dementia

Population study confirms link between traumatic brain injury and dementia

  • A very large dataset shows that a history of TBI significantly increases the risk of later dementia, with risk increasing for more injuries and more severe injuries.

A review of nearly 2.8 million patient cases in Denmark found that the risk of dementia in individuals with a history of TBI was 24% higher than those without a history of TBI, after accounting for other risk factors.

Risk was greater when the TBI was characterized as "severe" — 35% compared to an increased risk of 17% for a single "mild" TBI or concussion.

Moreover, dementia risk increased 33% higher for two or three TBIs, 61% higher for four TBIs, and 183% higher for five or more TBIs.

Additionally, the study found that if you have a brain injury in your 20s, the risk of developing dementia in your 50s increased by 60%.

The findings suggest that those with a history of TBI (particularly multiple injuries) should make an effort to reduce other risk factors, such as limiting alcohol and tobacco use, engaging in regular exercise, preventing obesity, and treating hypertension, diabetes, and depression.

Among the nearly 2.8 million people observed, 4.7% had at least one TBI diagnosis. Among first TBI diagnoses, 85% were characterized as mild.

Among men and women with TBI histories, men had slightly higher rate of developing dementia (30% vs. 19%).

Note that an earlier study (much smaller) found no evidence of a link between TBI and Alzheimer's.

This study involved 706 older adults from the National Alzheimer's Coordinating Center database, of whom 274 had Alzheimer’s. It found that there was no significant difference in the rate of cognitive decline between demographically and clinically similar participants with and without a history of TBI. This held regardless of APOE4 status.

However, researchers added the caveat that the findings should be interpreted cautiously due to the crude and limited assessment of TBI history available through the database.

https://www.eurekalert.org/pub_releases/2018-04/uowh-scl041018.php

https://www.eurekalert.org/pub_releases/2017-07/bumc-snl070517.php

 

Reference: 

[4372] Fann, J. R., Ribe A. Riisgaard, Pedersen H. Schou, Fenger-Grøn M., Christensen J., Benros M. Eriksen, et al.
(2018).  Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study.
The Lancet Psychiatry. 5(5), 424 - 431.

Tripodis, Y. et al. 2017. The Effect of Traumatic Brain Injury History with Loss of Consciousness on Rate of Cognitive Decline Among Older Adults with Normal Cognition and Alzheimer’s Disease Dementia. Journal of Alzheimer's Disease, 59 (1), 251-263.

 

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Dementia trend shows later onset with fewer years of the disease

  • A large study shows that the falling rates of dementia reflect later onset coupled with shorter time spent with the dementia.

A large study using data from the famous Framingham Heart Study has compared changes in dementia onset over the last three decades. The study found that over time the age of onset has increased while the length of time spent with dementia has decreased.

The study involved 5,205 participants from the Framingham Original and Offspring cohorts. Four 5-year periods anchored to different baseline examinations (participants have been examined every four years) were compared. These baseline years are (on average, because participants’ schedules are different): 1978, 1989, 1996, 2006. Participants were those who were aged 60 or older and dementia-free at the start of a time period. There were at least 2000 participants in each time period. In total, there were 371 cases of dementia, and 43% of dementia cases survived more than 5 years after diagnosis.

It was found that the mean age of dementia onset increased by around two years per time period, while age at death increased by around one year. Length of survival after diagnosis decreased over time for everyone, taken as a whole, and also for each gender and education level, taken separately. Survival was almost 6 years in the first time period, and only three years in the last. But the mean age of onset was 80 in the first period, compared to over 86 in the last.

However, the changes haven’t been steady over the 30 years, but rather occurred mostly in those with dementia in 1986–1991 compared to 1977–1983.

Part of the reason for the changes is thought to be because of the reduced risk of stroke (largely because of better blood pressure management), and the better stroke treatments available. Stroke is a major risk factor for dementia. Other reasons might include lower burdens of multiple infections, better education, and better nutrition.

https://www.eurekalert.org/pub_releases/2018-04/uoth-dts042318.php

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Three-minute test detects Lewy Body dementia

  • An easy new rating scale will help those with Lewy Body dementia be diagnosed much more quickly.

After Alzheimer's disease, the next most common type of dementia is Lewy Body disease. Far less widely known, this form of dementia is often diagnosed quite late. A new study has validated a simple rating scale that non-specialist clinicians can use to quickly and effectively diagnose LBD in about three minutes.

The Lewy Body Composite Risk Score (LBCRS) is a simple, one-page survey with structured yes/no questions for six non-motor features that are present in patients with LBD, but are much less commonly found in other forms of dementia.

The study involved 256 patients referred from the community. The LBCRS was able to discriminate between Alzheimer's disease and LBD with 96.8% accuracy, and provided sensitivity of 90% and specificity of 87%.

Earlier diagnosis will not only reduce the strain on sufferers and their families, but also reduce the risk of inappropriate medications that can have potentially serious adverse consequences, and increase the opportunity to receive appropriate symptomatic therapies at the earliest stages when they are likely to be most effective.

http://www.eurekalert.org/pub_releases/2015-10/fau-ttd102315.php

Reference: 

[4041] Galvin, J. E.
(2015).  Improving the clinical detection of Lewy body dementia with the Lewy body composite risk score.
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. 1(3), 316 - 324.

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Dementia sufferers become unaware of memory problems years before diagnosis

  • A large study found that people who developed dementia started to lose awareness of memory problems some 2½ years before dementia onset.
  • This loss of awareness was associated with three examples of neuropathology, including tau tangles and brain infarcts.

A ten-year study involving 2,092 older adults (average age 76) has found that people tended to lose awareness of memory problems two to three years before the onset of dementia.

Being unaware of your own memory problems is common in dementia, but previous research has focused on those already diagnosed with dementia. In this study, participants had no cognitive impairment at the beginning of the study.

Overall, subjective memory ratings taken annually were modestly correlated with performance (only modestly — people tend not to be that great at accurately assessing their own memory!), and this awareness was stable with age. However, in the subset of those who developed dementia (239 participants; 11%), this awareness started to deteriorate an average of 2.6 years before dementia was diagnosed (after which it dropped rapidly).

In a subset of those who died and had their brains examined (385 participants), a decline in memory awareness was associated with three pathologies:

  • tau tangles
  • gross cerebral infarcts
  • transactive response DNA-binding protein 43 pathology (TDP-43 is a protein involved in transcription, the first step in producing proteins from genes; mutations in the gene that produces TDP-43 have been linked to frontotemporal dementia and amyotrophic lateral sclerosis (ALS)).

There was no decline in memory awareness in those who didn't show any of these pathologies.

Those who were older at the beginning of the study were more likely to retain memory awareness longer, perhaps because they were more alert to memory problems.

http://www.theguardian.com/society/2015/aug/27/dementia-sufferers-start-losing-memory-up-to-three-years-before-condition-develops-us-study

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Alzheimer’s caregivers may benefit from tailored interventions

A study involving 206 spousal and adult children caregivers of dementia sufferers (mostly Alzheimer’s) has found that about 84% of caregivers reported a clinically significant burden. Three factors were significant contributors to the burden:

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Memory complaints linked to higher risk of MCI & dementia

Data from 6257 older adults (aged 55-90) evaluated from 2005-2012 has revealed that concerns about memory should be taken seriously, with subjective complaints associated with a doubled risk of developing mild cognitive impairment or dementia, and subjective complaints supported by a loved one being associated with a fourfold risk. Complaints by a loved one alone were also associated with a doubled risk.

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Distinguishing normal cognitive decline from more serious disorders

Data from two longitudinal studies of older adults (a nationally representative sample of older adults, and the Alzheimer’s Disease Neuroimaging Initiative) has found that a brief cognitive test can distinguish memory decline associated with healthy aging from more serious memory disorders, years before obvious symptoms show up.

Moreover, the data challenge the idea that memory continues to decline through old age: after excluding the cognitively impaired, there was no evidence of further memory declines after the age of 69.

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Tracking preclinical Alzheimer's progression

New research supports the classification system for preclinical Alzheimer’s proposed two years ago. The classification system divides preclinical Alzheimer's into three stages:

Stage 1: Levels of amyloid beta begin to decrease in the spinal fluid. This indicates that the substance is beginning to form plaques in the brain.

Stage 2: Levels of tau protein start to increase in the spinal fluid, indicating that brain cells are beginning to die. Amyloid beta levels are still abnormal and may continue to fall.

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‘Lopsided’ test scores may predict Alzheimer’s sooner

Cognitive testing for dementia has a problem in that low scores on some tests may simply reflect a person's weakness in some cognitive areas, or the presence of a relatively benign form of mild cognitive impairment (one that is not going to progress to dementia). A 2008 study found that one of every six healthy adults scored poorly on two or more of 10 tests in a brief cognitive battery. Following this up, the same researchers now show that a more holistic view might separate those who are on the path to dementia from those who are not.

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