seniors

Older adults with type 2 diabetes show reduced blood flow linked to worse cognition

July, 2015

A study involving 65 older adults (average age 66), of whom 35 had type 2 diabetes, has found that after two years, those with diabetes had decreases in their ability to regulate blood flow in the brain, and a reduced ability to regulate blood flow was associated with lower cognitive scores.

Specifically, at the start of the study those with diabetes scored an average 46 points on a cognitive test, compared with 55 in the control group. After two years, the diabetics' scores had fallen to an average of 41, while the scores of the control group hadn't fallen at all.

Greater decreases in blood flow regulation were also associated with higher levels of inflammation.

It's suggested that inflammation impairs blood flow regulation, and this accelerates cognitive decline.

http://www.eurekalert.org/pub_releases/2015-07/aaon-ssl070615.php

Reference: 

Chung, C.-C., Pimentel, D., Jor’dan, A. J., Hao, Y., Milberg, W., & Novak, V. (2015). Inflammation-associated declines in cerebral vasoreactivity and cognition in type 2 diabetes. Neurology, 85(5), 450–458. http://doi.org/10.1212/WNL.0000000000001820

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Physical activity linked to better memory for names and faces among older adults

  • A small study adds to evidence that walking improves memory in older adults, and indicates that this is particularly helpful for memory tasks the seniors find challenging.

A small study that fitted 29 young adults (18-31) and 31 older adults (55-82) with a device that recorded steps taken and the vigor and speed with which they were made, has found that those older adults with a higher step rate performed better on memory tasks than those who were more sedentary. There was no such effect seen among the younger adults.

Improved memory was found for both visual and episodic memory, and was strongest with the episodic memory task. This required recalling which name went with a person's face — an everyday task that older adults often have difficulty with.

However, the effect on visual memory had more to do with time spent sedentary than step rate. With the face-name task, both time spent sedentary and step rate were significant factors, and both factors had a greater effect than they had on visual memory.

Depression and hypertension were both adjusted for in the analysis.

There was no significant difference in executive function related to physical activity, although previous studies have found an effect. Less surprisingly, there was also no significant effect on verbal memory.

Both findings might be explained in terms of cognitive demand. The evidence suggests that the effect of physical exercise is only seen when the task is sufficiently cognitively demanding. No surprise that verbal memory (which tends to be much less affected by age) didn't meet that challenge, but interestingly, the older adults in this study were also less impaired on executive function than on visual memory. This is unusual, and reminds us that, especially with small studies, you cannot ignore the individual differences.

This general principle may also account for the lack of effect among younger adults. It is interesting to speculate whether physical activity effects would be found if the younger adults were given much more challenging tasks (either by increasing their difficulty, or selecting a group who were less capable).

Step Rate was calculated by total steps taken divided by the total minutes in light, moderate, and vigorous activities, based on the notion that this would provide an independent indicator of physical activity intensity (how briskly one is walking). Sedentary Time was the total minutes spent sedentary.

http://www.eurekalert.org/pub_releases/2015-11/bumc-slp112415.php

Reference: 

[4045] Hayes, S. M., Alosco M. L., Hayes J. P., Cadden M., Peterson K. M., Allsup K., et al.
(2015).  Physical Activity Is Positively Associated with Episodic Memory in Aging.
Journal of the International Neuropsychological Society. 21(Special Issue 10), 780 - 790.

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Rates of new dementia cases may be falling

  • Data from the very long-running Framingham Heart Study adds to evidence that, for those with at least a high school education, the rate of dementia is declining. Improved cardiovascular health and treatment appears to be an important factor in this decline.

As we all know, people are living longer and obesity is at appalling levels. For both these (completely separate!) reasons, we expect to see growing rates of dementia. A new analysis using data from the long-running Framingham Heart Study offers some hope to individuals, however.

Looking at the rate of dementia during four distinct periods in the late 1970s, late 1980s, 1990s, and 2000s, using data from 5205 older adults (60+), the researchers found that there was a progressive decline in the incidence of dementia at a given age, with an average reduction of 20% per decade since the 1970s (22%, 38%, and 44% during the second, third, and fourth epochs, respectively).

There are two important things to note about this finding:

  • the decline occurred only in people with a high school education and above
  • the decline was more pronounced with dementia caused by vascular diseases, such as stroke.

The cumulative risk over five years, adjusted for age and gender, were:

  • 3.6 per 100 persons during the first period (late 1970s and early 1980s)
  • 2.8 per 100 persons during the second period (late 1980s and early 1990s)
  • 2.2 per 100 persons during the third period (late 1990s and early 2000s)
  • 2.0 per 100 persons during the fourth period (late 2000s and early 2010s).

Part of the reason for the decline is put down to the decrease in vascular risk factors other than obesity and diabetes, and better management of cardiovascular diseases and stroke. But this doesn't completely explain the decrease. I would speculate that other reasons might include:

  • increased mental stimulation
  • improvements in lifestyle factors such as diet and exercise
  • better health care for infectious and inflammatory conditions.

The finding is not completely unexpected. Recent epidemiological studies in the U.S., Canada, England, the Netherlands, Sweden and Denmark have all suggested that “a 75- to 85-year-old has a lower risk of having Alzheimer’s today than 15 or 20 years ago.” Which actually cuts to the heart of the issue: individual risk of dementia has gone down (for those taking care of their brain and body), but because more and more people are living longer, the numbers of people with dementia are increasing.

http://www.futurity.org/dementia-rates-decline-1119512-2/

http://www.scientificamerican.com/article/is-dementia-risk-falling/

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Mentally challenging activities key to a healthy aging mind

  • A small study shows significant changes in brain activity among older adults engaged in learning a cognitively demanding skill.

A study involving 39 older adults has found that those randomly assigned to a “high-challenge” group showed improved cognitive performance and more efficient brain activity compared with those assigned to a low-challenge group, or a control group.

The high-challenge group spent at least 15 hours a week for 14 weeks learning progressively more difficult skills in digital photography, quilting, or a combination of both. The low-challenge group met to socialize and engage in activities related to subjects such as travel and cooking. The placebo group engaged in low-demand cognitive tasks such as listening to music, playing simple games, or watching classic movies.

The high-challenge group demonstrated increased neural efficiency in judging words, shown by lowered brain activity when word judgments were easy and increasing activity when they became hard. This is a pattern of response typical of young adults, and was not seen in them before the intervention, or among those in the other groups. To some extent, these changes were still seen a year later.

Moreover, there was a dose-dependent effect — meaning, those who spent more time engaging in the high-challenge activities showed the greatest brain changes.

So did those who were oldest, perhaps because their brains were most in need, perhaps because they were the most disengaged. Most likely, perhaps, because both of these were true.

The bottom line, though, is that, while all mental stimulation is good in terms of building cognitive reserve, actively learning, and really pushing yourself, is what you need to get to, or keep at, the top of your game.

http://www.eurekalert.org/pub_releases/2016-01/ip-mca011516.php

http://content.iospress.com/articles/restorative-neurology-and-neuroscience/rnn150533

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Some cognitive training helps less-educated older adults more

  • A large study in which older adults underwent various types of cognitive training has found that less-educated adults benefited more from training designed to speed processing.

Data from 2,800 participants (aged 65+) in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study has revealed that one type of cognitive training benefits less-educated people more than it does the more-educated.

While the effects of reasoning and memory training did not differ as a function of how much education the individual had, those older adults with less than a complete high school education experienced a 50% greater benefit from speed of information processing training than college graduates. This advantage was maintained for three years after the end of the training.

The training involved ten 60 to 75-minute sessions over six weeks that focused on visual search and processing information in shorter and shorter times.

Both reasoning and information processing speed training resulted in improved targeted cognitive abilities for 10 years among participants, but memory training did not. Memory training focused on mnemonic strategies for remembering lists and sequences of items, text material, and main ideas and details of stories and other text-based information. Reasoning training focused on improving the ability to solve problems containing a serial pattern.

The researchers speculate that speed of information processing training might help those with less than 12 years of education, who are at greater risk of dementia, close the gap between them and those with more education.

The training modules have been translated into online games delivered by Posit Science.

Less educated study participants were slightly older, less likely to be married, more likely to be African-American, and more likely to have hypertension or diabetes as well as heart disease than the more educated older adults.

http://www.eurekalert.org/pub_releases/2016-01/iu-irs012816.php

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Omega 3 levels affect whether B vitamins can slow brain's decline

  • B vitamins can help many older adults with mild cognitive impairment, but only if they have good levels of omega-3 fatty acids.

A study involving 266 people with mild cognitive impairment (aged 70+) has found that B vitamins are more effective in slowing cognitive decline when people have higher omega 3 levels.

Participants were randomly selected to receive either a B-vitamin supplement (folic acid, vitamins B6 and B12) or a placebo pill for two years. The vitamins had little to no effect for those with low levels of omega-3 fatty acids, but were very effective for those with high baseline omega-3 levels.

Levels of DHA appeared to be more important than levels of EPA, but more research is needed to confirm that.

The finding may help to explain why research looking at the effects of B vitamins, or the effects of omega-3 oils, have produced inconsistent findings.

The study followed research showing that B vitamins can slow or prevent brain atrophy and memory decline in people with MCI, and they were most effective in those who had above average blood levels of homocysteine.

http://www.eurekalert.org/pub_releases/2016-01/uoo-ola011916.php

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Some chronic viral infections could contribute to age-related cognitive decline

  • A longitudinal study confirms findings from cross-sectional studies that certain common viral infections are factors in age-related cognitive decline.

Growing research has implicated infections as a factor in age-related cognitive decline, but these have been cross-sectional (comparing different individuals, who will have a number of other, possibly confounding, attributes). Now a large longitudinal study provides more evidence that certain chronic viral infections could contribute to subtle cognitive deterioration in apparently healthy older adults.

The study involved 1,022 older adults (65+), who had annual evaluations for five years. It revealed an association between cognitive decline and exposure to several viruses: cytomegalovirus (CMV), herpes simplex (HSV 2), and the protozoa Toxoplasma gondii.

More specifically, the IgG levels for HSV-2 were significantly associated with baseline cognitive scores, while the IgG levels for HSV-2 (genital herpes), TOX (which has been much in the news in recent years for being harbored in domestic cats, and being implicated in various neurological disorders), and CMV (a common virus which unfortunately rarely causes symptoms), but not HSV-1 (the cold sore virus), were significantly associated with greater temporal cognitive decline that varied by type of infection.

More research is obviously needed to determine more precisely what the role of different infectious agents is in cognitive decline, but the findings do point to a need for a greater emphasis on preventing and treating infections. They also add to the growing evidence that age-related cognitive decline isn't 'normal', but something that occurs when other health-related factors come into play.

http://www.eurekalert.org/pub_releases/2016-02/uops-scv020416.php

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