brain atrophy

Alzheimer's diagnostic guidelines updated

June, 2011
  • Updated clinical guidelines now cover three distinct stages of Alzheimer's disease.

For the first time in 27 years, clinical diagnostic criteria for Alzheimer's disease dementia have been revised, and research guidelines updated. They mark a major change in how experts think about and study Alzheimer's disease.

The updated guidelines now cover three distinct stages of Alzheimer's disease:

  • Preclinical – is currently relevant only for research. It describes the use of biomarkers that may precede the development of Alzheimer’s.
  • Mild Cognitive Impairment– Current biomarkers include elevated levels of tau or decreased levels of beta-amyloid in the cerebrospinal fluid, reduced glucose uptake in the brain, and atrophy of certain brain regions. Primarily for researchers, these may be used in specialized clinical settings.
  • Alzheimer's Dementia – Criteria outline ways clinicians should approach evaluating causes and progression of cognitive decline, and expand the concept of Alzheimer's dementia beyond memory loss to other aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment.

The criteria are available at http://www.alzheimersanddementia.org/content/ncg

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Long-term users of ecstasy risk structural brain damage

June, 2011
  • A small study suggests that regular ecstasy use produces brain atrophy, especially in the hippocampus.

Imaging the brains of 10 young men who were long term users of ecstasy and seven of their healthy peers with no history of ecstasy use has revealed a significantly smaller hippocampus in those who used ecstasy. The overall proportion of gray matter was also lower, suggesting the effects of ecstasy may not be restricted to the hippocampus.

Both groups had used similar amounts of recreational drugs other than ecstasy, and drank alcohol regularly. The ecstasy group had not taken ecstasy for more than two months before the start of the study on average.

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[2218] den Hollander, B., Schouw M., Groot P., Huisman H., Caan M., Barkhof F., et al.
(2011).  Preliminary evidence of hippocampal damage in chronic users of ecstasy.
Journal of Neurology, Neurosurgery & Psychiatry.

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More evidence that Alzheimer's disease may be inherited from your mother

March, 2011
  • A new study adds to growing evidence that having a mother with Alzheimer's disease is a greater risk factor than if your father suffered the disease.

A two-year study involving 53 older adults (60+) has found that those with a mother who had Alzheimer's disease had significantly more brain atrophy than those with a father or no parent with Alzheimer's disease. More specifically, they had twice as much gray matter shrinkage, and about one and a half times more whole brain shrinkage per year.

This atrophy was particularly concentrated in the precuneus and parahippocampal gyrus. Those with the APOE4 gene also had more atrophy in the frontal cortex than those who didn’t carry the ‘Alzheimer’s gene’.

This adds to evidence indicating that maternal history is a far greater risk factor for Alzheimer’s than paternal history. Eleven participants reported having a mother with Alzheimer's disease, 10 had a father with Alzheimer's disease and 32 had no family history of the disease. It has been estimated that people who have first-degree relatives with Alzheimer's disease are four to 10 times more likely to develop the disease.

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The importance of the cerebellum for intelligence and age-related cognitive decline

March, 2011
  • A new study of older adults indicates atrophy of the cerebellum is an important factor in cognitive decline for men, but not women.

Shrinking of the frontal lobe has been associated with age-related cognitive decline for some time. But other brain regions support the work of the frontal lobe. One in particular is the cerebellum. A study involving 228 participants in the Aberdeen Longitudinal Study of Cognitive Ageing (mean age 68.7) has revealed that there is a significant relationship between grey matter volume in the cerebellum and general intelligence in men, but not women.

Additionally, a number of other brain regions showed an association between gray matter and intelligence, in particular Brodmann Area 47, the anterior cingulate, and the superior temporal gyrus. Atrophy in the anterior cingulate has been implicated as an early marker of Alzheimer’s, as has the superior temporal gyrus.

The gender difference was not completely unexpected — previous research has indicated that the cerebellum shrinks proportionally more with age in men than women. More surprising was the fact that there was no significant association between white memory volume and general intelligence. This contrasts with the finding of a study involving older adults aged 79-80. It is speculated that this association may not develop until greater brain atrophy has occurred.

It is also interesting that the study found no significant relationship between frontal lobe volume and general intelligence — although the effect of cerebellar volume is assumed to occur via its role in supporting the frontal lobe.

The cerebellum is thought to play a vital role in three relevant areas: speed of information processing; variability of information processing; development of automaticity through practice.

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Exercise improves executive function and math in sedentary children

February, 2011
  • A three-month trial comparing the effects of exercise programs on cognitive function in sedentary, overweight children, has found dose-related benefits of regular aerobic exercise.

A study involving 171 sedentary, overweight 7- to 11-year-old children has found that those who participated in an exercise program improved both executive function and math achievement. The children were randomly selected either to a group that got 20 minutes of aerobic exercise in an after-school program, one that got 40 minutes of exercise in a similar program, or a group that had no exercise program. Those who got the greater amount of exercise improved more. Brain scans also revealed increased activity in the prefrontal cortex and reduced activity in the posterior parietal cortex, for those in the exercise group.

The program lasted around 13 weeks. The researchers are now investigating the effects of continuing the program for a full year. Gender, race, socioeconomic factors or parental education did not change the impact of the exercise program.

The effects are consistent with other studies involving older adults. It should be emphasized that these were sedentary, overweight children. These findings are telling us what the lack of exercise is doing to young minds. I note the report just previous, about counteracting what we have regarded as “normal” brain atrophy in older adults by the simple action of walking for 40 minutes three times a week. Children and older adults might be regarded as our canaries in the coal mine, more vulnerable to many factors that can affect the brain. We should take heed.

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Walking counteracts brain atrophy in older adults

February, 2011
  • Walking 40 minutes a day three days a week prevented ‘normal’ atrophy in the brains of older adults.

Another study has come out proclaiming the cognitive benefits of walking for older adults. Previously sedentary adults aged 55-80 who walked around a track for 40 minutes on three days a week for a year increased the size of their hippocampus, as well as their level of BDNF. Those assigned to a stretching routine showed no such growth. There were 120 participants in the study.

The growth of around 2% contrasts with the average loss of 1.4% hippocampal tissue in the stretching group — an amount of atrophy considered “normal” with age. Although both groups improved their performance on a computerized spatial memory test, the walkers improved more.

The findings are consistent with a number of animal studies showing aerobic exercise increases neurogenesis and BDNF in the hippocampus, and human studies pointing to a lower risk of cognitive decline and dementia in those who walk regularly.

Reference: 

[2097] Erickson, K. I., Voss M. W., Prakash R S., Basak C., Szabo A., Chaddock L., et al.
(Submitted).  Exercise training increases size of hippocampus and improves memory.
Proceedings of the National Academy of Sciences.

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Career choice may determine where frontotemporal dementia begins

October, 2010
  • An international review of patients with frontotemporal dementia has revealed that the area of the brain first affected tends to be the hemisphere least used in the individual’s occupation.

A review of brain imaging and occupation data from 588 patients diagnosed with frontotemporal dementia has found that among the dementias affecting those 65 years and younger, FTD is as common as Alzheimer's disease. The study also found that the side of the brain first attacked (unlike Alzheimer’s, FTD typically begins with tissue loss in one hemisphere) is influenced by the person’s occupation.

Using occupation scores that reflect the type of skills emphasized, they found that patients with professions rated highly for verbal skills, such as school principals, had greater tissue loss on the right side of the brain, whereas those rated low for verbal skills, such as flight engineers, had greater tissue loss on the left side of the brain. This effect was expressed most clearly in the temporal lobes of the brain. In other words, the side of the brain least used in the patient's professional life was apparently the first attacked.

These findings are in keeping with the theory of cognitive reserve, but may be due to some asymmetry in the brain that both inclines them to a particular occupational path and renders the relatively deficient hemisphere more vulnerable in later life.

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Vitamin B supplements could delay onset of Alzheimer's

September, 2010
  • Vitamin B supplements markedly reduced brain atrophy in older adults with MCI, offering hope that they may be effective in delaying the development of Alzheimer’s.

A two-year study involving 271 older adults (70+) with mild cognitive impairment has found that the rate of brain atrophy in those taking folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d) and vitamin B6 (20 mg/d), was significantly slower than in those taking a placebo, with those taking the supplements experiencing on average 30% less brain atrophy. Higher rates of atrophy were associated with lower cognitive performance. Moreover those who with the highest levels of homocysteine at the beginning of the trial benefited the most, with 50% less brain shrinkage. High levels of homocysteine are a risk factor for Alzheimer’s, and folate, B12 and B6 help regulate it.

The finding that atrophy can be slowed in those with MCI offers hope that the treatment could delay the development of Alzheimer’s, since MCI is a major risk factor for Alzheimer’s, and faster brain atrophy is typical of those who go on to develop Alzheimer’s.

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Brain may age faster in people whose hearts pump less blood

September, 2010
  • A large study confirms that your cardiac health affects your brain, and provides evidence that the extent of this problem is greater than we think.

I have often spoken of the mantra: What’s good for your heart is good for your brain. The links between cardiovascular risk factors and cognitive decline gets more confirmation in this latest finding that people whose hearts pumped less blood had smaller brains than those whose hearts pumped more blood. The study involved 1,504 participants of the decades-long Framingham Offspring Cohort who did not have a history of stroke, transient ischemic attack or dementia. Participants were 34 to 84 years old.

Worryingly, it wasn’t simply those with the least amount of blood pumping from the heart who had significantly more brain atrophy (equivalent to almost two years more brain aging) than the people with the highest cardiac index. Those with levels at the bottom end of normal showed similar levels of brain atrophy. Moreover, although only 7% of the participants had heart disease, 30% had a low cardiac index.

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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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