Spring Arbor Living Blog

As our population ages, people with chronic cardiovascular disease, including atrial fibrillation (or irregular heartbeat), are living longer. In a study reported in the journal Heart Rhythm (Volume 7, page 433) researchers reported that atrial fibrillation may be associated with an increased risk of developing dementia and Alzheimer's disease.

Over 37,000 people, average age 60, from the ongoing Intermountain Heart Collaborative Study database were evaluated for signs of atrial fibrillation and for Alzheimer's disease or vascular, senile or nonspecific dementia. During an average of five years' follow-up, 4 percent developed dementia and 27 percent developed atrial fibrillation.

Atrial fibrillation was associated with each of the four types of dementia, independent of other cardiovascular diseases. The youngest group with atrial fibrillation (under age 70) had the highest risk of dementia; dementia is linked to older age, so this finding suggests the relationship between atrial fibrillation and dementia is particularly strong. Atrial fibrillation was also linked with the highest risk of death.

Take away: Because subjects with atrial fibrillation were identified as having higher risks of dementia and death, people with cardiovascular diseases -- who are urged to consider measures like diet, exercise, medication and avoiding tobacco for their heart disease -- might want to take these steps also to prevent or delay the development of Alzheimer's.

All the facts you need to make informed decisions if you have to confront Alzheimer's disease -- the most common cause of dementia

Written by Dr. Peter V. Rabins, director of the Division of Geriatric and Neuropsychiatry at the Johns Hopkins School of Medicine and Medical Editor of the Johns Hopkins Memory Bulletin, Diagnosing and Treating Alzheimer's Disease is an indispensable resource for anyone concerned about Alzheimer's disease. This new report provides all the facts you need to make informed decisions if you have to confront Alzheimer's disease. You'll learn how Alzheimer's is currently diagnosed ... the existing drugs that are used to treat it ... and various new therapies that may someday provide better treatment.

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Gaining weight, especially in the midsection, has been associated with a number of health conditions, including diabetes, heart disease and cancer. New research suggests that you can add shrinking brain size, an indication of Alzheimer's disease and dementia, to that list.

Using data collected from 733 healthy participants with an average age 60, investigators looked at the associations among body mass index (BMI), waist circumference, waist-to-hip ratio, amount of subcutaneous and visceral abdominal fat and four different magnetic resonance imaging (MRI) based measurements of brain volume.

Researchers discovered that although all of the assessments of weight were linked with a reduction in brain volume to some degree, the link was strongest between abdominal fat and decreased brain volume. This association was independent of BMI and measurements of insulin resistance.  The study was reported in the Annals of Neurology.

This finding sheds some light on the mechanisms that underlie the association between weight gain and dementia, which is still not well understood. People who are concerned about dementia should take steps to lower their amount of abdominal fat.

Original article - Johns Hopkins

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Lewy body dementia is a form of dementia that may account for as many as 20% of all dementia cases. Lewy bodies are tiny spherical deposits of a protein called alpha-synuclein that are found in the brains of patients with this disorder. The presence of Lewy bodies throughout the brain disrupts the brain's normal functioning. Lewy body dementia is now believed to be the second most common specific cause of dementia after Alzheimer's disease.

There is considerable overlap between Lewy body dementia and Alzheimer's and Parkinson's disease. In Lewy body dementia, patients experience a loss of dopamine-producing nerve cells similar to that seen in Parkinson's disease. They also lose acetylcholine-producing nerve cells, similar to what occurs in Alzheimer's disease.

Patients with Lewy body dementia often experience cognitive problems associated with Alzheimer's disease, such as memory loss, spatial impairment and language difficulties. They may also develop parkinsonian symptoms, such as muscle rigidity, a blank facial expression, soft voice, tremor, poor balance and gait disturbances. Some patients initially diagnosed with Parkinson's disease later go on to develop a dementia that closely resembles Lewy body dementia.

Certain symptoms of Lewy body dementia help distinguish it however. For example, early in the illness Lewy body dementia patients often experience detailed and extremely vivid hallucinations, unlike people with Alzheimer's disease. People with Lewy body dementia also tend to show marked fluctuations in their cognitive functioning, often several times a day. In addition, they tend to fall asleep easily during the day and have restless, disturbed sleep with behavioral acting out.

Recognition of these symptoms leads to an accurate diagnosis of Lewy body dementia. A correct diagnosis is particularly important because the medical management of patients with Lewy body dementia presents special challenges. The drugs that are normally used can aggravate other problems and cause potentially serious adverse reactions. In particular, antipsychotic drugs can provoke dangerous side effects, including a return to psychosis, and must be used cautiously, if at all. In addition, levodopa, a drug normally used to treat parkinsonian symptoms, may worsen hallucinations, so its dosage needs to be carefully adjusted in patients with Lewy body dementia.

This disease is named for Frederick Lewy, the physician who first identified them in 1912 while working in the laboratory of Dr. Alois Alzheimer.

Original article from Johns Hopkins

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The decision to move your loved one into an assisted living facility is not an easy one. As your loved one ages, they may need more help with daily activities like bathing or remembering medication. Moving to a facility that provides some assistance, without sacrificing independence, may be an option. This type of assisted living environment such as Spring Arbor, is a great option for long-term care.

What should you consider when looking for an assisted living community? First, think about what activities you or your loved one need help with. Here are some considerations to help guide you in your search.

What is most valuable in your loved one's life? What gives them purpose and meaning? Think about where their doctors, church, and family are. The assisted living facility should be near the things and people they hold dear. Seniors need to remain connected.

Think about current and future needs. If a progressive illness is involved look for a facility that can accommodate as mobility changes. Ask questions like: What are the levels of care offered? Are there ramps located throughout? Is the room or apartment fully accessible if a wheelchair is required in the future?

Also, if dementia is involved, there is a risk of wandering; is there an Alzheimer’s area that is safe and secure? When a loved one has Alzheimer's or a related dementia it can seem as though few options are available. As needs progress, the constant care and attention required can seem overwhelming. To meet this need, Spring Arbor offers  "Special Care Cottages" programs that are custom designed for residents with these unique challenges.

Get referrals. You will be surprised at how many people you know or how many people you can be connected with who have done this research. Also, contact your local agency on aging to find out if they can provide a list of facilities they'd recommend in your area.

Visit a few times beforehand. Stop by the community at least twice and take at least one guided tour. Show up unannounced for some other visits in order to see what happenings on a regular day. A nighttime visit is important because most of the staff has likely gone home.

Talk to current residents. If is it possible, talk to residents you meet during your on-site visits.

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Dr. Potter, chief of the Division of Geriatrics and Gerontology at the University of Nebraska Medical Center says:

Stay mentally active. What actually happens is that as we get older, synapses in the brain are stimulated by mental activity, so this helps to preserve mental ability. Just being well-educated is a good idea. Education and mental stimulation helps to create and preserve and develop new connections. So taking a course later in life is a good idea.

Following a good heart-healthy diet is good for memory because what's good for your heart is good for your brain. And you can actually stimulate develop of new brain cells with physical activity.

Dr. Mastrianni, Associate Professor of Neurology; Co-Director, Center for Comprehensive Care and Research on Memory Disorders at the University of Chicago Medical Center says:

There things one can do to avoid developing Alzheimer's disease or memory decline associated with aging.  Lifestyle changes that have shown benefit include routine physical exercise, staying socially active and eating a heart-healthy diet. At least 30 minutes a day of physical activity gets your heart pumping and improves oxygenation of brain cells.

Social activity may include staying actively working, or volunteering in local organizations or clubs.  Research suggests that having a large network of social interactions helps to maintain good brain function and even delay Alzheimer's disease.

Finally, eliminating unhealthy practices such as cigarettes, too little sleep, and too much stress can't hurt and are likely to help your brain function better.

Dr. Shulman, assistant professor of neurology and associate director of Cognitive and Behavioral Neurology at the Pearl Barlow Center for Memory Evaluation and Treatment at the Silberstein Alzheimer's Institute at NYU Langone Medical Center says:

There are four main pillars of keeping healthy memory or maintaining brain fitness: healthy diet, exercise, keeping mentally stimulated and avoiding depression. There is no single entity that we can modify that will decrease the likelihood of someone developing Alzheimer's. It's a combination of applying all of these.

The issue with avoiding depression is a controversial one: Is depression itself a risk factor for dementia, or is the early sign of depression the earliest sign of dementia itself? It looks increasingly like it's a risk factor for Alzheimer's disease, and there's a whole host of complicated reasons, but it does seem that if you keep stress-free and depression-free, that in and of itself is insurance for healthy aging.

Original article My Health News Daily

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The eyes are a window into the brain for many disorders, and Alzheimer's disease may be no exception.

In a pilot study, retinal scans to measure blood vessel thickness at the back of the eye showed strong correlations with the level of beta-amyloid deposits in the brain.

At a press briefing in advance of his formal presentation at the International Conference on Alzheimer's Disease (ICAD), Frost said the retinal scans could be a relatively easy and cheap way to screen people for preclinical Alzheimer's disease.

He reported early findings from a study which is tracking some 500 individuals as they age.

Some earlier studies have linked retinal abnormalities to cognitive dysfunction. For example, in a large 2009 study, patients with mild cognitive impairment were reported to be at almost 40% higher risk for age-related macular degeneration after controlling for other risk factors.

In the current study, participants were classified as having normal cognition, mild cognitive impairment (MCI), or Alzheimer's disease according to clinical assessments. A total of 146 were included in the current study: 110 healthy, 13 with MCI, and 13 with Alzheimer's disease.

The retinal scans measured central retinal arterial and venous diameters, with the arterio-venular ratio (AVR) as the primary indicator of possible Alzheimer's pathology.

Study participants also underwent PET scans.

Frost reported correlations between the retinal and PET scan data for 46 of the healthy controls, nine MCI patients, and three with Alzheimer's disease.

Preliminary findings from the study indicated that AVR values correlated significantly with amount of plaque build-up.

Perhaps the most important finding was that, in the cognitively normal individuals, the AVR values differed according to plaque build-up.

These values were significantly higher in the 15 individuals with large burdens relative to the 31 with low plaque levels.

Frost said the correlations were driven primarily by differences in retinal venous thickness.

William Klunk, of the University of Pittsburgh, who moderated the press briefing, said a test like this would probably be most useful as a preliminary screen.

Right now, the most accurate tests for detecting early or preclinical Alzheimer's disease require cerebrospinal fluid samples and PET scans. But these may be too expensive and invasive for broad screening of individuals with nonspecific symptoms or who only have risk factors for the disease.

"This test [the retinal scan] is on the end of easier to accomplish, completely noninvasive, and relatively inexpensive," he said.

However, "it's not going to have a perfect correlation to pathology in the brain," he added, although it could be very useful for identifying individuals who would possibly need more elaborate testing.

Original article on Medpagetoday.com

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Up to half of Alzheimer's disease cases worldwide are potentially attributable to seven preventable risk factors, a new study suggests. 

The findings show that Alzheimer's cases could be reduced if people quit smoking, increased their physical activity, enhanced their mental activity, controlled their blood pressure and diabetes, and managed their obesity and depression. 

The top 3 factors

In this study by University of California, San Fransisco, the authors reviewed previous research that examined factors that predispose people to developing Alzheimer's. They identified seven factors that were potentially within a person's control to change. 

Enhancing mental activity could make the biggest difference in developing Alzheimer's. That's because the study showed "low educational attainment" was the factor that impacts the largest portion of Alzheimer's cases worldwide. They defined low educational attainment as not completing higher education, having a low IQ or not participating in mentally stimulating leisure time activities, and found it contributes to 19% of Alzheimer's cases, or 6.5 million cases worldwide. 

Smoking contributes to the second-highest number of cases, 14% of cases, or 4.7 million cases worldwide.
Physical inactivity contributed to 13% of worldwide cases and was the third-largest factor. However, it was the highest contributor to cases in the U.S. — contributing to 21%, or 1.1 million cases. 

What really mattered was how common the risk factors were in the population. In the U.S., about a third of the population is sedentary, so a large number of Alzheimer's cases are potentially attributable to physical inactivity. 

However, worldwide, low education was more important, because so many people throughout the world are illiterate or are not educated beyond elementary school. And, smoking also contributed to a large percentage of cases worldwide because it is still very common. 

This suggests that smoking cessation and initiatives to increase physical activity could dramatically decrease  the number of Alzheimer's cases. 

A note of caution

It has been noted that while these seven factors may contribute to the development of Alzheimer's, none of the factors have been shown to cause the disease. 

However, the findings suggest "that preventive and therapeutic interventions have great potential," and that interventions should be carried out in high-risk populations. 

Globally, an estimated 33.9 million people have Alzheimer's, but that number could be reduced by 3 million if there was a 25% reduction in all seven of these risk factors. A 10% reduction in these seven factors could prevent 1.1 million cases. The number of worldwide cases is expected to triple over the next 40 years.

The results of the study were presented July 20 at The Alzheimer's Association 2011 International Conference on Alzheimer's Disease (ICAD), held in Paris. The study was simultaneously published online in the journal The Lancet Neurology. 

Original article on MSNBC.com

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One day your doctor might give you this prescription to prevent Alzheimer’s: Eat less red meat and sugar; eat more fruits, vegetables, fish and olive oil.

At least that seems to be the finding of a new study that found that eating a diet low in saturated fat and sugary treats can improve your memory and may reduce your risk of developing dementia.

Researchers with the University of Washington and Veterans Affairs Puget Sound medical center decided to see if a change in diet could affect the risk for Alzheimer’s or benefit those already suffering some mild but early symptoms of the disease.

What they found was that a diet rich in fruits, vegetables, grains, fish and olive oil can improve some memory skills in both healthy older adults, as well as those already experiencing cognitive difficulty.

More importantly, eating this kind of diet can help healthy adults reduce their risk of developing dementia, says study researcher Suzanne Craft with the Memory Wellness Program at the VA.

Researchers found that after four weeks on the low-fat diet, subjects had fewer toxic proteins and evidence of inflammation in their spinal fluid, both considered to be bio-markers for Alzheimer’s, Craft said.

“I like to think of this kind of diet as promoting healthy brain aging, as well as reducing the risk of Alzheimer’s,” she said.

The Washington state researchers wrote that they decided to take a “whole-diet” approach, rather than focus on a single dietary component, such as omega-3 fish oil. They also chose to test the subjects’ spinal fluid for bio-markers because of the importance of the central nervous system to brain health.

The 49 subjects, all older than 60, included 20 healthy adults with no signs of memory decline, and 29 who were at high-risk for Alzheimer’s, having already been diagnosed with some cognitive impairment.

They were randomly selected to either follow a four-week low-saturated fat, high-fiber plan similar to a Mediterranean diet, or a four-week high-saturated fat diet that included foods like red meat, butter, french fries and soda.

Both groups ate the same amount of protein and the diets were balanced so subjects did not lose or gain or weight.

However, for those who want to protect their brain health, it seems pretty clear from these preliminary results that eating a healthy diet is a powerful first step.

Original article on AARP

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The link to healthy diets and brain health is well established. The link to diet and Alzheimer's disease is less clearly established, but new information on curcumin (found in turmeric) may prove to be helpful.

The brain is particularly vulnerable to oxidative damage due to its high rate of metabolism and long-lived neurons. Free radicals can cause oxidative damage to important cellular components such as DNA, or the cell membrane. Cells may function poorly or die if there is too much oxidative damage.

Antioxidants defend the cells from free radical damage. Many long term studies have demonstrated that those with higher antioxidants in their diets from fruits, vegetables and certain spices have slower rates of cognitive decline than those who ate less of these foods.

Curcumin has been studied recently because of the low rates of Alzheimer's disease in India. The Indian population consumes large amounts of curcumin through Tumeric and have a relatively low (4 times less) incidence of Alzheimer's disease compared to the U.S. population.

Curcumin is a member of the ginger family and is the main ingredient of turmeric, a spice used in curry and many Middle Eastern dishes. Curcumin is an antioxidant with nonsteroidal anti-inflammatory properties which prevents the damage caused by free radicals. The more antioxidants in the diet, the more the cells are protected.

The National Institutes of Health and other research organizations have been completing Alzheimer's clinical trials. Recently, curcumin has been in the forefront of much of this research. Curcumin's powerful anti-inflammatory and anti-oxidant properties suppress the buildup of beta-amyloid in brain tissue.

The National Institute of Neurological Disorders and Stroke (NINDS) studied mice and found that curcumin crosses the blood-brain barrier to bind with beta-amyloid peptides. These peptides are dangerous when they build up into plaques.

As Alzheimer's disease develops, neurons go through a process from a healthy state to some loss of molecular efficiency, to a loss of synaptic function, to loss of synapses, and, ultimately, to cell death. When curcumin was fed to aged mice, there was a reduction in amyloid levels and the overall amount of dangerous plaque.

More studies are needed to investigate the safety and tolerability of curcumin in the elderly population. Research is also needed in the areas of using curcumin to prevent Alzheimer's Disease as well as to lessen symptoms.

As clinical trials produce more information about the efficacy of curcumin, guidelines will be established for those at risk and for those affected.

Original article on CDApress.com by Seanne Safail, , Ph.D, RD

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Disease develops years before symptoms show.

New guidelines for diagnosing Alzheimer's disease set forth methods for identifying the disease before it progresses to full-blown dementia, and for the first time include lab and brain-imaging tests that can help identify Alzheimer's as the likely cause of a person's mental decline.

The guidelines, revised for the first time in 27 years, reflect a firm consensus among Alzheimer's researchers that the disease begins to attack the intricate structures of the brain 10 years or more before the disabling mental problems appear. Therefore, to be effective, drug or other therapies will have to begin work early in that process.

So far, though, there are no therapies that alter the course of Alzheimer's disease. And in a media briefing, authors of the new diagnosis guidelines emphasized that while testing for Alzheimer's pathology in the brain may one day be used to identify the disease at much earlier stages, today the tests are primarily a research tool. They are not ready for routine use in doctors' offices.

Delaying disability

Even so, doctors hope the new diagnostic criteria encourage people with worrisome memory problems to seek help. There's a lot patients and their families can do to minimize the impact of Alzheimer's, from structuring the patient's environment to optimizing medical care, activities, exercise and diet.

New tests outlined in the guidelines involve looking at the brain with imaging technologies and examining the fluid obtained by a spinal tap. The imaging studies can reveal so-called plaques made up of a protein called amyloid, a defining feature of Alzheimer's. They also can indicate characteristic patterns of shrinkage or reduced metabolic activity in the brain. The cerebrospinal fluid tests look for levels of amyloid as well as of another protein, tau, which makes up the twisted strands or "tangles" that, like plaques, are signature brain pathology in Alzheimer's.

Weaknesses of the tests

Research studies have demonstrated that all these tests can help identify Alzheimer's as the cause of a patient's dementia, and can help predict which patients with milder symptoms will go on to develop dementia. But the tests aren't conclusive in themselves. They aren't standardized so that a certain result means the same thing in every medical center. And there's no clear cutoff separating normal findings from those indicating a problem.

Original article by: Katharine Greider from AARP Bulletin

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