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Archive for the ‘Alzheimer's/Dementia Research/Findings’ Category

Many people with Alzheimer’s have trouble sleeping, which can leave them exhausted during the day. Fatigue takes a toll on both patients and their caregivers. Indeed, irregular sleeping is a major reason why families move relatives with Alzheimer’s into long-term care. Light therapy is a promising treatment under investigation for people with Alzheimer’s who struggle with sleep.

Alzheimer’s patients who have trouble sleeping should first be evaluated for underlying sleep disorders and medical conditions that cause sleep trouble. Also, stopping medications that affect sleep or switching to more tolerable drugs may help.

No studies have found that conventional sleep aids, like Ambien (zolpidem) and Sonata (zaleplon), or sedative antidepressant medications like trazodone (Desyrel) effectively treat disturbed sleep in Alzheimer’s patients. And supplements that boost levels of melatonin (a hormone that makes people feel tired) have limited effect, perhaps because Alzheimer’s patients have fewer melatonin receptors in the brain than people without dementia.

Light therapy – regular exposure to sunlight or special bright lamps that mimic natural light – is another option. Exposure to bright light signals to the brain that it is daytime and helps set the body’s circadian rhythms — regular mental and biological changes that occur over a 24-hour cycle and regulate important functions, like preparing the body for sleep at night.

How well does light therapy work for Alzheimer’s patients? In a three-week study from the University of North Carolina at Chapel Hill, 66 adults with dementia living in long-term care facilities were exposed for varying amounts of time to bright ceiling lights installed in common areas.

Compared with participants who did not spend time under the lights, those who were exposed to light therapy for two and a half hours in the morning slept 16 minutes longer; those who were exposed for about eight and a half hours off and on throughout the day slept 14 minutes longer. The morning group was also able to fall asleep 29 minutes earlier, which is important since Alzheimer’s patients often can’t fall asleep until late at night.

But not all studies have produced positive results, and there are questions about the appropriate dosage. The amount of light prescribed for other conditions may not be sufficient for older patients with Alzheimer’s; eyes transmit less light with age, and visual problems are particularly common in patients with Alzheimer’s disease.

While researchers have yet to determine the ultimate benefits of light therapy or how much is needed to have an effect, “It’s still reasonable to encourage people with Alzheimer’s to stay in well-lit areas during the day,” says Peter Rabins, M. D., Director of Geriatric Psychiatry and Neuropsychiatry at Johns Hopkins.

This may be more practical than purchasing specialized equipment, he notes. “The light-therapy boxes used by people with disorders like depression require sitting still in front of a bright lamp, and this can be a challenge for those with Alzheimer’s.” Spending time outside in the morning may be a convenient way to produce similar effects.

The Alzheimer’s Association offers these tips for better sleep:
– Maintain regular meal times and sleep schedules.
– Discourage alcohol, caffeine, and nicotine use.
– Encourage daily exercise (but no later than 4 hours before bedtime)
– Don’t give Alzheimer’s drugs before bedtime.
– Discourage watching TV or staying in bed during wakeful periods.

(Source: John Hopkins Health Alerts, 14 December 2009)

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Cleaner Teeth cleaner BrainA major research grant will help scientists study the links between memory and oral health in a bid to establish control over Alzheimer’s disease. The news of a $1.3 million study to be carried out on thousands of participants has been welcomed by the UK’s leading oral health charity – the British Dental Health Foundation.

Research has long associated oral health with overall health problems, including dementia – though no studies have made clear how the state of the teeth and mouth affect mental function.

Last year researchers found a link between mild memory loss and gum disease* and the seven-figure grant will enable examination of medical records of thousands of Americans to further pursue the link.

Foundation chief executive Dr Nigel Carter welcomed the news saying: “Oral health and gum disease in particular has been increasingly linked to overall health through studies such as this exciting piece of research.

“The recent review of NHS dentistry suggested the government is committed to preventive care.

“It would be a great boost if scientists could prove preventive treatment could not only protect our teeth but also help prevent chronic diseases such as Alzheimer’s.

“We will watch developments with interest and urge the public to make sure they look after their oral health with simple steps which can reduce the risk of gum disease.

“Minimizing the risks caused by poor oral hygiene is as simple as brushing teeth twice a day with a fluoride toothpaste and visiting the dentist regularly for professional check-ups.”

The US studies will be led by Dr Bei Wu of the University of North Carolina and Dr Richard Crout of the University of West Virginia, who will continue with a program testing oral health and memory in 273 people aged 70.

The new funding will establish larger studies looking for links between oral health and brain function over time, while scientists will also seek to establish a link between improved cognitive function and better oral hygiene through intervention to improve oral health.

In an interview this week Dr Crout, who has predicted that dentists may in future be in a position to administer memory tests on older patients, said: “to have overall good general health you need to have good oral health.”

(Source: http://www.alzheimersweekly.com/Prevention/cleaner-teeth-cleaner-brain-a592.html)

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Problems carrying out daily chores or enjoying hobbies could predict which people with “mild cognitive impairment” will progress more quickly to Alzheimer’s dementia, U.S. researchers report.

According to the Alzheimer’s Association, mild cognitive impairment (MCI) is “a condition in which a person has problems with memory, language, or another mental function severe enough to be noticeable to other people and to show up on tests, but not serious enough to interfere with daily life.” This type of mental state is considered a risk factor for dementia.

In fact, some studies have found that about 10 percent to 15 percent of those with MCI will progress to dementia each year, according to background information in the new study.

Reporting in the September issue of the Archives of Neurology, the researchers sought to determine if there were telltale signs within MCI that might spot those people who would progress more rapidly to full-blown dementia. To do so, they collected data on 111 people with mild cognitive impairment, then evaluated these individuals using brain scans and cognition tests.

Over the next two years of follow-up, 28 people did go on to develop dementia.

“On their own, the tests did not predict which patients went on to develop dementia,” said lead researcher Sarah Tomaszewski Farias, an Associate Professor of Neurology at the University of California, Davis.

“However, level of daily function was a key predictor,” Farias said.

“So, if an older adult is starting to display problems in daily life, such as problems shopping independently, problems managing their own finances, problems performing household chores, and problems maintaining their hobbies, they are more likely to develop a dementia within several years,” she said.

Farias cautioned that the study involved people visiting a clinic because they were already having memory and other problems, so the implications could be different among the general population of older adults.

“If you look at individuals in the community, you see a much slower progression to dementia in those with some mild cognitive impairment,” she said. “The time to develop dementia once someone has mild cognitive impairment is probably slower in the general population of older adults than we had previously thought.”

Still, any kind of early warning is helpful, and Farias believes health-care providers should ask patients and those who know them well – a spouse or adult child – about how they are doing in their daily lives.

“It is important to keep in mind that sometimes individuals themselves lack awareness of some of these problems. So it is important, if at all possible, to get feedback from individuals who are familiar with how the older adult is functioning in their daily life,” she added.

“If there is evidence or suspicion that an older adult has some mild cognitive or memory problems, and it is starting to interfere with their ability to do daily activities, there is a higher likelihood this individual is developing a dementia and they should be closely monitored,” Farias said.

Greg M. Cole, a Neuroscientist at the Greater Los Angeles VA Healthcare System and Associate Director of the Alzheimer’s Center at UCLA David Geffen School of Medicine, said it is crucial to be able to identify people with early Alzheimer’s disease, “if we want to test methods of preventing it.”

“This study illustrates the difficulties in early diagnosis of Alzheimer’s disease in aging people with mild problems with memory and cognition,” Cole said.

“In my view, because memory and cognitive performance vary widely in our population no matter what age, the best indications of ongoing decline are going to be seen against past individual performance rather than some cross-sectional ‘normalized’ standard,” he said.

Dr. Ronald C. Petersen, Director of the Alzheimer’s Disease Research Center at the Mayo Clinic in Rochester, Minn., agreed that, despite the lack of effective treatments, spotting Alzheimer’s disease early remains important.

“If people in the family start to recognize a change in memory/learning patterns, that might be sufficient to identify someone who could develop Alzheimer’s disease,” Peterson said. “Don’t wait until the person is having trouble driving, is having trouble paying their bills or having trouble functioning in the community – that’s dementia,” he said. “This study tells us that we can identify important symptoms earlier and it may be worthwhile doing so.”

(Source: HealthDay, September 17, 2009)

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One of the many tragedies of Alzheimer’s disease is that patients don’t know until it’s too late that they actually have the condition. By the time the first signs of forgetfulness and confusion set in, experts believe, the disease has already been ravaging the brain for a decade or more, causing irreversible damage.

But researchers at the Cleveland Clinic report that they may have found a way to identify those most at risk of developing the neurological disorder long before symptoms develop — simply by asking them whether they recognize celebrities such as Britney Spears and Johnny Carson. It turns out that when people who are at highest risk of Alzheimer’s try to recognize a famous name, their brains activate in very different ways from those of people who aren’t at risk. And scientists can actually see this difference using functional magnetic resonance imaging, or fMRI.

In the Journal Neurology, a team led by Stephen Rao, a brain-imaging specialist, describes a study of 69 healthy men and women aged 65 to 85. The researchers divided the group into three: those who had no risk factors for Alzheimer’s, those who had a family history of the disease but no genetic indicators of it themselves and those who had both family members with Alzheimer’s as well as a version of a gene for a protein called apolipoprotein E4 (ApoE4) that has been linked to the condition. They slid all of the subjects into an fMRI machine, and while the volunteers were there, they saw names of both famous and not-so-famous people flashed in front of them.

Rao’s team found that when volunteers saw names such as Britney Spears, George Clooney, Albert Einstein and Marilyn Monroe, those who were at the highest risk of developing Alzheimer’s — those with both the genetic makeup and a family history — showed high levels of activity in the hippocampus, posterior cingulate and regions of the frontal cortex, all areas involved in memory. The control group showed the opposite pattern. Their brains became more excited when they saw unfamiliar names, which included Irma Jacoby, Joyce O’Neil and Virginia Warfield.

That could mean that the at-risk people were working harder to recognize the well-known celebrities, compensating for already damaged or destroyed neurons that were no longer functioning, while the control group had to struggle only when trying to place the names of noncelebrities, recruiting more nerve cells and connections, racking their memory banks and recall centers. Significantly, in neither group did pictures of the brain designed to pick up structural changes associated with dementia, like signs of atrophy and dead neurons, show any differences — at least not yet.

“This pushes the envelope further in attempting to detect dysfunction in the brain at a stage earlier than any detectable clinical measurement of cognitive decline,” says Dr. Ralph Nixon, a psychiatrist at New York University and vice chair of the medical and scientific advisory council of the Alzheimer’s Association. “We all know that the brain is changing metabolically at a very early stage of the disease, well before clinical symptoms. This type of technique validates that concept.”

While doctors can now test for the presence of ApoE4, you have to have two copies of a particular form of the gene to be at real risk of Alzheimer’s. If you do have them, your chances of developing the disease increase 10- to 20-fold. So far, the Alzheimer’s Association does not recommend widespread screening for the gene, even among those with a family history of Alzheimer’s, since most people who have the risky version of ApoE4 don’t have the necessary gene copies. But looking more closely at people who have a family history of the disease by adding an fMRI scan such as the one Rao conducted to the genetic screen could help doctors select those who do seem to be in the greatest danger of being claimed by the disorder.

The idea is not necessarily to diagnose Alzheimer’s earlier, says Rao. But imaging studies can help to identify those most vulnerable to cognitive decline so they can participate in clinical trials of new drugs designed to postpone or reduce symptoms. “If we can delay the onset of Alzheimer’s by five years,” he says, “by some estimates we can cut the incidence of Alzheimer’s in half. If we can delay the disease by 10 years, we could almost eliminate it because people would die from other conditions first.”

(Source: Time, August 26, 2009 – http://www.time.com/time/health/article/0,8599,1918352,00.html)

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Although seizures are more likely in people with Alzheimer disease (AD) than in the general population, they are not a common feature of AD, new research indicates.

In a study, researchers found that only about 1.5% of patients with AD developed seizures over an average of 3.7 years. “The observed incidence corresponds to less than 1 patient with a seizure for every 200 patients with AD followed up over the course of 1 year,” they point out in the Archives of Neurology this month.

And while earlier reports suggested that seizures occur in more advanced stages of the disease, there was no association in the current study between seizures and disease duration or brain function.

In the study, Dr. Nikolaos Scarmeas, from Columbia University Medical Center, New York, and colleagues followed 453 patients from the early stages of AD for up to 14 years (average, 3.7 years). The patients were in generally good health, well educated and mostly white. Their average age at the outset was 74 years.

During follow-up, 7 patients (1.5%) developed seizures.

The overall incidence of seizures was low, the researchers report, although significantly higher than expected for unprovoked seizures in age-matched people in the general population.

According to the investigators, only younger age was associated with higher seizure risk.

Scarmeas and colleagues suggest that younger patients with AD may have more aggressive disease, or may be more likely to have a clinical episode recognized.

Alternatively, the younger brain may be more susceptible to seizures.

(Source: Archives of Neurology, August 2009)

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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)

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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."

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