Last spring the International Journal of Geriatric Psychiatry reported that for males, by delaying retirement, the age of onset of Alzheimer’s disease (AD) was also delayed. On average, each additional year of work staved off Alzheimer’s disease by seven weeks.

Not known are questions such as:

• Did retirement somehow bring on the disease?
• Are people who are at risk for Alzheimer’s unlikely to keep working?

The researchers speculate that employment challenges may help to keep the mind healthy and agile as one ages. For many people, it’s a financial necessity to keep working, but it might prove to be a great benefit to the brain. Click here to read the abstract of the study.

According to the Alzheimer’s Association, Alzheimer’s disease is:

• responsible for $172 billion in annual costs in the United States
• the seventh leading cause of death in America
• not limited to the elderly, with people in their 30s, 40s, and 50s developing the disease
• currently affecting more than 5 million Americans, resulting in 11 million Alzheimer and dementia caregivers who provide $144 billion in unpaid care for their loved ones
• a disease someone in America develops every 70 seconds and by mid-century someone will develop Alzheimer’s every 33 seconds.

The statistics are staggering. If a person enjoys work, then by all means it might be a good way to delay the onset of Alzheimer’s disease. On the other hand, if one does not enjoy working or if it is too stressful, then delaying retirement would not be a good option. There are so many things that one can do in retirement to continue to stimulate the brain.

The Alzheimer’s Association has a booklet called, Maintain Your Brain, and subtitled — there is growing evidence that lifestyle can affect your brain health. You can obtain this 16-page online booklet by clicking here. If you want a quick summary, the 10 ways to maintain your brain discussed are:

1. Head first
   Good health starts with your brain. It’s one of the most vital body organs, and it needs care and maintenance.
2. Take brain health to heart
   What’s good for the heart is good for the brain. Do something every day to prevent heart disease, high blood pressure, diabetes and stroke — all of which can increase your risk of Alzheimer’s.
3. Your numbers count
   Keep your body weight, blood pressure, cholesterol and blood sugar levels within recommended ranges.
   
4. Feed your brain
   Eat less fat and more antioxidant-rich foods.
5. Work your body
   Physical exercise keeps the blood flowing and may encourage new brain cells. Do what you can — like walking 30 minutes a day — to keep both body and mind active.
6. Jog your mind
   Keeping your brain active and engaged increases its vitality and builds reserves of brain cells and connections. Read, write, play games, learn new things, do crossword puzzles.
7. Connect with others
   Leisure activities that combine physical, mental and social elements may be most likely to prevent dementia. Be social, converse, volunteer, join a club or take a class.
8. Heads up! Protect your brain
   Take precautions against head injuries. Use your car seat belts, unclutter your house to avoid falls, and wear a helmet when cycling or in-line skating.
9. Use your head
   Avoid unhealthy habits. Don’t smoke, drink excessive alcohol or use street drugs.
10. Think ahead — start today!
    You can do something today to protect your tomorrow.

In September 2008, the International Journal of Geriatric Psychiatry published an interesting article: Smell test predicts performance on delayed recall memory test in elderly with depression. Who would’ve thought that a smell test might be a tool to forecast cognitive impairment. But it turns out that the elderly, particularly those diagnosed with depression, have an increased risk for cognitive dysfunction and dementia.

According to sensonics.com, Sensonics, Inc. tests can be used to detect smell loss but cannot be used alone to diagnose disease. Smell and taste monitor the intake into the body of all nutrients and airborne chemicals required for life.

Here is an abstract of the study that was done.

Purpose

To assess the validity of the CC-SIT (Cross-Cultural Smell Identification Test) as a screening test for cognitive impairment in elderly with depression.

Methods

Forty-one patients, aged 60 and over, were assessed with the CC-SIT and CVLT (California Verbal Learning Test) after three months of treatment of a Major Depressive Episode (DSM-IV) at the Day Hospital for Depression, Baycrest. Patients already diagnosed with dementia, or other psychiatric and neurological disorders, were excluded. Receiver Operating Characteristics (ROC) analysis was applied to assess the CC-SIT’s accuracy in identifying individuals with impairment (2 SD below the mean for age and education or less) on CVLT delayed recall trials.

Results

Forty-one patients (33 women and eight men) were assessed. Mean age was 76.8 (SD: 6.5), mean HRSD scores before treatment was 22.0 (SD: 5.1). Nine patients had impairment on CVLT delayed recall measures. The area under the ROC curve was 0.776 (95% CI = 0.617-0.936).

Conclusions

Our results support the use of the CC-SIT as a screening tool for cognitive impairment among elderly with depression as an indicator for the need of a comprehensive neuropsychological evaluation. Replication with larger samples is necessary. Copyright © 2008 John Wiley & Sons, Ltd.

There’s been a lot of news about Alzheimer’s disease recently because of the annual meeting of the Alzheimer’s Association International Conference on Alzheimer’s Disease (AAICAD) which met from July 10 to 15, 2010 in Honolulu, Hawaii. The AAICAD is the world’s largest conference of its kind. It brought together almost 4,000 researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer’s disease and related disorders.

Alzheimer’s disease research continues to be under-funded, but this appears to be the most significant disease that the baby boomer generation will face. There were many interesting and significant items to come out of the conference, but I want to mention two of them because they immediately impact us. I mentioned in a previous post that participating in a clinical trial could prove to be very time-consuming, but if this is of interest to you, here is good news for you.

The Alzheimer’s Association announced the launch of Alzheimer’s Association TrialMatchTM, a confidential, free, and interactive tool that provides comprehensive clinical trial information and an individualized trial matching service for people with Alzheimer’s disease and related dementias. The Internet (www.alz.org/trialmatch) and phone-based (800-272-3900) program provides a first-of-its-kind service in Alzheimer’s by delivering individualized matches to clinical trials for people with Alzheimer’s, their healthcare professionals, caregivers, and healthy volunteers.

Second, we know that diet and exercise can play a role in either slowing down or reducing the risk of dementia. For example, adding turmeric to the diet (click here) might be beneficial.

Evidence from three long-term, large-scale studies (Framingham Study, Cardiovascular Health Study, NHANES III) supports the association of physical activity and certain dietary elements (tea, vitamin D) with possibly maintaining cognitive ability and reducing dementia risk in older adults. Plus, a new study in an animal model of Alzheimer’s reported today at AAICAD 2010 suggests that an antioxidant-rich diet with walnuts may benefit brain function. Research has pointed towards a number of factors that may impact our risk of Alzheimer’s and cognitive decline, the strongest being reducing cardiovascular risk factors. The Alzheimer’s Association and others have repeatedly called for longer-term, larger-scale research studies to clarify the roles that these factors play in the health of the aging brain. These studies from AAICAD 2010 are some of the first reports of this type in Alzheimer’s, and that is encouraging, but it is not yet definitive evidence.

Next year the group will meet in Paris, France from July 16-21. We look forward to more exciting news to come out of the meetings. For more research findings, click here.

ICAD 2011

Here are two evils — Alzheimer’s disease and cancer. Which would you choose? Of course, neither. I recently read something that said if you have Alzheimer’s you’re not likely to get cancer and vice versa, if you get cancer, you’re not likely to get Alzheimer’s. So that got me researching — is Alzheimer’s disease protection for cancer?

In December 2009, Neurology published a report by Dr. Catherine M. Roe of Washington University School of Medicine in St. Louis which stated that understanding the link between Alzheimer’s disease and cancer may lead to possible treatments.

Roe and her team studied 3,020 people aged 65 and older. They were followed for an average of five years to see if they developed dementia and an average of eight years for cancer. Here is how the study started:

• 164 (5.4%) had Alzheimer’s disease
• 522 (17.3%) had cancer

Here is what they found:

For people who had Alzheimer’s disease at the outset, the risk of future cancer was reduced by 69 percent compared to those who did not have Alzheimer’s disease when the study started.

For white people who had cancer when the study started, their risk of developing Alzheimer’s disease was reduced by 43 percent compared to people who did not have cancer at the start of the study.

This effect, however, did not apply to minority populations. In fact, the opposite effect was observed in minority populations — those who started out with cancer at the beginning of the study were more likely to develop Alzheimer’s disease. However, the sample size of minorities starting off with cancer (29 individuals) was too small for the result to be considered significant.

Overall, the results of this study support previous findings that cancer and brain degenerative diseases such as Parkinson’s and Alzheimer’s disease may share common molecular underpinnings. However, Roe noted in an email to Reuters Health, “Since we found no associations between vascular dementia and cancer, we don’t think that cancer is linked to dementia generally.”

Vascular dementia, the second most common form of dementia after Alzheimer’s disease, is caused by clogged blood vessels and other conditions affecting the blood supply to the brain. Based on the current study, only the degenerative form of dementia, and not the form caused by lack of blood to the brain, appears to be somehow protective against cancer.

To read the full article, click here.

The American Journal of Alzheimer’s Disease and Other Dementias recently reported in an open-label pilot study that apple juice improved behavioral, but not cognitive symptoms in moderate-to-late Alzheimer’s disease patients. Although this was a very small study of only 21 institutionalized patients who drank two 4-ounce glasses of apple juice twice a day for a month, the study suggests that apple juice may be a useful nutritional supplement since, as Alzheimer’s disease (AD)  progresses, the mood of AD patients may decline as well. It may help ease the burden for caregivers.

The study said, “Caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion.”

Exactly how apple juice might help remains unclear. It’s possible that the antioxidant nutrients in the apple juice reduces the oxidative damage to the brain tissue.

Since this was a very small study funded by the apple industry with no placebo, the conclusions need to be viewed with caution. However, given that apple juice is a healthy and inexpensive beverage, it would seem a positive thing for caregivers to try.

Continuing my highlights of Alzheimer’s Care with Dignity by Frank Fuerst, in today’s post I list 6 caregiver products that Fuerst considers specifically helpful for people with dementia. You may be able to get them free or at a reduced cost. Ask your contacts such as members of your support group or see if it’s a Medicare-qualified item.

Consult his guide for a complete list, but the following are those that solved major physical and psychological challenges for him. Having gotten them sooner he feels would’ve prevented a good deal of stress.

1. Bathroom transfer bench
2. Geriatric chair
3. Plastic runner
4. Hand-held shower
5. Stair lift
6. Wheelchair

A bathroom transfer bench is one where two legs remain inside of the tub with suction cups and two legs are outside of the tub.  It comes with a backrest. Since the person remains seated while bathing, a hand-held shower works well. (Hand-held showers work well for cleaning the tub as well).

A geriatric chair is like a wheelchair except that it is larger and more comfortable. Get one with a tray that can swing down and out of the way.

Plastic runners will help to keep your carpet in good condition in case of accidents. They have spikes on the bottom to hold it in place. Not all plastic runners are alike even though they may look alike. Since you need to walk on the runner, a softer plastic might be more  comfortable than a stiffer one. Use them in areas where there are likely to be accidents such as from the bed to the bathroom and in eating areas.

Stair lifts are expensive, but might still be a less costly alternative to other home alterations. Fuerst suggests that you check the Internet. One source is http://silvercross.com for more information. They also sell used equipment and will buy back equipment, but don’t expect to recover much of your purchase price.

Finally, wheelchairs are available everywhere, but if you’ve never ridden in one, they are not exactly comfortable. Be sure to add a cushion, preferably a high quality gel cushion as mentioned in this post.

In my last post, I reviewed Alzheimer’s Care with Dignity by Frank Fuerst. It’s a book that I believe should be at your fingertips. In this post and others to follow, I want to highlight some of the chapters that were especially interesting and helpful. One of the most important members of your team is your doctor and in this post, I highlight how to choose a doctor for Alzheimer’s disease patients. However, Fuerst quotes the Alzheimer’s Association in the June 2006 report to Congress:

When a person under age 65 goes to a doctor with symptoms of dementia, the doctor may not even think of dementia as a possibility or may not know how to diagnose it. As a result, getting an accurate diagnosis can be a long, difficult, and frustrating process.

For Fuerst, it took almost three years and he states:

If one suspects early onset dementia, one should choose a doctor who can distinguish between depression, menopause, and dementia. A neuro-psychiatrist may be more likely to recommend tests that will give a more accurate diagnosis. The best choice for most people is a doctor whom other doctors highly recommend.

What makes an ideal doctor? A Mayo Clinic study suggests the following:

1. Confident
2. Empathetic
3. Humane
4. Personal
5. Forthright
6. Respectful
7. Thorough

Are there any other traits you could recommend?

Caregiving at a Glance

The Alzheimer’s Family Day Center has a wonderful booklet for Alzheimer’s disease caregivers called Caregiving at a Glance. It’s designed with tabs that you can simply slip your finger under and get to the information you need. Sample topics covered include:

• Sleeping
• Bathing
• Car and Home Safety
• Activities … What to do Between Meals
• Hostility and Aggression

On the topic of “Wandering,” for example, they suggest you register your loved one with the Safe Return program sponsored by the Alzheimer’s Association. You can call them toll-free at 1.888.572.8566 or on the Web at www.alz.org/safereturn.

“Troublesome Behaviors” is another section of this booklet. This covers a wide gamut, but they talk about things like screaming, repetitive phrases, or picking at clothes, tearing paper into tiny shreds, and other behaviors that develop in the middle to the late stages of the disease.

This wonderful resource is available at the Alzheimer’s Family Day Center by calling 703.204.4664 or e-mailing them at AFDC@alzheimersfdc@org.  The booklet is free – one copy per person. It was published with the permission of the Alzheimer’s Association. The project was supported, in part, by a grant from the Administration on Aging, Department of Health and Human Services, Washington, DC, 20201.

In this, the third of our series of breakthrough tests for Alzheimer’s disease, scientists at the University of California San Diego (UCSD), have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). This study promises to improve diagnosis and monitoring of Alzheimer’s disease (AD).

The techniques were applied to the dataset of the multi-institution Alzhiemer’s Disease Neuroimaging Initiative (ADNI). What the scientists at UCSD were able to demonstrate was that the sub-regional brain volume measurements outperform available measures for tracking the severity of AD, including widely used cognitive testing and measures of global brain-volume loss.

According to insciences.org, the new research shows that changes in the brain’s memory regions, in particular a region of the entorhinal cortex, offer sensitive measures of the early stages of the disease. According to Anders M. Dale, PhD, professor of neurosciences and radiology at the UC San Diego School of Medicine, who led the study, “Loss of volume in the hippocampus is a consistent finding when using MRI, and is a reliable predictor of cognitive decline. However, we have now developed and validated imaging biomarkers to not only track brain atrophy, but distinguish the early stages of Alzheimer’s disease from changes related to normal aging.”

The study’s co-author, James Brewer, MD, PhD, a neurologist and assistant professor in the Departments of Radiology and Neurosciences at UCSD adds that, “The technique is extremely powerful, because it allows a researcher to examine exactly how much brain-volume loss has occurred in each region of the brain, including cortical regions, where we know the bad proteins of Alzheimer’s disease build up.”

If a picture is worth a thousand words, here are serial MRI brain scans, taken six months apart, that show progression from mild cognitive impairment to Alzheimer’s disease with significant atrophy (blue) and ventricle enlargement (orange/red).

For more information, see “Analyzing Structural Brain Changes in Alzheimer’s Disease” at insciences.org.