seniors

Muted emotions misleading in Alzheimer's disease

August, 2010

Indications that blunted emotions are part of Alzheimer’s are a warning not to assume that reduced emotional response is a sign of depression.

A small study suggests that the apathy shown by many Alzheimer's patients may not simply be due to memory or language problems, but to a decreased ability to experience emotions. The seven patients were asked to rate pictures of positive and negative scenes (such as babies and spiders) by putting a mark closer or further to either a happy face or a sad face emoticon. Closeness to the face indicated the strength of the emotion felt. Although most of the time the Alzheimer’s patients placed their mark in the appropriate direction, they did make more inappropriate choices than the control group, and typically also gave less intense judgments.

Both comprehension problems and depression were ruled out. A lower emotional response may result from damage to brain areas that produce neurotransmitters, which typically occurs early in Alzheimer’s. It may be that medication to replace or increase these neurotransmitters would improve emotional experience.

This finding is a warning that apathy should not be automatically taken to mean that the patient is depressed. The researchers, enabled by the small size of the study, tested more thoroughly for depression than is usually the case in large studies. It may be that in these studies, this apathy has often been confounded with depression — which may explain the inconsistencies in the research into depression and Alzheimer’s (see the news item just previous to this).

The finding may also help caregivers understand that any emotional indifference is not ‘personal’.

Reference: 

[1674] Drago, V., Foster P. S., Chanei L., Rembisz J., Meador K., Finney G., et al.
(2010).  Emotional Indifference in Alzheimer's Disease.
J Neuropsychiatry Clin Neurosci. 22(2), 236 - 242.

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Larger head size may protect against Alzheimer's symptoms

August, 2010
  • Another study finding larger head size helps protect people with Alzheimer’s brain damage from cognitive impairment.

Confirming previous research, a study involving 270 Alzheimer’s patients has found that larger head size was associated with better performance on memory and thinking tests, even when there was an equivalent degree of brain damage. The findings are consistent with the theory of cognitive reserve. They also point to the importance of brain development early in life, since the brain reaches 93% of its final size at age six, and while partly determined by genes, brain growth is also influenced by nutrition, infections, and brain injuries.

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Common medications increase risk of mild cognitive impairment

August, 2010

A large study of older African-Americans has found taking common medications with anticholinergic effects was correlated with an increased risk of developing mild cognitive impairment.

Anticholinergics are widely used for a variety of common medical conditions including insomnia, allergies, or incontinence, and many are sold over the counter. Now a large six-year study of older African-Americans has found that taking one anticholinergic significantly increased an individual's risk of developing mild cognitive impairment and taking two of these drugs doubled this risk. The risk was greater for those who didn’t have the ‘Alzheimer’s gene’, APOE-e4.

This class of drugs includes Benadryl®, Dramamine®, Excedrin PM®, Nytol®, Sominex®, Tylenol PM®, Unisom®, Paxil®, Detrol®, Demerol® and Elavil® (for a more complete list of medications with anticholinergic effects, go to http://www.indydiscoverynetwork.org/AnticholienrgicCognitiveBurdenScale....).

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Brain fitness program produces working memory improvement in older adults

August, 2010

A new study shows improvement in visual working memory in older adults following ten hours training with a commercial brain training program. The performance gains correlated with changes in brain activity.

While brain training programs can certainly improve your ability to do the task you’re practicing, there has been little evidence that this transfers to other tasks. In particular, the holy grail has been very broad transfer, through improvement in working memory. While there has been some evidence of this in pilot programs for children with ADHD, a new study is the first to show such improvement in older adults using a commercial brain training program.

A study involving 30 healthy adults aged 60 to 89 has demonstrated that ten hours of training on a computer game designed to boost visual perception improved perceptual abilities significantly, and also increased the accuracy of their visual working memory to the level of younger adults. There was a direct link between improved performance and changes in brain activity in the visual association cortex.

The computer game was one of those developed by Posit Science. Memory improvement was measured about one week after the end of training. The improvement did not, however, withstand multi-tasking, which is a particular problem for older adults. The participants, half of whom underwent the training, were college educated. The training challenged players to discriminate between two different shapes of sine waves (S-shaped patterns) moving across the screen. The memory test (which was performed before and after training) involved watching dots move across the screen, followed by a short delay and then re-testing for the memory of the exact direction the dots had moved.

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Benefits of music training on the brain

August, 2010

A comprehensive review of the recent research into the benefits of music training on learning and the brain concludes music training in schools should be strongly supported.

A review of the many recent studies into the effects of music training on the nervous system strongly suggests that the neural connections made during musical training also prime the brain for other aspects of human communication, including learning. It’s suggested that actively engaging with musical sounds not only helps the plasticity of the brain, but also helps provide a stable scaffolding of meaningful patterns. Playing an instrument primes the brain to choose what is relevant in a complex situation. Moreover, it trains the brain to make associations between complex sounds and their meaning — something that is also important in language. Music training can provide skills that enable speech to be better heard against background noise — useful not only for those with some hearing impairment (it’s a common difficulty as we get older), but also for children with learning disorders. The review concludes that music training tones the brain for auditory fitness, analogous to the way physical exercise tones the body, and that the evidence justifies serious investment in music training in schools.

Reference: 

[1678] Kraus, N., & Chandrasekaran B.
(2010).  Music training for the development of auditory skills.
Nat Rev Neurosci. 11(8), 599 - 605.

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Brain training reverses age-related cognitive decline

August, 2010

A month's training in sound discrimination reversed normal age-related cognitive decline in the auditory cortex in old rats.

A rat study demonstrates how specialized brain training can reverse many aspects of normal age-related cognitive decline in targeted areas. The month-long study involved daily hour-long sessions of intense auditory training targeted at the primary auditory cortex. The rats were rewarded for picking out the oddball note in a rapid sequence of six notes (five of them of the same pitch). The difference between the oddball note and the others became progressively smaller. After the training, aged rats showed substantial reversal of their previously degraded ability to process sound. Moreover, measures of neuron health in the auditory cortex had returned to nearly youthful levels.

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Low vitamin D levels associated with cognitive decline

August, 2010

Another study shows that older adults with low levels of vitamin D have higher levels of cognitive decline, particularly in executive function (but not attention).

Another study has come out showing that older adults with low levels of vitamin D are more likely to have cognitive problems. The six-year study followed 858 adults who were age 65 or older at the beginning of the study. Those who were severely deficient in vitamin D were 60% more likely to have substantial cognitive decline, and 31% more likely to have specific declines in executive function, although there was no association with attention. Vitamin D deficiency is common in older adults in the United States and Europe (levels estimated from 40% to 100%!), and has been implicated in a wide variety of physical disease.

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Link among Alzheimer's disease, Down syndrome, atherosclerosis and diabetes

January, 2010

New evidence suggests that Down syndrome, Alzheimer's, diabetes, and cardiovascular disease, all share a common disease mechanism.

It’s been suggested before that Down syndrome and Alzheimer's are connected. Similarly, there has been evidence for connections between diabetes and Alzheimer’s, and cardiovascular disease and Alzheimer’s. Now new evidence shows that all of these share a common disease mechanism. According to animal and cell-culture studies, it seems all Alzheimer's disease patients harbor some cells with three copies of chromosome 21, known as trisomy 21, instead of the usual two. Trisomy 21 is characteristic of all the cells in people with Down syndrome. By age 30 to 40, all people with Down syndrome develop the same brain pathology seen in Alzheimer's. It now appears that amyloid protein is interfering with the microtubule transport system inside cells, essentially creating holes in the roads that move everything, including chromosomes, around inside the cells. Incorrect transportation of chromosomes when cells divide produces new cells with the wrong number of chromosomes and an abnormal assortment of genes. The beta amyloid gene is on chromosome 21; thus, having three copies produces extra beta amyloid. The damage to the microtubule network also interferes with the receptor needed to pull low-density lipoprotein (LDL — the ‘bad’ cholesterol) out of circulation, thus (probably) allowing bad cholesterol to build up (note that the ‘Alzheimer’s gene’ governs the low-density lipoprotein receptor). It is also likely that insulin receptors are unable to function properly, leading to diabetes.

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Hypertension linked to dementia in older women

January, 2010
  • A large study has found that women with high blood pressure had significantly higher amounts of white matter lesions (a risk factor for dementia) 8 years later.

Part of the Women's Health Initiative study looking at the effect of hormone therapy on thinking and memory in postmenopausal women, involving over 1400 women, has found those who had high blood pressure at the start of the study (eight years earlier) had significantly higher amounts of white matter lesions. Damage to white matter seems to be an independent risk factor for dementia. The finding adds to evidence suggesting that preventing hypertension helps protect against dementia. High blood pressure is common in the U.S. — of the nearly 99,000 women enrolled in the WHI study, 37.8% had hypertension. You can watch the researcher discussing the findings at http://www.eurekalert.org/multimedia/pub/19494.php?from=152110

Reference: 

Kuller, L. H., Margolis, K. L., Gaussoin, S. A., Bryan, N. R., Kerwin, D., Limacher, M., et al. (2009). Relationship of Hypertension, Blood Pressure, and Blood Pressure Control With White Matter Abnormalities in the Women's Health Initiative Memory Study (WHIMS) MRI Trial. The Journal of Clinical Hypertension, 9999(9999). doi: 10.1111/j.1751-7176.2009.00234.x.

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Specific hippocampal atrophy early sign of MCI & Alzheimer's

January, 2010
  • People with MCI who later developed Alzheimer's disease showed 10-30% greater brain atrophy in two specific regions.

A three-year study involving 169 people with mild cognitive impairment has found that those who later developed Alzheimer's disease showed 10-30% greater atrophy in two specific locations within the hippocampus, the cornu ammonis (CA1) and the subiculum. A second study comparing the brains of 10 cognitively normal elderly people and seven who were diagnosed with MCI between two and three years after their initial brain scan and with Alzheimer's some seven years after the initial scan, has confirmed the same pattern of hippocampal atrophy, from the CA1 to the subiculum, and then other regions of the hippocampus.

Reference: 

Apostolova, L.G. et al. In press. Subregional hippocampal atrophy predicts Alzheimer's dementia in the cognitively normal. Neurobiology of Aging, Available online 24 September 2008.

[392] Apostolova, L. G., Thompson P. M., Green A. E., Hwang K. S., Zoumalan C., Jack, Jr C. R., et al.
(2010).  3D comparison of low, intermediate, and advanced hippocampal atrophy in MCI.
Human Brain Mapping. 9999(9999), NA - NA.

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