Optimal levels of cardiovascular health in older age associated with lower dementia risk

A French study involving 6,626 older adults (65+) found that having optimal levels in more measures of cardiovascular health (nonsmoking, weight, diet, physical activity, cholesterol, blood glucose and blood pressure) was associated with lower dementia risk and slower rates of cognitive decline. Dementia risk and rates of cognitive decline lowered with each additional metric at the recommended optimal level.

The measures come from an American Heart Association seven-item checklist aimed at preventing cardiovascular disease.

https://www.eurekalert.org/pub_releases/2018-08/jn-hol081618.php

Dementia risk increased in 50-year-olds with blood pressure below hypertension threshold

New findings from the large, long-running Whitehall II study revealed that 50-year-olds who had blood pressure that was higher than normal but still below the usual threshold for treating hypertension, were at increased risk of developing dementia in later life.

This increased risk was seen even when they didn’t have other heart or blood vessel-related problems.

The study involved 8,639 people, of whom 32.5% were women. Participants were aged between 35-55 in 1985, and had their blood pressure measured in 1985, 1991, 1997 and 2003. 385 (4.5%) developed dementia by 2017.

Those who had a systolic blood pressure of 130 mmHg or more at the age of 50 had a 45% greater risk of developing dementia than those with a lower systolic blood pressure at the same age. This association was not seen at the ages of 60 and 70, and diastolic blood pressure was not linked to dementia.

https://www.eurekalert.org/pub_releases/2018-06/esoc-dri061118.php

https://www.theguardian.com/science/2018/jun/13/dementia-risk-to-50-year-olds-with-raised-blood-pressure-study

Intensive blood pressure control reduces risk of MCI

Preliminary results from the Systolic Blood Pressure Intervention Trial (SPRINT) has found that aggressive lowering of systolic blood pressure produced significant reductions in the risk of MCI, and MCI/dementia.

The randomized clinical trial compared an intensive strategy with a systolic blood pressure goal of less than 120 mm Hg and a standard care strategy targeting a systolic blood pressure goal of less than 140 mm Hg. The study involved 9,361 hypertensive older adults (mean age 67.9).

The intensive treatment group had a 19% lower rate of new cases of MCI, and the combined outcome of MCI plus probable all-cause dementia was 15% lower. Serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or acute renal failure occurred more frequently in the intensive-treatment group (4.7% vs 2.5%).

Participants were seen monthly for the first 3 months and every 3 months thereafter. Medications were adjusted on a monthly basis and lifestyle modification was encouraged. 30% of the participants were African American and 10% were Hispanic.

Preliminary results from 673 participants in the trial revealed that total white matter lesion (WML) volume increased in both treatment groups, but the increase was significantly less in the intensive treatment group. There was no significant difference in total brain volume change.

The findings were reported at the Alzheimer's Association International Conference (AAIC) 2018 in Chicago.

https://www.eurekalert.org/pub_releases/2018-07/aa-sib072218.php

Arterial stiffness linked to dementia risk

A long-running study involving 356 older adults (average age 78) found that those with high levels of arterial stiffness were 60% more likely to develop dementia during the next 15 years compared to those with lower levels.

Arterial stiffness is correlated with subclinical brain disease and cardiovascular risk factors, but adjusting for these factors didn't reduce the association between arterial stiffness and dementia — indicating that arterial stiffness and subclinical brain damage markers are independently related to dementia risk.

Arterial stiffening can be reduced by antihypertensive medication and perhaps also healthy lifestyle changes such as exercise. This study found that exercise at an average age of 73 was associated with lower arterial stiffness five years later.

https://www.eurekalert.org/pub_releases/2018-10/uops-lsi101518.php

Hypertension linked to brain atrophy & poorer waste management

A rat study found that hypertensive rats exhibited larger ventricles, decreased brain volume, and impaired fluid transport. It’s suggested that hypertension interferes with the clearance of macromolecules from the brain, such as amyloid-beta.

https://www.eurekalert.org/pub_releases/2019-06/sfn-hb061119.php

How alcohol increases Alzheimer's risk

A cell-culture study using rodent microglia found that some of the genes affected by alcohol and inflammation are also implicated in processes that clear amyloid beta, suggesting that alcohol may impede the clearance of amyloid beta in the brain.

In the study, rat microglial cells were exposed either to alcohol, pro-inflammatory chemicals called cytokines, or alcohol and cytokines, for 24 hours. Gene expression was altered for 312 genes under the alcohol condition; for 3,082 for the pro-inflammatory condition, and 3,552 for the alcohol and pro-inflammatory condition. Changes in gene expression ranged from a 50% decrease to a 72% increase. Many of the genes were involved in phagocytosis; just a handful of genes were involved in both phagocytosis and inflammation.

https://www.eurekalert.org/pub_releases/2018-06/uoia-hda060418.php

Chronic heavy drinking trebles dementia risk

Data from the French National Hospital Discharge database, involving over a million people diagnosed with dementia between 2008 and 2013, found that 38% of the 57,000 cases of early-onset dementia were directly alcohol-related and 18% had an additional diagnosis of alcohol use disorders.

Overall, alcohol use disorders were associated with a three times greater risk of all types of dementia.

The study only looked at people admitted to hospital due to chronic heavy drinking, so it will understate the link between alcohol use and dementia risk.

Moreover, heavy drinkers who had given up alcohol for a time did not reduce their dementia risk (although they were less likely to die early).

https://www.eurekalert.org/pub_releases/2018-02/cfaa-lso022018.php

https://www.theguardian.com/society/2018/feb/20/chronic-heavy-drinking-leads-to-serious-risk-of-dementia-study-warns

A long-running study involving 8225 adults found that self-reported diet during midlife (mean age 50) was not significantly associated with subsequent risk for dementia.

Dietary intake was assessed in 1991-1993, 1997-1999, and 2002-2004, with follow-up for incident dementia until March 31, 2017. Diet quality was assessed using the Alternate Healthy Eating Index (AHEI), an 11-component diet quality score (score range, 0-110), with higher scores indicating a healthier diet.

There were 344 cases of incident dementia developed in the study period. 69.1% of participants were male.

https://www.eurekalert.org/pub_releases/2019-03/jn-wdq030719.php

High LDL linked to early-onset Alzheimer's

Elevated cholesterol levels have been linked to increased risk of Alzheimer's later in life, and APOE4 is known to raise levels of circulating cholesterol, particularly low-density lipoprotein (LDL) ("bad cholesterol"). A new study has investigated whether LDL is also linked to early-onset Alzheimer's.

The study involved genetically testing 2,125 people, 654 of whom had early-onset Alzheimer's, and testing for cholesterol in a subset of 267 participants. It found that APOE4 explained about 10% of early-onset Alzheimer's, which is similar to estimates in late-onset Alzheimer's disease. About 3% of early-onset Alzheimer's cases had at least one of the known early-onset Alzheimer's risk factors (APP, PSEN1, PSEN2).

Those with elevated LDL levels were more likely to have early-onset Alzheimer's disease, compared with patients with lower cholesterol levels. This was true even after the researchers controlled for APOE genotype.

There was no link between HDL (high-density lipoprotein) cholesterol levels and early-onset Alzheimer's, and only a very slight association between the disease and triglyceride levels.

The researchers also found a new possible genetic risk factor for early-onset Alzheimer's disease. Early-onset Alzheimer's cases were higher in participants with a rare variant of a gene called APOB. This gene encodes a protein that is involved in the metabolism of lipids, or fats, including cholesterol.

https://www.eurekalert.org/pub_releases/2019-05/varc-hll052419.php

Good cholesterol may cut women’s dementia risk

A long-running study found that women who had normal levels of the “good” cholesterol, HDL, in 1992 had less white matter damage in their brain two decades later.

The data come from 135 participants in the long-running Women's Healthy Ageing Project. The study found that a higher cardiovascular risk score in midlife was associated with a greater degree of white matter hyperintensity lesions 20 years later, but, intriguingly, that this was predominantly driven by HDL cholesterol level, after controlling for age, education, and APOEe4 status.

https://www.futurity.org/good-cholesterol-women-brains-dementia-1899132/

I rarely report on drugs, but because I do have a number of early reports on the four drugs approved for use with Alzheimer’s, I wanted to provide this update.

The four drugs are donepezil, rivastigmine, galantamine and memantine. This review is said to be the first to rank their comparative safety and effectiveness. It used evidence from 142 clinical trials published between 1996 and 2015. The number of patients in each study ranged from 13 to 2,045, and the review evaluated a total of 33,889 patients.

Donepezil was the most effective medication for Alzheimer's dementia across all effectiveness outcomes, including cognition, behavior and overall health, according to the study. It was also the only cognitive enhancer that produced effects that could be observed clinically, not merely statistically.

However, patients who took donepezil were more likely to experience side effects including nausea, vomiting and diarrhea than those who received a placebo.

Previous research found that these drugs don’t improve cognition or function in people with MCI, and these patients experience significantly more nausea, diarrhea, vomiting and headaches.

https://www.eurekalert.org/pub_releases/2017-09/smh-srs092817.php

Memantine plus care program dramatically better at reducing Alzheimer's symptoms than drug alone

A small study found that combining a specific care management program with memantine multiplied the drug’s ability to improve daily function by about 7.5 times.

The Comprehensive, Individualized, Person-Centered Management program (CI-PCM) includes caregiver training, residence assessment, therapeutic home visits, and caregiver support groups.

In the 28-week, blinded, randomized controlled trial, 10 patient-caregiver groups enrolled in the CI-PCM were compared against 10 pairs receiving standard community care. All patients were taking memantine. Participants were assessed at the end of the trial using a recognized tool called Functional Assessment Staging (FAST), which measures losses in the ability of a person to independently carry out daily activities, such as dressing, bathing and toileting.

Caregiver training included "memory coaching" that teaches patients how to accomplish skills they lost.

The findings were presented July 16 at the Alzheimer's Association International Conference 2017 in London.

https://www.eurekalert.org/pub_releases/2017-07/nlmc-dcw071317.php