Alzheimers

Alzheimer's & other dementias

Cognitive stimulation beneficial in dementia

April, 2012

A review supports cognitive stimulation therapy for those with mild to moderate dementia.

A review of 15 randomized controlled trials in which people with mild to moderate dementia were offered mental stimulation has concluded that such stimulation does indeed help slow down cognitive decline.

In total, 718 people with mild to moderate dementia, of whom 407 received cognitive stimulation, were included in the meta-analysis. The studies included in the review were identified from a search of the Cochrane Dementia and Cognitive Improvement Group Specialized Register, and included all randomized controlled trials of cognitive stimulation for dementia which incorporated a measure of cognitive change.

Participants were generally treated in small groups and activities ranged from discussions and word games to music and baking. Treatment was compared to those seen without treatment, with "standard treatments" (such as medicine, day care or visits from community mental health workers), or with alternative activities such as watching TV and physical therapy.

There was a “clear, consistent benefit” on cognitive function for those receiving cognitive stimulation, and these benefits were still seen one to three months after the treatment. Benefits were also seen for social interaction, communication and quality of life and well-being.

While no evidence was found for improvements in the mood of participants, or their ability to care for themselves or function independently, or in problem behaviors, this is not to say that lengthier or more frequent interventions might not be beneficial in these areas (that’s purely my own suggestion).

In one study, family members were trained to deliver cognitive stimulation on a one-to-one basis, and the reviewers suggested that this was an approach deserving of further attention.

The reviewers did note that the quality of the studies was variable, with small sample sizes. It should also be noted that this review builds on an earlier review, involving a subset of these studies, in which the opposite conclusion was drawn — that is, at that time, there was insufficient evidence that such interventions helped people with dementia. There is no doubt that larger and lengthier trials are needed, but these new results are very promising.

Reference: 

[2809] Woods, B., Aguirre E., Spector A. E., Orrell M., Woods B., Aguirre E., et al.
(Submitted).  Cognitive stimulation to improve cognitive functioning in people with dementia.
The Cochrane Library.

Source: 

http://www.eurekalert.org/pub_releases/2012-02/w-csb021012.php

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Walking speed and grip strength may predict dementia, stroke risk

March, 2012

More evidence comes for a link between lower physical fitness and increased risk of dementia in a large study that extends earlier findings to middle-aged and younger-old.

Following on from research showing an association between lower walking speed and increased risk of dementia, and weaker hand grip strength and increased dementia risk, a large study has explored whether this association extends to middle-aged and younger-old adults.

Part of the long-running Framingham study, the study involved 2,410 men and women with an average age of 62, who underwent brain scans and tests for walking speed, hand grip strength and cognitive function. During the follow-up period of up to 11 years, 34 people (1.4%) developed dementia (28 Alzheimer’s) and 79 people (3.3%) had a stroke.

Those who had a slower walking speed at the start of the study were one-and-a-half times more likely to develop dementia compared to people with faster walking speed, while stronger hand grip strength was associated with a 42% lower risk of stroke or transient ischemic attack in people over age 65.

Slower walking speed and weaker hand grip strength were also associated with lower brain volume and poorer cognitive performance. Specifically, those with slower walking speed scored significantly worse on tests of visual reproduction, paired associate learning, executive function, visual organization, and language (Boston Naming test). Higher hand grip strength was associated with higher scores on tests of visual reproduction, executive function, visual organization, language and abstraction (similarities test).

While the nature of the association is not yet understood, the findings do seem to support the benefits of physical fitness. At the least, these physical attributes can serve as pointers to the need for more investigation of an older person’s brain health. But they might also serve as a warning to improve physical fitness.

Reference: 

Camargo, E.C., Beiser, A., Tan, Z.S., Au, R., DeCarli, C., Pikula, A., Kelly-Hayes, M., Kase, C., Wolf, P. & Seshadri, S. 2012. Walking Speed, Handgrip Strength and Risk of Dementia and Stroke: The Framingham Offspring Study. To be presented April 25 at the American Academy of Neurology's 64th Annual Meeting in New Orleans.

Source: 

http://www.eurekalert.org/pub_releases/2012-02/aaon-hfy020712.php

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Nicotine patch shows benefits in mild cognitive impairment

February, 2012

A pilot study suggests that wearing a nicotine patch may help improve memory loss in older adults with mild cognitive impairment.

The study involved 74 non-smokers with amnestic MCI (average age 76), of whom half were given a nicotine patch of 15 mg a day for six months and half received a placebo. Cognitive tests were given at the start of the study and again after three and six months.

After 6 months of treatment, the nicotine-treated group showed significant improvement in attention, memory, speed of processing and consistency of processing. For example, the nicotine-treated group regained 46% of normal performance for age on long-term memory, whereas the placebo group worsened by 26%.

Nicotine is an interesting drug, in that, while predominantly harmful, it can have positive effects if the dose is just right, and if the person’s cognitive state is at a particular level (slipping below their normal state, but not too far below). Too much nicotine will make things worse, so it’s important not to self-medicate.

Nicotine has been shown to improve cognitive performance in smokers who have stopped smoking and previous short-term studies with nicotine have shown attention and memory improvement in people with Alzheimer's disease. Nicotine receptors in the brain are reduced in Alzheimer’s brains.

Because the dose is so crucial, and the effects so dependent on brain state (including, one assumes, whether the person has been a smoker or not), more research is needed before this can be used as a treatment.

Reference: 

[2736] Newhouse, P., Kellar K., Aisen P., White H., Wesnes K., Coderre E., et al.
(2012).  Nicotine treatment of mild cognitive impairment.
Neurology. 78(2), 91 - 101.

Source: 

http://www.eurekalert.org/pub_releases/2012-01/vumc-sfn010912.php
http://www.eurekalert.org/pub_releases/2012-01/aaon-ctn010312.php

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Higher risk of mild cognitive impairment among older men

February, 2012

Significant differences in the risk of mild cognitive impairment for men and women, and in the risk of developing the two sub-types, suggests that risk factors should be considered separately for genders and sub-type.

More data from the long-running Mayo Clinic Study of Aging has revealed that, in this one part of the U.S. at least, MCI develops at an overall rate of 6.4% a year among older adults (70+), with a higher rate for men and the less-educated.

The study involved 1,450 older adults (aged 70-89), who underwent memory testing every 15 months for an average of three years. By the end of the study period, 296 people had developed MCI, a rate of 6.4% per year. For men, the rate was 7.2% compared to 5.7% for women.

It should be noted that these rates apply to a relatively homogeneous group of people. Participants come from one county in Minnesota, an overwhelmingly white part of the U.S.

MCI comes in two types: amnestic (involving memory loss) and non-amnestic. Amnestic MCI was more than twice as common as non-amnestic MCI. The incidence rate of aMCI was also higher for men (4.4%) than women (3.3%), as was the risk of naMCI (2% vs 1.1%).

Those who had less education also had higher rates of MCI. For aMCI, the rate for those with 12 years or less of education was 4.3%, compared to 3.25% for those with more education. Similarly, for naMCI, the rates were 2% and 1%, respectively.

While the great majority of people diagnosed with MCI continued to have the disorder or progressed to dementia, some 12% were later re-diagnosed as not having it. This, I would presume, probably reflects temporary ‘dips’ in cognitive performance as a consequence of physical or emotional problems.

The differences between aMCI and naMCI, and between genders, suggest that risk factors for these should be considered separately.

Reference: 

[2739] Roberts, R. O., Geda Y. E., Knopman D. S., Cha R. H., Pankratz V. S., Boeve B. F., et al.
(2012).  The incidence of MCI differs by subtype and is higher in men.
Neurology. 78(5), 342 - 351.

Source: 

http://www.eurekalert.org/pub_releases/2012-01/aaon-sma011712.php
http://www.eurekalert.org/pub_releases/2012-01/mc-mcf012512.php

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Physical evidence bilingualism delays onset of Alzheimer's symptoms

January, 2012
  • Brain scans reveal that active bilinguals can have nearly twice as much brain atrophy as monolinguals before cognitive performance suffers.

Growing evidence points to greater education and mentally stimulating occupations and activities providing a cognitive reserve that enables people with developing Alzheimer's to function normally for longer. Cognitive reserve means that your brain can take more damage before it has noticeable effects. A 2006 review found that some 30% of older adults found to have Alzheimer’s when autopsied had shown no signs of it when alive.

There are two relevant concepts behind the protection some brains have: cognitive reserve (which I have mentioned on a number of occasions), and brain reserve, which is more structural. ‘Brain reserve’ encapsulates the idea that certain characteristics, such as a greater brain size, help protect the brain from damage. Longitudinal studies have provided evidence, for example, that a larger head size in childhood helps reduce the risk of developing Alzheimer’s.

While cognitive reserve has been most often associated with education, it has also been associated with occupation, bilingualism, and music. A new study provides physical evidence for how effective bilingualism is.

The Toronto study involved 40 patients with a diagnosis of probable Alzheimer’s, of whom half were bilingual (fluent in a second language, and consistent users of both languages throughout their lives). Bilingual and monolingual patients were matched on a test of cognitive function (the Behavioral Neurology Assessment). The two groups were similar in education levels, gender, and performance on the MMSE and the clock drawing test. The groups did differ significantly in occupational status, with the monolinguals having higher job status than the bilinguals.

Notwithstanding this similarity in cognitive performance, brain scans revealed that the bilingual group had substantially greater atrophy in the medial temporal lobe and the temporal lobe. The two groups did not differ in measures of central and frontal atrophy, however — these regions are not associated with Alzheimer’s.

In other words, bilingualism seems to specifically help protect those areas implicated in Alzheimers, and the bilinguals could take much greater damage to the brain before it impacted their cognitive performance. It is suggested that the act of constantly switching between languages, or suppressing one language in favor of other, may help train the brain to be more flexible when the need comes to compensate for damaged areas.

The findings are consistent with previous observational studies suggesting that bilingualism delays the onset of Alzheimer's symptoms by up to five years.

Reference: 

[2712] Schweizer, T. A., Ware J., Fischer C. E., Craik F. I. M., & Bialystok E.
(2011).  Bilingualism as a contributor to cognitive reserve: Evidence from brain atrophy in Alzheimer’s disease.
Cortex.

Valenzuela MJ and Sachdev P. 2006. Brain reserve and dementia: A systematic review. Psychological Medicine, 36(4): 441e454.

Source: 

http://www.eurekalert.org/pub_releases/2011-10/smh-trf101311.php

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Brain atrophy may predict risk for early Alzheimer's disease

January, 2012
  • Shrinking of certain brain regions predicts age-related cognitive decline and dementia, with greater brain tissue loss markedly increasing risk.

A study involving 159 older adults (average age 76) has confirmed that the amount of brain tissue in specific regions is a predictor of Alzheimer’s disease development. Of the 159 people, 19 were classified as at high risk on the basis of the smaller size of nine small regions previously shown to be vulnerable to Alzheimer's), and 24 as low risk. The regions, in order of importance, are the medial temporal, inferior temporal, temporal pole, angular gyrus, superior parietal, superior frontal, inferior frontal cortex, supramarginal gyrus, precuneus.

There was no difference between the three risk groups at the beginning of the study on global cognitive measures (MMSE; Alzheimer’s Disease Assessment Scale—cognitive subscale; Clinical Dementia Rating—sum of boxes), or in episodic memory. The high-risk group did perform significantly more slowly on the Trail-making test part B, with similar trends on the Digit Symbol and Verbal Fluency tests.

After three years, 125 participants were re-tested. Nine met the criteria for cognitive decline. Of these, 21% were from the small high-risk group (3/14) and 7% from the much larger average-risk group (6/90). None were from the low-risk group.

The results were even more marked when less stringent criteria were used. On the basis of an increase on the Clinical Dementia Rating, 28.5% of the high-risk group and 9.7% of the average-risk group showed decline. On the basis of declining at least one standard deviation on any one of the three neuropsychological tests, half the high-risk group, 35% of the average risk group, and 14% (3/21) of the low-risk group showed decline. (The composite criteria required both of these criteria.)

Analysis estimated that every standard deviation of cortical thinning (reduced brain tissue) was associated with a nearly tripled risk of cognitive decline.

The 84 individuals for whom amyloid-beta levels in the cerebrospinal fluid were available also revealed that 60% of the high-risk group had levels consistent with the presence of Alzheimer's pathology, compared to 36% of those at average risk and 19% of those at low risk.

The findings extend and confirm the evidence that brain atrophy in specific regions is a biomarker for developing Alzheimer’s.

Reference: 

[2709] Dickerson, B. C., & Wolk D. A.
(2012).  MRI cortical thickness biomarker predicts AD-like CSF and cognitive decline in normal adults.
Neurology. 78(2), 84 - 90.

Dickerson BC, Bakkour A, Salat DH, et al. 2009. The cortical signature of Alzheimer’s disease: regionally specific cortical thinning relates to symptom severity in very mild to mild AD dementia and is detectable in asymptomatic amyloidpositive individuals. Cereb Cortex;19:497–510.

Source: 

http://www.eurekalert.org/pub_releases/2011-12/aaon-bsm121311.php

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HIV-associated dementia

Older news items (pre-2010) brought over from the old website

HIV-related memory loss linked to Alzheimer's protein

More than half of HIV patients experience memory problems and other cognitive impairments as they age. Now analysis of biomarkers in the cerebrospinal fluid have demonstrated how HIV-related cognitive impairment is like Alzheimer's-related dementia, and how it is different. The comparison of 49 HIV patients with cognitive impairments (average age 48), 21 HIV patients with normal cognitive function (average age 43), 68 patients with mild Alzheimer's (average age 74) and 50 normal, healthy controls (average age 50), found similarly low levels of amyloid beta in those HIV patients with cognitive impairments and those with Alzheimer’s — surprising researchers, and confirming an earlier study. Unlike the HIV patients however, those with mild Alzheimer's had significantly higher levels of tau.

[215] Clifford, D. B., Fagan A. M., Holtzman D. M., Morris J. C., Teshome M., Shah A. R., et al.
(2009).  CSF biomarkers of Alzheimer disease in HIV-associated neurologic disease.
Neurology. WNL.0b013e3181c5b445 - WNL.0b013e3181c5b445.

http://www.eurekalert.org/pub_releases/2009-12/wuso-hml120209.php

HIV infection and chronic drinking together impair encoding of new experiences

A study involving 40 individuals with HIV, 38 with chronic alcoholism, 47 with both HIV and chronic alcoholism, and 39 controls, has found that although those with only one of these disorders mostly performed at levels comparable to controls on episodic and working memory tasks, those who were both positive for HIV and had a history of chronic heavy drinking were impaired on tests of immediate episodic memory (but not working memory) — meaning that they have trouble encoding new information for long-term memory. The finding is consistent with the fact that the mediotemporal lobe is affected early by both these conditions. Heavy drinking is very common among those infected with HIV.

[440] Fama, R., Rosenbloom M. J., Nichols N. B., Pfefferbaum A., & Sullivan E. V.
(2009).  Working and episodic memory in HIV infection, alcoholism, and their comorbidity: baseline and 1-year follow-up examinations.
Alcoholism, Clinical and Experimental Research. 33(10), 1815 - 1824.

http://www.eurekalert.org/pub_releases/2009-07/ace-hia072009.php

Green tea extract protects against HIV-associated dementia

A compound derived from green tea greatly reduced the neurotoxicity of proteins secreted by the human immunodeficiency virus, suggesting a new approach to the prevention and treatment of HIV-associated dementia.

Brian Giunta reported the findings May 1 at Experimental Biology 2007 in Washington, DC.

http://www.eurekalert.org/pub_releases/2007-05/uosf-gte042707.php

AIDS-related cognitive impairment exists in two separate forms

Cognitive impairment in people with AIDS is caused when the HIV virus attacks the brain and can be a complicated syndrome resulting in deficits in mood, behavior, motor coordination and thought processes. While the incidence of severe dementia in people with AIDS has decreased significantly, a greater number of people are living with a milder form of cognitive impairment. A study of 54 participants with AIDS and 23 HIV-negative control subjects has found that cognitive impairment in people with AIDS exists in two forms -- one mild, another severe -- each affecting different areas of the brain. Of the 54 participants with AIDS, 17 demonstrated some level of mental impairment. The mild impairment group only showed problems in the area of psychomotor speed, and demonstrated atrophy in the frontal and anterior cingulate cortices. Those in the severe impairment group showed impairments in memory and visual-spatial processing as well as psychomotor speed, and had more significant atrophy that was located in the caudate and putamen.

The findings were presented April 5 at the American Academy of Neurology 58th Annual Meeting in San Diego.

http://www.eurekalert.org/pub_releases/2006-04/uopm-aci040306.php

AIDS inflicts specific pattern of brain damage

A new imaging study has revealed a startlingly selective pattern of destruction inflicted by AIDS on brain regions. Only motor, language and sensory functions were affected. Also surprisingly, there was no difference in brain tissue loss between those taking antiretroviral drugs and those not. It appears that the blood barrier prevents these drugs entering the brain.

[1143] Thompson, P. M., Dutton R. A., Hayashi K. M., Toga A. W., Lopez O. L., Aizenstein H. J., et al.
(2005).  Thinning of the cerebral cortex visualized in HIV/AIDS reflects CD4+ T lymphocyte decline.
Proceedings of the National Academy of Sciences of the United States of America. 102(43), 15647 - 15652.

http://www.eurekalert.org/pub_releases/2005-10/uoc--ais100605.php

A friendly reminder for HIV patients

Treating HIV requires patients to rigorously follow a medication schedule; more than most diseases, the virus easily develops a resistance to the drugs if not taken reliably. Moreover, HIV can cause brain damage, making it more difficult for some patients to remember. A device known as Jerry (more formally, the Disease Management Assistance System) flashes a light and verbally tells the patient the exact dosage and medication to take at the correct time. Of the 58 patients in a recent study, those with Jerry took their medication 80% of the time, while those without did so only 65% of the time. The difference was only significant for those with memory impairment: of the 31 memory-impaired patients, those using Jerry had a 77% adherence rate, while those without Jerry had a 57% adherence rate.

[1337] Andrade, A. S. A., McGruder H. F., Wu A. W., Celano S. A., Skolasky R. L., Selnes O. A., et al.
(2005).  A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment.
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 41(6), 875 - 882.

http://www.journals.uchicago.edu/CID/journal/rapid.html
http://www.eurekalert.org/pub_releases/2005-09/jhmi-afr091305.php

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Common health complaints increase Alzheimer's risk

October, 2011

Two large studies respectively find that common health complaints and irregular heartbeat are associated with an increased risk of developing Alzheimer’s, while a rat study adds to evidence that stress is also a risk factor.

A ten-year study involving 7,239 older adults (65+) has found that each common health complaint increased dementia risk by an average of about 3%, and that these individual risks compounded. Thus, while a healthy older adult had about an 18% chance of developing dementia after 10 years, those with a dozen of these health complaints had, on average, closer to a 40% chance.

It’s important to note that these complaints were not for serious disorders that have been implicated in Alzheimer’s. The researchers constructed a ‘frailty’ index, involving 19 different health and wellbeing factors: overall health, eyesight, hearing, denture fit, arthritis/rheumatism, eye trouble, ear trouble, stomach trouble, kidney trouble, bladder control, bowel control, feet/ankle trouble, stuffy nose/sneezing, bone fractures, chest problems, cough, skin problems, dental problems, other problems.

Not all complaints are created equal. The most common complaint — arthritis/rheumatism —was only slightly higher among those with dementia. Two of the largest differences were poor eyesight (3% of the non-demented group vs 9% of those with dementia) and poor hearing (3% and 6%).

At the end of the study, 4,324 (60%) were still alive, and of these, 416 (9.6%) had Alzheimer's disease, 191 (4.4%) had another sort of dementia and 677 (15.7%) had other cognitive problems (but note that 1,023 were of uncertain cognitive ability).

While these results need to be confirmed in other research — the study used data from broader health surveys that weren’t specifically designed for this purpose, and many of those who died during the study will have probably had dementia — they do suggest the importance of maintaining good general health.

Common irregular heartbeat raises risk of dementia

In another study, which ran from 1994 to 2008 and followed 3,045 older adults (mean age 74 at study start), those with atrial fibrillation were found to have a significantly greater risk of developing Alzheimer’s.

At the beginning of the study, 4.3% of the participants had atrial fibrillation (the most common kind of chronically irregular heartbeat); a further 12.2% developed it during the study. Participants were followed for an average of seven years. Over this time, those with atrial fibrillation had a 40-50% higher risk of developing dementia of any type, including probable Alzheimer's disease. Overall, 18.8% of the participants developed some type of dementia during the course of the study.

While atrial fibrillation is associated with other cardiovascular risk factors and disease, this study shows that atrial fibrillation increases dementia risk more than just through this association. Possible mechanisms for this increased risk include:

  • weakening the heart's pumping ability, leading to less oxygen going to the brain;
  • increasing the chance of tiny blood clots going to the brain, causing small, clinically undetected strokes;
  • a combination of these plus other factors that contribute to dementia such as inflammation.

The next step is to see whether any treatments for atrial fibrillation reduce the risk of developing dementia.

Stress may increase risk for Alzheimer's disease

And a rat study has shown that increased release of stress hormones leads to cognitive impairment and that characteristic of Alzheimer’s disease, tau tangles. The rats were subjected to stress for an hour every day for a month, by such means as overcrowding or being placed on a vibrating platform. These rats developed increased hyperphosphorylation of tau protein in the hippocampus and prefrontal cortex, and these changes were associated with memory deficits and impaired behavioral flexibility.

Previous research has shown that stress leads to that other characteristic of Alzheimer’s disease: the formation of beta-amyloid.

Reference: 

[2567] Song, X., Mitnitski A., & Rockwood K.
(2011).  Nontraditional risk factors combine to predict Alzheimer disease and dementia.
Neurology. 77(3), 227 - 234.

[2566] Dublin, S., Anderson M. L., Haneuse S. J., Heckbert S. R., Crane P. K., Breitner J. C. S., et al.
(2011).  Atrial Fibrillation and Risk of Dementia: A Prospective Cohort Study.
Journal of the American Geriatrics Society. 59(8), 1369 - 1375.

[2568] Sotiropoulos, I., Catania C., Pinto L. G., Silva R., Pollerberg E. G., Takashima A., et al.
(2011).  Stress Acts Cumulatively To Precipitate Alzheimer's Disease-Like Tau Pathology and Cognitive Deficits.
The Journal of Neuroscience. 31(21), 7840 - 7847.

Source: 

http://www.scientificamerican.com/blog/post.cfm?id=alzheimers-risk-linke... http://www.eurekalert.org/pub_releases/2011-08/ghri-cih080611.php http://www.eurekalert.org/pub_releases/2011-05/m-smi052611.php

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Helping Alzheimer's sufferers

Behavioral and cognitive strategies that can help those suffering from Alzheimer's.

Older news items (pre-2010) brought over from the old website

Memory grows less efficient very early in Alzheimer's

A study of 109 healthy older adults (average age 75), 41 older adults with very early Alzheimer's, 13 with early Alzheimer's, and 35 younger adults (25 or younger) has found that those with Alzheimer’s — even those in the very early stages — were significantly less efficient than their healthy age peers at remembering items according to their value. It may be that Alzheimer's makes it harder for people to encode what they learn in a strategic way. This research suggests the potential for improved memory training.

Castel, A.D., Balota, D.A. & McCabe, D.P. 2009. Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease. Neuropsychology, 23 (3), 297-306.

http://www.eurekalert.org/pub_releases/2009-05/apa-mgl042909.php

Pictures better than words for memory-damaged patients

We’ve long known that pictures are remembered better than words. Now a study has found that this picture superiority still exists in those with mild cognitive impairment and very mild Alzheimer’s disease. Moreover, frontally-based brainwave patterns were similar to those of controls when pictures were being retrieved, but not for words. The findings support the idea that those with mild Alzheimer’s can successfully use implicit memory (memory without conscious awareness) to support recognition, and this may point to new strategies for dealing with their memory problems.

Castel, A.D., Balota, D.A. & McCabe, D.P. 2009. Memory Efficiency and the Strategic Control of Attention at Encoding: Impairments of Value-Directed Remembering in Alzheimer's Disease. Neuropsychology, 23 (3), 297-306.

http://www.physorg.com/news160307482.html

Treating sleep apnea in Alzheimer's patients helps cognition

A study of 52 men and women with mild to moderate Alzheimer's disease and obstructive sleep apnea (OSA) has found significant improvement in patients' neurological test scores after continuous positive airway pressure (CPAP) treatment. CPAP also reduced daytime sleepiness, a common complaint of Alzheimer's patients and their caregivers. The prevalence of OSA in patients with dementia has been estimated to be as high as 70 to 80%.

Ancoli-Israel, S. et al. 2008. Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer's Disease: A Randomized Controlled Study. Journal of the American Geriatrics Society, 56 (11),2076-2081.

http://www.eurekalert.org/pub_releases/2008-12/uoc--tsa120308.php

Hypnosis shown to reduce symptoms of dementia

This one’s really quite weird. A study found that people living with dementia who received hypnosis therapy over a nine month period showed an improvement in concentration, memory and socialization compared to groups receiving the normal treatment (who declined in these measures) and those attending a regular discussion group (who stayed the same). Relaxation, motivation and daily living activities also improved with the use of hypnosis. The findings point to the role of depression and anxiety in worsening the symptoms of dementia. The latest follow-up study has found that many of the benefits in the hypnosis group were maintained 12 months later.

Duff, S.C. & Nightingale, D.J. 2008. Long-term outcomes of hypnosis in changing the quality of life in patients with dementia. European Journal of Clinical Hypnosis, 7 (1)

http://www.eurekalert.org/pub_releases/2008-07/uol-hst072808.php
http://www.sciencedaily.com/releases/2008/07/080728111402.htm

More sleep improves cognition in Alzheimer patients with OSA

A study involving 52 participants with an average age of 77.8 years who had Alzheimer disease and obstructive sleep apnea (OSA) has found that it was increases in total sleep time in those given continuous positive airway pressure treatment that was associated with improvements in cognition, rather than improvement in oxygen levels. This suggests that the cognitive dysfunction associated with OSA in patients with dementia may be in part an effect of short sleep time.

The findings were presented at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

http://www.eurekalert.org/pub_releases/2008-06/aaos-iit050708.php

Mediterranean diet may help Alzheimer's patients live longer

A study of 192 people with Alzheimer's disease has found that those who most closely followed a Mediterranean diet were 76% less likely to die during the 4 ½ year study period compared to those who followed the diet the least. A previous study by the same researchers found that healthy people who eat a Mediterranean diet lowered their risk of developing Alzheimer's disease. The Mediterranean diet includes a high intake of vegetables, legumes, fruits, cereals, fish, monounsaturated fatty acids; a low intake of saturated fatty acids, dairy products, meat and poultry; and a mild to moderate amount of alcohol.

Scarmeas, N., Luchsinger, J.A., Mayeux, R. & Stern, Y. 2007. Mediterranean diet and Alzheimer disease mortality. Neurology, 69, 1084-1093.

http://www.sciencedaily.com/releases/2007/09/ 070910162411.htm
http://www.eurekalert.org/pub_releases/2007-09/aaon-mdm090407.php

Alzheimer's weight gain initiative improved patients' intellectual abilities

In a small, three-month study, Swedish researchers have found a way to increase the weight of people with Alzheimer's, with consequent improved intellectual abilities, by improving communication and patient involvement, altering meal routines and providing a more homely eating environment.

Mamhidir et al. 2007. Weight increase in patients with dementia and alteration in meal routines and meal environment after integrity promoting care. Journal of Clinical Nursing, 16, 987-996.

http://www.eurekalert.org/pub_releases/2007-05/bpl-awg051507.php

Enhanced environment restores memory in mice with neurodegeneration

Research involving genetically engineered mice has found that mice whose brains had lost a large number of neurons due to neurodegeneration regained long-term memories and the ability to learn after their surroundings were enriched with toys and other sensory stimuli. The same effect was also achieved through the use of a drug that encourages neuronal growth. The findings suggest not only new approaches to treatment for those with Alzheimer's or other neurodegenerative diseases, but also supports recent suggestions that "memory loss" may be an inaccurate description of the kinds of mental deficits associated with neurodegenerative diseases. The memories are still there; they are simply inaccessible.

Fischer, A., Sananbenesi, F., Wang, X., Dobbin, M. & Tsai, L-H. 2007. Recovery of learning and memory is associated with chromatin remodelling. Nature, 447, 178-182.

http://www.eurekalert.org/pub_releases/2007-04/hhmi-eer042507.php

Computer-based 'games' enhance mental function in Alzheimer's patients

An interactive multimedia internet-based game has been shown to benefit cognition in patients with Alzheimer's disease more than classic exercises of mental stimulation commonly used with dementia patients. The study compared patients receiving no cognitive intervention, those enrolled in a daily program that included 2.5 to 3.5 hours of cognitive stimulation tasks, musical therapy, arts and crafts, physical activity and programs that reinforced instrumental activities of daily living, and those who also used an interactive multimedia internet-based system which allowed them to carry out a variety of different cognitive stimulation tasks at varying levels of difficulty throughout the day. After 12 weeks, both intervention groups performed better on tests than the control group; at 24 weeks, the dual-intervention group did better than the program-only group. The study points to the value of cognitive stimulation to slow the rate of cognitive loss.

Tárraga, L. et al. 2006. A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 77, 1116-1121.

http://www.eurekalert.org/pub_releases/2006-10/uopm-ce102306.php

Elders with dementia can tap into memory stores to give advice

Surprisingly, it appears that the best way to converse with an Alzheimer’s patient may be to ask them for advice. In two studies, researchers found that adults with moderate to severe symptoms of dementia can still be quite coherent and informative when asked for advice. In the first study, 14 people with early to advanced stages of dementia were asked about marriage, children and church in a purely social way, such as "Tell me about your children," and then later were asked for advice on the same topics, as in, "I'm thinking about having children. What kind of advice can you give me on that?" Patients were more coherent, informative and focused on the topic when asked for advice as opposed to when they were simply asked about their children, church or marriage. In the second study, six adults with dementia and six older adults without dementia, were given a booklet of pictures to guide them in teaching someone a simple recipe. Both groups successfully taught students to prepare the recipes, although those with dementia did need more prompting to finish the task.

Dijkstra, K., Bourgeois, M., Youmans, G. & Hancock, A. 2006. Implications of an Advice-Giving and Teacher Role on Language Production in Adults With Dementia. Gerontologist, 46, 357-366.

http://www.eurekalert.org/pub_releases/2006-07/fsu-sew071706.php

Missing eyeglasses impair activities for a third of nursing home patients with Alzheimer's disease

A study of nearly 100 Alzheimer’s patients in nursing homes has determined that one third of them were not using or did not have glasses that were strong enough to correct their eyesight. Apart from causing disorientation, limiting mobility and increasing the chance of falls, the loss of vision is likely to impact on mental stimulation, by making it difficult or impossible to engage in mentally stimulating activities such as reading or watching television.

Koch, J.M., Datta, G., Makhdoom, S. & Grossberg, G.T. 2005. Unmet Visual Needs of Alzheimer’s Disease Patients in Long-term Care Facilities. Journal of the American Medical Directors Association, 6(4), 233-237.

http://www.eurekalert.org/pub_releases/2005-07/slu-mem071905.php

New memory aid helps dementia sufferers remember

An innovative memory aid based on an interactive multimedia computer system aims to stimulate more enjoyable, rewarding conversation between sufferers and those who care for them. CIRCA (Computer Interactive Reminiscence and Conversation Aid) involves a simple touch-screen with easy-to-follow instructions; it displays a choice of three random categories (entertainment, local life etc) and three media (music, photo, video). The images, video or sound clips then act as a memory trigger and conversation prompt. During development, CIRCA was tested on 40 dementia sufferers with very encouraging results. CIRCA could become available on the market in 2-3 years.

http://www.eurekalert.org/pub_releases/2005-06/eaps-nma061505.php

Weight loss may be an early sign of dementia in the elderly

An analysis of data from 1,890 men who were participants in The Honolulu-Asia Aging Study has found that the weight loss common in people with dementia begins 2-4 years before the onset of clinical dementia symptoms. It’s possible that treatment interventions directed toward maintaining optimal nutrition and preventing excess weight loss could slow the disease.

Stewart, R., Masaki, K., Xue, Q-L., Peila, R., Petrovitch, H., White, L.R. & Launer, L.J. 2005. A 32-Year Prospective Study of Change in Body Weight and Incident Dementia: The Honolulu-Asia Aging Study. Archives of Neurology, 62, 55-60.

http://www.eurekalert.org/pub_releases/2005-01/jaaj-wlm010505.php

Studies suggest people with early AD can still learn

A new study suggests that people who have early stage Alzheimer's disease could be more capable of learning than previously thought. The study found that mildly impaired Alzheimer’s patients who participated in 3-to-4 months of cognitive rehabilitation had a 170% improvement, on average, in their ability to recall faces and names and a 71% improvement in their ability to provide proper change for a purchase. The participants also could respond to and process information more rapidly and were better oriented to time and place. These improvements were still evident 3 months after the cognitive training ended.

Loewenstein, D.A., Acevedo, A., Czaja, S.J. & Duara, R. 2004. Cognitive Rehabilitation of Mildly Impaired Alzheimer Disease Patients on Cholinesterase Inhibitors. American Journal of Geriatric Psychiatry, 12(4), 395-402.

http://www.eurekalert.org/pub_releases/2004-07/nioa-ssp062904.php

Alzheimer's may leave some forms of memory intact

A new study has demonstrated that people with Alzheimer's disease retain the capability for a specific form of memory used for rote learning of skills, despite their other memory loss. The finding suggests new strategies to improve training and rehabilitative programs for Alzheimer's sufferers. It also confirms other studies suggesting that a number of brain systems are more intact in Alzheimer's than previously thought.

[1219] Lustig, C., & Buckner R. L.
(2004).  Preserved Neural Correlates of Priming in Old Age and Dementia.
Neuron. 42(5), 865 - 875.

http://www.eurekalert.org/pub_releases/2004-06/hhmi-als060404.php
http://www.eurekalert.org/pub_releases/2004-06/cp-ssh060304.php

Program helps physical and behavioral well-being of Alzheimer's patients

A controlled trial of 153 community-dwelling patients diagnosed with Alzheimer’s examined the effectiveness of a home-based exercise program combined with caregiver training in behavioral management techniques in reducing functional dependence and delay institutionalization. The program resulted in improved physical health and less depression. Specifically, after three months, those receiving the training were more likely to exercise at least 60 minutes a week, to have fewer days of restricted activity, to have improved scores for physical role functioning, and improved Cornell Depression Scale for Depression in Dementia scores, and have less institutionalization due to behavioral disturbance.

Teri, L. et al. 2003. Exercise Plus Behavioral Management in Patients With Alzheimer Disease: A Randomized Controlled Trial. JAMA, 290, 2015-2022.

Alzheimer patients who scored well on memory tests show unique compensatory brain activity

A study of 12 healthy older adults and 11 older patients with probable early-stage Alzheimer's compared their performance in a series of semantic and episodic memory tasks on a computer screen, using PET scans. Overall, Alzheimer's patients performed less accurately on the semantic and episodic tasks compared to the normal controls. However, the range of scores was quite large in the Alzheimer group, with some performing poorly and others performing within the normal range. For those patients who did better on the memory tasks, researchers found that their prefrontal network activity was more expansive compared to the error-prone patients. This additional activity was happening in the right frontal and temporoparietal areas. It was a unique neural pattern not found in the controls either. This provides the most direct evidence to date that Alzheimer's patients can use additional neural resources in the prefrontal cortex to compensate for losses attributable to the degenerative process of the disease.

Grady, C.L., McIntosh, A.R., Beig, S., Keightley, M.L., Burian, H. & Black, S.E. 2003. Evidence from Functional Neuroimaging of a Compensatory Prefrontal Network in Alzheimer's Disease. Journal of Neuroscience, 23, 986-993.

http://www.eurekalert.org/pub_releases/2003-02/bcfg-apw013103.php

Memory training may help some Alzheimer's patients

Following anecdotal "success stories" of memory training provided by rehabilitation experts, researchers in London conducted a controlled study to see whether such training could be standardized for a larger group of people, and whether the benefits of training endured. The study involved 12 participants with probable Alzheimer's Disease (AD) at the minimal or mild stage, when they still had some capacity for learning. The researchers then trained participants to remember the names of people whom they had difficulty naming from a set of 12 photos that included people in their social network and famous people. They used such memory aids as mnemonic devices, which use the image to jog memory through some kind of meaningful association; "vanishing cues," a method in which participants fill in more and more letters in the person's name, until they can recall that name without any help; and "expanding rehearsal," in which people test themselves on what they've learned, in spaced intervals over time. All training minimized the chance of errors, which helped to reduce distress and raise confidence. By training participants' memory for just half of their photo sets, researchers were able to compare memory training with no training, for each participant. Participants learned the face-name association at the rate of one per week, adding each new pair to their practice until they worked at all six pairs. They continued practicing until a one-month follow-up test of the face-name pairs. Testing was repeated at three, six and 12 months. The memory training produced a statistically significant improvement in group performance on free recall of trained items. Participants kept their memory gains six months after training, and scores remained above baseline levels after 12 months -- even without further practice. Not all participants benefited from the training. Further research is needed to discover what distinguishes those who benefitted from those who didn’t. One factor that was found, was that those who were more aware of their memory problems were more likely to respond well to memory training.

Clare, L.,Wilson, B.A., Carter, G., Roth, I., Hodges & J.R. 2002. Relearning Face-Name Associations in Early Alzheimer's Disease. Neuropsychology, 16 (4), 538-47.

http://www.eurekalert.org/pub_releases/2002-10/apa-mtm101502.php

Helping Alzheimer's sufferers remember

Alzheimer sufferers recalled significantly more details of long-ago events when music was played during recall. Recent memory was not affected. It is suggested that music could be played at particular times when better recall is desirable, such as when relatives visit.

The study involved 23 older adults with mild-to-moderate dementia. Participants were tested in each of four auditory background conditions presented randomly, one week apart: quiet; cafeteria noise; familiar music (first movement of Vivaldi's “The Four Seasons”); novel music (Fitkin's “Hook”). Questions were drawn from three life eras: up to age 20; around ages 20—50; and recent past and present. Sound conditions (music or noise) were significantly better than quiet (mean recall 67% vs 61%). There was no difference between familiar and novel music, but there was a small difference between noise and music (66% vs 68%). This difference was greater for remote memory; there was no difference between noise and music for memory of recent past. Overall, the Alzheimer's patients had much better recall for older memories.

The improvement in recall for the sound conditions over quiet, and the similarity between all sound conditions, points to arousal as the crucial factor. The greater effectiveness of music compared to noise may signal an associational effect. Further research exploring the effects of different pieces of music would help clarify this.

Valentine, E. & Foster, N. 2000. Reported at the British Psychological Society's London Conference, December 20.

http://www.guardian.co.uk/uk/2000/dec/24/paulharris.theobserver1

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Caregivers

Older news items (pre-2010) brought over from the old website

Close caregiver relationship may slow Alzheimer's decline

A study of 167 pairs of caregivers and Alzheimer's patients has found that by the end of the study patients whose caregivers had scored their relationship as particularly close lost less than half as many points on average on a common cognitive test called the Mini-Mental State Exam (MMSE) as patients with more distant caregivers. The scores were based on a survey in which caregivers rated their level of agreement or disagreement with six statements, such as "My relationship with the care recipient is close"; "The care recipient makes me feel like a special person"; and "The care recipient and I can always discuss things together." The effect was strongest when the caregiver was a spouse, as opposed to an adult child or in-law. Patients with close spouses showed rates of decline similar to patients taking Alzheimer's drugs called acetylcholinesterase inhibitors. However, it can’t be ruled out that the effect may be due to slower decline encouraging caregivers to remain close. A follow-up study is planned to answer this question.

http://www.eurekalert.org/pub_releases/2009-07/jhmi-ccr072209.php

Norton, M.C. et al. 2009. Caregiver–Recipient Closeness and Symptom Progression in Alzheimer Disease. The Cache County Dementia Progression Study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, Advance Access published on June 29, 2009.

Results of caregiver survey

Results from the third annual Alzheimer’s Foundation of America Investigating Caregivers’ Attitudes and Needs Survey found that about three in five caregivers say their children aged 8 to 21 are involved in caring for a loved one with Alzheimer’s. Of the caregivers who feel they do a good job balancing the care of their loved ones with Alzheimer’s disease and children under 21, more than one-third (36%) specifically cited support from children as a contributor to their success. Additionally, nearly two-thirds (63%) would like more information about how to help their children cope when a loved one is diagnosed with Alzheimer’s. Caregivers of sufferers whose diagnosis was delayed for a year or more say the delay was most often due to lack of caregiver familiarity with symptoms or insufficient knowledge about Alzheimer’s. Additional key survey findings can be found at www.alzfdn.org.

http://www.eurekalert.org/pub_releases/2008-03/fi-nad032508.php

Counseling Alzheimer's caregivers postpones the nursing home

A long-running study of 406 people caring for a spouse with dementia has found that a program of individual and family counseling sessions and ongoing support for caregivers delays by an average of 1.5 years the time when people with dementia are usually put in nursing homes.

http://www.eurekalert.org/pub_releases/2006-11/nyum-cac110806.php

Mittelman, M.S., Haley, W.E., Clay, O.J. & Roth, D.L. 2006. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology, 67, 1592-1599.

Individualized counseling helps caregivers

A study of 642 people who were caring for a relative with Alzheimer's disease or a related disorder has found that those who participated in a counseling program were less likely to suffer depression and felt more confident and able to deal with caring for their relative. Hispanic and white participants saw the greatest benefit. In African-Americans, the intervention was effective among spouse-caregivers, but relatively ineffective among caregivers who were caring for a relative other than their husband or wife. Hispanics had the greatest improvement in reduction of caregiver depressive symptoms and problem behaviors of the recipient. Whites saw the most impact in the area of social support and African-American spouse-caregivers had the most positive outcome in reducing the caregiver burden and improving self-care.

http://www.eurekalert.org/pub_releases/2006-11/uopm-idc111506.php
http://www.eurekalert.org/pub_releases/2006-11/nioa-npe111606.php

Belle, S.H. et al. 2006. Enhancing the Quality of Life of Dementia Caregivers from Different Ethnic or Racial Groups: A Randomized, Controlled Trial. Annals of Internal Medicine, 145(10), 727-738.

Collaborative care has better outcomes for both patients and caregivers

An 18-month study involving 153 older adults with Alzheimer's disease and their caregivers has found that restructuring the primary care practice environment to emphasize a team approach to care significantly improved the quality of care and behavioral and psychological symptoms of dementia. Caregivers were also less stressed and less depressed.

http://www.eurekalert.org/pub_releases/2006-05/iu-lai050406.php

Callahan, C.M. et al. 2006. Effectiveness of Collaborative Care for Older Adults With Alzheimer Disease in Primary Care: A Randomized Controlled Trial. JAMA, 295, 2148-2157.

Enhanced counseling eases depression among caregivers

A new report from of the NYU Spouse-Caregiver Intervention Study shows that a six-session counseling and long-term support program substantially eases the depression of people caring for a loved one with Alzheimer’s, and that the mental health benefits apparently are long lasting. The study involved 406 caregivers, half of whom received the usual counseling--sessions provided on an ad-hoc basis upon request (control group). The other half was given three additional types of counseling: two sessions of individual counseling, four sessions of counseling with their family, and then weekly meetings with a support group of fellow caregivers. After one year, some 45% of the control group had symptoms of clinical depression, compared with 30% of those who had received special counseling. This group still showed fewer symptoms of depression on average than those in the control group three years later. There was no difference after five years. It was suggested that key factors in the enhanced treatment program were having the same counselor for all sessions, the use of multiple types of coordinated therapy, and counseling tailored to the particular coping challenges that each of the caregivers and their families were dealing with.

http://www.eurekalert.org/pub_releases/2004-05/nyum-ece042704.php

Mittelman, M.S., Roth, D.L., Coon, D.W. & Haley, W.E. 2004. Sustained Benefit of Supportive Intervention for Depressive Symptoms in Caregivers of Patients With Alzheimer’s Disease. American Journal of Psychiatry, 161, 850-856.

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