Spring Arbor Living Blog

As we age and our memory starts to fade, we all worry about our mental health and the potential for cognitive decline. But maintaining our mental health may not be any harder than going for a walk. A new, nine year study found that walking can keep dementia at bay. So put on your sneakers and go for a walk. Walking six miles a week protects the brain from shrinkage, which may slow the progress of cognitive decline.

Brain size shrinks late in adulthood which often is the start of dementia. Other studies suggest that physical activity protects against the deterioration of brain tissue, but no long-term studies have tested that theory. A study from the University of Pittsburgh wanted to do just that.

They asked 299 healthy, dementia-free men and women, average age 78, to keep track of the number of blocks they walked in a week.

After nine years, the researchers measured the brain size of the participants using high-resolution brain scans. The men and women who walked more had more gray matter. Those who walked approximately six to nine miles a week fared best, even after taking into account variables such as age, sex, body mass index and education. Walking more than 6-9 miles in a week didn't provide extra benefits.

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In this excerpt from a recent issue of Health After 50, Marilyn Albert, Ph.D., director of the Johns Hopkins Alzheimer’s Disease Research Center, talks about current methods of diagnosing Alzheimer's Dementia.

•   Traditionally, how has Dementia been diagnosed? How accurately can it be diagnosed today?

Research now tells us that Dementia progresses over time and likely begins years or decades before symptoms first appear. But right now, we can only diagnose Dementia late in the game. 

To diagnose Dementia we rule out other potential causes for cognitive decline, such as stroke, tumor or metabolic syndrome (a combination of medical disorders that raises the risk of heart disease, diabetes and stroke that may also increase the risk of dementia).

We then run a battery of cognitive tests and brain scans to rule out other neurological disorders and to determine whether the pattern of symptoms seems consistent with Dementia. If these things match up, we can give a probable diagnosis of Dementia. At major medical centers, a probable Alzheimer's Dementia diagnosis can be 80 to 90 percent accurate.

•   What are biomarkers, and how will they help with earlier, more accurate diagnosis of Dementia?

"Biomarker" is a term that describes a measurable change in a person that will give us information about what is going on in his or her brain tissue. For example, the signature of Alzheimer’s disease includes amyloid plaques [abnormal accumulation of amyloid proteins] and neurofibrillary tangles (deposits of defective tau proteins, a type of protein abundant in the brain).

The proteins related to the plaques and tangles are present in the spinal fluid of patients with Dementia. They’re also present in those with mild cognitive impairment (MCI) -- slight problems in thinking, learning and remembering that sometimes progress to full-blown dementia.

The proteins serve as biomarkers of the progressive changes taking place in the brain. In clinical research, tau and amyloid have been shown to predict the progression of patients with MCI to Dementia and ultimately Alzheimer's.

In other words, measuring these proteins allows us to say more accurately and at an earlier stage of disease that we are pretty sure this person is going to develop Alzheimer’s dementia. Imaging procedures, such as PET (positron-emission tomography) and MRI (magnetic resonance imaging), also can provide information about the pathology present in the brain. For example, amyloid can now be measured with PET.

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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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Brain scans may help identify which individuals with a mild decline in their mental abilities will go on to develop Alzheimer's disease, according to a new study.
 
The research focused on patients with mild cognitive impairment, a condition in which people experience noticeable declines in their cognitive function, including memory and language problems. These changes are not severe enough to interfere with everyday activities, according to the Alzheimer's Association.
It is known that about 15 to 20 percent of such patients will go on to develop Alzheimer's, but researchers don't know which ones.

In the new study, which involved magnetic resonance imaging (MRI), researchers were able to identify a high-risk group – patients who had a 69 percent chance of developing Alzheimer's disease in the next year.

The study used the MRI scans to identify brain characteristics that put people at risk for Alzheimer's. The researchers determined some patients had just a 3 percent risk of developing Alzheimer's in the next year, which is about the same as for a healthy older person. Others had a 40 percent risk of developing the condition in the next year, or double the risk associated with a diagnosis of mild cognitive impairment, and still others were identified as part of the high-risk group, said study researcher Linda K. McEvoy, an assistant professor in the department of radiology at the University of California, San Diego School of Medicine.

A similar technique could be used one day by doctors to determine the Alzheimer's risk for patients with mild cognitive impairment. However, the patients in the study were not representative of the general population — they had been selected to exclude people who experienced other types of memory problems, such as those due to a stroke. A larger study would be needed before the results could be translated to the doctor's office.

Alzheimer's disease risk
The study looked at MRI scans of the brains of 203 healthy adults, 164 patients with Alzheimer's disease and 317 patients with mild cognitive impairment. Each patient had their brain scanned at the start of the study and again a year later.

The researchers first compared the brains of Alzheimer's disease patients with those of healthy people, looking for differences in the degree of  shrinkage, or atrophy, in particular areas of the brain. Once they developed a way to distinguish these two groups of people, "we could use the same equations on the mild cognitive impairment (MCI) subjects to determine their risk of developing Alzheimer's disease," McEvoy said.
 
When the researchers included information about how the brains had changed in the time between the two scans, they were able to identify the high-risk group.

Future applications
Information in this study will be critical once we have ways to prevent Alzheimer's disease, McEvoy said. "Currently there's no cure or prevention for Alzheimer's disease. But there's a lot of research going on right now into different potential therapies. If any of those therapies turn out to be useful, then this kind of information will be crucial — a doctor needs to know who's at higher risk in order to treat them".

 Original article by Rachael Rettner- MyHealthNewsDaily

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