Health & age-related problems

New brief tool to screen for cognitive impairment in elderly patients

December, 2010

A 2-minute questionnaire does an excellent job of indicating older adults with cognitive impairment.

A simple new cognitive assessment tool with only 16 items appears potentially useful for identifying problems in thinking, learning and memory among older adults. The Sweet 16 scale is scored from zero to 16 (with 16 representing the best score) and includes questions that address orientation (identification of person, place, time and situation), registration, digit spans (tests of verbal memory) and recall. The test requires no props (not even pencil and paper) and is easy to administer with a minimum of training. It only takes an average of 2 minutes to complete.

A score of 14 or less correctly identified 80% of those with cognitive impairment (as identified by the Informant Questionnaire on Cognitive Decline in the Elderly) and correctly identified 70% of those who did not have cognitive impairment. In comparison, the standard MMSE correctly identified 64% of those with cognitive impairment and 86% of those who were not impaired. In other words, the Sweet 16 missed diagnosing 20% of those who were (according to this other questionnaire) impaired and incorrectly diagnosed as impaired 30% of those who were not impaired, while the MMSE missed 36% of those who were impaired but only incorrectly diagnosed as impaired 14% of those not impaired.

Thus, the Sweet 16 seems to be a great ‘first cut’, since its bias is towards over-diagnosing impairment. It should also be remembered that the IQCDE is not the gold standard for cognitive impairment; its role here is to provide a basis for comparison between the new test and the more complex MMSE. In comparison with a clinician’s diagnosis, Sweet 16 scores of 14 or less occurred in 99% of patients diagnosed by a clinician to have cognitive impairment and 28% of those without such a diagnosis.

The great benefit of the new test is of course its speed and simplicity, and it seems to offer great promise as an initial screening tool. Another benefit is that it supposedly is unaffected by the patient’s education, unlike the MMSE. The tool is open access.

The Sweet 16 was developed using information from 774 patients who completed the MMSE, and then validated using a different group of 709 older adults.

Reference: 

[1983] Fong, T. G., Jones R. N., Rudolph J. L., Yang F. M., Tommet D., Habtemariam D., et al.
(2010).  Development and Validation of a Brief Cognitive Assessment Tool: The Sweet 16.
Arch Intern Med. archinternmed.2010.423 - archinternmed.2010.423.

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DHA improves memory in older adults with cognitive impairment

December, 2010

A largish clinical study of cognitively impaired older adults has found six months of DHA supplements improved visual and verbal learning, though not working memory.

There have been mixed findings about the benefits of DHA (an omega-3 fatty acid), but in a study involving 485 older adults (55+) with age-related cognitive impairment, those randomly assigned to take DHA for six months improved the score on a visuospatial learning and episodic memory test. Higher levels of DHA in the blood correlated with better scores on the paired associate learning task. DHA supplementation was also associated with better verbal recognition, but not better working memory or executive function.

Other research has found no benefit from DHA to those already with Alzheimer’s, although those with Alzheimer’s tend to have lower levels of DHA in the blood. These findings reinforce the idea that the benefit of many proactive lifestyle strategies, such as diet and exercise, may depend mainly on their use before systems deteriorate.

The daily dose of algal DHA was 900 mg. The study took place at 19 clinical sites in the U.S., and those involved had an MMSE score greater than 26.

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Brain changes found in football players thought to be concussion-free

November, 2010

Another study adds to evidence that the extent of the problems of repeated impact to the head in football have been under-estimated.

Monitoring of 11 football players at a high school in Indiana, who wore helmets equipped with sensors that recorded impart, has revealed the problem of head injuries is deeper than was thought. Brain scans and cognitive tests, in addition to the impact data, found that some players who hadn't been diagnosed with concussions nevertheless had developed changes in brain function, correlated with cognitive impairment. The findings point to the dangers of repeated impact, regardless of whether consciousness is lost.

The research is ongoing, and aims to determine how many blows it takes to cause impairment, and whether players accumulate damage over several sessions, or recover. The work to date suggests that those who developed impairment in the absence of concussion received a large number of blows primarily to the top and front of the head. This is just above the dorsolateral prefrontal cortex, which showed changes in activation. Visual working memory was the function principally affected.

Researchers are also working to create a helmet that reduces the cumulative effect of impacts.

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Old bees' memory fades too

November, 2010
  • New research shows that many old bees, like many older humans, have trouble replacing out-of-date knowledge with new memories.

I love cognitive studies on bees. The whole notion that those teeny-tiny brains are capable of the navigation and communication feats bees demonstrate is so wonderful. Now a new study finds that, just like us, aging bees find it hard to remember the location of a new home.

The study builds on early lab research that demonstrated that old bees find it harder to learn floral odors. In this new study, researchers trained bees to a new nest box while their former nest was closed off. Groups composed of mature and old bees were given several days in which to learn the new home location and to extinguish the bees' memory of their unusable former nest box. The new home was then disassembled, and groups of mixed-age bees were given three alternative nest locations to choose from (including the former nest box). Some old bees (those with symptoms of senescence) preferentially went to the former nest site, despite the experience that should have told them that it was unusable.

The findings demonstrate that memory problems and increasing inflexibility with age are not problems confined to mammals.

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Cognitive effects of heavy alcohol and marijuana use in adolescents

November, 2010

Alcohol and marijuana abuse associated with specific cognitive impairments in adolescents, but more surprisingly family history of substance abuse can also have an effect.

A study involving 48 adolescents, of whom 19 had been diagnosed with substance abuse/dependence, and 14 had a family history of substance abuse but no history of personal use, has found that greater alcohol use was associated with a significant decrease in attention and executive function (which is involved in planning and decision-making), while greater marijuana use was associated with poorer memory. Adolescents in the substance abuse group had lower scores in attention, memory, and processing speed, compared to the other groups, while those with a family history of abuse (but no personal history) had poorer visuospatial ability.

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Women's brains grow after giving birth

November, 2010

A small study indicates that nurturing mothers and increased reward centers in the brain go hand-in-hand — although the jury’s still out on which comes first.

The issue of “mommy brain” is a complex one. Inconsistent research results make it clear that there is no simple answer to the question of whether or not pregnancy and infant care change women’s brains. But a new study adds to the picture.

Brain scans of 19 women two to four weeks and three to four months after they gave birth showed that grey matter volume increased by a small but significant amount in the midbrain (amygdala, substantia nigra, hypothalamus), prefrontal cortex, and parietal lobe. These areas are involved in motivation and reward, emotion regulation, planning, and sensory perception.

Mothers who were most enthusiastic about their babies were significantly more likely to show this increase in the midbrain regions. The authors speculated that the “maternal instinct” might be less of an instinctive response and more of a result of active brain building. Interestingly, while the brain’s reward regions don’t usually change as a result of learning, one experience that does have this effect is that of addiction.

While the reasons may have to do with genes, personality traits, infant behavior, or present circumstances, previous research has found that mothers who had more nurturing in their childhood had more grey matter in those brain regions involved in empathy and reading faces, which also correlated with the degree of activation in those regions when their baby cried.

A larger study is of course needed to confirm these findings.

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Explaining and preventing post-surgery memory loss

November, 2010

More evidence of the evils of inflammation for cognitive functioning comes from a mouse study that points to a simple remedy for the cognitive impairment that often follows major surgery.

Major surgery often produces cognitive dysfunction, usually temporary, but for some, long-lasting. It has been suggested that the problem might have to do with the immune system's inflammatory response. A new mouse study provides more evidence for this.

The study found that giving the mice a common inhibitor of the inflammatory response (anti-tumor necrosis factor (TNF) antibody), before orthopedic surgery, decreased postoperative cognitive decline. It’s hoped human clinical testing of this approach will begin within a year.

Interestingly, the curry spice curcurmin, and catechins found in green tea, are also said to inhibit the tumor necrosis factor. Both of these have been implicated in reducing dementia and age-related cognitive impairment.

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Memory impairment more common in people with a history of cancer

November, 2010

A very large study has found everyday memory problems among middle-aged and elderly are more likely in those with a history of cancer.

Confirming earlier indications from small studies, a very large nationwide survey has found that people who have had cancer are 40% more likely to experience memory problems that interfere with daily functioning.

The U.S. study involved nearly 10,000 people aged 40 and older, of whom 1,305 (13.3%) reported they had cancer or a history of cancer. Of these, 14% answered yes to the question "Are you limited in any way because of difficulty remembering or because you experience periods of confusion?" Of those who did not have a history of cancer, 8% answered yes to this question.

The degree to which these memory problems are related to the treatment or to the cancer itself (or even perhaps to the experience of having cancer) is one that needs further investigation, but the researcher suggests the finding points to memory issues being more common among cancer sufferers than realized, and recommends that cognitive assessment should be a standard part of cancer treatment.

The study is noteworthy in including all cancers, rather than focusing on one. Nevertheless, I hope that we eventually see a published paper (these results were presented at conference) that also analyses the data in terms of different cancers, different treatments, and length of time since the cancer.

Earlier reports on ‘chemobrain’, and possible ways to help

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Results were presented at the Third AACR Conference on The Science of Cancer Health Disparities.

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Chemotherapy alters brain tissue in breast cancer patients

October, 2010

More evidence for the reality of ‘chemobrain’, showing physical changes in the brain.

Over the years I’ve reported on a number of studies investigating the effect of chemotherapy on the brain. A new study uses brain imaging, before and after treatment for breast cancer, to show that there is an anatomic basis for “chemobrain” complaints. The study, involving 17 breast cancer patients treated with chemotherapy after surgery, 12 women with breast cancer who did not undergo chemotherapy after surgery, and 18 women without breast cancer, found that gray matter density decreased in the frontal lobe, temporal lobe, cerebellum and right thalamus, shortly after chemotherapy.

The areas affected are consistent with memory and executive functions like multi-tasking and processing speed being the most typically affected functions. Post-surgery scans were carried out at one month, and at one year. Gray matter density in most women had improved by one year after chemotherapy ended.

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Factors linked to cognitive deficits in type 2 diabetes

October, 2010

Cognitive deficits and even dementia are more common in older diabetics. A new study points to three health issues that, if present, increase the risk that older diabetics will develop cognitive problems.

Type 2 diabetes is known to increase the risk of cognitive impairment in old age. Now analysis of data from 41 older diabetics (aged 55-81) and 458 matched controls in the Victoria Longitudinal Study has revealed that several other factors make it more likely that an older diabetic will develop cognitive impairment. These factors are: having higher (though still normal) blood pressure, having gait and balance problems, and/or reporting yourself to be in bad health regardless of actual problems.

Diabetes and hypertension often go together, and both are separately associated with greater cognitive impairment and dementia risk, so it is not surprising that higher blood pressure is one of the significant factors that increases risk. The other factors are less expected, although gait and balance problems have been linked to cognitive impairment in a recent study, and they may be connected to diabetes through diabetes’ effect on nerves. Negativity about one’s health may reflect emotional factors such as anxiety, stress, or depression, although depression and well-being measures were not themselves found to be mediating effects for cognitive impairment in diabetics (Do note that this study is not investigating which factors, in general, are associated with age-related cognitive impairment; it is trying to establish which factors are specifically sensitive to cognitive impairment in older diabetics).

In the U.S., type 2 diabetes occurs in over 23% of those over 60; in Canada (where this study took place) the rate is 19%. It should be noted that the participants in this study are not representative of the general population, in that they were fairly well-educated older Canadians, most of whom have benefited from a national health care system. Moreover, the study did not have longitudinal data on these various factors, meaning that we don’t know the order of events (which health problems come first? How long between the development of the different problems?). Nevertheless, the findings provide useful markers to alert diabetics and health providers.

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