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An easy way to test for Alzheimer’s disease

An easy way to test for Alzheimer’s disease

The beginning was the worst. It frustrated Janet Parkerson when her father started to forget what he had done that day or the day before.

But soon, names slipped his mind too, and then he failed to recognise people. Then he lost his ability to talk and to walk, and then he died, bedridden.

“I saw my father die of Alzheimer’s,” said Parkerson, 85. “I’ve experienced a lot of what it’s like – it’s terribly sad – and I would be very happy to help people not go through that.”

That’s why she decided to enroll in a five-year-long Alzheimer’s research study in 2014.

In fall 2018, she eagerly sat in the auditorium of East Ridge at Cutler Bay, her Pine Crest senior living community in Florida, United States, alongside about 50 other fellow residents, some of whom had also volunteered for the studies.

They were all there to hear from the man who recruited them for the study, Dr David Loewenstein, a University of Miami expert in neuropsychology who has been studying Alzheimer’s for 32 years.

Dr Loewenstein spoke about one of his team’s most recent findings: For the first time, they successfully used a behavioural test to identify which patients with cognitive impairment are most likely to develop Alzheimer’s.

He and his colleagues found patients with mild cognitive impairment, then divided them into three groups.

The first was patients with underlying Alzheimer’s, as proved by their high levels of amyloid, an aggregation of a protein in the brain of Alzheimer’s patients.

The second was patients who had the symptoms of Alzheimer’s, but didn’t have the high levels of amyloid, which meant they probably had another disease.

And the third included patients with other neurological conditions, such as depression.

Dr Loewenstein’s team used a cognitive stress test developed in 2013 by the University of Miami, and it involves researchers asking patients to learn a list of 15 words from three categories, five from each.

They then ask the patients to learn a new list of 15 words from the same categories.

Using the test, they found the patients with the high amyloid levels had the most trouble remembering the second list of words because the first interfered, even after the patients were given multiple attempts.

This means they accurately identified patients who actually have Alzheimer’s from those who look like they do, but don’t. “It’s a landmark finding,” said Dr Loewenstein.

When he finished his hour-long presentation at East Ridge on Oct 1, 2018, about 15 people rushed to talk to him. Most were fascinated by the fact some of them had had a part in the discovery.

Dr Loewenstein and his team have received more than US$10mil (RM41.4mil) in US state and federal funding for research in the last five years.

In June 2018, he was named the director of the Center for Cognitive Neuroscience and Aging at the University of Miami, which aims to tackle Alzheimer’s as it becomes a greater issue.

As more and more baby boomers get older, the number of Alzheimer’s patients is increasing.

Dr Loewenstein said if the disease isn’t stopped, in the next 10 to 15 years, it will wreak havoc for patients and their families, as well as bankrupt the US federal government, because the cost to care for the ill will be so high.

His team’s most recent milestone with the cognitive stress test helps researchers better understand Alzheimer’s and identify the earliest changes that take place in the brain because of it.

This test could potentially help doctors screen patients for Alzheimer’s at a much cheaper cost than through an amyloid PET scan.

The test will also help scientists better select candidates with Alzheimer’s for clinical and prevention trials.

“I’m satisfied with the effort,” Dr Loewenstein said. “We’re trying very hard, but I don’t think I’ll be completely satisfied until we have a cure or a prevention.

“We’re close, but we’re still not there.” – Miami Herald/Tribune News Service

15 common misconceptions and surprising realities about dementia and Alzheimer’s disease

15 common misconceptions and surprising realities about dementia and Alzheimer’s disease

Dementia currently affects about 50 million people in the world.

Dementia currently affects about 50 million people in the world.
De Visu/Shutterstock

There are about 50 million people in the world living with dementia. It’s the umbrella term given to the symptoms caused by various diseases – most commonly Alzheimer’s. This is expected to go up to 152 million in 2050, according to Alzheimer’s Research UK.

Despite the massive impact dementia has on the economy and people’s livelihoods, there are still many misconceptions around it. There are also some facts that still surprise people.

We spoke to Alzheimer’s Research UK to find out what people normally get wrong, and what they often don’t know, about dementia.

1. Alzheimer’s disease and dementia are not the same thing


Dementia is a term used for symptoms like confusion, memory loss, mood changes, and personality changes. There are a whole range of conditions that can cause dementia, not just Alzheimer’s. The most common are Alzheimer’s Disease, dementia with Lewy bodies, vascular dementia and Frontotemporal dementia.

“Sometimes people will say to me, oh well she has Alzheimer’s disease, but she doesn’t have dementia… But really, if you have Alzheimer’s disease and you’re showing symptoms, then you have dementia,” said Laura Phipps, the head of communications and engagement at Alzheimer’s Research UK. “Dementia is just a word for the symptoms.”

2. People react differently to the words


Although dementia and Alzheimer’s are often confused, people tend to have different reactions to hearing each word.

“When you ask them to think about Alzheimer’s disease, they will put that in with other physical health conditions, like heart disease, stroke, cancer, diabetes,” Phipps said. “And when you ask them to think about dementia, they don’t know what to do with it, and they tend to put it in with things like age and mental health.”

So even though dementia is caused by illnesses like Alzheimer’s, the word itself is conflated with being more of a mental disorder, than something caused by a physical disease.

3. Dementia isn’t an inevitable part of getting older

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A common misconception is that you get a bit forgetful as you get older, so dementia falls into that as an inevitability that just happens to most people.

“They’ll say, ‘oh yeah my grandma had dementia but she was very old,’ so it’s almost followed by an excuse that it was OK because they were old,” Phipps said. “And so I think that drives this kind of view in society that the diseases that cause dementia are not that important because there’s not much you can do about them.”

But this isn’t true. Dementia is caused by diseases. People understand cancer is a disease, that you shouldn’t have it and it’s unfair, Phipps said, but that’s not yet universally accepted by people when it comes to dementia.

4. More people at 90 don’t have dementia than have it

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By the time people get to 90 years old, they are more likely not to have any diseases that cause dementia than have one.

Phipps said dementia research is behind a lot of other research because they have an extra mountain to climb. Because people think dementia is inevitable, they are less likely to want to support and fund research.

5. Almost half of adults don’t realise it causes death


A survey by Alzheimer’s Research UK found that 51% of adults recognise that dementia leads to death. That means almost half don’t realise, even though it’s the UK’s leading cause of death right now.

“These are physical diseases that ultimately are terminal – they will shorten your life,” Phipps said. “But people don’t recognise that, and again this just shows there is a lack of seriousness about it.”

“You hear people joke about it, like oh have you got Alzheimer’s. And actually, you wouldn’t joke about someone having another fatal illness. It’s not appropriate in society to do that. But people will still do that about dementia because they don’t recognise that diseases that cause dementia like Alzheimer’s are terminal. They will end your life too soon.”

6. A brain that is affected by Alzheimer’s can weigh 140 grams less than an unaffected brain

Marcelo Hernandez/Getty

There was an Alzheimer’s UK campaign in 2016 called Share the Orange because a brain that is affected by Alzheimer’s can weight up to 140g less than a normal brain – about the weight of an orange.

“That’s actually a huge amount of brain that’s lost, but you can’t see it,” Phipps said. “So if someone was walking around and they had 75% of their leg, you’d probably notice and you might treat them better or cut them some slack or help them out. You can’t see that physical effect with dementia.”

7. There are more symptoms than memory loss

Jakob Owens / Unsplash

There is a slightly simplified view of dementia that it’s all about getting forgetful when you get older. Memory loss is the most common symptom, Phipps said, but there are many more.

“As dementia progresses, people get more and more symptoms, including physical symptoms,” she said. “So they won’t be able to move around, they’ll have difficulty speaking, they’ll have trouble swallowing – and it’s ultimately those symptoms that make people immobile and much more frail and susceptible to things like falls or infections that they don’t recover from.”

8. A third of risk factors are within our control


People often understand the risk of dementia, Phipps said. About a third of cases of dementia could actually be down to risk factors that are in our control.

Age is the biggest risk factor because dementia mostly affects older people. Some people have a genetic predisposition to developing diseases like Alzheimer’s, which is out of their control.

“But there are also lifestyle factors that can influence your risk of dementia,” Phipps said. “And at a population level, these come out as things like smoking, like depression, physical inactivity, high blood pressure… so often it’s things that are likely to impact your heart.”

Only about a quarter of UK adults realise there is anything they can do to reduce their risk of dementia, according to Alzheimer’s Research UK surveys.

“If you were to address things like having more aggressive treatment of blood pressure, or stopping people becoming overweight, and if nobody smoked, then we would see a reduction in the number of people getting dementia,” said Phipps. “So there are things people can do that are within their control that can reduce their risk of dementia.”

9. Heart health and brain health are intrinsically linked

Matt Cardy/Getty Images

Many of the risk factors associated with dementia are the same as those associated with heart health. This is because your brain and heart are intrinsically linked together.

“The majority of the blood that is pumped by your heart is used by your brain,” said Phipps. “So anything that damages how your heart is working will have a knock-on effect on your brain health. And so a lot of the risk factors for dementia at the moment with the best evidence are also heart health risk factors.”

So even though people may be unsure about the risk factors of dementia, if you tell them it’s the same as the ones for cardiovascular disease, stroke, and heart attacks, they might have a better idea.

10. Mid life is the most important window for risk reduction


Many of the most important avoidable risk factors for dementia appear in mid-life, between the ages of about 40 and 64, according to the Alzheimer’s Society, such as type 2 diabetes and high blood pressure.

People who have had periods of depression in mid or later life also have increased rates of dementia.

11. It doesn’t just affect old people


Dementia doesn’t just affect older people. About 2-8% of all cases worldwide affect younger people. In the UK, there are about 40,000 people under the age of 65 living with dementia, but people tend to think it’s not something that strikes until later life.

“In 2015 we did some polling, and 46% of people think dementia mostly affects older people, 15% think it affects only older people, and 9% think it can also affect younger people,” Phipps said.

12. Sometimes, it only affects sight and perception

Irina Bg/Shutterstock

Sometimes memory loss isn’t a symptom of dementia until it is very advanced. The type of dementia Terry Pratchett had, for example, affected how his brain interpreted vision from his eyes.

“So actually he didn’t have memory loss until the late stages, but he couldn’t really see at all,” Phipps said. “So he couldn’t type, and had big gaps in his vision where he couldn’t see things.”

Alzheimer’s Research UK has a virtual reality dementia experience online called A Walk Through Dementia, which shows some of the visual perception tricks dementia can have on someone.

“One thing people often tell us about is that puddles on the ground can look like holes because there are issues with perception and depth perception and colour perception,” said Phipps. “You know when you go into a shop and they used to have those big black mats in front of the door… for some people with dementia that looks like a massive abyss.”

Imagine being faced with large holes in the ground. It would be confusing and alarming. Phipps said this means people with dementia won’t go into shops, or they won’t enter bathrooms because the shiny floors look like water.

“If your brain was working 100% you would probably be able to perceive the difference between shiny and wet,” she said. “But if there’s damage in your brain you just can’t quite make the judgement. Those things seem small but they can have a huge impact.”

13. Aggression and confusion may come from these small perception errors

Joe Raedle/Getty Images

Small changes can have big impacts on how people with dementia live. It may be something small that is confusing them with a simple fix, but the person with dementia may not be able to articulate the problem.

“There’s a big movement now for people who are showing signs of aggression or agitation, and rather than immediately giving them anti-psychotic drugs, is to try and look at their environment,” said Phipps. “Because it might be something really small like a change in routine or a change in the lamps or the way shadows are being cast around the room that could be having a massive impact on their level of anxiety, causing them to be agitated and aggressive.”

Small tweaks to their environment, like having more lights, or keeping the curtains open, could have a big impact on their quality of life.

14. Disrupted sleep can be a factor

Omar Havana/Getty Images

Research has shown that disrupted sleep may be associated with a higher risk of early signs of Alzheimer’s disease. This could mean that sleeping badly is an early warning sign of someone developing dementia.

Bad sleep could either be a symptom of dementia, or a cause – or it could be that both are true.

Other research supports the sleep theory, with one study finding that just one night of disrupted sleep could lead to a spike in Alzheimer’s-related proteins.

15. There is no cure or treatment for the progression of diseases that cause dementia

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There is currently no cure for the diseases that cause dementia, and no treatments that will modify the progression.

Some drugs can help people to address certain symptoms, but they don’t stop the disease progressing in the brain.

This is why understanding that dementia may be preventable is so important, Phipps said, because increased awareness means more research.

“There seems to be less stigma, and people seem to be more open about talking about diagnosis with someone, or having a conversation with somebody with dementia,” she said. “I think awareness of dementia is better than it’s ever been, but understanding of dementia hasn’t quite caught up.”

Suffering a stroke may double the risk of dementia

Suffering a stroke may double the risk of dementia

IN the largest study of its kind ever conducted, new UK research has found that people who suffer a stroke could be around twice as likely to develop dementia.

Led by researchers at the University of Exeter Medical School, the new meta-analysis looked at data on stroke and dementia risk gathered from 48 studies with a total of 3.2 million people around the world.

After taking into account other risk factors for dementia, such as blood pressure, diabetes and cardiovascular disease, the researchers found that having a stroke still significantly increased the risk of the condition, providing the strongest evidence yet that stroke plays a role in dementia risk.

The findings also support previous research which has also found an association between the two conditions, however previous studies did not establish to what extent a stroke may increase the risk of dementia.

“We found that a history of stroke increases dementia risk by around 70%, and recent strokes more than doubled the risk. Given how common both stroke and dementia are, this strong link is an important finding. Improvements in stroke prevention and post-stroke care may therefore play a key role in dementia prevention,” said study author Dr Ilianna Lourida, of the University of Exeter Medical School.

“Around a third of dementia cases are thought to be potentially preventable, though this estimate does not take into account the risk associated with stroke. Our findings indicate that this figure could be even higher, and reinforce the importance of protecting the blood supply to the brain when attempting to reduce the global burden of dementia,” added Dr David Llewellyn.

The team noted that as most people who have a stroke do not go on to develop dementia, further research is now needed to assess whether other factors could modify the increased risk of dementia, and whether differences in care and lifestyle following a stroke can reduce the risk of dementia further.

According to the World Health Organization, 15 million people have a stroke each year and around 50 million people have dementia.

The findings can be found published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. – AFP Relaxnews

A healthy heart leads to a healthy brain

A healthy heart leads to a healthy brain

You know it’s important to eat right, exercise and keep your cholesterol under control to reduce your risk of a heart attack or stroke.

If that’s not enough of an incentive, new research suggests that taking care of your cardiovascular system will pay off for your brain as well.

A study of more than 6,600 senior citizens found that the better they scored on seven measures of cardiovascular health, the lower their risk of dementia over the ensuing years.

The difference was dramatic: Among those with the lowest scores, dementia developed at a rate of 13.3 cases per 100 people. But among those with the highest scores, there were only 7.1 cases per 100 people.

The results, published in the Journal of the American Medical Association (JAMA), should prompt doctors and patients alike to focus on cardiovascular fitness for the sake of preserving cognitive health, experts said.

“To achieve a lifetime of robust brain health free of dementia, it is never too early or too late to strive for attainment of ideal cardiovascular health,” Dr Jeffrey Saver, a leader of the University of California, Los Angeles, Stroke Center, and Dr Mary Cushman of the University of Vermont, both in the United States, wrote in an editorial that accompanies the study.

“Given the ageing population, this positive health message is important to communicate to all members of society.”

There have already been many clues that vascular problems can translate into brain problems.

Narrowed, blocked or leaky blood vessels can lead to strokes, which are the number two cause of dementia (after Alzheimer’s disease).

Observational studies have turned up connections between cardiovascular conditions in midlife and cognitive conditions in late life.

The new study adds to the picture by focusing on adults who are already in their senior years.

The data came from the Three-City Study, a research effort from France that enrolled residents of Bordeaux, Dijon and Montpellier.

All of the participants were at least 65 years old when they enrolled in the study (their average age was 73.7 years). Upon joining, they were given a battery of physical and cognitive tests.

For the JAMA report, the researchers focused on seven metrics of cardiovascular health that the American Heart Association (AHA) call “Life’s Simple 7”.

Four of the metrics are behavioural (diet, exercise, weight management and smoking status) and three are biological (blood pressure, blood sugar and cholesterol).

Study participants were given a score of 0, 1 or 2 for each of the categories, to reflect whether their compliance with the AHA’s targets was “poor”, “intermediate” or “optimal”.

For example, to earn two points for a healthy diet, people had to eat at least one portion of fresh fruit, one portion of raw vegetables, and one portion of cooked fruit or vegetables each day, plus at least two portions of fish each week.

To earn two points for weight, they had to have a body mass index under 25; to earn two points for blood pressure, they needed a reading below 120/80 mmHg without the assistance of medication.

High scores were rare. Only 6.5% of study participants had optimal measurements for at least five of the seven categories.

At the other end of the spectrum, 36.4% of participants received optimal scores in no more than two categories.

The 6,626 seniors in the study were tracked for an average of 8.5 years. During that time, 745 of them were diagnosed with dementia.

The risk wasn’t the same for everyone.

Among those with optimal levels for none or just one of the seven metrics, the diagnosis rate was 1.76 dementia cases per 100 person-years (a measure that accounts for the number of people in the study and the length of time they participated).

For each additional metric that was at optimal levels, the risk of dementia fell by about 10%.

The study authors put it like this: Imagine a 73-year-old man who has a low level of education and does not carry a well-known genetic variant linked with an increased risk of Alzheimer’s disease.

If this man did not meet any of the AHA standards, it would take about six years for his global cognitive level to fall by one “standard unit”.

However, if he met all seven of the AHA standards, it would take twice as long for his cognitive level to decline by the same amount.

The authors acknowledged that getting people to upgrade from poor to optimal status on Life’s Simple 7 would be “challenging”.

Simply motivating them to reach “intermediate” status would be much more doable, and still quite valuable, they wrote.

However, the study did not track changes in people’s cardiovascular health over time, so there was no way to know whether improving one’s cardiovascular health was associated with a lower dementia risk, they added. – Los Angeles Times/Tribune News Service

When it comes to alcohol, take the middle road

When it comes to alcohol, take the middle road

Genetics, head injury and poor nutrition have all been linked to dementia. Scientists are now adding both heavy drinking and abstaining from alcohol to the list, according to a new report.

Researchers from the French National Institute of Health and Medical Research based in France and the United Kingdom recently conducted a study, published in the British Medical Journal, to determine the relationship between midlife alcohol consumption and risk of dementia into early old age.

To do so, they observed more than 9,000 people, aged 35 to 55, taking part in the Whitehall II Study, which is examining the impact of social, behavioural and biological factors on long-term health.

The analysts assessed their alcohol consumption and dependence over the course of several years.

They then collected hospital records to review the number of participants hospitalised for alcohol-related chronic diseases and cases of dementia.

After analysing the results, they found both abstinence in midlife and drinking more than 14 units of alcohol a week were both associated with higher risk of dementia, compared to just drinking one to 14 units weekly.

In fact, they discovered that heavy drinkers who up their consumption by seven units a week may have a 17% increase in dementia risk.

In the UK, 14 units of alcohol weekly is the recommended maximum limit, and a unit is approximately 8 grams of alcohol. A standard glass of wine is about 2 units of alcohol and a beer is about 1.75 units.

“(Our findings) strengthen the evidence that excessive alcohol consumption is a risk factor for dementia,” the authors said in a statement.

“(We) encourage use of lower thresholds of alcohol consumption in guidelines to promote cognitive health at older ages.”

They also added their results “should not motivate people who do not drink to start drinking, given the known detrimental effects of alcohol consumption for mortality, neuropsychiatric disorders, cirrhosis of the liver and cancer.”

They now hope for more studies that further explore the effects of light to moderate alcohol in relation to the memory loss condition. – The Atlanta Journal-Constitution/Tribune News Service

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