A study released today and scheduled to be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans April 21 to April 28, 2012, shows that those over 70 eating more than 2,100 calories per day, nearly double their risk of memory loss, or mild cognitive impairment (MCI). MCI is considered to be the stage between normal memory loss that comes with aging and early Alzheimer’s disease.
Study author Yonas E. Geda, MD, MSc, with the Mayo Clinic in Scottsdale, Arizona and a member of the American Academy of Neurology said :

“We observed a dose-response pattern which simply means; the higher the amount of calories consumed each day, the higher the risk of MCI.”

1,233 people between the ages of 70 and 89 and free of dementia residing in Olmsted County, Minn. were studied. 163 had MCI and participants noted the amount of calories they ate or drank in a food questionnaire. They were divided into three equal groups based on their daily caloric consumption. One-third of the participants consumed between 600 and 1,526 calories per day, one-third between 1,526 and 2,143 and one-third consumed between 2,143 and 6,000 calories per day.

Even after adjusting for history of stroke, diabetes, amount of education, and other factors that can affect risk of memory loss, the risk for the highest calorie group was nearly double that of the lower calorie group. There was no noticeable difference in risk for the middle group.

Geda concluded :

“Cutting calories and eating foods that make up a healthy diet may be a simpler way to prevent memory loss as we age.”

The co-authors of the study include Ronald C. Petersen, MD, Fellow of the American Academy of Neurology, and other investigators of the Mayo Clinic Study of Aging in Rochester, Minn.

Rupert Shepherd

A large, prospective study led by a researcher at Rush University Medical Center indicates that chronic exposure to particulate air pollution may accelerate cognitive decline in older adults. The results of the study were published in the Feb. 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

In the study, women who were exposed to higher levels of ambient particulate matter (PM) over the long term experienced more decline in their cognitive functioning over a four-year period. Higher levels of long-term exposure to both coarse PM (PM2.5-10) and fine PM (PM2.5) were associated with significantly faster cognitive decline.

PM air pollution consists of small particles suspended in the air. Particles that are less than 2.5 microns in diameter, which is 1/30th the width of human hair, are called fine PM and particles larger than 2.5-10 microns is called coarse PM.

These associations were present at levels of PM exposure typical in many areas of the United States.

There are few recent studies that analyze air pollution and cognitive function in older adults, but this is the first study to examine change in cognitive function over a period of time and whether exposure to the size of particulate matter is important.

Jennifer Weuve, MPH., ScD, assistant professor of the Rush Institute of Healthy Aging and the principal investigator of the study, along with her colleagues, evaluated air pollution, both coarse and fine, in relation to cognitive decline in older women using a study population from the Nurses’ Health Study Cognitive Cohort, which included 19,409 U.S. women ages 70 to 81 for a 14-year period going back as far as 1988.

“Our study explored chronic exposure to particulate air pollution in relation to decline in cognitive functioning among older women,” said Weuve. “Very is little known about the role of particulate matter exposure and its association with cognitive decline.”

Exposure to particulate air pollution is associated with cardiovascular risk, which itself may play a role in causing or accelerating cognitive decline.

“Unlike other factors that may be involved in dementia such as diet and physical activity, air pollution is something we can intervene on as a society at large through policy, regulation and technology,” said Weuve.

“Therefore, if our findings are confirmed in other research, air pollution reduction is a potential means for reducing the future population burden of age-related cognitive decline, and eventually, dementia,” said Weuve.

Cognitive loss and brain degeneration currently affect millions of adults, and the number will increase, given the population of aging baby boomers. Today, nearly 20 percent of people age 65 or older suffer from mild cognitive impairment and 10 percent have dementia.

UCLA scientists previously developed a brain-imaging tool to help assess the neurological changes associated with these conditions. The UCLA team now reports in the February issue of the journal Archives of Neurology that the brain-scan technique effectively tracked and predicted cognitive decline over a two-year period.

The team has created a chemical marker called FDDNP that binds to both plaque and tangle deposits – the hallmarks of Alzheimer’s disease – which can then be viewed using a positron emission tomography (PET) brain scan, providing a “window into the brain.” Using this method, researchers are able to pinpoint where in the brain these abnormal protein deposits are accumulating.

“We are finding that this may be a useful neuro-imaging marker that can detect changes early, before symptoms appear, and it may be helpful in tracking changes in the brain over time,” said study author Dr. Gary Small, UCLA’s Parlow-Solomon Professor on Aging and a professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA.

Small noted that FDDNP-PET scanning is the only available brain-imaging technique that can assess tau tangles. Autopsy findings have found that tangles correlate with Alzheimer’s disease progression much better than do plaques.

For the study, researchers performed brain scans and cognitive assessments on the subjects at baseline and then again two years later. The study involved 43 volunteer participants, with an average age of 64, who did not have dementia. At the start of the study, approximately half (22) of the participants had normal aging and the other half (21) had mild cognitive impairment, or MCI, a condition that increases a person’s risk of developing Alzheimer’s disease.

Researchers found that for both groups, increases in FDDNP binding in the frontal, posterior cingulate and global areas of the brain at the two-year follow-up correlated with progression of cognitive decline. These areas of the brain are involved in decision-making, complex reasoning, memory and emotions. Higher initial baseline FDDNP binding in both subject groups was associated with a decline in cognitive functioning in areas such as language and attention at the two-year follow-up.

“We found that increases in FDDNP binding in key brain areas correlated with increases in clinical symptoms over time,” said study author Dr. Jorge R. Barrio, who holds UCLA’s Plott Chair in Gerentology and is a professor of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA. “Initial binding levels were also predictive of future cognitive decline.”

Among the subjects with mild cognitive impairment, the level of initial binding in the frontal and parietal areas of the brain provided the greatest accuracy in identifying those who developed Alzheimer’s disease after two years. Of the 21 subjects with MCI, six were diagnosed with Alzheimer’s at follow-up, and these six subjects had higher initial frontal and parietal binding values than the other subjects in the MCI group.

In the normal aging subjects, three developed mild cognitive impairment after two years. Two of these three participants had had the highest baseline binding values in the temporal, parietal and frontal brain regions among this group.

Researchers said the next step in research will involve a longer duration of follow-up with larger samples of subjects. In addition, the team is using this brain-imaging technique in clinical trials to help track novel therapeutics for brain aging, such as curcumin, a chemical found in turmeric spice.

“Tracking the effectiveness of such treatments may help accelerate drug discovery efforts,” Small, the author of the new book “The Alzheimer’s Prevention Program,” said. “Because FDDNP appears to predict who will develop dementia, it may be particularly useful in tracking the effectiveness of interventions designed to delay the onset of dementia symptoms and eventually prevent the disease.”

Small recently received research approval from the U.S. Food and Drug Administration to use FDDNP-PET to study people with mild cognitive impairment to determine whether a high-potency form of curcumin – a spice with anti-amyloid, anti-tau and anti-inflammatory properties – can prevent Alzheimer’s disease and the accumulation of plaques and tangles in the brain.

On Tuesday, lawmakers in Nebraska and Kansas advanced bills that would place new restrictions on abortion late in pregnancy. Summaries appear below.

~ Nebraska: State senators voted 38-5 to end the first round of debate on legislation (LB 1103), now being referred to by supporters as the “Pain-Capable Unborn Child Prevention Act,” that would prohibit most abortions at and after 20 weeks post-fertilization based on the assertion by some experts that fetuses feel pain after that point, the Omaha World-Herald reports. According to the article, expert opinions vary on the point at which fetuses feel pain. Current state law prohibits abortion after viability, a precedent established in Roe v. Wade (Hammel, Omaha World-Herald, 3/30). The Associated Press reports that this, “first-of-its-kind proposal would overhaul the legal underpinnings of abortion restrictions,” noting that current restrictions use fetal viability as the criteria, not fetal pain. Although viability can vary on a case by case basis, it generally is attained at 22 to 24 weeks, according to the AP. The bill also would narrow the state standard for health exceptions by allowing abortion after 20 weeks only if a woman were near death or at risk of irreversible physical harm. Under the state’s current standards, post-viability abortion is permitted to preserve the health or life of the woman, leaving it to health care providers to determine the health issues meeting this standard (Jenkins, Associated Press, 3/31). According to the World-Herald, the bill “would chip away at a key provision” of Roe and “is sure to spark a new legal battle over abortion rights that could go all the way to the U.S. Supreme Court” (Omaha World-Herald, 3/30). The AP reports that the bill also is intended to “shut down” the clinic of abortion provider LeRoy Carhart, who offers abortion services up to 22 weeks at his Omaha, Neb., clinic (Associated Press, 3/31). Opponents of the bill argue that supporters’ goal is to set a new legal precedent and prioritize politics over physicians’ judgment. They also note that no abortions were performed in Nebraska after 20 weeks in the past year (Omaha World-Herald, 3/30). Janet Crepps of the Center for Reproductive Rights said that the bill has the “most narrow health exception for the late abortions that we’ve seen anywhere” (Associated Press, 3/31).

~ Kansas: The state House and Senate both approved a bill (HB 2115) that would require physicians to report a specific medical diagnosis to justify an abortion after 22 weeks of pregnancy, the Kansas City Star reports. The bill also would allow pregnant women, their partners or guardians of minors to sue abortion providers if they believe an abortion is performed illegally (Klepper, Kansas City Star, 3/30). The bill now goes to Gov. Mark Parkinson (D), an abortion-rights supporter (AP/KOAM, 3/31). Parkinson has not said whether he will sign or veto the bill. The Senate vote was three votes shy of the two-thirds majority required to override a veto, according to the AP/NTV (Hanna, AP/NTV, 3/31). The Topeka Capital-Journal reports that the bill excludes some of the most controversial elements of a similar measure that then-Gov. Kathleen Sebelius (D) vetoed last year. For example, lawmakers removed a provision that would have broadened laws on who can pursue criminal litigation against abortion providers (Hollingsworth/Carpenter, Topeka Capital-Journal, 3/31). According to the AP/NTV, supporters and opponents of the bill both say it is intended to prevent late-abortion providers from establishing practices in the state, which has not had a late-abortion provider since George Tiller was murdered last year (AP/NTV, 3/31). Some lawmakers criticized the process used to consider the bill, noting that the legislation was assigned to the Senate Utilities Committee. “I’m wondering how a committee on utilities is involved and has anything to do with a conference committee about women’s reproductive health,” state Sen. Vicki Schmidt (R) said (Topeka Capital-Journal, 3/31).

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The February issue of Archives of Neurology, one of the JAMA/Archives journals, carries a report this month on the Mediterranean diet. It appears that a Mediterranean-style diet reduces the burden of white matter hyperintesity volume. White matter hyperintesity volume is a marker of small vessel damage in the brain.

White matter hyperintensities (WMHs) visible on brain magnetic resonance imaging (MRI) are markers of chronic small vessel damage, according to background information in the article.

Hannah Gardener, Sc.D., of the University of Miami Miller School of Medicine, and colleagues evaluated data from 966 participants. They examined the association between a Mediterranean diet and WMH Visibles. Participants were given a food frequency questionnaire to establish dietary patterns during the previous year, and answers were used to determine scores that evaluated how close their diet was to the genuine Mediterranean one. The WMHV was measured by quantitative brain MRI. The authors write:

“Although diet may be an important predictor of vascular disease, little is known about the possible association between dietary habits and WMHs. Studies have suggested that consumption of a MeDi [Mediterranean Diet] is associated with a reduced risk of the metabolic syndrome, coronary heart disease, stroke and cognitive disorders, but no studies to date, to our knowledge, have examined the association between a MeDi and WMH volume (WMHV).”

The survey had 11.6 percent of participants scoring 0 to 2 on the MeDi scale, 15.8 percent scored 3, 23 percent scored 4, 23.5 percent scored 5, and 26.1 percent scored 6 to 9. Women had lower MeDi scores than men, and participants who reported moderate to heavy levels of physical activity were more likely to report greater consumption of a MeDi. Participants with MeDi scores of 6 or higher also had lower BMI.

Their findings indicate that a lower burden of WMHV in those people with a greater consumption of a MeDi. The association was independent of sociodemographic and vascular risk factors including physical activity, smoking, blood lipid levels, hypertension, diabetes, history of cardiac disease and BMI. Additionally, after adjustment, the only component of the MeDi score that was independently associated with WMHV was the ratio of monounsaturated to saturated fat.
The authors conclude :

“In summary, the current study suggests a possible protective association between increased consumption of a MeDi and small vessel damage … The associations with WMHV may be driven by the favorable ratio of monounsaturated fat consumption over saturated fat. However, the results of the analysis of the individual MeDi scale components suggests that the overall dietary pattern, rather than any of the individual components, may be more etiologically relevant in relation to WMHV.”

Rupert Shepherd

Curcumin, a substance extracted from turmeric, prolongs life and enhances activity of fruit flies with a nervous disorder similar to Alzheimer’s. The study conducted at Linkoping University, indicates that it is the initial stages of fibril formation and fragments of the amyloid fibrils that are most toxic to neurons.

Ina Caesar, as the lead author, has published the results of the study in the prestigious journal PLoS One.

For several years curcumin has been studied as a possible drug candidate to combat Alzheimer’s disease, which is characterized by the accumulation of sticky amyloid-beta and Tau protein fibres. Link?¶ping researchers wanted to investigate how the substance affected transgenic fruit flies (Drosophila melanogaster), which developed evident Alzheimer’s symptoms. The fruit fly is increasingly used as a model for neurodegenerative diseases.

Five groups of diseased flies with different genetic manipulations were administered curcumin. They lived up to 75 % longer and maintained their mobility longer than the sick flies that did not receive the substance.

However, the scientists saw no decrease of amyloid in the brain or eyes. Curcumin did not dissolve the amyloid plaque; on the contrary it accelerated the formation of fibres by reducing the amount of their precursor forms, known as oligomers.

The results confirm our belief that it is the oligomers that are most harmful to the nerve cells, says Professor Per Hammarstrom, who led the study.

We now see that small molecules in an animal model can influence the amyloid form. To our knowledge the encapsulation of oligomers is a new and exciting treatment strategy.

Several theories have been established about how oligomers can instigate the disease process. According to one hypothesis, they become trapped at synapses, inhibiting nerve impulse signals. Others claim that they cause cell death by puncturing the cell membrane.

Curcumin is extracted from the root of herbaceous plant turmeric and has been used as medicine for thousands of years. More recently, it has been tested against pain, thrombosis and cancer.

A study published in the Journal of Alzheimer’s Disease shows that 39% of non-demented elderly Swedish people suffer from subjective impairment, and 25% from objective cognitive impairment. The nation-wide study of twins conducted by researchers at the Aging Research Center of Karolinska Institutet in Sweden, also demonstrates that higher education is a major protective factor, emphasizing the significance of environmental aspects over genetics, in mild cognitive disorders in the elderly. ??????

The researchers examined the distribution and heritability of subjective and objective cognitive impairment, using data obtained from the Swedish Twin Registry. The study involved 11,926 twins, aged 65 years and older.

Whilst individuals with objective cognitive impairment display a reduced score in performance tests that measure different cognitive abilities, for instance in memory and attention, those with subjective cognitive impairment experience similar problems, although only at a subjective level. The researchers subsequently discovered that the majority, i.e. 64% of non-demented Swedish elderly suffer from subjective and objective cognitive impairment combined affect, which indicates mild cognitive disorders may be a major public health concern, even in the absence of dementia. ??????

The study also emphasizes that subjective and objective cognitive impairments have specific socio-demographic profiles, particularly in comparison with people who have objective cognitive impairment. The researchers found that only those elderly individuals with subjective complaints and enjoyed a better education, were more likely to be married, and had a higher socio-economic status, which suggests these favorable life conditions may have a protective effect. Co-twin control examinations demonstrated that the cognitive functioning of those who were disadvantaged with a lower educational level was mostly unrelated to genetic background and early life environment.

Study leader, Dr Barbara Caracciolo at the Aging Research Center in Stockholm comments:

??????”This underlies the relevance of adult life educational achievements for preserved cognitive functioning in older life.”

???The researchers noted that 63% of participants suffered from subjective and 52% from objective heritable cognitive impairment in identical twins, compared with 63% and 50% in non-identical twins of the same sex, and 42% and 29% in non-identical twins of different sexes. The researchers indicate that environmental influences have a major impact on the occurrence of mild cognitive disorders in non-demented elderly and not the individuals’ genetic background, given that there is no significant difference in the link between genetically identical twins and non-identical twins.

: Petra Rattue

Cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, according to a systematic review by Cochrane researchers. Despite concerns that cognitive improvements may not be matched by improvements in quality of life, the review also found positive effects for well-being.

There is a general belief that activities that stimulate the mind help to slow its decline in people with dementia. Cognitive stimulation provides people with dementia with activities intended to stimulate thinking, memory and social interaction, in order to delay the worsening of dementia symptoms. In 2011, the World Alzheimer’s Report recommended that cognitive stimulation should be routinely offered to people with early stage dementia. However, increased interest in its use in dementia in recent years has provoked concern about its effectiveness and potential negative effects on well-being.

The review, published in The Cochrane Library, included 15 randomised controlled trials involving 718 people with mild to moderate dementia, mainly in the form of Alzheimer’s disease or vascular dementia. Participants were treated in small groups and involved in different activities, from discussions and word games to music and baking. All activities were designed to stimulate thinking and memory. Improvements were weighed against those seen without treatment, with “standard treatments”, which could include medicine, day care or visits from community mental health workers, or in some cases alternative activities such as watching TV and physical therapy.

“The most striking findings in this review are those related to the positive effects of cognitive stimulation on performance in cognitive tests,” said lead author, Bob Woods, of the Dementia Services Development Centre Wales, at Bangor University in Bangor, UK. “These findings are perhaps the most consistent yet for psychological interventions in people with dementia.”

Those who received cognitive stimulation interventions scored significantly higher in cognitive function tests, which measure improvements in memory and thinking. These benefits were still being seen one to three months after treatment. In addition, positive effects on social interaction, communication and quality of life or well-being were observed in a smaller number of the trials, based on self-reported or carer-reported measures.

In one trial, family members were trained to deliver cognitive stimulation on a one-to-one basis, with no additional strain on burden on caregivers reported. “Involving family caregivers in the delivery of cognitive stimulation is an interesting development and deserving of further attention,” said Woods.

A new study, which will be presented at the American Academy of Neurology’s 64th Annual Meeting in New Orleans, April 21st to April 28th, reveals that the amount of shut-eye people sleep may later affect their memory’s function and the risk of Alzheimer’s.

Study author, Yo-El Ju, M.D., from the University School of Medicine, St. Louis, and a member of the American Academy of Neurology, explained:

“Disrupted sleep appears to be associated with the build-up of amyloid plaques, a hallmark marker of Alzheimer’s disease, in the brains of people without memory problems. Further research is needed to determine why this is happening and whether sleep changes may predict cognitive decline.”

To determine their findings, the authors analyzed the sleep patterns of 100 patients, aged between 45 and 80, who did not show any signs of dementia. 50% of these patients had a history of Alzheimer’s disease in their families, the other 50% did not have any history of Alzheimer’s disease in their families.

The researchers placed a monitor on the patients in order to record their sleep for 2 weeks. They were also asked to record their sleeping habits and fill out surveys.

The study determined that 25% of the patients showed signs of amyloid plaques, which predict Alzheimer’s in the future, and can be seen many years before they are diagnosed with the progressive disease. The mean amount of time the participants slept during the study was 8 hours. However, the average was reduced – to 6.5 hours – because of disruptions in their sleep throughout the night.

The people who did not wake up frequently during the night were 5 times less likely to possess the amyloid plaque build-up than the people who did not sleep well. The people who did not sleep well were also found to have a greater chance of having the “markers” of early stage Alzheimer’s. This means, those who spent 85% of their time in bed, sleeping soundly, have a lower risk of Alzheimer’s than those who spent 85% of the time in bed tossing and turning.

Ju concludes:

“The association between disrupted sleep and amyloid plaques is intriguing, but the information from this study can’t determine a cause-effect relationship or the direction of this relationship. We need longer-term studies, following individuals’ sleep over years, to determine whether disrupted sleep leads to amyloid plaques, or whether brain changes in early Alzheimer’s disease lead to changes in sleep.

Our study lays the groundwork for investigating whether manipulating sleep is a possible strategy in the prevention or slowing of Alzheimer’s disease”

This study was funded by the Ellison Foundation and the National Institutes of Health.

Christine Kearney

Alternative therapies for dementia patients need to be researched and applied more consistently if they are to help care organisations improve the well-being of patients and reduce the number of antipsychotic drugs prescribed.

Research published today (Wednesday 15 February 2012) by a team at the Universities of Hull and Maastricht highlights a pressing need for more comprehensive research into the Government’s recommended method of an alternative treatment, known as functional or behavioural analysis.

Entitled “Function analysis-based interventions for challenging behaviour in dementia”, the study is published in The Cochrane Library 2012, Issue 2. It focuses on functional, or behaviour, analysis, an approach to dementia care recommended by the National Institute for Health and Clinical Excellence (NICE) in its guidelines on supporting people with dementia and their carers.

The study shows that functional analysis is indeed a promising alternative approach to antipsychotic and other drug therapies but its true value is difficult to evaluate since most studies have applied the approach as part of a broad based programme of a range of other supportive interventions.

Esme Moniz-Cook, Honorary Professor of Clinical Psychology and Ageing at the University of Hull, who is leading the research explains:

“Functional analysis is a systematic approach to understanding the causes of behaviours that challenge staff and family carers. People with dementia can show their distress or discomfort in many different ways. Functional analysis approaches are therefore always individualised to the person and the caregiver’s particular circumstances. If unsystematic methods are used – such as trying a range of therapies that also may include some but not all components of the functional analysis approach, it is then hard to establish what – if anything – has helped in the care situation. This may be why practitioners often readily resort to psychotropic drug therapies before persisting with the best potential set of distress-alleviating therapies that could help the person and the carer.

“Since our study has shown that functional analytic-based interventions for behaviours that challenge others have strong promise in dementia care, large scale clinical trials are needed. These should be designed and supervised by professionally trained staff in both family care and care home settings. Improved knowledge and training on functional analysis as an approach to treatment is also required if the systematic approach to detecting and addressing the causes of distress in people with dementia and their carers is to be achieved.”

About one third of people with dementia live in care homes with as many as 87% described with behaviour that is seen as challenging. In addition, when family carers become distressed and challenged by their relative’s behaviour, this leads to breakdown of care at home and entry to long term care homes.

Professor Moniz-Cook says: “If a systematic functional analysis approach was used to detect the causes of distress or difficulty for the person and carer and thus provide the best set of interventions for both, it may be possible to delay breakdown of care at home associated with behaviours that are seen as challenging.”

By reducing distress and discomfort for people with dementia there is also potential for reducing premature requests for pharmacological interventions. Where some drugs are associated with increased risks to overall quality of life in dementia care, functional analysis-based interventions that are delivered and monitored on a regular basis may therefore have the positive spin-off of an improved quality of life for the person with dementia.”

Professor Moniz-Cook is already on course to address these issues. She is heading up a project called Challenge DemCare, a ??2 million programme funded by the Department of Health’s National Institute for Health Research.

The programme has enlisted national and international experts in functional analysis, to develop an e-learning tool to train staff working in care homes. This is now available for dissemination. An additional e-tool for the use of professionals supporting carers in both family homes and care homes is also being tested widely in family care and care homes settings across England.

“The Challenge DemCare staff training and e-tool systems provide resources for focusing on functional analysis-based interventions rather than other treatments and therapies that run the risk of being used on an ad-hoc basis” explains Professor Moniz-Cook. “It is designed to help professionals design practical and personalised programmes for people with dementia and their carers to reduce distress and difficulties in the short to medium term and enhance efficacy, wellbeing and quality of life in the longer term.”

The systems are currently being tested with some 800 residents living in 63 care homes across Yorkshire, as well with over 300 people and their family carers living at home. In the latter set of studies professionals across seven NHS Trusts in England are trained to deliver personalised support to both the person and the family carer. Comprehensive results from these studies are due in 12 months time.