Alzheimers

Alzheimer's & other dementias

Healthy diet could slow or reverse early effects of Alzheimer's disease

August, 2010

A mouse study demonstrates that the right diet can reverse Alzheimer’s damage in the early stages.

Following on from previous research with mice that demonstrated that a diet rich in methionine could increase the risk of developing Alzheimer's Disease through its effect on homocysteine levels, a new study has found that these effects were reversible if the mice then switched to a healthier diet. The mice, after five months on a methionine-rich diet, were divided into two groups, with one group continuing the diet and the second switching to the healthy diet for an additional two months. The cognitive impairment, and the build-up in amyloid plaques, was completely reversed after two months.

Methionine is an amino acid typically found in red meats, fish, beans, eggs, garlic, lentils, onions, yogurt and seeds. I note, however, that most of the items in this list are usually considered healthy! Fish, in particular, has been shown in a number of studies to reduce the risk of Alzheimer’s. The point is that methionine in itself is an essential amino acid and necessary for a healthy brain, but this indicates that, as with many foods, moderation is important. Clearly a balance is required; equally clearly, we still haven’t quite worked out the ‘perfect’ Alzheimer’s-prevention diet. Nevertheless, this study is welcome in demonstrating that diet can have such an effect on the brain, and adds to our knowledge of what makes a good diet for staving off dementia.

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Music aids Alzheimer's patients in remembering new information

August, 2010

A small study has found that music can help patients with Alzheimer's disease recognize verbal information.

The study involved 13 patients and 14 controls, who listened to either spoken lyrics or lyrics sung with full musical accompaniment while reading the printed lyrics on a screen. The 40 lyrics were four-line excerpts of children’s songs, all characterized by having simple, unrepeated lyrics, repetitive melodies, and a perfect end-rhyme scheme for the four lines. The participants were then given these 40 lyrics mixed in with 40 other similar lyrics, and asked whether they had heard it earlier. Alzheimer’s patients were markedly more likely to recognize those they had heard sung (40% compared to 28% of the spoken). Interestingly, the controls showed no difference, although of course their performance was considerably better (77% and 74%).

It may be that setting new information, such as simple instructions, to music might help Alzheimer’s patients remember it.

On a side note, a recent study found that classical music (four short pieces by different composers) affected the heart rates of people in a vegetative state in the same way as they did those of healthy listeners, suggesting that music affects emotion at very deep level. (see http://www.newscientist.com/article/dn19123-classical-music-moves-the-he...)

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Special care plan does not slow decline in patients with Alzheimer's

August, 2010

A large French study has found no evidence that special care plans for dementia patients improve the outcomes.

A study involving over 1100 patients with mild to moderate Alzheimer's disease at 50 French clinics has revealed that receiving a comprehensive care plan involving regular 6-monthly assessments (with standardised guidelines for the management of problems) produced no benefits compared to receiving the usual care (an annual consultation). After two years, there was no significant difference in functional decline between the two groups, and no difference in the risk of being admitted to an institution or death. While this argues against guideline-based interventions for dementia care (widely recommended), it may be that the treatment received by both groups was superior to that received by those who do not attend a specialized memory clinic. It remains to be seen whether the findings would be different for patients being treated in general practice.

It should also be noted that this study only measured the effects on daily activities, institutionalization, and death. A number of studies have found improvements in specific behaviors (eg, reduced behavioral problems, reduced agitation, or improved quality of life) as a result of particular care programs. The fact that, in this case, interventions were more frequent early in the study compared to later, suggests that the care plan may not have been all that easy to implement.

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Muted emotions misleading in Alzheimer's disease

August, 2010

Indications that blunted emotions are part of Alzheimer’s are a warning not to assume that reduced emotional response is a sign of depression.

A small study suggests that the apathy shown by many Alzheimer's patients may not simply be due to memory or language problems, but to a decreased ability to experience emotions. The seven patients were asked to rate pictures of positive and negative scenes (such as babies and spiders) by putting a mark closer or further to either a happy face or a sad face emoticon. Closeness to the face indicated the strength of the emotion felt. Although most of the time the Alzheimer’s patients placed their mark in the appropriate direction, they did make more inappropriate choices than the control group, and typically also gave less intense judgments.

Both comprehension problems and depression were ruled out. A lower emotional response may result from damage to brain areas that produce neurotransmitters, which typically occurs early in Alzheimer’s. It may be that medication to replace or increase these neurotransmitters would improve emotional experience.

This finding is a warning that apathy should not be automatically taken to mean that the patient is depressed. The researchers, enabled by the small size of the study, tested more thoroughly for depression than is usually the case in large studies. It may be that in these studies, this apathy has often been confounded with depression — which may explain the inconsistencies in the research into depression and Alzheimer’s (see the news item just previous to this).

The finding may also help caregivers understand that any emotional indifference is not ‘personal’.

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[1674] Drago, V., Foster P. S., Chanei L., Rembisz J., Meador K., Finney G., et al.
(2010).  Emotional Indifference in Alzheimer's Disease.
J Neuropsychiatry Clin Neurosci. 22(2), 236 - 242.

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Depression increases risk of dementia

August, 2010
  • New data from a large long-running study provides more conclusive evidence that depression is indeed a risk factor for dementia.

Data from the long-running Framingham Heart Study has revealed that depression significantly increased the risk of developing dementia. Of the 125 people (13%) who were classified as having depression at the start of the study, 21.6% had developed dementia by the end of the study (17 years later). This compares to around 16.6% of those who weren’t depressed. When age, gender, education, homocysteine, and APOE gene status were taken into account, depressed participants had a more than 50% increased risk of developing dementia. Moreover, for each 10-point increase on the self-report scale used to measure depression (CES-D), there was a significant increase in the dementia risk. These findings, from one of the largest and longest population-based studies, should clarify the inconsistent results from earlier research.

There are several possible ways depression might increase the risk of dementia — for example, through the brain inflammation or the increased level of certain proteins that occurs during depression; or through the effects on lifestyle (reduced exercise, social engagement, poor diet).

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Larger head size may protect against Alzheimer's symptoms

August, 2010
  • Another study finding larger head size helps protect people with Alzheimer’s brain damage from cognitive impairment.

Confirming previous research, a study involving 270 Alzheimer’s patients has found that larger head size was associated with better performance on memory and thinking tests, even when there was an equivalent degree of brain damage. The findings are consistent with the theory of cognitive reserve. They also point to the importance of brain development early in life, since the brain reaches 93% of its final size at age six, and while partly determined by genes, brain growth is also influenced by nutrition, infections, and brain injuries.

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Link among Alzheimer's disease, Down syndrome, atherosclerosis and diabetes

January, 2010

New evidence suggests that Down syndrome, Alzheimer's, diabetes, and cardiovascular disease, all share a common disease mechanism.

It’s been suggested before that Down syndrome and Alzheimer's are connected. Similarly, there has been evidence for connections between diabetes and Alzheimer’s, and cardiovascular disease and Alzheimer’s. Now new evidence shows that all of these share a common disease mechanism. According to animal and cell-culture studies, it seems all Alzheimer's disease patients harbor some cells with three copies of chromosome 21, known as trisomy 21, instead of the usual two. Trisomy 21 is characteristic of all the cells in people with Down syndrome. By age 30 to 40, all people with Down syndrome develop the same brain pathology seen in Alzheimer's. It now appears that amyloid protein is interfering with the microtubule transport system inside cells, essentially creating holes in the roads that move everything, including chromosomes, around inside the cells. Incorrect transportation of chromosomes when cells divide produces new cells with the wrong number of chromosomes and an abnormal assortment of genes. The beta amyloid gene is on chromosome 21; thus, having three copies produces extra beta amyloid. The damage to the microtubule network also interferes with the receptor needed to pull low-density lipoprotein (LDL — the ‘bad’ cholesterol) out of circulation, thus (probably) allowing bad cholesterol to build up (note that the ‘Alzheimer’s gene’ governs the low-density lipoprotein receptor). It is also likely that insulin receptors are unable to function properly, leading to diabetes.

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Hypertension linked to dementia in older women

January, 2010
  • A large study has found that women with high blood pressure had significantly higher amounts of white matter lesions (a risk factor for dementia) 8 years later.

Part of the Women's Health Initiative study looking at the effect of hormone therapy on thinking and memory in postmenopausal women, involving over 1400 women, has found those who had high blood pressure at the start of the study (eight years earlier) had significantly higher amounts of white matter lesions. Damage to white matter seems to be an independent risk factor for dementia. The finding adds to evidence suggesting that preventing hypertension helps protect against dementia. High blood pressure is common in the U.S. — of the nearly 99,000 women enrolled in the WHI study, 37.8% had hypertension. You can watch the researcher discussing the findings at http://www.eurekalert.org/multimedia/pub/19494.php?from=152110

Reference: 

Kuller, L. H., Margolis, K. L., Gaussoin, S. A., Bryan, N. R., Kerwin, D., Limacher, M., et al. (2009). Relationship of Hypertension, Blood Pressure, and Blood Pressure Control With White Matter Abnormalities in the Women's Health Initiative Memory Study (WHIMS) MRI Trial. The Journal of Clinical Hypertension, 9999(9999). doi: 10.1111/j.1751-7176.2009.00234.x.

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Specific hippocampal atrophy early sign of MCI & Alzheimer's

January, 2010
  • People with MCI who later developed Alzheimer's disease showed 10-30% greater brain atrophy in two specific regions.

A three-year study involving 169 people with mild cognitive impairment has found that those who later developed Alzheimer's disease showed 10-30% greater atrophy in two specific locations within the hippocampus, the cornu ammonis (CA1) and the subiculum. A second study comparing the brains of 10 cognitively normal elderly people and seven who were diagnosed with MCI between two and three years after their initial brain scan and with Alzheimer's some seven years after the initial scan, has confirmed the same pattern of hippocampal atrophy, from the CA1 to the subiculum, and then other regions of the hippocampus.

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Apostolova, L.G. et al. In press. Subregional hippocampal atrophy predicts Alzheimer's dementia in the cognitively normal. Neurobiology of Aging, Available online 24 September 2008.

[392] Apostolova, L. G., Thompson P. M., Green A. E., Hwang K. S., Zoumalan C., Jack, Jr C. R., et al.
(2010).  3D comparison of low, intermediate, and advanced hippocampal atrophy in MCI.
Human Brain Mapping. 9999(9999), NA - NA.

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Mental fluctuations may signal Alzheimer's disease

January, 2010

A study has found that mental fluctuations were very rare in those without Alzheimer's, but occurred in nearly 12% of those with very mild or mild Alzheimer’s.

A study involving 511 older adults (average age 78) has found that 11.6% of those with very mild or mild Alzheimer’s (43% of the participants) had mental lapses, compared to only 2 of the 295 without Alzheimer’s. Those with mental lapses also tended to have more severe Alzheimer’s. Although mental lapses are characteristic of dementia with Lewy bodies, this is the first study to look at them in connection with Alzheimer’s. Having mental lapses was defined as having three or four of the following symptoms:

  • Feeling drowsy or lethargic all the time or several times per day despite getting enough sleep the night before
  • Sleeping two or more hours before 7 p.m.
  • Having times when the person's flow of ideas seems disorganized, unclear, or not logical
  • Staring into space for long periods

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