Alzheimers

Alzheimer's & other dementias

Exercise may be #1 way to prevent dementia

  • A long-running study involving women only found that regular exercise in middle age was the most effective they could do to prevent later cognitive decline.

A long-running study following 387 Australian women found that regular exercise in middle age was the best lifestyle change they could make to prevent cognitive decline in their later years.

The women were aged 45-55 when the study began in 1992. Health and lifestyle factors were assessed at intervals over the next 20 years.

Memory was assessed using a Verbal Episodic Memory test in which they were asked to learn a list of 10 unrelated words and attempt to recall them 30 minutes later.

Frequent physical activity, normal blood pressure, and high good cholesterol were all strongly associated with better recall, with regular exercise of any type emerging as the number one protective factor against memory loss.

The benefits of exercise were cumulative, meaning that every year’s activity counted. Similarly, the negative effects of high blood pressure were also cumulative. What you do over the course of your life, especially in middle age, matters! Which is not to say that’s a reason not make changes later in life. Better late than never definitely applies.

Reference: 

Szoeke, C., Lehert, P., Henderson, V. W., Dennerstein, L., Desmond, P., & Campbell, S. (2016). Predictive Factors for Verbal Memory Performance Over Decades of Aging: Data from the Women’s Healthy Ageing Project. The American Journal of Geriatric Psychiatry, 24(10), 857–867. https://doi.org/10.1016/j.jagp.2016.05.008

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Weak handgrip may warn of cognitive impairment

  • A large study finds weaker handgrip strength is associated with a progressively greater risk of developing severe cognitive impairment.
  • Another large long-running study similarly finds slow walking speeds and weak grip strength is associated with a greater risk of developing Alzheimer's disease.
  • Weaker grip strength, in those older than 65, was also linked to a higher risk of stroke.

A large study, involving nearly 14,000 older adults (50+) participating in the 2006 Health and Retirement Study, found that weaker handgrip strength was associated with a greater risk of developing cognitive impairment, especially severe impairment, over the eight-year study period.

Moreover, there was a dose-response type relationship, with every 5-kilogram (11-pound) reduction in handgrip strength being associated with a 10% greater risk of cognitive impairment and an 18% greater risk of severe cognitive impairment.

Handgrip strength was assessed with a hand-held dynamometer, and cognitive function with a modified Mini-Mental State Examination.

It’s suggested that reduced grip strength is associated with neural degeneration, but that maintaining your physical strength will protect you.

Data from the very long-running Framingham Heart Study also found that those who had slow walking speeds and weak grip strength had a significantly greater risk of developing Alzheimer’s disease in the next 11 years. Additionally, those older than 65 years had a higher risk of stroke if their hand grip strength was weak.

Participants were aged 35-84. Walking speed was assessed by walking a certain distance as fast as they could without running.

Reference: 

McGrath, R., Robinson-Lane, S. G., Cook, S., Clark, B. C., Herrmann, S., O’Connor, M. L., & Hackney, K. J. (2019). Handgrip Strength Is Associated with Poorer Cognitive Functioning in Aging Americans. Journal of Alzheimer’s Disease, 70(4), 1187–1196. https://doi.org/10.3233/JAD-190042

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High cholesterol intake & eggs don't increase dementia risk

A large, long-running Finnish study looking at the dietary habits of 2,497 men aged 42-60 has found that a high intake of dietary cholesterol was not associated with the risk of dementia or Alzheimer's disease, even among carriers of the ‘Alzheimer’s gene’ APOE4.

Previous research has found that the effect of dietary cholesterol on serum cholesterol levels is more visible in carriers of APOE4. In Finland, the prevalence of the APOE4 gene variant is exceptionally high and approximately a third of the population are carriers.

The consumption of eggs was not only not associated with an increased risk of dementia or Alzheimer's, but on the contrary, was associated with better cognitive performance on some tests.

The highest level of average daily dietary cholesterol intake was 520 mg and these participants consumed an average of one egg per day.

Reference: 

Ylilauri, M.P.T. et al. 2017. Association of dietary cholesterol and egg intakes with risk of incident dementia or Alzheimer's disease: The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Clinical Nutrition; First published online January 4, 2017. doi: 10.3945/ajcn.116.146753 http://ajcn.nutrition.org/content/early/2017/01/04/ajcn.116.146753.abstract?papetoc

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This brain training program cuts dementia risk

  • A large 10-year study investigating the benefits of a brain training program for older adults found that training designed to improve processing speed & visual attention in particular reduced dementia risk.

Findings from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study, which followed 2,802 healthy older adults for 10 years, has found that those who participated in computer training designed to improve processing speed and visual attention had a 29% lower risk of developing dementia compared to controls, with more training producing lower risk. Those who received instruction in memory or reasoning strategies showed no change in dementia risk.

Participants were randomly placed into a control group or one of three different cognitive training groups. One was instructed in memory strategies, another in reasoning strategies, and one was given individualized, computerized speed of processing training.

There were 10 initial sessions of training, each 60 to 75 minutes, over six weeks. Participants were assessed at the beginning of the study, after the first six weeks, and at one, two, three, five, and 10 years. Some of each group received four additional “booster” training sessions in months 11 and 35.

Among those who completed the most sessions (5 or more booster sessions), indicators of dementia were evident in 5.9% of the computerized speed training group; 9.7% of the memory strategy group; 10.1% of the reasoning strategy group. The control group had a dementia incidence rate of 10.8%.

14% of those who received no training developed dementia in the next 10 years, compared with 12.1% of those who received the initial processing speed training, and 8.2% of those who also received the additional booster training.

A decade after training began, the scientists found that 22.7% of people in the speed training group had dementia, compared with 24.2% in both memory and reasoning groups. In a control group of people who had no training, the dementia rate was 28.8%. This effect is greater than the protection offered by antihypertensive medications against major cardiovascular events.

It's suggested that some of the reason for this effect may be that the training builds up brain reserve, perhaps by improving brain efficiency, or in some way improving the health of brain tissue.

Some of the participants told researchers that the training encouraged them to enroll in classes at a local college or keep driving, and it’s possible that the motivational boost for continued social and intellectual engagement might also help explain the benefits.

Other research has found that processing speed training is associated with a lower risk of depression and improved physical function, as well as better everyday functioning.

The processing speed training was designed to improve the speed and accuracy of visual attention, with both divided and selective attention exercises. To perform the divided attention training task, participants identified a central object—such as a truck—while simultaneously locating a target in the periphery—the car. The speed of these objects became increasingly faster as participants mastered each set. In the more difficult training tasks, adding distracting objects made the task even more challenging, thus engaging selective attention.

The training program is available as the “Double Decision” exercise in the BrainHQ.com commercial product.

Of the 1220 who completed the 10-year follow-up, 260 developed dementia during the period.

http://www.futurity.org/speed-of-processing-training-dementia-1613322/

https://www.eurekalert.org/pub_releases/2017-11/uosf-ibf111417.php

https://www.theguardian.com/society/2017/nov/16/can-brain-training-reduce-dementia-risk-despite-new-research-the-jury-is-still-out

http://www.scientificamerican.com/article/brain-training-cuts-dementia-risk-a-decade-later/

Reference: 

[4490] Edwards, J. D., Xu H., Clark D. O., Guey L. T., Ross L. A., & Unverzagt F. W.
(2017).  Speed of processing training results in lower risk of dementia.
Alzheimer's & Dementia: Translational Research & Clinical Interventions. 3(4), 603 - 611.

Full text available at https://www.trci.alzdem.com/article/S2352-8737(17)30059-8/fulltext

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Moving more in old age may protect brain from dementia

  • A long-running study found older adults who moved more were less likely to develop dementia, even when they had brain pathologies characteristic of dementia.

A long-running study involving 454 older adults who were given physical exams and cognitive tests every year for 20 years has found that those who moved more than average maintained more of their cognitive skills than people who were less active than average, even if they have brain lesions or biomarkers linked to dementia.

Participants wore an activity monitor for a week, an average of two years before death. The range of physical activity was extreme, with the average being 155,000 counts/day and the standard deviation being 116,000 counts. Daily physical activity was affected by age (unsurprisingly) and education.

For every increase in physical activity by one standard deviation, participants were 31% less likely to develop dementia. For every increase in motor ability by one standard deviation, participants were 55% less likely to develop dementia.

191 had dementia and 263 did not. The participants donated their brains for research upon their deaths. The average age at death was 91 years. Almost all (95.6%) showed at least one brain pathology, with 85% having at least two, and the average being three. Pathologies include Alzheimer's pathology, Lewy Bodies, nigral neuronal loss, TDP-43, hippocampal sclerosis, micro- and macro-infarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy.

https://www.eurekalert.org/pub_releases/2019-01/rumc-mmi011119.php

https://www.theguardian.com/science/2019/jan/16/activity-sharpens-even-dementia-affected-brains-report-suggests

Reference: 

Buchman, Aron S. et al. 2019. Physical activity, common brain pathologies, and cognition in community-dwelling older adults. Neurology, 92 (8), e811-e822; DOI: 10.1212/WNL.0000000000006954

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Slower walking speeds linked to dementia risk

  • A large, long-running study has found older adults with a slower walking speed were more likely to develop dementia in the next decade.
  • Another long-running study has found that slowing over 14 years was linked to brain atrophy in the hippocampus, and cognitive impairment.

Data from the English Longitudinal Study of Aging, in which nearly 4,000 older adults (60+) had their walking speed assessed on two occasions in 2002-2003 and in 2004-2005, those with a slower walking speed were more likely to develop dementia in the next 10 years. Those who experienced a faster decline in walking speed over the two-year period were also more likely to develop dementia.

https://www.eurekalert.org/pub_releases/2018-03/ags-oaw032318.php

A long-running study involving 175 older adults (70-79) found that slowing in walking speed over a 14-year period was associated with cognitive impairment, and with shrinkage of the right hippocampus specifically.

Gait slowing over an extended period of time was a stronger predictor of cognitive decline than slowing at a single time point. All the participants slowed over time, but those who slowed by 0.1 seconds more per year than their peers were 47% more likely to develop cognitive impairment.

The finding held even when the researchers took into account slowing due to muscle weakness, knee pain and diseases, including diabetes, heart disease, and hypertension.

Typically, a slowing gait is seen as a physical issue, but doctors should consider that there may be a brain pathology driving it.

http://www.futurity.org/gait-hippocampus-brains-dementia-1472892/

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Healthy lifestyle associated with lower dementia risk regardless of genes

  • A very large study found that an unhealthy lifestyle and high genetic risk were independently associated with higher dementia risk, and a healthy lifestyle reduced the risk for those at high genetic risk.

Data from 196,383 older adults (60+; mean age 64) in the UK Biobank found that a healthy lifestyle was associated with lower dementia risk regardless of genes.

Both an unhealthy lifestyle and high genetic risk were associated with higher dementia risk.

Lifestyle factors included smoking, physical activity, diet, and alcohol consumption. Bearing in mind that lifestyle factors were self-reported, 68.1% followed a healthy lifestyle, 23.6% were intermediate, and 8.2% followed an unhealthy lifestyle. Regarding genes, 20% were at high risk, 60% were intermediate, and 20% were at low risk.

Of those at high genetic risk, 1.23% developed dementia in the 8-year period (remember that these are people who are still relatively — the average age at study end would still only be 72), compared with 0.63% of those at low genetic risk. Of those at high genetic risk plus an unhealthy lifestyle, 1.78% developed dementia compared to 0.56% of those at low risk with a healthy lifestyle. Among those who had a high genetic risk but a healthy lifestyle, 1.13% developed dementia in the period.

I trust that these people will continue to be followed — it will be very interesting to see the statistics in another 10 years.

There were 1,769 new cases of dementia during the 8-year study period.

https://www.eurekalert.org/pub_releases/2019-07/jn-ihl071219.php

https://www.theguardian.com/society/2019/jul/14/healthy-lifestyle-may-cut-risk-of-dementia-regardless-of-genes

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Keeping active in middle age tied to lower dementia risk

  • A very long-running Swedish study found that women with high levels of mental or physical activity in midlife were less likely to develop dementia.

A very long-running study, in which 800 Swedish women (aged 38-54) were followed for 44 years, found that women with a high level of mental activities in midlife were 46% less likely to develop Alzheimer's disease and 34% less likely to develop dementia overall, compared with women with the low level of mental activities. Women who were physically active were 52% less likely to develop dementia with cerebrovascular disease and 56% less likely to develop mixed dementia, compared with women who were inactive.

Mental activities included intellectual activities, such as reading and writing; artistic activities, such as going to a concert or singing in a choir; manual activities, such as needlework or gardening; club activities; and religious activity.

Participants were given scores in each of the five areas based on how often they participated in mental activities, with a score of zero for no or low activity, one for moderate activity and two for high activity. For example, moderate artistic activity was defined as attending a concert, play or art exhibit during the last six months, while high artistic activity was defined as more frequent visits, playing an instrument, singing in a choir or painting. Low activity was defined as scores of zero to two and high activity as scores of three to 10 (44% and 56% of participants, respectively).

The physically active group ranged from light physical activity such as walking, gardening, bowling or biking for a minimum of four hours per week to regular intense exercise such as running or swimming several times a week or engaging in competitive sports. Most (82%) were in the active group.

Of the 438 women with the high level of mental activity, 104 (23.7%) developed dementia, compared to 90 (25.9%) of the 347 women with the low level of activity. Of the 648 women with the high level of physical activity, 159 (24.5%) developed dementia, compared to 35 (25.5%) of the 137 women who were inactive.

I note that distinction between those with high and low levels of activity seems very broad-brush. I don’t know why the researchers didn’t analyze the data in a more refined manner — comparing the most active with the least active would be more usual, and would be more likely to show a greater effect. But perhaps that's the point — showing that even with this smaller distinction, a significant effect is still found.

During the study, 194 women developed dementia. Of those, 102 had Alzheimer's disease, 27 had vascular dementia, 41 had mixed dementia, and 14 had other dementias. 81 (41.8%) of those with dementia also had cerebrovascular disease.

https://www.eurekalert.org/pub_releases/2019-02/uog-eai022419.php

Full text available at https://n.neurology.org/content/early/2019/02/21/WNL.0000000000007021

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Cognitive & motor training combined may slow progress of dementia

  • A very small study found that just 30 minutes of visually-guided movements per week could slow and even reverse the progress of dementia in those in the early stages of dementia.

Various forms of dementia, including Alzheimer's, involve brain network problems. Brain regions are not coordinating as well as they should; white matter is dysfunctional, impairing communications. It has even been suggested that problems in the default mode network (the "resting state" of the brain) may be the ultimate driver of the pathological characteristics of Alzheimer's, such as amyloid plaques, tau tangles, and brain atrophy. Regardless of the order of events, it does seem that network dysfunction is one of the big problems in dementia.

It's with this in mind that a pilot study has investigated the benefits of a program designed to simultaneously recruit networks involved in cognition and motor action.

37 elderly people were divided into four groups based on their level of cognition: 12 with normal levels of cognitive performance; 8 with below-average cognition; 6 with mild-to-moderate impairment; 11 with severe cognitive impairment. They completed a 16-week cognitive-motor training program that consisted of weekly sessions involving playing a videogame that required goal-directed hand movements on a computer tablet. Specifically, players had to slice moving objects by sliding their finger through it. Each object sliced earned a point, and bonus points were awarded for slicing multiple objects in a single movement. Each session lasted 20-30 minutes.

Cognition was assessed using the Dementia Rating Scale and the Montreal Cognitive Assessment questionnaire. Cognitive-motor functioning was assessed using the Brain Dysfunction Indicator. Tests occurred 2 weeks prior to training and 2 weeks after.

Two groups showed significant improvement in their cognitive scores after training: the sub-average group, and those with mild-to-moderate impairment. While those who were severely impaired showed no improvement, neither did they decline over the period.

It’s suggested that the communication between frontal lobe and motor control areas is a crucial factor in the program’s success.

https://www.eurekalert.org/pub_releases/2018-07/yu-cam072518.php

Full text available at https://www.karger.com/Article/FullText/490173

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