Alzheimer’s Harder to Detect in Elderly

  

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A new study suggests that symptoms of Alzheimer’s may be harder to detect in patients over the age of 80. The study tested the relationship between age-related brain shrinkage and Alzheimer’s correlated memory loss. It used just over 100 Alzheimer’s patients and 125 dementia-free people who were grouped by age.

These participants then underwent a series of brain tests with scans that looked at attention, information processing speed and memory.

“People in both groups had similar levels of overall cognitive impairment, but the pattern of changes associated with Alzheimer's disease seemed to be less noticeable in very-old patients than in the young-old”[1].

Compared to other younger patients, the immediate memory and processing speed in very old Alzheimer’s patients was less abnormal indicating that it may be harder to diagnose. 

The study also demonstrated that 80+ Alzheimer’s patients had less thinning of certain areas of the cerebral cortex and cerebellum than the younger patients. This also supports the “hard to diagnose” conclusion because thickness of these brain areas decreases in everyone with age so the differences aren’t as noticeable.

Antidepressants Not Better than Placebo for Alzheimer’s

  

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A new study revealed that two commonly prescribed antidepressants for dementia patients are not better than a sugar pill for reducing depression symptoms in Alzheimer’s patients.

This study published in the Lancet tested Zoloft (sertraline) and Remeron (mirtazapine), which are both generic antidepressants that have generated more severe side effects than placebo. These side effects have led researchers to suggest that these types of medicine should be only used in dementia patients who cannot be treated in a simpler fashion.

The study only tested around 300 patients but was still the largest placebo-controlled trial to date on antidepressants in dementia patients.

More than one-fifth of the 35 million people around the world who have dementia have also been linked with depression symptoms, making this study immensely important. “Alan Manevitz, M.D., a psychiatrist at Lenox Hill Hospital, in New York City, agrees with the authors' conclusion that doctors should consider nondrug treatments before prescribing antidepressants to depressed dementia patients”[1]. 

This study is a key step forward yet it is surely not a final statement on the subject. It was a bit small and the findings weren’t diverse enough to apply to a large population of patients. Hopefully more progress will be made on this issue in the future.

Progress with Blood Tests for Alzheimer’s

  

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Scientists are getting closer and closer to a critical milestone in diagnosing Alzheimer’s patients. They are extremely close to succeeding at creating a blood test to screen people for the disease.

Currently, Alzheimer’s is diagnosed only after people start having memory problems or unexpected change in behavior. They then undergo an in-depth medical interview, a memory assessment test and occasionally an MRI to look for brain shrinkage. The problem is that these processes are overly expensive and impractical for routine use.

That’s why two recent studies are being hailed around the medical world as a large step forward in Alzheimer’s research. Australian researchers reported a few weeks ago that their blood tests showed more accuracy than ever seen before when tested with over 1000 patients. “The test correctly identified 83 percent of people with high amyloid levels and correctly ruled out 85 percent of people without this condition”[1].

The other study used blood tests to screen for autoantibodies (special markers in blood) and showed even better experimental results. “The blood test correctly detected Alzheimer's disease in people already diagnosed with the devastating brain disorder with 96 percent accuracy, according to the researchers. The test could also distinguish who didn't have the disease from a control group of non-affected adults with 92.5 percent accuracy”[2]. 

This research is a huge step forward but the scientists cautioned spectators saying that there is still a long way to go. Let’s hope that future studies like these continue to show as exciting and ground-breaking results.

Exercise Keeps the Brain Strong

  

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A few weeks ago, we blogged about how exercise not only is crucial to maintain a healthy and fit body but also can play an important role in reducing anxiety. Today new studies reveal that exercise may also be vital to keeping your mind strong and preventing memory loss and brain disease.

The most encouraging study, by Canadian researchers, concludes that even modest activity had a significant effect on brain function as the years progressed. The study measured the energy expenditure and cognitive functioning of a large group of seniors over five years and discovered that 90% of the people who exercised could think and remember perfectly for a longer time.

Laura Middleton, an associate professor at the University of Waterloo in Ontario and lead author of the study, said that their “results indicate that vigorous exercise isn’t necessary” to protect your mind[1]. All you need are simple activities like walking the dog or gardening on a regular basis to keep your mind fit and healthy.

A similar study of women in their 70s with vascular disease came to the same conclusion as there was a decreasing rate of cognitive decline among the more active group. Dr. Eric Larson, the vice president of research at Group Health Research Institute said “if we can push out the onset of dementia by 5, 10 or more years, that changes the dynamics of aging” and he was hopeful that exercise can be the solution. Now all that’s needed is to find a way to get everybody active and moving.

Dementia: Can Painkillers Help Recovery?

  

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Dementia is a reduction in brain function that occurs with certain diseases such as Alzheimer’s. It adversely affects memory, thinking, language, judgment, and behavior[1]. Alzheimer’s is extremely common as it affects 13% of people over 65 and 50% over 85 years old. Extreme agitation and aggression are commonalities in patients with advanced dementia and can create extreme stress for loved ones as well as medical practitioners. These facts make new research increasingly important in the fight to help as many people as possible.

A new study concludes that ordinary painkillers may work more effectively than antipsychotic drugs to calm agitation in dementia patients. Normally, powerful antipsychotics are the primary medications prescribed but this treatment can cause strokes and even death. This new study led by Dag Aarsland treated over 300 patients with one of four different medications. 

The patients treated with ordinary painkillers such as paracetemol showed a marked improvement leading researchers to conclude that “the intervention produced a clinically and statistically significant reduction in agitation and pain”[2]. The scientists urged more studies to confirm their results but this definitely opens the door to newer and simpler treatments for dementia patients. Hopefully this is another key step in the path to helping every patient in their recovery.

Could Falls Be A Sign Of Alzheimer's Disease?

  

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A presentation at this week's Alzheimer's Association International Conference has brought up a link between falls and Alzheimer's disease.

Elderly adults with Alzheimer's are more likely to fall than elderly adults without the disease. That's why scientists at the Alzheimer's Disease Research Center at Washington University have been following 125 older adults over 8 months and having them record any time they've fallen.

To determine whether any of the study participants have preclinical Alzheimer's, they were tested for the presence of amyloids, a known sign of the disease. Among those without amyloids, the fall rate was about 30 percent. Among those with amyloids -- and by extension, preclinical Alzheimer's -- the fall rate was 66 percent. 

"There was a statistically significant marked difference in the fall rates between the 2 groups," study author Dr. Susan Stark told Medscape.

"These are all cognitively normal, healthy, aging people who otherwise do not look any different from us, so this hints to us that there are probably things other than the changes in the brain that are occurring that are affecting other things," Dr. Stark said. 

"We are trained to look for cognitive changes, but in fact there probably are other changes that are happening. In this case, it's the motor changes that are making a fall occur."

The results are important because falls witnessed by a caretaker or relative or nurse could cause increased vigilance for the disease by physicians and even earlier diagnoses. There are even some promising potential treatments for the disease, but Alzheimer's must be caught early for them to be effective.

Alzheimer’s and its Connection to General Health

  

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Previous articles both on this blog and other sources have indicated that genetics and age are the primary factors that contribute to Alzheimer’s and dementia but new studies show that there are other more surprising indicators as well.

The author of the study, Kenneth Rockwood concluded that “keeping up with your general health may help reduce the risk for dementia”[1]. The study followed over 7,000 people who were older than 65 and cognitively healthy. It evaluated their conditions at both the five and ten year marks after the start of the study.

This study looked beyond the normal factors associated with Alzheimer’s and dementia. “Researchers evaluated the group based on an index that included 19 different health deficits frequently associated with aging...it was the first time an evaluation of dementia using non-cognitive factors has ever been done. After 10 years, 40 percent of the participants had died. Of the participants left, 607 had developed Alzheimer’s or some other form of dementia, while an additional 677 participants had developed some other cognitive problem. The remaining 883 participants who were cognitively healthy were the subject who scored lowest, or healthiest, on the initial health index evaluation. Those who had died or had developed dementia or Alzheimer’s were among patients who had scored highest on their initial health index evaluations. Researchers also found that each health problem a participant had, made him or her 3% more likely to develop dementia over those who didn’t have the same problems” [1].

Although further research is needed in this area, it is clear that by improving general health people should be able to lessen the likelihood of having to deal with Alzheimer’s or dementia later in life.

Connection between Diet and Alzheimer’s

  

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Alzheimer’s disease is a growing concern in modern society as over 26 million people globally are affected by it each year[1]. It is known as the incurable, terminal brain disorder that slowly steals the minds of its victims. The emotional and financial costs for families experiencing this disease with a loved one can be enormous. There has recently been an increase in research relating to this disease in an effort to help slow the effects and find a cure.

This is where a nutritious diet comes in. A healthy diet has been proven to be important for your body but recent studies say it is good for your brain and can help prevent Alzheimer’s as well. The study concluded that “diet may be a powerful environmental factor that modulates Alzheimer disease risk”[2]. The results are only preliminary but definitely seem to indicate a connection between eating healthier and reducing your risk for Alzheimer’s.

Similarly, another study isolated fruits, vegetables and omega-3 fatty acids as specific dietary elements that were beneficial in reducing the risk of Alzheimer’s. This study discovered that people who followed the diet above were “38 percent less likely to develop Alzheimer's disease”[3]. 

Overall, it is clear that diet has some effect on reducing Alzheimer’s but more research is necessary to confirm the correlations described in the studies above.

Where's The Bus? Redirecting Alzheimer's Patients at a Nursing Home

  

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Faced with patients who would try to "escape" nursing homes for homes where they had lived many years ago, a German elder care organization found that missing Alzheimer's and dementia patients often were found at bus stops, as their still-functioning long term memory told them they could get home by taking a bus.

Rather than dealing with the police, a nursing home in Dusseldorf tried a radical approach: They installed a fake bus stop.

Residents were delighted with the autonomy they were given, and staff could intercept patients as they waited for a bus that would never come. The now-famous experiment was replicated at other nursing homes in Germany, and became a prime example of "redirecting," a strategy for dealing with Alzheimer's patients who cannot be reasoned with.

In a recent edition of the New York Times' New Old Age blog, a similar tale of redirecting is recounted. A woman in a nursing home is obsessed over the "theft" of a red box and gray suitcase, to the point that she cannot be distracted from her obsession. Family members and staff try to reason with her, but find that it is to no avail. Finally, a family member brings a red box and suitcase to her room and tells her that he's found them. She is once again at peace.

Those with Alzheimer's often cannot be "taught," as their often irrational behaviors are due to the loss of brain tissue. Rather than arguing with a loved one with Alzheimer's to no avail, experts recommend "redirecting" the situation to bring peace and comfort to the situation.

Here are some examples of redirection from the New York Times and a handout from the Alzheimer's Association:

- A loved one expresses a desire to go to a childhood home that's 3,000 miles away. Instead of listing the reasons why a multi-state trek is difficult or impossible, the caregiver says that the trip is OK but that he needs to get dressed first. Often, the small delay will be enough time that the original intent for getting dressed will be forgotten.

- If someone with Alzheimer's says they want to travel somewhere, often a short walk will satisfy their curiosity.

- If a person with Alzheimer's asks for a friend or relative who died years ago, don't remind them of the death. Say something like, "I'm sure he'll be here any minute," or "I'm sure he's fine."

As the Alzheimer's Association states, "Wait for an opportunity to redirect and always talk positively about the future. Remember, you can never win an argument with an Alzheimer’s patient."