Alzheimer's Disease - Dementia

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Alzheimer's Disease - Dementia

NIH - Medical Encyclopedia Alzheimer's Disease

"Alzheimer's disease (AD), one form of dementia, is a progressive, degenerative brain disease. It affects memory, thinking, and behavior. Memory impairment is a necessary feature for the diagnosis of this or any type of dementia. Change in one of the following areas must also be present: language, decision-making ability, judgment, attention, and other areas of mental function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Early onset AD is much less common, accounting for only 5-10% of cases. However, it tends to progress rapidly. The brain tissue shows "neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell), "neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein), and "senile plaques" (areas where products of dying nerve cells have accumulated around protein). Although these changes occur to some extent in all brains with age, there are many more of them in the brains of people with AD."

Highlighted Articles

Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. (Neurology. 2007)

"CONCLUSIONS: Regardless of the neuropathologic criteria used, education is predictive of dementia status among individuals with neuropathologic Alzheimer disease. These results support the theory that individuals with greater cognitive reserve, as reflected in years of education, are better able to cope with AD brain pathology without observable deficits in cognition."

Nutritional factors, cognitive decline, and dementia. (Brain Res Bull. 2006)

"Nutritional factors and nutritional deficiencies have been repeatedly associated with cognitive impairment. … Deficiencies of several B vitamins have been associated with cognitive dysfunction in many observational studies. More recently, deficiencies of folate (B(9)) and cobalamine (B(12)) have been studied in relation to hyperhomocysteinemia as potential determinants of cognitive impairment, dementia, and Alzheimer's disease (AD). A small number of studies assessed the association between intake of macronutrients and cognitive function or dementia. Among the others, the intake of fatty acids and cholesterol has received particular attention. Although the results are not always consistent, most studies have reported a protective role of dietary intakes of poly- and mono-unsaturated fatty acids against cognitive decline and AD."

Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older (Annals of Internal Medicine 2006)

"Conclusion: These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer disease, further supporting its value for elderly persons."

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Alzheimer's Disease - Dementia

General Information

NEWS:

10 Million Baby Boomers Face Alzheimer's, Report Predicts “The age of highest risk for Alzheimer's starts at 65, McConnell said. "Some of these people are already developing the disease, and those numbers are just going to increase dramatically over the next several decades," he added. This is going to have a huge impact on baby boomers' lives, their families, and the nation's health-care system, McConnell said. “

Alzheimer's Expert Urges Boomers To Think About Their Cognitive Health Now “While a study in the October 15, 2008 JAMA demonstrates that B vitamins do not slow cognitive decline once Alzheimer's disease has struck, there is a large body of scientific evidence showing that some nutrients may help keep the brain healthy as one ages. A leading expert thinks the time is now for Baby Boomers to look seriously at maintaining cognitive wellness. According to the Alzheimer's Association, 10 million Boomers can expect to get Alzheimer's disease as they age.”

Alzheimer's Starts Earlier For Heavy Drinkers, Smokers “Researchers found that people who were heavy drinkers developed Alzheimer's 4.8 years earlier than those who were not heavy drinkers. Heavy smokers developed the disease 2.3 years sooner than people who were not heavy smokers. People with APOE-4 developed the disease three years sooner than those without the gene variant. Adding the risk factors together led to earlier onset of the disease. People who had all three risk factors developed the disease 8.5 years earlier than those with none of the risk factors. The 17 people in the study with all three risk factors developed Alzheimer's at an average age of 68.5 years; the 374 people with none of the three risk factors developed the disease at an average age of 77 years.”

Brighter Lighting Improves Symptoms in Patients With Dementia

Dementia Diagnosis Typically Means Death Within Five Years “People with dementia survive an average of four and a half years following their diagnosis, new British research shows. However, age, sex and any existing disability can alter life expectancy, according to the report in the Jan. 11 online issue of the British Medical Journal. Common socioeconomic influences, such as marital status, social class and living in a community or residential home, did not appear to have an influence on longevity, the study found. “

Hypercholesterolemia in Midlife Raises Dementia Risk “High serum total cholesterol levels in midlife increase the risk of developing Alzheimer's disease 3 decades later, new research shows. Alzheimer's disease was 1.5 times more prevalent in men and women who had total cholesterol levels of 249 to 500 mg/dL when they were middle-aged than in people with normal cholesterol levels, according to a retrospective study that involved 9752 members of a Kaiser Permanente health plan in northern California. “

Lack Of Imagination In Older Adults Linked To Declining Memory “According to the study, episodic memory, which represents our personal memories of past experiences, "allows individuals to project themselves both backward and forward in subjective time." Therefore, in order to create imagined future events, the individual must be able to remember the details of previously experienced ones extract various details and put them together to create an imaginary event, a process known as the constructive-episodic-simulation.“

Man With Alzheimer's Fights 'Family Disease'

Occasional Memory Loss Tied To Lower Brain Volume “People who occasionally forget an appointment or a friend's name may have a loss of brain volume, even though they don't have memory deficits on regular tests of memory or dementia, according to a study published in the October 7, 2008, issue of Neurology®, the medical journal of the American Academy of Neurology. … The study found that in people with occasional subjective memory problems, the hippocampus was smaller than in people who had no memory problems. On average, the hippocampus had a volume of 6.7 milliliters in those with occasional subjective memory problems, compared to 7.1 milliliters in people with no memory problems. "These occasional, subjective memory complaints could be the earliest sign of problems with memory and thinking skills and we were able to discover that these subjective memory complaints were linked to smaller brain volumes.”

One In Six Women, One In Ten Men At Risk For Alzheimer's Disease In Their Lifetime

Small Vessel Disease Responbsible For 1/3 Of Risk For Dementia, Autopsy Study Shows “Alzheimer's disease may be what most people fear as they grow older, but autopsy data from a long-range study of 3,400 men and women in the Seattle region found that the brains of a third of those who had become demented before death showed evidence of small vessel damage: the type of small, cumulative injury that can come from hypertension or diabetes.”

Statins Offer No Protection Against Alzheimer's Disease “A large, longitudinal study suggests that statin use does not lower the risk of Alzheimer's disease (AD), nor does it appear to reduce cerebral infarction or classic AD brain pathology, including the burden of amyloid and tangles. The study results, which run contrary to some cross-sectional data, are consistent with findings of other longitudinal studies. In addition, this current study is the first to examine the link between statin use and incident AD, cognitive decline, and pathologic changes in the brain in the same cohort. “

Study Suggests Early-Stage Alzheimer's Patients Who Were More Fit Had Less Brain Atrophy“Exercise and physical fitness have been shown to slow age-related brain cell death in healthy older adults.”

Women Over 90 More Likely To Have Dementia Than Men “The researchers reviewed an analysis of 911 people enrolled in the 90+ Study. Of those, 45 percent of the women had dementia, as opposed to 28 percent of the men. The analysis did not determine when the subjects first experienced dementia. The 90-plus age group, or the "oldest old," is the fastest growing segment of the population, according to the U.S. Census. While there are currently nearly 2 million nonagenarians in the U.S. alone, that number is projected to increase to 10 to 12 million by the middle of the century, raising concerns that the current health care system may not be able to accommodate this population. … Research has shown that dementia prevalence for both men and women increases from age 65 to 85. The frequency of dementia increases with age from less than 2 percent for the 65-69-year-olds, to 5 percent for the 75-79-year-olds and to more than 20 percent for the 85-89-year-olds. … It found that the likelihood of having dementia doubled every five years in women after reaching 90, but not in men. The results also showed that women with a higher education appeared to be as much as 45 percent less likely to have dementia compared to women with less education.”

ARTICLES:

JOURNAL ARTICLES:

A randomized placebo-controlled trial of Ginkgo biloba for the prevention of cognitive decline (NEUROLOGY 2008)

Aggression in Individuals Newly Diagnosed With Dementia. (Am J Alzheimers Dis Other Demen. 2008)

Alzheimer and frontotemporal pathology in subsets of primary progressive aphasia (Annals of Neurology 2008)

[Apolipoprotein e4 in dementia with Lewy bodies.] (Neurologia. 2008)

Association of Adiposity Status and Changes in Early to Mid-Adulthood With Incidence of Alzheimer's Disease (American Journal of Epidemiology 2008)

Associations of job demands and intelligence with cognitive performance among men in late life (NEUROLOGY 2008) “Conclusions: Intellectually demanding work was associated with greater benefit to cognitive performance in later life independent of related factors like education and intelligence. The fact that individuals with lower intellectual aptitude demonstrated a stronger positive association between work and higher cognitive performance during retirement suggests that behavior may enhance intellectual reserve, perhaps even years after peak intellectual activity.”

Clinicopathological and genetic correlates of frontotemporal lobar degeneration and corticobasal degeneration. (J Neurol. 2008)

Clock drawing performance and brain morphology in mild cognitive impairment and Alzheimer's disease. (Brain Cogn. 2008)

Cognitive impairment and effects on upper body strength of adults with dementia. (J Aging Phys Act. 2008) “The findings from this exploratory investigation suggest that dementia is associated with strength loss, a key contributor to functional disability; this further justifies efforts to investigate mechanisms responsible for this decay and to preserve muscle integrity by integrating physical activity interventions, notably, muscle strengthening, into the lifestyle of adults with dementia.”

Early-Onset Dementia Is Associated with Higher Mortality (Dement Geriatr Cogn Disord 2008) “Patients with dementia were subdivided into 2 groups, with early- (<65 years) or late-onset dementia ( 65 years), and compared with non-demented controls of the same age range. … Dementia with Lewy bodies and vascular dementia (frequently seen at older age) and frontotemporal lobar degeneration and 'other dementias' (often found at younger age) had a six- to eightfold increased mortality risk. Conclusion: Dementia is a risk factor for death. Especially in young patients the impact of dementia on mortality is high.”

Education and reported onset of symptoms among individuals with Alzheimer disease. (Arch Neurol. 2008)

Education, cognitive function, and severity of neuropathology in Alzheimer disease (NEUROLOGY 2008) “Conclusions: We found no evidence of larger education-related differences in cognitive function when Alzheimer disease (AD) neuropathology was more advanced. Higher Mini-Mental State Examination scores among more educated persons with mild or no AD may reflect better test-taking skills or cognitive reserve, but these advantages may ultimately be overwhelmed by AD neuropathology.”

Effects of Antihypertensive Drug Treatment on the Risk of Dementia and Cognitive Impairment (Pharmacotherapy. 2008) “Four randomized, placebo-controlled trials were conducted regarding treatment with antihypertensive drugs and incidence of cognitive impairment and/or dementia. Two of the four studies found that antihypertensive drugs significantly reduced the risk of dementia. However, the other two did not find a significant difference between use of antihypertensive drugs or placebo and the incidence of dementia. The antihypertensive drug classes that showed a significant reduction were ACE inhibitors, angiotensin II receptor blockers, thiazide diuretics, and dihydropyridine calcium channel blockers. The randomized, placebo-controlled trials were limited by a high differential dropout rate in both treatment and placebo groups and the use of various definitions of dementia and cognitive impairment. Increasing evidence has indicated that ACE inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics are beneficial in reducing dementia risk compared with other antihypertensive drug classes”

Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's. (BMC Health Serv Res. 2008)

Low HDL Cholesterol Is a Risk Factor for Deficit and Decline in Memory in Midlife. The Whitehall II Study. (Arterioscler Thromb Vasc Biol. 2008)

Low plasma eicosapentaenoic acid and depressive symptomatology are independent predictors of dementia risk (American Journal of Clinical Nutrition 2008) “Conclusions: A high plasma EPA concentration may decrease the risk of dementia, whereas high ratios of n–6 to n–3 fatty acids and of AA to DHA may increase the risk of dementia, especially in depressed older persons.”

Mild Cognitive Impairment in the General Population: Occurrence and Progression to Alzheimer Disease (Am J Geriatr Psychiatry 2008)

Mortality after a Diagnosis of Dementia in a Population Aged 75 and Over in Spain (Neuroepidemiology 2008) “Conclusion: Dementia is a major risk factor for death in advanced age, with the highest mortality rates in women. Moderate and severe dementia was associated with an increased mortality risk even after appropriate control of comorbid conditions.”

Olfaction and the 5-Year Incidence of Cognitive Impairment in an Epidemiological Study of Older Adults (Journal of the American Geriatrics Society 2008) “CONCLUSION: Olfactory impairment at baseline was strongly associated with 5-year incidence of cognitive impairment as measured using the MMSE. Odor identification testing may be useful in high-risk settings, but not in the general population, to identify patients at risk for cognitive decline.”

Olfaction in patients with mild cognitive impairment and Alzheimer's disease (Neurobiology of Aging 2008) “We concluded that deficits in olfactory detection thresholds and identification occur early in AD, before clinical symptoms are fully developed, and decline further over the course of the disease. High detection thresholds, together with impaired identification, may be useful as an early indicator of AD.”

Plasma amyloid ß protein is elevated in late-onset Alzheimer disease families (NEUROLOGY 2008)

Poor performance in Clock-Drawing Test associated with visual memory deficit and reduced bilateral hippocampal and left temporoparietal regional blood flows in Alzheimer's disease patients (Psychiatry and Clinical Neurosciences 2008)

Prevalence of dementia after age 90. Results from The 90+ Study (Neurology 2008) “Conclusions: In a very large sample of participants aged 90 and older, prevalence of all-cause dementia doubled every 5 years for women but not men.”

Prevalence of dementia subtypes: A 30-year retrospective survey of neuropathological reports. (Arch Gerontol Geriatr. 2008) “The neuropathological diagnosis was Alzheimer's disease (AD) in 42.0% of the cases, vascular dementia (VaD) in 23.7%, dementia of combined Alzheimer and vascular pathology in 21.6%, and frontotemporal dementia in 4.0% of the patients. The remaining 8.8% of the patients had other dementia disorders, including combinations other than combined Alzheimer and vascular pathology.”

Relation between the clock drawing test (CDT) and structural changes of brain in dementia. (Arch Gerontol Geriatr. 2008)

Smoking history and cognitive function in middle age from the Whitehall II study. (Arch Intern Med. 2008) “CONCLUSIONS: Smoking was associated with greater risk of poor memory. Middle-aged smokers are more likely to be lost to follow-up by death or through nonparticipation in cognitive tests. Ex-smokers had a lower risk of poor cognition, possibly owing to improvement in other health behaviors.”

Total Daily Activity is Associated With Cognition in Older Persons (Am J Geriatr Psychiatry 2008) “Conclusions: Objective measures of total daily physical activity were associated with a broad range of cognitive abilities in older persons. These findings support the link between physical activity and cognition in the elderly.”

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