Smell Tests Don't Predict Alzheimer's, Study Finds - Misleading Reports May Create False Hope -- Or False Alarm

SMELL TESTS should not be used to predict Alzheimer's disease, the most common form of dementia, according to a new study.

Although there is a link between the two, Researchers found other medical problems may cause people to lose their sense of smell, and it may not necessarily mean they will develop the progressive brain disorder later in life.

"A nonspecific association between poor smell function and Alzheimer's dementia is not the same as actually being able to use a smell test to predict Alzheimer's," Dr. Gordon Sun, a General Otolaryngologist at the University of Michigan in Ann Arbor, said in a University News Release.

"Unfortunately, this misinterpretation of the research has led to the promotion of these tests by the media and public figures like Dr. Oz," he added. "This study helps set the record straight about where the evidence currently stands."

In conducting the comprehensive review, the study's authors examined nearly 1,200 articles dating back to 1984. Two studies that tracked patients over time and 30 studies that evaluated patients at one specific point in time met inclusion criteria.

"Understandably, researchers, clinicians and the public are eager for a simple, accurate, and inexpensive way to predict or diagnose Alzheimer's early, but we're not there yet," argued Sun, who is also a Robert Wood Johnson Foundation/U.S. Veterans Affairs Clinical Scholar at the University of Michigan Medical School.

"My concern is that by promoting smell tests at this point, we create false hope or even false alarm among seniors and their families," he said. "Additional research is needed before we can rely on smell tests to predict the later onset of Alzheimer's."

The study, published online on 10 May in the Journal Laryngoscope, concluded that patients visit their primary care physician if they are concerned about their risk for Alzheimer's disease.

(Source:  HealthDayNews, 10 May 2012)

Early Detection May Delay Alzheimer's Development Among Patients

A Researcher has found A New Way To Approach Early Detection of Alzheimer's Disease.

The researcher at the University of the Basque Country (UPV/EHU) Xabier Elcoroaristizabal is looking for complementary genetic factors.

One of our genes is apolipoprotein E (APOE), which often appears with a variation which nobody would want to have: APOEe4, the main genetic risk factor for sporadic Alzheimer's disease (the most common form in which this disorder manifests itself and which is caused by a combination of hereditary and environmental factors).

It is estimated that at least 40 percent of the sporadic patients affected by this disease are carriers of APOEe4, but this also means that much more still remains to be studied.

Elcoroaristizabal has opened up a channel for making a start by analysing candidate genes, which always in combination with APOEe4, could help to explain more cases.

The long-term aim is to contribute towards the early detection of Alzheimer's disease by identifying signs that could be detectable in the very early phases. And, as Elcoroaristizabal explains, while there is no cure for this disorder, the alternative is to get ahead of it and delay its development.

"Certain preventive measures involving cognitive stimulation delay its appearance. There are even new drugs that could start to be used earlier. Today there is no solution, but the more we maintain a person's correct cognitive state, the better," he said.

The individuals who develop Alzheimer's go through a transition period first of all, and this could be the key moment for the effective application of preventive measures. This is mild cognitive impairment (MCI), in which slight cognitive alterations take place but do not affect everyday activities.

Among the different types of MCI, one affects memory almost exclusively (amnestic MCI), and those people who suffer from it have a high probability of developing the disorder. The difficult and interesting part is knowing which genetic components are linked to this impairment and also in determining by what percentage the risk of developing the disease increases, a task which Elcoroaristizabal has set himself.

"If we can identify which genes are involved and what susceptibility factors there are, preventive measures could be taken," he said.

So a contrast study has been carried out among a sample of patients with MCI, ones with Alzheimer's and healthy people. This can be used to observe the changes and narrow down the field for the zones to be studied, so that candidate genes can be sought there.

Elcoroaristizabal himself notes one example among the many others identified.

"It has been observed that the brain's capacity to control cholesterol levels seems to play a key role throughout the illness. So, protein encoding genes linked to this control have been analysed," he claimed.

In this quest for candidate genes, Elcoroaristizabal has confirmed that the APOEe4 genetic variation is, in fact, the main risk factor for developing Alzheimer's disease. But it does not end there; he has identified several genes which, as long as they are manifested in combination with APOEe4, could take us one step further towards the early detection of this disorder.

"Genes that in some way are connected with neurotransmission channels, oxidative stress or the effectiveness of oestrogens seem to be linked to a greater risk for APOEe4 carriers," he explains. Specifically, the candidate genes are as follows: COMT (neurotransmission), SOD2 (oxidative stress elimination) and ESR1 and ESR2 (oestrogen action facilitators).

His thesis is entitled 'Molecular markers in mild amnestic cognitive impairment and Alzheimer's disease' (Marcadores moleculares en deterioro cognitivo leve tipo amn sico y enfermedad de Alzheimer). An initial article on this can be read in the Journal BMC Neuroscience.

The study has been published in the Journal BMC Neuroscience (ANI).

(Source: ANI, 24 December 2011)

DO YOU SMELL THAT?

What do strawberries, lemon, smoke, leather and pineapple have in common? Well, according to a recent study on memory, they're five of the ten most recognisable smells that may help detect the first signs of Alzheimer's disease.

The inability to recognise these scents appears to show which people are developing dementia as opposed to those suffering simple mental decline due to aging, says Dr D.P. Devanand of the New York State Psychiatric Institute and Columbia University.

Using a relatively quick and easy ten-smell test, Devanand evaluated 150 patients with minimal to mild cognitive impairment every six months, and 63 healthy subjects annually, for an average follow-up of five years.

However, Devanand cautioned that these results are very preliminary and that it's difficult to accurately diagnose who is going to get Alzheimer's over time.

Scientists hope this ''scratch and sniff'' test will improve diagnoses, so patients can begin taking antidementia drugs long before Alzheimer's would normally be diagnosed.

(Source: http://www.rdasia.com/do_you_smell_that)

Study : Laughter Good Medicine for Dementia Patients

LAUGHTER may be good medicine for elderly dementia patients - and best of all, it does not have side effects.

Australian humour therapist, Jean Paul Bell was originally a clown doctor working with sick children, but now he makes the elderly laughs as well through a programme called Play-Up.

Bell was also the key humour therapist in a Sydney-based study into the impact of humour therapy on mood, agitation, behavioural disturbances and social engagement in dementia patients, a study that showed those who took part seemed happier.

"The whole idea behind the Play-Up Programme and what we're doing at the Arts Health Institute is encouraging them to play more because we believe that they've got the potential to keep playing right until they take their breath," Bell said.

He set up the Arts Health Institute to train aged-care staff in fostering playful relationships with their patients, particularly those with dementia.

The study, called the SMILE Study, took place over three years, involving 36 nursing homes and 400 residents.

Dressed in a bright blue jacket with brass buttons and shoulder tabs, Bell uses a combination of games, jokes and songs - accompanying himself on a ukulele - to get the elderly to laugh.

In addition to seeming more content, the dementia patients involved in the study seemd less agitated by 20%, said lead researcher Low Lee-Fay at the University of New South Wales' School of Psychiatry.

"The percentage may sound like a small effect but it's about the same amount, the same effect as you would get if you gave them an antipsychotic medication - medication you would use to treat schizophrenia, bi-polar disorder," Low said.

Best of all, the dementia patients were not the only ones who benefited from the study.

"The staff were invigorated, they felt that their jobs were enhanced," said therapist, Joanne Rodrigues.

"They were part of something that they could see the real benefits (of)."

(Source: Reuters, 29 September 2011)

Low Vitamin B12 Levels May Lead to Brain Shrinkage, Cognitive Problems

Older people with low blood levels of vitamin B12 markers may be more likely to have lower brain volumes and have problems with their thinking skills, according to researchers at Rush University Medical Center.

The results of the study are published in the September 27 Issue of Neurology, the medical journal of the American Academy of Neurology.

Foods that come from animals, including fish, meat, especially liver, milk, eggs and poultry are usual sources of vitamin B12.

The study involved 121 older residents of the South side of Chicago who are a part of the Chicago Health and Aging Project (CHAP), which is a large, ongoing prospective Rush a biracial cohort of 10,000 subjects over the age of 65.

The 121 participants had blood drawn to measure levels of vitamin B12 and B12-related markers that can indicate a B12 deficiency. The same subjects took tests measuring their memory and other cognitive skills.

An average of four-and-a-half years later, MRI scans of the participants’ brains were taken to measure total brain volume and look for other signs of brain damage.

Having high levels of four of five markers for vitamin B12 deficiency was associated with having lower scores on the cognitive tests and smaller total brain volume.

“Our findings definitely deserve further examination,” said Christine C. Tangney, PhD, associate professor in the department of clinical nutrition at Rush University Medical Center, and lead author of the study. “It’s too early to say whether increasing vitamin B12 levels in older people through diet or supplements could prevent these problems, but it is an interesting question to explore. Findings from a British trial with B vitamin supplementation are also supportive of these outcomes.”

On the cognitive tests, the scores ranged from -2.18 to 1.42, with an average of 0.23. For each increase of one micromole per liter of homocysteine—one of the markers of B12 deficiency—the cognitive scores decreasedby 0.03 standardized units or points.

Christine Tangney noted that the level of vitamin B12 itself in the blood was not associated with cognitive problems or loss in brain volume. She said that low vitamin B12 can be difficult to detect in older people when looking only at blood levels of the vitamin.

“Our findings lend support for the contention that poor vitamin B12 status is a potential risk factor for brain atrophy and may contribute to cognitive impairment,” said Tangney.

Other researchers at Rush involved in the study were Dr. Neelum T. Aggarwal, Hong Li, Robert S. Wilson, PhD, Dr. Denis Evans and Martha Clare Morris, ScD.

The study was supported by the National Institute on Aging.

(Source: HealthNewsDigest.com, 26 September 2011)

MODERN BRAIN SCANNING TECHNOLOGY OFFERS SIMPLE LOOK AT EVERYTHING FROM HEAD TRAUMA TO TUMORS

The Charles M. and Marilyn Newman Professor and Chairman of Radiology at Mount Sinai, Drayer has been a radiologist specializing in the brain and spine for 30 years.

WHO’S AT RISK:

Thanks to advances in MRI and CT technology, doctors can get highly detailed images of the brain, a procedure used for patients with a wide variety of conditions. “Any patients with neurological or psychiatric symptoms might require an image of their brain, including patients [suffering from] stroke, brain tumor, multiple sclerosis, brain infections, Alzheimer’s, Parkinson’s and head injury,” says Drayer.

As for groups at risk, “The same group at risk of heart attack is at risk of stroke, which some people call a ‘brain attack,’ ” says Drayer. “The warning signs of stroke are called TIA [transient ischemic attack], and people with high blood pressure, diabetes and a history of smoking are at higher risk.” Alzheimer’s and Parkinson’s diseases are associated with advancing age, while brain-tumor and head-trauma patients can be any age, including children, teenagers and otherwise healthy young adults.

SIGNS AND SYMPTOMS:

Doctors have identified a cluster of symptoms that most often bring people in for brain imaging. “Key signs are weakness or numbness, often on one side of the body, loss of speech, vision or hearing, dementia or loss of memory, confusion, involuntary movements and headaches,” says Drayer. “Anyone who is acutely becoming weak or losing their speech should immediately come to an ER in a stroke center that is equipped to prevent the more severe consequences.”

Many neurological conditions will affect one side of the body more than the other. “That’s because a condition affecting one side of the brain usually causes symptoms on the other side of the body,” says Drayer. “For instance, if the tumor is on the right side of the brain, they might have symptoms in the left arm or leg.”

The standard test for people who have suffered head trauma is a CT scan. “That’s now routine,” says Drayer. “If you’ve had severe head trauma, we scan to see if there’s blood on the brain.” Alzheimer’s and Parkinson’s patients most often present with symptoms such as memory loss and tremors or other involuntary movement.

Some patients pick up on their own symptoms, and sometimes doctors or family members note them. “Some patients have chronic problems, others subacute problems, others acute problems — for example, after an auto accident or a stroke,” says Drayer. “At some point they need an image, an MRI or CT scan, to help determine their course of treatment.”

TRADITIONAL TREATMENT:

Modern brain imaging is light-years ahead of the technology in use as recently as 1970. “Traditionally, imaging of the brain was very invasive and difficult,” says Drayer. “For example, for the brain you would do a pneumoencephalogram, where doctors did a spinal tap and inserted air into spinal fluid.

“It was kind of barbaric,” says Drayer, “but it was the best thing we had in 1970.” The patient often had to be hospitalized for a week to recuperate from this diagnostic procedure.

New technology is fast, noninvasive and usually painless. “Now we do an MRI or CT scan to image the brain or spine,” says Drayer. “It takes five minutes for a CT scan or 45 for an MRI. What used to take a week in the hospital and wasn’t as accurate, now takes only 45 minutes and is accurate to millimeter resolution.” The images are now digital, and instead of running X-ray films around the hospital, doctors can read them immediately at work stations and share them with referring physicians or the patient.

In the past, imaging was only diagnostic. “We used it to find out: ‘Do you have a disease or don’t you have a disease?’ ” says Drayer. “Now we use imaging for prevention and therapy as well. Interventional neuroradiologists are treating disease rather than just diagnosing it. ... Imaging is giving information at the molecular level to see biochemical and physiological events in the brain,” says Drayer. “This helps us understand the underpinning of the disease.”

“CT scans are extremely quick and simple,” says Drayer. “There is radiation involved, so we try to keep the dose as low as possible.” These scans are good for very sick and unresponsive patients and are especially good for determining if there is acute blood on the brain, which is why they are standard in cases of head trauma. CT is also used during the acute stroke phase.

The highly sensitive MRI is the scan familiar from television; the patient lies down and enters a tubular chamber. “The MRI can be a little claustrophobic, but 95% of patients handle it well,” says Drayer. “It provides much more elegant and complete information.” Doctors choose MRI scans — which usually last about 45 minutes — for what Drayer calls “healthy sick people,” such as those with a neurological or psychiatric problem who are otherwise healthy — for example, a young woman with transient weakness or loss of vision being checked for multiple sclerosis.

PET scans are becoming more important in brain imaging. “This is molecular imaging — it defines the biochemistry of the disease,” says Drayer, who explains the scans are commonly used for following the progress of brain tumors and Alzheimer’s disease.

These tests are also extremely accurate: “We can see things in the brain that are a millimeter in size.”

RESEARCH BREAKTHROUGHS:

Now that the technology for CT, MRI and PET scans is so advanced, doctors think the next big breakthroughs will be in understanding how the brain works. “Eventually, we’ll be able to look at the brain not just when it has a disease — like stroke, Alzheimer’s — but when it is normal and we understand how it works,” says Drayer. “Already we use functional MRI to show for example, that if you’re a professional musician, your brain works differently from a nonmusician; if you’re a professional golfer, your brain works differently when you hit a golf ball than a less experienced golfer.”

The next steps for brain imaging will be for doctors to determine individuals who are more prone to developing chronic diseases like Alzheimer’s and Parkinson’s; they can then lay the groundwork for preventing or delaying the onset of these debilitating disorders.

QUESTIONS FOR YOUR DOCTOR:

A good question to start with is, “Could I benefit from a CT or MRI scan?” Your internist, neurologist or neurosurgeon will determine whether you are a good candidate.

Another good question is, “What are the risks?” For MRI, there is no risk except the discomfort of lying in the MRI machine. “In cases of severe claustrophobia, some people need to be sedated to help them through the exam,” says Drayer. For CT scans, the risk is the radiation intrinsic to the exam, but most centers are very diligent about using the lowest possible dose.

(Source: CNN DailyNews, June 3, 2009)

MUSIC THERAPY TREATS DISEASES AND CONDITIONS FROM PARKINSON'S DISEASE TO DEMENTIA

Belting out tunes in the shower may not only be music to your ears, but may also treat a variety of disorders such as Parkinson’s disease, aphasia and dementia.

Singing has both physical and neurological benefits, according to a CNN article in which Dr. Wendy Magee, International Fellow in Music Therapy at the Institute of Neuropalliative Rehabilitation in London, described music as a “mega-vitamin for the brain” that can improve a host of conditions.

“When neural pathways are damaged for one particular function such as language, musical neural pathways are actually much more complex and much more widespread within the brain,” she told CNN. “Music seems to find re-routed paths and that is why it is such a useful tool in terms of helping people with different kinds of brain damage because it can help to find new pathways in terms of brain functioning.”

Music is effective in treating not just certain medical disorders but also autism and Attention Deficit Hyperactivity Disorder (ADHD), says Dr. Robert Melillo, Co-Founder of the Brain Balance Achievement Centers and the author of “Disconnected Kids” (Penguin, 2009).

“Music works to stimulate the balance center of the brain and different chemicals in the brain, such as dopamine, which we know is deficient in Parkinson’s disease,” Melillo explains. “Music can help stimulate the production of dopamine.”

Music is a powerful tool that is used in treatments of kids with ADHD as well, he says. “Different areas of the brain need to be coordinated from a timing standpoint for the brain to work completely as a whole,” he says. “Music, because it has a rhythm to it, can actually cause the brain to change the speed in different areas so that the timing becomes better.”

Researchers in Finland, according to the CNN piece, showed that listening to music for several hours daily can help stroke victims with their rehabilitation while another study described how stroke patients taught to play the piano or drums made faster progress in their recovery than patients who were treated only with traditional therapy.

Music is used to assist stroke patients by having them sing, rather than say the words as they work to regain speech, explains Ellayne S. Ganzfried, Executive Director of the National Aphasia Association.

The treatment, called melodic intonation therapy (MIT), is used in patients recovering from a stroke or brain injury, she says.

“Music is in the right side of the brain and language is in the left,” Ganzfried explains. “It’s thought that if we stimulate the right side of the brain then the left side of the brain will make the connection as well.”

Music may help those with Alzheimer’s and dementia, according to the CNN article, because the therapist can use familiar songs to bring out memories in a patient that may have been lost. And music gives joy both to the singer and the listener, says Gary Baker, a member of the Peace of Heart choir. The group has given 1,200 free performances in nursing homes, hospices, homeless shelters and hospitals.

“Our mission is to heal with music, and the reaction of our audiences is often powerful and emotional,” Baker says. “It seems to be part of the psychology of the human brain that music offers healing. And it offers a little bit of pleasure at the same time.”

(Source: CNN Daily News, June 4, 2009)