seniors

Link between gum disease and poorer cognition in older adults

September, 2010

A strong association between gum inflammation and poorer cognitive performance in 70-year-olds has been found in a small study.

Following on from indications that gum disease might be a risk factor for dementia, analysis of data from 152 subjects in the Danish Glostrop Aging Study has revealed that periodontal inflammation at age 70 was strongly associated with lower cognitive scores (on the Digit Symbol Test). Those with periodontal inflammation were nine times more likely to test in the lower range compared to those with little or no periodontal inflammation. A larger follow-up study, among a more ethnically diverse range of subjects, is planned. I hope they also plan to extend the cognitive testing.

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The findings were presented by Dr. Angela Kamer at the 2010 annual meeting of the International Association for Dental Research July 16, in Barcelona, Spain.

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Vitamin B supplements could delay onset of Alzheimer's

September, 2010
  • Vitamin B supplements markedly reduced brain atrophy in older adults with MCI, offering hope that they may be effective in delaying the development of Alzheimer’s.

A two-year study involving 271 older adults (70+) with mild cognitive impairment has found that the rate of brain atrophy in those taking folic acid (0.8 mg/d), vitamin B12 (0.5 mg/d) and vitamin B6 (20 mg/d), was significantly slower than in those taking a placebo, with those taking the supplements experiencing on average 30% less brain atrophy. Higher rates of atrophy were associated with lower cognitive performance. Moreover those who with the highest levels of homocysteine at the beginning of the trial benefited the most, with 50% less brain shrinkage. High levels of homocysteine are a risk factor for Alzheimer’s, and folate, B12 and B6 help regulate it.

The finding that atrophy can be slowed in those with MCI offers hope that the treatment could delay the development of Alzheimer’s, since MCI is a major risk factor for Alzheimer’s, and faster brain atrophy is typical of those who go on to develop Alzheimer’s.

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More reason to eat berries for a healthy brain

September, 2010

A new study adds to the evidence that berries and other foods rich in polyphenols help your brain fight age-related cognitive decline.

A number of studies have found evidence that fruits and vegetables help fight age-related cognitive decline, and this has been thought to be due to their antioxidant and anti-inflammatory effects. A new study shows there may be an additional reason why polyphenols benefit the aging brain. One reason why the brain works less effectively as it gets older is that the cells (microglia) that remove and recycle biochemical debris not only fail to do their housekeeping work, but they actually begin to damage healthy cells. Polyphenols restore normal housekeeping, by inhibiting the action of a protein that shuts down the housekeeping (autophagy) process.

While many fruits and vegetables are good sources of polyphenols, berries and walnuts, and fruit and vegetables with deep red, orange, or blue colors, are particularly good.

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Poulose, S. & Joseph, J. 2010. Paper presented at the 240th National Meeting of the American Chemical Society.

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Brain may age faster in people whose hearts pump less blood

September, 2010
  • A large study confirms that your cardiac health affects your brain, and provides evidence that the extent of this problem is greater than we think.

I have often spoken of the mantra: What’s good for your heart is good for your brain. The links between cardiovascular risk factors and cognitive decline gets more confirmation in this latest finding that people whose hearts pumped less blood had smaller brains than those whose hearts pumped more blood. The study involved 1,504 participants of the decades-long Framingham Offspring Cohort who did not have a history of stroke, transient ischemic attack or dementia. Participants were 34 to 84 years old.

Worryingly, it wasn’t simply those with the least amount of blood pumping from the heart who had significantly more brain atrophy (equivalent to almost two years more brain aging) than the people with the highest cardiac index. Those with levels at the bottom end of normal showed similar levels of brain atrophy. Moreover, although only 7% of the participants had heart disease, 30% had a low cardiac index.

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The problem of 'destination amnesia'

September, 2010

Two studies demonstrate why knowing whether you’ve told someone something is difficult for all of us, and that this is particularly so as you get older.

A number of studies have found that source memory (knowing where you heard/read/experienced something) is a particular problem for older adults. Destination memory (knowing who you’ve told) is an area that has been much less studied. Last year I reported on why destination memory is difficult for all of us (my report is repeated below). A follow-up study has found not only that destination memory is a particular problem for older adults, but that it is in fact a worse problem than source memory. Moreover, destination amnesia (falsely believing you've told someone something) is not only more common among older adults, but is associated with greater confidence in the false belief.

The study compared the performance of 40 students (aged 18-30) and 40 healthy older adults (aged 60-83). In the first task, the participant read out loud 50 interesting facts to 50 celebrities (whose faces appeared on a computer screen), and were then tested on their memory of which fact they told to which famous person. In the second task, they had to remember which famous person told them which particular fact. Older adults' performance was 21% worse than their younger counterparts on the destination memory test, but only 10% worse (50% vs 60%) on the source memory test. This latter difference was not statistically significant.

The 2009 study, involving 60 students, found good reason for destination memory to be so poor — apparently outgoing information is less integrated with context than incoming information is. In the study, 50 random facts were linked with the faces of 50 famous people; half the students then “told” each fact to one of the faces, reading it aloud to the celebrity’s picture. The other half read each fact silently and saw a different celebrity moments afterward. In the subsequent memory test, students who simulated telling the facts did 16% worse. In another experiment using personal facts, it was significantly worse.

However, the final experiment found that you could improve your destination memory by saying the name of the person you’re speaking to, as you tell them. The findings also suggest that self-focus is an important factor: increasing self-focus (e.g. by telling a personal story) worsened destination memory; reducing self-focus (e.g. by naming the listener) improved it.

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[1809] Gopie, N., Craik F. I. M., & Hasher L.
(2010).  Destination memory impairment in older people..
Psychology and Aging.

[396] Gopie, N., & MacLeod C. M.
(2009).  Destination Memory: Stop Me if I've Told You This Before.
Psychological Science. 20(12), 1492 - 1499.

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Brain fitness programs may help frail elderly walk faster

September, 2010
  • Walking speed and balance may be improved in seniors through a brain training program. Research has indicated that a common pathology underlies cognitive impairment and gait and balance problems.

On the subject of the benefits of walking for seniors, it’s intriguing to note a recent pilot study that found frail seniors who walked slowly (no faster than one meter per second) benefited from a brain fitness program known as Mindfit. After eight weeks of sessions three times weekly (each session 45-60 minutes), all ten participants walked a little faster, and significantly faster while talking. Walking while talking requires considerably more concentration than normal walking. The success of this short intervention (which needs to be replicated in a larger study) offers the hope that frail elderly who may be unable to participate in physical exercise, could improve their mobility through brain fitness programs. Poor gait speed is also correlated with a higher probability of falls.

The connection between gait speed and cognitive function is an interesting one. Previous research has indicated that slow gait should alert doctors to check for cognitive impairment. One study found severe white matter lesions were more likely in those with gait and balance problems. Most recently, a longitudinal study involving over 900 older adults has found poorer global cognitive function, verbal memory, and executive function, were all predictive of greater decline in gait speed.

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More support for the benefits of walking for older brains

September, 2010

Many studies have now shown that walking helps older brains fight cognitive decline, but a new study shows that this is also associated with improved connectivity in important brain networks.

A study involving 65 older adults (59-80), who were very sedentary before the study (reporting less than two episodes of physical activity lasting 30 minutes or more in the previous six months), has found that those who joined a walking group improved their cognitive performance and the connectivity in important brain circuits after a year. However, those who joined a stretching and toning group showed no such improvement. The walking program involved three 40-minute walks at a moderate pace every week. The two affected brain circuits (the default mode network and the fronto-executive network) typically become less connected with age. It is worth emphasizing that the improvement was not evident at the first test, after six months, but only at the second 12-month test.

Interestingly, I noticed in the same journal issue a study into the long-term benefits of dancing for older adults. The study compared physical and cognitive performance of those who had engaged in amateur dancing for many years (average: 16.5 years) and those with no dancing or sporting engagement. The dancing group were overall significantly better than the other group on all tests: posture, balance, reaction time, motor behavior, cognitive performance. However, the best dancers weren’t any better than individuals in the other group; the group difference arose because none of the dancers performed poorly, while many of the other group did.

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Post-traumatic stress disorder increases dementia risk

September, 2010

A very large study has found that military veterans with PTSD were twice as likely to develop dementia in old age, compared to vets without PTSD.

A study involving over 180,000 older veterans (average age 68.8 at study start), of whom 29% had PTSD, has revealed that those with PTSD had a significantly greater risk of developing dementia. Over the seven years of the study, 10.6% of the veterans with PTSD developed dementia compared to 6.6% of those without PTSD. When age was used as the time scale, the risk for those with PTSD was more than double. Results were similar when those with a history of head injury, substance abuse, or clinical depression, were excluded.

One possibility for the link is that the stress induced by PTSD contributes to the development of dementia.

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Healthy diet could slow or reverse early effects of Alzheimer's disease

August, 2010

A mouse study demonstrates that the right diet can reverse Alzheimer’s damage in the early stages.

Following on from previous research with mice that demonstrated that a diet rich in methionine could increase the risk of developing Alzheimer's Disease through its effect on homocysteine levels, a new study has found that these effects were reversible if the mice then switched to a healthier diet. The mice, after five months on a methionine-rich diet, were divided into two groups, with one group continuing the diet and the second switching to the healthy diet for an additional two months. The cognitive impairment, and the build-up in amyloid plaques, was completely reversed after two months.

Methionine is an amino acid typically found in red meats, fish, beans, eggs, garlic, lentils, onions, yogurt and seeds. I note, however, that most of the items in this list are usually considered healthy! Fish, in particular, has been shown in a number of studies to reduce the risk of Alzheimer’s. The point is that methionine in itself is an essential amino acid and necessary for a healthy brain, but this indicates that, as with many foods, moderation is important. Clearly a balance is required; equally clearly, we still haven’t quite worked out the ‘perfect’ Alzheimer’s-prevention diet. Nevertheless, this study is welcome in demonstrating that diet can have such an effect on the brain, and adds to our knowledge of what makes a good diet for staving off dementia.

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Special care plan does not slow decline in patients with Alzheimer's

August, 2010

A large French study has found no evidence that special care plans for dementia patients improve the outcomes.

A study involving over 1100 patients with mild to moderate Alzheimer's disease at 50 French clinics has revealed that receiving a comprehensive care plan involving regular 6-monthly assessments (with standardised guidelines for the management of problems) produced no benefits compared to receiving the usual care (an annual consultation). After two years, there was no significant difference in functional decline between the two groups, and no difference in the risk of being admitted to an institution or death. While this argues against guideline-based interventions for dementia care (widely recommended), it may be that the treatment received by both groups was superior to that received by those who do not attend a specialized memory clinic. It remains to be seen whether the findings would be different for patients being treated in general practice.

It should also be noted that this study only measured the effects on daily activities, institutionalization, and death. A number of studies have found improvements in specific behaviors (eg, reduced behavioral problems, reduced agitation, or improved quality of life) as a result of particular care programs. The fact that, in this case, interventions were more frequent early in the study compared to later, suggests that the care plan may not have been all that easy to implement.

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