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:

Alzheimer's and Even Mild Dementia Hasten Death “Those with Alzheimer's disease had a three-fold greater risk of dying compared to those not experiencing cognitive function problems. Those with mild cognitive impairment were 50 percent more likely to die. The risk of death increased as cognitive impairment became more severe.”

Apple Juice Can Delay Onset Of Alzheimer's Disease, Study Suggests “In the most recent study Shea and his team demonstrated that mice receiving the human equivalent of 2 glasses of apple juice per day for 1 month produced less of a small protein fragment, called "beta-amyloid" that is responsible for forming the "senile plaques" that are commonly found in brains of individuals suffering from Alzheimer's disease. Dr. Shea commented that "These findings provide further evidence linking nutritional and genetic risk factors for age-related neurodegeneration and suggest that regular consumption of apple juice can not only help to keep one's mind functioning at its best, but may also be able to delay key aspects of Alzheimer's disease and augment therapeutic approaches."”

Cognitive Decline Begins In Late 20s, Study Suggests “A new study indicates that some aspects of peoples' cognitive skills — such as the ability to make rapid comparisons, remember unrelated information and detect relationships — peak at about the age of 22, and then begin a slow decline starting around age 27. … Salthouse found that average memory declines can be detected by about age 37. However, accumulated knowledge skills, such as improvement of vocabulary and general knowledge, actually increase at least until the age of 60. "These patterns suggest that some types of mental flexibility decrease relatively early in adulthood, but that how much knowledge one has, and the effectiveness of integrating it with one's abilities, may increase throughout all of adulthood if there are no pathological diseases," Salthouse said. However, Salthouse points out that there is a great deal of variance from person to person, and, he added, most people function at a highly effective level well into their final years, even when living a long life. “

Dementia Incidence and Prevalence Continues to Rise Even in the Oldest Old “Results of 2 new studies show that both the incidence and prevalence of dementia continue to rise in a linear fashion among the so-called "oldest old," those in their 80s and 90s and even among centenarians. The results, from the population-based Monzino 80-Plus Study in Italy and the 90+ Study in the United States, would appear to contradict fairly conclusively the previously held idea that conversion to dementia plateaus or even declines in this oldest-old population. "The prevalence and incidence rates of dementia found in the Monzino 80-Plus study continue to rise also in very advanced ages," Ugo Lucca, MD, from the Laboratory of Geriatric Neuropsychiatry at the Istituto di Ricerche Farmacologiche Mario Negri, in Milan, Italy. "Age remains the most important risk factor for dementia, and we need to further our understanding of its role if effective therapeutic and preventive strategies are to be developed." Claudia Kawas, MD, from the University of California, Irvine, showed a linear increase in dementia risk from 10% in the 90- to 95-year-olds to a "whopping" 41% for centenarians in the 90+ Study. “

Dementia Is a Terminal Illness, But Palliative Care Often Poor “The presence of distressing symptoms and burdensome interventions of limited benefit are "2 things that are not really indicative of high-quality palliative care," she said. However, when family members understood the poor prognosis and clinical course of end-stage dementia, patients were far less likely to undergo aggressive intervention, Dr. Mitchell added. "For example, if the family felt they both understood the clinical complications that were expected and the poor prognosis, 27% of those patients got a burdensome intervention in the last 90 days of life, compared to 73% of those patients whose family members didn't understand either of those things." "It really comes down to what the goals of care are," she added. When it becomes clear to families that these patients have a poor prognosis, and they understand the types of complications the patients will face near the end, most want the goal of care to be comfort for the patient, she explained. Families can then take the different problems that arise and consider the treatment options, whether they be palliative or aggressive, and decide which one is going to promote that goal of comfort for the patient, Dr. Mitchell said. "I think as soon as the preferences turn toward comfort with an understanding of where these folks are in the end stage of the disease, that's when you can comfortably stop doing some of those things that don't promote comfort," Dr. Mitchell concluded.”

Dementia Less Likely In Calm And Outgoing People “The researchers concluded that: "Low neuroticism in combination with high extraversion is the personality trait associated with the lowest dementia risk; however, among socially isolated individuals even low neuroticism alone seems to decrease dementia risk." In other words, it appears that people with a calm, outgoing and optimistic outlook on life are less likely to develop dementia, but perhaps surprisingly, being a calm sort of person also reduces dementia risk among the socially isolated. Wang said that previous studies had shown that "chronic distress can affect parts of the brain, such as the hippocampus, possibly leading to dementia", so this might partly explain the biological mechanism behind the link with low neuroticism.”

Dietary intake of fish and omega-3 fatty acids in relation to long-term dementia risk. (Am J Clin Nutr. 2009) “CONCLUSION: In this Dutch cohort, who had a moderate consumption of fish and omega-3 PUFAs, these dietary factors do not appear to be associated with long-term dementia risk.”

Difficulties With Activities of Daily Living Strong Predictor of Progression to Dementia

Education Doesn't Slow Alzheimer's Decline “Education does not slow the rate of cognitive decline among the elderly, new research shows. The finding contradicts several earlier studies that suggested more education lowered the risk for Alzheimer's disease and dementia. "Your rate of cognitive decline really doesn't depend on the number of years of schooling you've had," said study author Robert S. Wilson, a professor of neuropsychology at Rush Alzheimer's Disease Center at Rush University Medical Center in Chicago. However, more education "does give you the advantage of having a higher level of cognitive functioning in old age. You have to decline for somewhat longer to reach the effect where you're no longer able to be independent and engage in self-care," he noted.”

Even Mild Infections Hasten Decline With Alzheimer's “For people with Alzheimer's disease, even a minor infection can double the rate of memory loss, British researchers report. In this new study, researchers found that Alzheimer's patients who had respiratory, gastrointestinal or other infections -- even minor bumps and bruises -- can have high levels of tumor necrosis factor-alpha (TNF-a), in their blood. TNF-a is a protein linked to inflammation, and has been associated with memory loss or other types of cognitive decline. "Illnesses that we normally consider to be of little consequence in the healthy aged person need to be taken more seriously in patients with Alzheimer's disease," said lead researcher Clive Holmes, from the Clinical Neurosciences Research Division at the University of Southampton in the U.K. "Short-lived illnesses or conditions that cause inflammation outside the brain are associated with a marked decline in memory function in patients that have Alzheimer's disease. This decline is not a temporary effect, and remains after the illness has resolved," he added. “

Irregular Heartbeat Tied to Alzheimer's Disease “The abnormal heartbeat called atrial fibrillation is associated with later development of Alzheimer's disease, a large-scale study finds.”

Language Skills In Your Twenties May Predict Risk Of Dementia Decades Later

New Research Highlights Dramatically Reduced Risk Of Developing Dementia

Number of children is associated with neuropathology of Alzheimer's disease in women (Neurobiology of Aging 2009)

Predicting risk of dementia in older adults (NEUROLOGY 2009) “Results: Subjects had a mean age of 76 years at baseline; 59% were women and 15% were African American. Fourteen percent (n = 480) developed dementia within 6 years. The final late-life dementia risk index included older age (1–2 points), poor cognitive test performance (2–4 points), body mass index <18.5 (2 points), 1 apolipoprotein E 4 alleles (1 point), cerebral MRI findings of white matter disease (1 point) or ventricular enlargement (1 point), internal carotid artery thickening on ultrasound (1 point), history of bypass surgery (1 point), slow physical performance (1 point), and lack of alcohol consumption (1 point) (c statistic, 0.81; 95% confidence interval, 0.79–0.83). Four percent of subjects with low scores developed dementia over 6 years compared with 23% of subjects with moderate scores and 56% of subjects with high scores.”

Rethinking Alzheimer's Disease and Its Treatment Targets “The standard explanation for what causes Alzheimer's is known as the amyloid hypothesis, which posits that the disease results from of an accumulation of the peptide amyloid beta, the toxic protein fragments that deposit in the brain and become the sticky plaques that have defined Alzheimer's for more than 100 years . … Bartzokis notes that myelination of the brain follows an inverted U-shaped trajectory, growing strongly until our 50s, when it very slowly begins to unravel as we age. The myelin that is deposited in adulthood ensheaths increasing numbers of axons with smaller axon diameters and so spreads itself thinner and thinner, Bartzokis said. As a result, it becomes more susceptible to the ravages of age in the form of environmental and genetic insults and slowly begins to break down faster than it can be repaired.”

Shrinking In Hippocampus Area Of Brain Precedes Alzheimer's Disease “For the people who did not have dementia at the beginning of the study, those with smaller hippocampal volumes and higher rates of shrinkage were two to four times as likely to develop dementia as those with larger volumes and a slower rate of atrophy. "This finding seems to reflect that at the stage of mild cognitive impairment, considerable atrophy has already occurred in the hippocampus," said study author Wouter Henneman, MD, of VU University Medical Center in Amsterdam, The Netherlands. "In people who already have Alzheimer's disease, the loss of nerve cells is more widespread throughout the brain."”

Spouse Has Dementia? You're at Risk, Too

Study Links Midlife Blood Pressure Change to Incident Dementia

Warning: Alzheimer's risk and Anesthetics “ … for Alzheimer's patients, a cool head may make the disease worse. In the research report, scientists show that a protein associated with Alzheimer's (called "tau") builds up in brain cells at an increased rate when temperatures fall, such as when a patient is anesthetized or experiences hypothermia. This finding should be of immediate concern to surgeons, dentists, and any other health care professionals who anesthetize patients with Alzheimer's or patients at an elevated risk for the disease.”

ARTICLES:

What is Dementia? What Causes Dementia? Symptoms of Dementia

JOURNAL ARTICLES:

Apathy predicts more severe parkinsonism in Alzheimer's disease. (Am J Geriatr Psychiatry. 2009) “CONCLUSION: Apathy may be an early manifestation of a more aggressive AD phenotype characterized by loss of motivation, increasing parkinsonism, a faster cognitive and functional decline, and more severe depression.”

APOE {varepsilon}2 is associated with intact cognition but increased Alzheimer pathology in the oldest old (Neurology 2009)

Ascorbic Acid and rates of cognitive decline in Alzheimer's disease. (J Alzheimers Dis. 2009)

Association of Adiposity Status and Changes in Early to Mid-Adulthood With Incidence of Alzheimer's Disease (American Journal of Epidemiology 2008) “In conclusion, obesity, central obesity, and weight loss among women seem to play a role in the etiology of AD, while underweight and weight gain among men increase the risk.”

Bone Density and Brain Atrophy in Early Alzheimer's Disease. (J Alzheimers Dis. 2009) “BMDy is reduced in the earliest clinical stages of AD and associated with brain atrophy and memory decline, suggesting that central mechanisms may contribute to bone loss in early AD.”

Characteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up. (Clin Nutr. 2009)

Contribution of vascular risk factors to the progression in Alzheimer disease. (Arch Neurol. 2009) “CONCLUSION: Higher prediagnosis total cholesterol and LDL-C concentrations and history of diabetes were associated with faster cognitive decline in patients with incident AD, which provides further evidence for the role of vascular risk factors in the course of AD.”

Cumulative incidence of vitamin B12 deficiency in patients with Alzheimer disease. (J Neurol Sci. 2009) “CONCLUSION: Our pilot data indicate that vitamin B12 levels decreased in this cohort of AD patients putting a substantial percentage at risk of deficiency and reaching deficiency state in a meaningful number of patients. Repeat screening for B12 deficiency after approximately 2 years of follow-up seems warranted in order to prevent hematological and neurological manifestations that may significantly alter their quality of life.”

Delirium accelerates cognitive decline in Alzheimer disease (NEUROLOGY 2009;)

Dietary fish and meat intake and dementia in Latin America, China, and India: a 10/66 Dementia Research Group population-based study. (Am J Clin Nutr. 2009) “CONCLUSIONS: Our results extend findings on the associations of fish and meat consumption with dementia risk to populations in low- and middle-income countries and are consistent with mechanistic data on the neuroprotective actions of omega-3 (n-3) long-chain polyunsaturated fatty acids commonly found in fish. The inverse association between fish and prevalent dementia is unlikely to result from poorer dietary habits among demented individuals (reverse causality) because meat consumption was higher in those with a diagnosis of dementia.”

Does Anxiety Affect Risk of Dementia? Findings From the Caerphilly Prospective Study. (Psychosom Med. 2009) “Conclusions: Anxiety is a risk factor for CIND and dementia. The extent to which the association is independent of depression and whether or not it is causal requires further study.”

Executive functioning in Alzheimer's disease and vascular dementia. (Int J Geriatr Psychiatry. 2009)

High medical co-morbidity and family history of dementia is associated with lower cognitive function in older patients. (Fam Pract. 2009)

How to Bathe a Person with Dementia: An Evidence-Based Guide (Geriatrics & Aging 2009)

Incidence and prediction of falls in dementia: a prospective study in older people. (PLoS ONE. 2009) “The management of symptomatic orthostatic hypotension, autonomic symptoms and depression, and the encouragement of physical activity may provide the core elements for the most fruitful strategy to reduce falls in people with dementia.”

Mechanisms of Nitrosamine-Mediated Neurodegeneration: Potential Relevance to Sporadic Alzheimer's Disease. (J Alzheimers Dis. 2009)

Mild cognitive impairment associated with limbic and neocortical lewy body disease: a clinicopathological study (Brain 2009)

Prevalence and Causes of Early-Onset Dementia in Japan. A Population-Based Study (Stroke 2009) “Results—We identified 617 subjects with EOD. The estimated prevalence of EOD in the target population was 42.3 per 100 000 (95% CI, 39.4 to 45.4). Of the illnesses that cause EOD, vascular dementia was the most frequent (42.5%) followed by Alzheimer disease (25.6%), head trauma (7.1%), dementia with Lewy bodies/Parkinson disease with dementia (6.2%), frontotemporal lobar degeneration (2.6%), and other causes (16.0%). Conclusions—The prevalence of EOD in Japan appeared to be similar to that in Western countries with the notable exception that vascular dementia was the most frequent cause of EOD in Japan.”

Progression of Mild Cognitive Impairment to Dementia. Contribution of Cerebrovascular Disease Compared With Medial Temporal Lobe Atrophy (Stroke 2009)

Review: Blood pressure and dementia — a comprehensive review (Therapeutic Advances in Neurological Disorders 2009) “Hypertension in midlife is particularly associated with an increased risk of developing dementia.”

Statins for the prevention of dementia (Cochrane Reviews 2009) “There is good evidence from RCTs that statins given in late life to individuals at risk of vascular disease have no effect in preventing AD or dementia. Biologically it seems feasible that statins could prevent dementia due to their role in cholesterol reduction and initial evidence from observational studies was very promising. Indication bias may have been a factor in these studies however and the evidence from subsequent RCTs has been negative.”

Ten-Year Change in Plasma Amyloid ß Levels and Late-Life Cognitive Decline (Arch Neurol. 2009)

The Clinical Course of Advanced Dementia (NEJM 2009) “Conclusions Pneumonia, febrile episodes, and eating problems are frequent complications in patients with advanced dementia, and these complications are associated with high 6-month mortality rates. Distressing symptoms and burdensome interventions are also common among such patients. Patients with health care proxies who have an understanding of the prognosis and clinical course are likely to receive less aggressive care near the end of life.”

The Nun Study - Clinically silent AD, neuronal hypertrophy, and linguistic skills in early life (NEUROLOGY 2009)

Total daily sleep duration and the risk of dementia: a prospective population-based study (European Journal of Neurology 2009) “Conclusions: Prolonged sleep duration (night-time sleep and daytime napping) may be associated with an increased risk of dementia.“

Uric Acid and Dementia in Community-Dwelling Older Persons. (Dement Geriatr Cogn Disord. 2009)

What is 'early onset dementia'? (Psychogeriatrics. 2009)

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