seniors

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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Mediterranean diet reduces brain shrinkage in old age

  • The Mediterranean diet is the diet most associated with cognitive and health benefits in older adults.
  • A new study has found larger brain volumes among those following this sort of diet, equivalent to that of brains five years younger.
  • Much of this was associated with two components of the diet in particular: eating fish regularly, and eating less meat.

Another study adds to the growing evidence that a Mediterranean diet is good for the aging brain.

The New York study used data from 674 non-demented older adults (average age 80). It found that those who closely followed such a diet showed significantly less brain shrinkage. Specifically, total brain volume was an average 13.11 milliliters greater, with grey matter volume 5 millilitres greater, and white matter 6.4 millilitres greater.

Eating at least five of the recommended Mediterranean diet components was associated with benefits equivalent to five years of age. By far the most important of these components was regular fish and reduced meat intake — at least 3 to 5 ounces of fish weekly; no more than 3.5 ounces of meat daily.

This is consistent with a considerable amount of research indicating the benefits of fish in fighting age-related cognitive decline.

http://www.theguardian.com/lifeandstyle/2015/oct/21/mediterranean-diet-may-slow-the-ageing-process-by-five-years

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Alzheimer's disease consists of 3 distinct subtypes

  • A very small study points to three subtypes of Alzheimer's disease, each of which seems to be associated with:
    • different physiological abnormalities
    • different causes and risk factors
    • different symptoms / progression
    • different age-onsets.
  • This suggests that effective treatments need to be tailored to the subtype.

A two-year study which involved metabolic testing of 50 people, suggests that Alzheimer's disease consists of three distinct subtypes, each one of which may need to be treated differently. The finding may help explain why it has been so hard to find effective treatments for the disease.

The subtypes are:

  • Inflammatory, in which markers such as C-reactive protein and serum albumin to globulin ratios are increased.
  • Non-inflammatory, in which these markers are not increased but other metabolic abnormalities (such as insulin resistance, hypovitaminosis D, and hyper-homocysteinemia) are present. This tends to affect slightly older individuals than the first subtype: 80s rather than 70s.
  • Cortical, which affects relatively young individuals (typically 50s- early 70s) and appears more widely distributed across the brain than the other subtypes, showing widespread cortical atrophy rather than marked hippocampal atrophy. It typically presents with language and number difficulties first, rather than memory loss. Typically, there is an impaired ability to hold onto a train of thought. It is often misdiagnosed, typically affects people without a family history of Alzheimer's, who do not have an Alzheimer's-related gene, and is associated with a significant zinc deficiency (Zinc is implicated in multiple Alzheimer's-related metabolic processes, such as insulin resistance, chronic inflammation, ADAM10 proteolytic activity, and hormonal signaling. Zinc deficiency is relatively common, and associated with increasing age.).

The cortical subtype appears to be fundamentally a different condition than the other two.

I note a study I reported on last year, that found different molecular structures of amyloid-beta fibrils in the brains of Alzheimer's patients with different clinical histories and degrees of brain damage. That was a very small study, indicative only. However, I do wonder if there's any connection between these two findings. At the least, I think this approach a promising one.

The idea that there are different types of Alzheimer's disease is of course consistent with the research showing a variety of genetic risk factors, and an earlier study indicating at least two pathways to Alzheimer's.

It's also worth noting that the present study built on an earlier study, which showed that a program of lifestyle, exercise and diet changes designed to improve the body's metabolism reversed cognitive decline within 3-6 months in nine out of 10 patients with early Alzheimer's disease or its precursors. Note that this was a very small pilot program, and needs a proper clinical trial. Nevertheless, it is certainly very interesting.

http://www.eurekalert.org/pub_releases/2015-09/uoc--adc091615.php

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Bredesen, D.E. 2015. Metabolic profiling distinguishes three subtypes of Alzheimer's disease. AGING, 7 (8), 595-600. Full text at http://www.impactaging.com/papers/v7/n8/full/100801.html

Bredesen, D.E. 2014. Reversal of cognitive decline: A novel therapeutic program. AGING, Vol 6, No 9 , pp 707-717. Full text at http://www.impactaging.com/papers/v6/n9/full/100690.html

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More evidence that stress increases risk of Alzheimer's

  • A stress hormone has been found to be associated with more amyloid-beta protein, in mice and human neurons.
  • The finding helps explain why stress is a risk factor for Alzheimer's.
  • A previous 38-year study supports this with the finding that women who scored highly in "neuroticism" in middle age, had a greater chance of later developing Alzheimer's.
  • This link was largely accounted for by chronic stress experienced by these women over the four decades.

A study involving both mice and human cells adds to evidence that stress is a risk factor for Alzheimer's.

The study found that mice who were subjected to acute stress had more amyloid-beta protein in their brains than a control group. Moreover, they had more of a specific form of the protein, one that has a particularly pernicious role in the development of Alzheimer's disease.

When human neurons were treated with the stress hormone corticotrophin releasing factor (CRF), there was also a significant increase in the amyloid proteins.

It appears that CRF causes the enzyme gamma secretase to increase its activity. This produces more amyloid-beta.

The finding supports the idea that reducing stress is one part of reducing your risk of developing Alzheimer's.

A neurotic personality increases the risk of Alzheimer's disease

An interesting study last year supports this.

The study, involving 800 women who were followed up some 40 years after taking a personality test, found that women who scored highly in "neuroticism" in middle age, have a greater chance of later developing Alzheimer's. People who have a tendency to neuroticism are more readily worried, distressed, and experience mood swings. They often have difficulty in managing stress.

The women, aged 38 to 54, were first tested in 1968, with subsequent examinations in 1974, 1980, 1992, 2000, and 2005. Neuroticism and extraversion were assessed in 1968 using the Eysenck Personality Inventory. The women were asked whether they had experienced long periods of high stress at each follow-up.

Over the 38 years, 153 developed dementia (19%), of whom 104 were diagnosed with Alzheimer's (13% of total; 68% of those with dementia).

A greater degree of neuroticism in midlife was associated with a higher risk of Alzheimer's and long-standing stress. This distress accounted for a lot of the link between neuroticism and Alzheimer's.

Extraversion, while associated with less chronic stress, didn't affect Alzheimer's risk. However, high neuroticism/low extraversion (shy women who are easily worried) was associated with the highest risk of Alzheimer's.

The finding supports the idea that long periods of stress increase the risk of Alzheimer's, and points to people with neurotic tendencies, who are more sensitive to stress, as being particularly vulnerable.

http://www.eurekalert.org/pub_releases/2015-09/uof-uhr091615.php

http://www.eurekalert.org/pub_releases/2014-10/uog-anp101414.php

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Stroke speeds age-related cognitive decline

  • A large study shows stroke is associated not only with an immediate drop in cognitive ability, but also with faster declines in some cognitive functions.
  • The finding points to a need for better long-term care.

Data from 23,572 Americans from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study has revealed that those who survived a stroke went on to have significantly faster rates of cognitive decline as they aged.

Participants, who were aged 45 years or older, had no history of cognitive impairment at the beginning of the population-based study. Over the next five to seven years, 515 of them (2%) had a stroke.

Stroke was associated with an acute decline in global cognition, new learning, and verbal memory. Those who had a stroke showed faster declines in global cognition and executive function (but not new learning nor verbal memory) over the next years.

Global cognition was assessed using the Six-Item Screener [SIS]; new learning by the Consortium to Establish a Registry for Alzheimer Disease Word-List Learning; verbal memory by the Word-List Delayed Recall; executive function by the Animal Fluency Test.

The findings suggest a need for better long-term follow-up care for stroke survivors, including therapy to retain or even regain cognitive ability.

http://www.eurekalert.org/pub_releases/2015-07/uomh-mt070715.php

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Low vitamin D speeds age-related cognitive decline

  • On average, older adults with low levels of vitamin D showed much faster decline in episodic memory and executive function.
  • Older adults with dementia had significantly lower levels of vitamin D compared to those with MCI or normal cognition.
  • Low vitamin D was more common in African-Americans and Hispanics, compared to whites.

A study involving 382 older adults (average age 75) followed for around five years, has found that those who don’t get enough vitamin D may experience cognitive decline at a much faster rate than people who have adequate vitamin D.

Participants included 17.5% with dementia at the beginning of the study, 32.7% with MCI, and 49.5% cognitively healthy.

Those with dementia had lower levels of vitamin D than the other two groups.

While some people with low vitamin D didn’t show any cognitive decline and some with adequate vitamin D declined quickly, people with low vitamin D on average declined two to three times as fast as those with adequate vitamin D, in two crucial cognitive domains: episodic memory and executive function. Semantic memory and visuospatial ability were not significantly affected.

Factors such as age, gender, education, BMI, season of blood draw, vascular risk, and presence of the 'Alzheimer's gene', ApoE4, were controlled for.

Unlike previous studies of vitamin D and dementia, the participants were racially and ethnically diverse and included whites (41%), African Americans (30%), and Hispanics (25%). Nearly two-thirds (61%) had low vitamin D levels in their blood, including 54% of the whites and 70% of the African-Americans and Hispanics.

Vitamin D is primarily obtained through sun exposure. Accordingly, people with darker skin are more likely to have low levels of vitamin D because melanin blocks ultra-violet rays.

It remains to be seen whether Vitamin D supplements could slow cognitive decline.

http://www.futurity.org/vitamin-d-cognitive-decline-1003932/

 

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