seniors

Compound in celery, peppers reduces age-related memory deficits

November, 2010

One precursor of age-related cognitive impairment and dementia is inflammation. Research suggests why that might be, and explains why the plant nutrient luteolin can help fight memory impairment.

Inflammation in the brain appears to be a key contributor to age-related memory problems, and it may be that this has to do with the dysregulation of microglia that, previous research has shown, occurs with age. As these specialized support cells in the brain do normally when there’s an infection, with age microglia start to produce excessive cytokines, some of which result in the typical behaviors that accompany illness (sleepiness, appetite loss, cognitive deficits and depression).

Now new cell and mouse studies suggests that the flavenoid luteolin, known to have anti-inflammatory properties, apparently has these benefits because it acts directly on the microglial cells to reduce their production of inflammatory cytokines. It was found that although microglia exposed to a bacterial toxin produced inflammatory cytokines that killed neurons, if the microglia were first exposed to luteolin, the neurons lived. Exposing the neuron to luteolin had no effect.

Old mice fed a luteolin-supplemented diet for four weeks did better on a working memory test than old mice on an ordinary diet, and restored levels of inflammatory cytokines in their brains to that of younger mice.

Luteolin is found in many plants, including carrots, peppers, celery, olive oil, peppermint, rosemary and chamomile.

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Mental activity may slow cognitive decline initially, but speed up dementia later

October, 2010

Another study has come out suggesting that the advantage of mental stimulation is to delay cognitive decline, but at the cost of faster decline later (it’s still a good bargain).

A long-running study involving 1,157 healthy older adults (65+) who were scored on a 5-point scale according to how often they participated in mental activities such as listening to the radio, watching television, reading, playing games and going to a museum, has found that this score is correlated to the rate of cognitive decline in later years.

Some 5 ½ years after this initial evaluation, 395 (34%) were found to have mild cognitive impairment and 148 (13%) to have Alzheimer’s. Participants were then tested at 3-yearly intervals for the next 6 years. The rate of cognitive decline in those without cognitive impairment was reduced by 52% for each point on the cognitive activity scale, but for those with Alzheimer's disease, the average rate of decline per year increased by 42% for each point on the cognitive activity scale. Rate of decline was unrelated to earlier cognitive activity in those with MCI (presumably they were at the balance point).

This is not terribly surprising when you think of it, if you assume that the benefit of mental stimulation is to improve your brain function so that it can better cope with the damage happening to it. But eventually it reaches the point where it can no longer compensate for that damage because it is so overwhelming.

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Friends, family detect early Alzheimer's signs better than traditional tests

October, 2010

Cognitive tests only test you at a particular moment in time; early signs of Alzheimer's are more evident in declines in everyday behavior that are most visible to other people.

Confirming earlier research, a study involving 257 older adults (average age 75) has found that a two-minute questionnaire filled out by a close friend or family member is more accurate that standard cognitive tests in detecting early signs of Alzheimer’s.

The AD8 asks questions about changes in everyday activities:

  • Problems with judgment, such as bad financial decisions;
  • Reduced interest in hobbies and other activities;
  • Repeating of questions, stories or statements;
  • Trouble learning how to use a tool or appliance, such as a television remote control or a microwave;
  • Forgetting the month or year;
  • Difficulty handling complicated financial affairs, such as balancing a checkbook;
  • Difficulty remembering appointments; and
  • Consistent problems with thinking and memory.

Problems with two or more of these are grounds for further evaluation. The study found those with AD8 scores of 2 or more were very significantly more likely to have early biomarkers of Alzheimer’s (abnormal Pittsburgh compound B binding and cerebrospinal fluid biomarkers), and was better at detecting early stages of dementia than the MMSE. The AD8 has now been validated in several languages and is used in clinics around the world.

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Low levels of omega-3 fatty acid may contribute to Alzheimer’s

October, 2010

A finding that the livers of Alzheimer’s patients have an impaired ability to make the omega-3 fatty acid DHA may suggest a new approach.

Low levels of DHA, an omega-3 fatty acid, have been found in the brains of those with Alzheimer's disease, but the reason has not been known. A new study has found that lower levels of DHA in the liver (where most brain DHA is manufactured) were correlated with greater cognitive problems in the Alzheimer’s patients. Moreover, comparison of postmortem livers from Alzheimer’s patients and controls found reduced expression of a protein that converts a precursor acid into DHA, meaning the liver was less able to make DHA from food.

The findings may explain why clinical trials in which Alzheimer's patients are given omega-3 fatty acids have had mixed results. They also suggest that it might be possible to identify at-risk persons using specific blood tests, and perhaps delay the development of Alzheimer’s with a chemically enhanced form of DHA.

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Career choice may determine where frontotemporal dementia begins

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

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

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

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

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Cognitive decline is not simply a function of getting old

October, 2010
  • New research suggests that even “normal” cognitive decline with age reflects the type of brain damage that is (in greater amount) characteristic of dementia.

Findings from the long-running Religious Orders Study, from 354 Catholic nuns and priests who were given annual cognitive tests for up to 13 years before having their brains examined post-mortem, has revealed that even the very early cognitive impairments we regard as normal in aging are associated with dementia pathology. Although pathology in the form of neurofibrillary tangles, Lewy bodies, and cerebral infarctions were all associated with rapid decline, they were also associated with “normal” mild impairment. In the absence of any of these lesions, there was almost no cognitive decline.

Previous research has shown that white matter lesions are very common in older adults, and mild cognitive impairment is more likely in those with quickly growing white matter lesions; importantly, the crucial factor appears to be the rate of growth, not the amount of lesions. This new study extends the finding, suggesting that any age-related cognitive impairment reflects the sort of brain pathology that ultimately leads to dementia (if given enough time). It suggests that we should be more proactive in fighting such damage, instead of simply regarding it as normal.

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Factors linked to cognitive deficits in type 2 diabetes

October, 2010

Cognitive deficits and even dementia are more common in older diabetics. A new study points to three health issues that, if present, increase the risk that older diabetics will develop cognitive problems.

Type 2 diabetes is known to increase the risk of cognitive impairment in old age. Now analysis of data from 41 older diabetics (aged 55-81) and 458 matched controls in the Victoria Longitudinal Study has revealed that several other factors make it more likely that an older diabetic will develop cognitive impairment. These factors are: having higher (though still normal) blood pressure, having gait and balance problems, and/or reporting yourself to be in bad health regardless of actual problems.

Diabetes and hypertension often go together, and both are separately associated with greater cognitive impairment and dementia risk, so it is not surprising that higher blood pressure is one of the significant factors that increases risk. The other factors are less expected, although gait and balance problems have been linked to cognitive impairment in a recent study, and they may be connected to diabetes through diabetes’ effect on nerves. Negativity about one’s health may reflect emotional factors such as anxiety, stress, or depression, although depression and well-being measures were not themselves found to be mediating effects for cognitive impairment in diabetics (Do note that this study is not investigating which factors, in general, are associated with age-related cognitive impairment; it is trying to establish which factors are specifically sensitive to cognitive impairment in older diabetics).

In the U.S., type 2 diabetes occurs in over 23% of those over 60; in Canada (where this study took place) the rate is 19%. It should be noted that the participants in this study are not representative of the general population, in that they were fairly well-educated older Canadians, most of whom have benefited from a national health care system. Moreover, the study did not have longitudinal data on these various factors, meaning that we don’t know the order of events (which health problems come first? How long between the development of the different problems?). Nevertheless, the findings provide useful markers to alert diabetics and health providers.

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Memory problems more common in older men?

October, 2010

A large community study of older adults has found mild cognitive impairment was more prevalent in men.

A study involving 2,050 people aged 70 to 89 has found that mild cognitive impairment was 1.5 times more common in men than women. Among the 1,969 who did not have dementia, over 16% (329) had MCI — around 11% amnestic MCI (MCI-A) and 5% non-amnestic (MCI-MCD). A total of 19% of men had MCI, compared to 14% of women. MCI was also more common among the never-married, those with the APOEe4 (Alzheimer’s risk) gene, and those with less education.

This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men. However, I note that some years ago I reported on a Dutch study involving some 600 85-year-olds, that found that significantly more women than men had a good memory (41% vs 29%; good mental speed on word and number recognition tests was also found in more women than men: 33% vs 28%). This was considered particularly surprising, given that significantly more of the women had limited formal education compared to the men.

The researchers suggested biological factors such as the relative absence of cardiovascular disease in the women might account for the difference. I would suggest another factor might be social, given that social stimulation has been shown to help prevent cognitive decline, and women are more likely than men to keep up social links in old age.

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New advice on how much cognitive abilities decline with age

October, 2010

A new study suggests that inconsistencies in rate of age-related cognitive decline may be partly due to practice effects, but though decline does occur it is slower than some have estimated.

Reports on cognitive decline with age have, over the years, come out with two general findings: older adults do significantly worse than younger adults; older adults are just as good as younger adults. Part of the problem is that there are two different approaches to studying this, each with their own specific bias. You can keep testing the same group of people as they get older — the problem with this is that they get more and more practiced, which mitigates the effects of age. Or you can test different groups of people, comparing older with younger — but cohort differences (e.g., educational background) may disadvantage the older generations. There is also argument about when it starts. Some studies suggest we start declining in our 20s, others in our 60s.

One of my favorite cognitive aging researchers has now tried to find the true story using data from the Virginia Cognitive Aging Project involving nearly 3800 adults aged 18 to 97 tested on reasoning, spatial visualization, episodic memory, perceptual speed and vocabulary, with 1616 tested at least twice. This gave a nice pool for both cross-sectional and longitudinal comparison (retesting ranged from 1 to 8 years and averaged 2.5 years).

From this data, Salthouse has estimated the size of practice effects and found them to be as large as or larger than the annual cross-sectional differences, although they varied depending on the task and the participant’s age. In general the practice effect was greater for younger adults, possibly because younger people learn better.

Once the practice-related "bonus points" were removed, age trends were flattened, with much less positive changes occurring at younger ages, and slightly less negative changes occurring at older ages. This suggests that change in cognitive ability over an adult lifetime (ignoring the effects of experience) is smaller than we thought.

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Deep Brain Stimulation shows promise for patients with Alzheimer's

September, 2010

A safety trial has shown that Deep Brain Stimulation is safe for those with mild Alzheimer’s, and may slow cognitive decline.

A pilot study involving six patients with mild Alzheimer’s has shown using Deep Brain Stimulation (DBS) is safe and may help improve memory, or at least slow decline. Patients received continuous stimulation for 12 months, between 2005 and 2008. Impaired glucose utilization in the temporal and parietal lobes was dramatically reversed early in the treatment, and maintained after the year of continuous stimulation. Performance on cognitive tests showed possible improvement and/or slowing in the rate of cognitive decline at 6 and 12 months in three of the six patients.

The principal aim of this pilot study was to assess the safety of the procedure, and it is now hoped to move on to a larger study to assess its effectiveness. Anyone interested in more information about participating in the next phase should visit: http://www.uhn.on.ca/Focus_of_Care/KNC/Functional_Neurosurgery/research.asp.

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