mainstream approaches to treating dementia.

I’m making this investment on my own, not through the foundation. The first Alzheimer’s treatments might not come to fruition for another decade or more, and they will be very expensive at first. Once that day comes, our foundation might look at how we can expand access in poor countries.

But before we can even begin to think about how we do that, we need lots of scientific breakthroughs. With all of the new tools and theories in development, I believe we are at a turning point in Alzheimer’s R&D. Now is the right time to accelerate that progress before the major costs hit countries that can’t afford high priced therapies and where exposure to the kind of budget implications of an Alzheimer’s epidemic could bankrupt health systems.

This is a frontier where we can dramatically improve human life. It’s a miracle that people are living so much longer, but longer life expectancies alone are not enough. People should be able to enjoy their later years—and we need a breakthrough in Alzheimer’s to fulfill that. I’m excited to join the fight and can’t wait to see what happens next.

(Source: GatesNotes Insider)

Colombia Village's 'Curse' Could Hold Alzheimer's Cure

When John Jairo, a meticulous night watchman, lost his job for leaving all of his employer's doors open, his family knew they were hit by the "Yarumal curse."

Yarumal, a Colombian village perched in the Andes Mountains, has a high incidence of a genetic mutation that predisposes its population to Alzheimer's - a bleak heritage that scientists now hope could help lead to a treatment to prevent the disease.

Jairo is just 49 but his brain has already been gnawed away by Alzheimer's, a disease caused by toxic proteins that destroy brain cells, leading to memory loss and death.

Emaciated, he gazes vacantly at his daughter Jennifer, who at 18 years old already fears his fate.

"I'm constantly afraid it will happen to me. Whenever I lose something, I tell myself it's because I've already got it," she said.

Her father, "who used to be so happy," has been reduced to a restless, sometimes aggressive ghost of himself, who tries to escape the house day and night, she said.

Last year, a neighbor with the same condition slipped out without anyone noticing. His family found him frozen to death in the hills nearby.

Inherited from the village's European ancestors, the "paisa" genetic mutation -- named for the residents of the Colombian province of Antioquia - causes a devastating form of early-onset Alzheimer's.

A single parent can hand down the mutation, located on the 14th chromosome.

Those who have it have a 50 percent chance of developing Alzheimer's, sometimes by age 40.

In some families, parents and children have progressed through the illness together, from memory loss to dementia.

But a talented neurologist named Francisco Lopera, who grew up in Yarumal, hopes there is a blessing in the village's curse.

'Brain Bank'

Neurobanco is Colombia's only brain bank and a mainstay for global research on brain diseases, with a donation of 234 brains stored at -80 degrees Celcius, many of which belonged to Alzheimer patients (AFP Photo/Raul Arboleda)

Thirty years ago, Lopera, the Head of the Neuroscience Program at the University of Antioquia, set himself an ambitious mission: to find a treatment to prevent Alzheimer's, the most common form of dementia in the world.

"Most treatments have failed because they're administered too late. Our strategy is to intervene before the disease destroys the brain," said Lopera.

For several months, he has been testing an experimental drug on a group of 300 healthy patients aged 30 to 60 years old who have the paisa mutation.

The results are expected around 2020.

The trials are part of a $100 million project financed by the National Institutes of Health and Banner Research Institute in the United States, as well as Swiss pharmaceutical group Roche.

The active molecule in Lopera's drug targets the beta-amyloid proteins that attack the brain.

The stakes are high worldwide: more than 36 million people suffer from Alzheimer's and, without a cure, the number could rise to 66 million in 2030 and 115 million in 2050, according to the World Health Organization.

That's nearly one new case every four seconds - three times the rate of HIV infections.

"We don't know what causes Alzheimer's, but for one percent of the cases worldwide, it's genetic in origin. And that opens a very important window toward finding a preventive treatment," said Lopera, who estimates 5,000 people are at risk in and around Yarumal.

At his university, a small room filled with refrigerators and formaldehyde jars holds a "brain bank" created with organ donations from local residents -- an invaluable research source.

"It was very hard for them to accept, in addition to their suffering, donating their loved ones' brains," said Lucia Madrigal, a nurse in the neuroscience department who organizes cognitive stimulation workshops for patients.

"But without that social link, the scientific project could never have seen the light of day," she said.

Herself a fit 60 something with no plans to retire, she has lived Yarumal's nightmare along with residents.

"Some say they'd rather kill themselves. Then they get sick and they forget," she said.

Marta, an energetic 72 year-old grandmother from Yarumal, who has settled in the regional capital Medellin, said she is praying for Lopera's treatment to work.

Two of her daughters, aged 43 and 47, are suffering memory loss and "becoming small children again," she said.

Another daughter, 53-year-old Alitee, is "just a body" who drinks from a baby bottle.

"I've trusted my children to God. It's his decision," she said.

  

(Source:  AFP - By Philippe Zygel, December 18, 2014 12:01 PM)

BEWARE OF GRAPEFRUIT DRUG INTERACTIONS

Grapefruit and grapefruit juice are good for you -- unless you're on one of an increasingly wide range of medications that interact with them. A report published by CMAJ (Canadian Medical Association Journal) indicates the number of drugs affected by grapefruit juice is on the rise.  More than 85 drugs are now identified as problematic -- and many are commonly used by people over age 45.

The problem centered around compounds in grapefruit called furanocoumarins, which can block an enzyme in the gut that metabolizes certain drugs. This can lead to higher-than-normal levels of certain oral drugs getting into the bloodstream. Less frequently, grapefruit can block drug transporters, leading to an insufficient dose of medication. Just one whole grapefruit or an 8-ounce glass of juice can interact with drugs up to three days after consumption.

Effects vary from person to person. Serious adverse effects can include acute kidney failure, respiratory depression, rhabdomyolysis (muscle breakdown that can lead to kidney damage), gastrointestinal bleeding and torsade de pointes - a potentially fatal increase in heart rhythm.

Current advice from experts is to avoid consuming grapefruit and its juice if you're on a drug that interacts with it. The same recommendation goes for Seville oranges (often used in marmalade), limes, pomelos and tangelos, which have also been found to interfere with drug metabolism. (Sweet oranges, such as navel and Valencia, don't contain furanocoumarins and remain safe to eat.)

In addition, the Food and Drug Administration advises you to:

·     Ask your pharmacist about potential interactions when you fill a prescription.

·    Read the patient information that comes with your prescription and over-the-counter drugs.

·   Check the labels of fruit juices and other drinks to make sure they don't contain grapefruit juice, if you're on one or more drugs that interact.

(Source:  John Hopkins Health Alert, Posted in Healthy Living on 8 January 2014)

INSIGHTS INTO THE GENETICS OF ALZHEIMER’S DISEASE

Having a family member who has Alzheimer's increases the risk of developing the disease. However, only a handful of Alzheimer's patients - less than 5 percent - have the disease as a result of an identifiable defective gene (a gene mutation).

In families with a mutation, Alzheimer's disease is carried as a dominant trait (which means that each offspring has a 50 percent chance of inheriting the abnormal gene) on one of three chromosomes -- the amyloid precursor protein (APP) gene on chromosome 21, the presenilin-1 (PS-1) gene on chromosome 14 and the presenilin-2 (PS-2) gene on chromosome 1.

The prevalence of these gene mutations is low. As an example, the defective APP gene has been found in only 25 families worldwide. Although these mutations affect only a small number of families, a person carrying one of them will inevitably develop Alzheimer's if he or she lives long enough.

Researchers expect to find other genetic abnormalities linked to Alzheimer's disease. In fact, scientists have already pinpointed an area on chromosome 10 that appears to contain genes that influence Alzheimer's. A possible new gene, sortilin-related receptor L (SORL1), has also been identified. Scientists believe there may be as many as a dozen genes that contribute to Alzheimer's risk, but each is likely to contribute only a little bit to the overall incidence of the disease.

Genetic predisposition to Alzheimer's. Having a genetic predisposition to Alzheimer's disease is different from carrying a genetic mutation. A predisposition means that, although Alzheimer's "runs in the family," it is not associated with one of the genetic defects discussed above. Some family members develop Alzheimer's while others do not.

A predisposition suggests that other risk factors interact with a person's genetic makeup to increase the chance that he or she will develop Alzheimer's or to cause the disease to begin earlier in life. For example, in one study of identical twins, who share an identical genetic makeup, the age of Alzheimer's onset varied by as much as 15 years.

(Source:  John Hopkins Health Alert, 2 December 2013)

HOW HYPERTENSION AFFECTS MEMORY

Two out of three Americans age 60 and older have some form of high blood pressure -  which is blood pressure that measures 140/90 mm Hg or higher. Hypertension (the medical term for high blood pressure) affects Americans from all walks of life. Yet even though high blood pressure is easy to detect and is almost always treatable, too few people know that they have high blood pressure or even know much about it.

How does high blood pressure impact memory? The most obvious way is via stroke, which occurs when an artery supplying blood to a portion of the brain becomes blocked or suddenly ruptures.

Each year approximately 700,000 Americans suffer strokes, and many die because of them. Of those 500,000 who survive their first stroke, about 25 percent will have a second stroke within five years.

The damage to brain cells caused by a stroke can produce lasting disabilities that may impair a person's memory, senses, motor skills, behavior, language ability and thought processes. The specific deficits that occur depend on which portions of the brain are damaged, as well as the type and severity of the stroke.

Hypertension is a major risk factor for stroke. High blood pressure damages blood vessels that carry blood to the brain, and this damage leads to the buildup of arterial plaque, an accumulation of inflammatory cells, cholesterol and other tissue products within blood vessels. When one of these plaques ruptures, it travels through an artery and eventually gets lodged in a place where the diameter of the plaque is larger than the diameter of the blood vessels. This causes a blood clot to form at that spot.

If the clot completely cuts off blood supply to brain cells responsible for memory or other cognitive functions, the cells die. The death of these cells then leads to impairments in thinking, moving and sensing.

Having high blood pressure is also linked with greater declines in cognitive function when a stroke occurs. In a prospective, observational study, investigators tracked stroke incidence and cognitive performance among 9,704 women ages 65 and older. They found that among participants who had suffered strokes, those who had normal blood pressure before the stroke had better cognitive function afterward than those who were hypertensive beforehand.

(Source:  John Hopkins Health Alert,16 December 2013)

TO DRINK OR NOT TO DRINK: ALCOHOL AND MEMORY

Alcohol's effects on memory depend on the amount consumed. Heavy alcohol consumption, especially binge drinking, takes a toll on memory function. In a study published in epidemiology, midlife binge drinking more than tripled the risk of developing dementia in later life. (Binge drinking was defined as consuming more than five bottles of beer or one bottle of wine on one occasion at least monthly.) The risk of dementia was more than 10 times higher among drinkers who had passed out at least twice during one year.

In contrast, mild to moderate drinking appears to have a protective effect on memory. The source of this protection is not fully understood, but modest alcohol consumption is believed to improve blood flow in the brain and may help prevent small "silent" strokes.

In research published in the Journal of the American Medical Association, investigators reported that people who drank one to six alcoholic beverages a week had a 54 percent lower risk of dementia than people who never drank. Consuming 14 or more drinks per week, in contrast, was associated with an increased risk of dementia.

Some research shows that being a nonsmoker factors into the protective effect of alcohol. A study published in the Journal of Alzheimer's Disease found that those who consumed a moderate amount of alcohol had a lower risk of developing Alzheimer's - especially if they were nonsmokers.

Although no optimal level of alcohol consumption has been established, experts recommend that men consume no more than two drinks per day and women, no more than one drink per day. (One drink equals 12 oz. of regular beer, about 5 oz. of wine or 1.5 oz. of 80-proof distilled liquor.) Women who have an elevated risk of breast cancer should talk with their doctors about drinking alcohol, because as little as one drink a day can boost breast cancer risk. Research is still emerging on how the type of alcohol -  beer, wine or liquor - affects dementia risk.

Despite the apparent cognitive benefits of moderate alcohol consumption, nondrinkers should not start drinking to prevent dementia. The risks of excessive alcohol consumption are many, including alcoholism and automobile accidents.

(Source:  John Hopkins Health Alert, Memory, posted 4 November 2013)

An Exercise RX to Ward Off Cognitive Decline

In the not too distant past, doctors knew little about the value of exercise for the heart. But beginning in the 1950s, findings from a number of important studies began to demonstrate that not only was a lack of physical activity harmful to the heart, but increased physical activity was good for it.

In much the same way, researchers are in the early stages of discovering the impact of physical activity, or lack thereof, on cognitive function. Much of the evidence to date suggests that physical activity does indeed offer some protection against cognitive decline.

Still, plenty of questions remain, and among those yet to be answered: How much physical activity is enough to help? And can any amount of physical activity reverse or slow the rate of decline in those with or at risk for cognitive impairment or Alzheimer's disease?

How much physical activity is enough? Results from several studies have provided intriguing clues about the amount of physical activity needed to slow the rate of cognitive decline. For example, findings from nearly 17,000 participants in the Nurses' Health Study demonstrated that women aged 70 years and older who walked at an easy pace for at least 90 minutes per week had higher cognitive scores than those who walked less than 40 minutes per week.

The results, which were reported in the Journal of the American Medical Association, also demonstrated that women who reported the highest rates of physical activity showed significantly less cognitive decline than women who reported the lowest rates of physical activity. Perhaps most striking: The apparent cognitive benefits of greater physical activity were similar in extent to being about three years younger.

What you can do now. Clearly, there's no specific exercise prescription for preventing or reversing cognitive decline. But given the evidence that physical activity is beneficial to the brain - as well as to your heart, lungs and bones -- it's a good idea to get moving.

The American Heart Association recommendation of 150 minutes of moderate exercise per week is a reasonable goal for many people. However, if you or a family member with mild cognitive impairment has been sedentary or has other medical conditions, get the OK from the doctor before you start.

Even if you or your family member is not up to 30 minutes five days a week, any physical activity you enjoy, such as gardening, is likely to be a boon to your overall well-being.

If a family member has more advanced Alzheimer's disease, keep in mind that he or she may be able to derive benefit from some type of physical activity until the final stages. For example, simple gentle stretching exercises can help reduce muscle and joint pain and help increase and maintain flexibility. Again, be sure to consult with the doctor to determine what type of activity is safe, realistic and helpful.

(Source:  John Hopkins Health Alert, posted in Memory, 14 October 2013)

World Alzheimer Report 2013 "Ä Journey of Caring" - An Analysis of Long-Term Care for Dementia

The World Alzheimer Report 2013 ‘A Journey of Caring: An Analysis of Long-Term Care for Dementia’, reveals that, as the world population ages, the traditional system of “informal” care by family, friends, and community will require much greater support. Globally, 13% of people aged 60 or over require long-term care. Between 2010 and 2050, the total number of older people with care needs will nearly treble from 101 to 277 million.

Long-term care is mainly about care for people with dementia; around half of all older people who need personal care have dementia, and 80% of older people in nursing homes are living with dementia. The worldwide cost of dementia care is currently over US$600 billion, or around 1% of global GDP.

The report which was researched and authored by Prof Martin Prince, Dr Matthew Prina and Dr Maëlenn Guerchet on behalf of the Global Observatory for Ageing and Dementia Care which is hosted at the Health Service and Population Research Department, King’s College London.

Recommendations: 

·       Governments around the world should make dementia a priority by implementing national plans, and  by initiating urgent national debates on future arrangements for long-term care

·     Systems should to be in place to monitor the quality of dementia care in all settings – whether in  care homes or in the community

·    Autonomy and choice should be promoted at all stages of the dementia journey, prioritising the  voices of people with dementia and their caregivers

·       Health and social care systems should be better integrated and coordinated to meet people’s needs

·      Front-line caregivers must be adequately trained and systems will need to be in place to ensure paid  and unpaid carers receive appropriate financial reward in order to sustain the informal care system  and improve recruitment and retention of paid carers

·      Care in care homes is a preferred option for a significant minority – quality of life at home can be as good, and costs are comparable if the unpaid work of family caregivers is properly valued

·      The quality of care in care homes should be monitored through the quality of life and satisfaction 

   of their residents, in addition to routine inspections, as care homes will remain an important  component of long-term care.

More information, click on ->  World Alzheimer Report "A Jounrey of Caring"

(Source:  ADI)

From Research: The Link Between Late-Onset Depression and Dementia Risk

Depression that first manifests in midlife or later may be a harbinger of dementia, a new study says.  The study was published in the Archives of General Psychiatry (Volume 69, page 493).

Researchers reviewed data from the records of more than 13,000 adults who were long-term members of the Kaiser Permanente Medical Care Program and who had signed up in the 1960s and 1970s to participate in a research study for middle-aged people.

To identify midlife depression, the researchers reviewed surveys that had asked participants whether they often felt unhappy or depressed, and they examined hospital records to identify admissions related to a diagnosis of depression.  More recent medical records were also reviewed to identify late-life depression and dementia diagnoses.

In participants with depressive symptoms in late life - whether or not they were combined with midlife symptoms - the risk of Alzheimer's was doubled. Combined midlife and late-life depressive symptoms more than tripled the risk of vascular dementia.

Takeaway Message 

These findings don't prove that depression that first occurs in midlife or beyond is a sign of dementia. Moreover, the researchers didn't attempt to determine whether treatment could reduce risk. Still, if you are experiencing depression, it's important to discuss it with your doctor. Effective treatments for depression are available.

(Source:  John Hopkins Health Alert, Posted in Memory, 9 September 2013)

COPING WITH A DIAGNOSIS OF EARLY-STAGE DEMENTIA

When you reach age 65, you have a one in 10 chance of developing dementia during your remaining lifetime. Clinicians are now making a concerted effort to diagnose dementia in the early stages, when patients may still have the capacity to understand the disease's course and to make important decisions about future care and interventions.

Being told you have an incurable disease that slowly robs intellectual functioning can take an emotional toll. Adjusting to a diagnosis at any stage of dementia is a complex, evolving process for the person diagnosed and his or her family. You may experience mixed feelings and a range of reactions, including:

A loss of Self

Dementia poses a threat to personality and character. Understandably, dementia's symptoms, such as forgetting faces and struggling to express yourself, can leave feelings of loss, uncertainty and frustration. Experiencing acute grief and mourning your loss of self-identity is common.

Unawareness

Most individuals with Alzheimer's disease aren't aware they have impaired memory and thinking. For others, unawareness increases as the disease progresses. This suggests that unawareness is part of the brain disease in some individuals. Arguing with them or repeatedly demonstrating to them that they're forgetful won't help and is likely to upset them more.

Denial

Other individuals outwardly deny or ignore the diagnosis of dementia but seem to be aware from their behavior that they have a problem. Research suggests that this reaction can sometimes be a self-monitoring strategy in an attempt to be seen by others as a person, not an object, and maintain self-esteem.

Relief

Certain individuals and their loved ones report feeling relief upon hearing the diagnosis of dementia. The anxiety of not knowing what's causing symptoms like forgetfulness can be a tremendous burden. A diagnosis can confirm suspicions that dementia is the cause and legitimizes the need for support and therapeutic interventions.

Secretiveness or Embarrassment

It's common for individuals to be reluctant to reveal their dementia diagnosis for fear of how others might perceive them. As a result, these individuals are often tempted to stop seeing friends or family members and become socially isolated - outcomes that are clearly undesirable, since studies show that maintaining social connectedness is key to coping with the psychological impact of a dementia diagnosis.

Anxiety, Anger, Sadness or Depression

These are all normal reactions. Demoralization is especially common in the disease's early stages the same way it is when grieving any other loss. Behavioral therapy or counseling may ease feelings of anxiety and depression if they interfere with everyday functioning.

(Source:  John Hopkins Health Alert, Posted Memory, 2 September 2013)

ANEMIA MIGHT RAISE DEMENTIA RISK, STUDY SUGGESTS

Screening elderly for the blood condition makes sense, researcher says.

Older adults suffering from anemia - lower than normal red blood cell levels - may be at increased risk for dementia, a new study suggests.

Anemia affects as many as 23 percent of seniors, the researchers say.

"We found a 60 percent increased risk of dementia with anemia. After controlling for other factors such as other medical illness, demographics, etcetera, the risk remained elevated 40 to 50 percent," said lead study author Dr. Kristine Yaffe, a Professor of Psychiatry, Neurology and Epidemiology at the University of California, San Francisco.

"Given how common both anemia and dementia are in older adults, more attention to the connection between the two is important, and I do think screening older adults for anemia makes sense," said Yaffe.

The study of more than 2,500 men and women in their 70s doesn't actually prove that anemia causes dementia, however.

"Because we studied this prospectively, we do think, as best we can tell, that anemia is causally related to dementia, but with observational studies one can never say for sure. But we did our best to exclude other explanations," Yaffe said.

The job of red blood cells is to carry oxygen throughout the body. When you are anemic, less oxygen is delivered to brain cells, Yaffe explained. "We think the association is about low oxygen being carried to the brain," she said.

Anemia could also indicate poor overall health, the study authors noted. Causes of anemia include iron deficiency and blood loss. Cancer, kidney failure and certain chronic diseases can also lead to anemia.

The study - published online July 31 in Neurology -  should remind doctors that many conditions can lead to dementia, and treating them might ward off mental decline, one expert said.

"One concern about the increased visibility and prevalence of Alzheimer's disease is that some physicians will be tempted to jump straight to that diagnosis without first having followed the 'rule out reversible causes' rule," said Dr. Sam Gandy, director of the Mount Sinai Center for Cognitive Health in New York City. Alzheimer's disease is the most common form of dementia.

"We must always seek to exclude treatable, reversible causes of dementia such as depression, nutritional deficiencies, endocrine disorders and metabolic disorders before rushing into a diagnosis of Alzheimer's," he said.

During the study, all of the participants were tested for anemia and took memory and thinking tests over 11 years.

Almost 400 participants were anemic at the study's start. Over the course of the study, about 18 percent of participants - 455 - developed dementia, the researchers found.

Of participants with anemia, 23 percent developed dementia, compared with 17 percent of those who weren't anemic.

People who were anemic at the study's start had a 41 percent higher risk of developing dementia than those without anemia after the researchers took into account factors such as age, race, sex and education.

Additional research is needed to confirm this association before recommendations are made regarding dementia prevention, the study authors suggested.

(Source:  HealthDay.com, 31 July 2013)

RESEARCH ON VASCULAR DEMENTIA AND EXERCISE

Mental decline in older adults who live independently can be delayed if they get regular physical activity, says a new study. Specifically, the study reports that exercise can reduce the risk of vascular-related dementia by more than 50 percent and cognitive impairment without dementia by 60 percent.

Vascular dementia results from blood vessel disease and is associated with conditions like high blood pressure, plaque buildup in artery walls, diabetes and stroke.

The study, which was reported in the online edition of Stroke, followed 638 people, average age of 74, for three years. Sixty-four percent said they were physically active 30 minutes a day for three days a week.

Their activities involved walking, biking and taking gym classes. The results were disappointing, however, when it came to protecting against Alzheimer's. Researchers found no relationship between activity and the risk of developing Alzheimer's. 

(Source:  John Hopkins Health Alert, Memory 22 July 2013)

DETERMINING THE EXTENT OF ALZHEIMER’S DISEASE WITH BRAAK STAGING

Normally, tau protein is used by the brain's neurons as a kind of "scaffolding." But for reasons that are still unclear, as people age the tau protein starts to aggregate into filaments inside the neurons. These tau filaments soon grow out of control, eventually forming distinctive tau tangles. They fill up the neurons and cause them to burst. At this point, neuron death is unstoppable.

Braak staging - developed by German pathologist Heiko Braak - is a way to measure the severity of Alzheimer's disease based on how many tau tangles there are in the brain, and where they are, based on brain autopsy. 

Braak Stage 1 - Braak stage 1 is the point at which tau protein starts to clump into tau tangles. In stage 1 there are no external symptoms and it might take many years before there is noticeable dementia. Nearly everyone will reach Braak stage 1 between 40 and 90 years of age. About 30 percent of 50-year-olds will reach Braak stage 1.

Braak Stage 2 - Tau tangles have accumulated further and have caused some neurons to burst apart and die. Mental testing reveals minimal impairment. Tau tangles at this are found in the brains of about 60 percent of people over age 65. 

Braak Stage 3 - Tau tangles and neuronal death have likely caused some memory impairment, but only about 10 percent of patients will be diagnosed as suffering from dementia. About 45 percent of 80-year-olds have reached this stage. 

Braak Stage 4 - Tau tangles are beginning to form in the outer layers of the cerebral cortex. The patient is experiencing significant impairments in memory and other aspects of cognitive function. 70 percent of patients with this level of tau tangles in the brain will be diagnosed with dementia.

Braak Stage 5 - Tau tangles have caused extensive neuronal death, giving rise to severe memory and cognitive impairment. They are beginning to involve deep areas of the brain that control the initiation of movement. About 80 percent of patients with this level of tangles will be diagnosed with moderate to severe dementia.

Braak Stage 6 - Tau tangles have formed extensively throughout the brain and have caused extensive neuronal death. The outer layers of the brain that integrate activities and the deep areas of the brain that control movement are filled with tau tangles. All patients with this many tau tangles in the brain will be diagnosed as suffering from severe dementia. They will be completely unable to care for themselves and will have difficulty recognizing family members

(Source:  John Hopkins Health Alert, Memory on 29 July 2013)