Women Bear Greatest Burden of Alzheimer's

By Mary Elizabeth Dallas, HealthDay News 

Survey finds they're more likely than men to have Alzheimer's or take care of someone with the disease. 

 

MONDAY, July 18, 2011 (HealthDay News) — Women fear Alzheimer's disease more than any other illness except cancer, and they are more often on the front lines of providing care for loved ones battling the disease, new research shows.

"With statistics consistently pointing to the fact that more women are living with Alzheimer's and caring for people with Alzheimer's, it is clear women are disproportionately affected by this disease," said Angela Geiger, chief strategy officer of the Alzheimer's Association.

A survey of women in France, Germany, Spain, Poland and the United States revealed that women are at the center of the global Alzheimer's epidemic. The multinational research team found women in all five countries were more concerned than men about a loved one developing the disease.

Women in all countries, the survey also found, were more likely than men to be involved in the daily care of someone with the disease. In fact, women in France and Poland were significantly more involved in the decision-making and financial support of an Alzheimer's patient.

If roles were reversed and those polled were to develop the disease, most identified their spouse as the person who would be responsible for their primary care. Men, however, identified their wives 6 percent to 18 percent more often than wives identified their husbands. In contrast, women were more likely to say they would rely on their children or paid caregivers outside the family to care for them.

Despite their fear of the disease, which currently affects 36.5 million people worldwide, and their greater burden as caregivers, 71 percent of women in France and 76 percent of women in the United States seem to be more optimistic that a treatment for Alzheimer's will be developed within five years. That may be one reason why the survey also showed that women believe government spending on Alzheimer's research should be increased.

"These insights reinforce the conclusions published in The Shriver Report: A Women's Nation Takes on Alzheimer's, which found the impact of Alzheimer's on women is significant. The perspectives we see in this survey must prompt thoughtful conversations about Alzheimer's with our friends, family members and government officials to change the trajectory of Alzheimer's disease," concluded Geiger.

The research was slated for presentation Monday at the Alzheimer's Association International Conference in Paris. Research presented at medical meetings should be viewed a preliminary until it is published in a peer-reviewed medical journal.

Falls Could Signal Early Alzheimer's Disease

By HealthDay News Staff 

Seniors whose brain scans indicated preclinical disease twice as likely to fall, study finds. 

 

SUNDAY, July 17, 2011 (HealthDay News) — Compared with older people with no signs of Alzheimer's, those whose brains show early signs of the disease are twice as likely to experience a fall, researchers have found. 

In the new study, investigators looked at brain scans of 125 older adults who were participating in a study of memory and aging. The seniors were also asked to keep track of how many times they fell over the course of eight months. 

An increased risk of falls was noted among individuals whose scans showed early signs of Alzheimer's. The study authors suggested that falls could indicate the need for an evaluation for the memory-robbing disease. 

"To our knowledge, this is the first study to identify a risk of increased falls related to a diagnosis of preclinical Alzheimer's disease," study author Susan Stark, an assistant professor of occupational therapy and neurology at Washington University in St. Louis, said in a news release from the Alzheimer's Association International Conference. 

"This finding is consistent with previous studies of mobility problems among persons with very early symptomatic Alzheimer's or mild cognitive impairment. It suggests that higher rates of falls can occur very early in the disease process," Stark added. 

The study, which was slated for presentation Sunday at the Alzheimer's Association International Conference in Paris, found that of the 125 adults studied, 48 people experienced at least one fall. 

The brain scans of the participants showed that higher levels of an imaging agent that binds to the abnormal protein growth that is a signature of Alzheimer's disease, was associated with a 2.7 times higher risk of a fall for each unit of increase on the scan. 

The researchers noted that Alzheimer's has been linked to balance and gait disorders, as well as problems with visual and spatial perception, which could put people with the disease at higher risk for falls. Based on their findings, they added, these symptoms may appear before other more obvious signs of the disease, such as memory loss and impaired thinking. 

"Growing scientific evidence suggests that 'silent' biological changes may be occurring in the brain a decade or more before we can see the outward symptoms of Alzheimer's," Maria Carrillo, Alzheimer's Association senior director of medical and scientific relations, said in the news release. "According to this study, a fall by an older adult who otherwise has a low risk of falling may signal a need for diagnostic evaluation for Alzheimer's." 

The study authors concluded that additional research is needed to improve early detection and intervention in Alzheimer's disease. Lowering the risk of falls, they added, could also have an economic impact since these incidents contribute to higher rates of disability among older adults, premature placements in nursing homes and more than $19 billion in direct medical costs in 2000 alone. 

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Could a Diet Help Prevent Alzheimer's?

By Amanda Gardner, HealthDay News

Low-fat, low-glycemic eating plan improved 'biomarkers' of the disease, researchers say. 

 

MONDAY, June 13, 2011 (HealthDay News) — The low-fat, low-glycemic diet often promoted for general health and well-being may lower the risk of developing Alzheimer's disease if adopted early in life, researchers say. 

But starting such an eating plan after symptoms surface doesn't seem to help prevent deterioration of brain function, according to new research published online June 13 in Archives of Neurology. 

"This is not the first time this concept has emerged, that things you do in midlife or earlier on may have effects later on," said Dr. Marc L. Gordon, chief of neurology at Zucker Hillside Hospital and an Alzheimer's researcher at the Feinstein Institute for Medical Research in Manhasset, N.Y. 

"For example, we know that midlife obesity is associated epidemiologically with a higher risk of late-life dementia," he continued. "Whether that's causal or an effect of the disease is open to speculation, but it suggests that there may be periods of vulnerability that are different in different times in the life span." 

Although numerous studies have probed connections between lifestyle factors and cognitive ability, no solid proof yet exists that diet (or much else) can prevent Alzheimer's, the most common form of dementia among the elderly. 

A low-glycemic diet, which focuses on eating fruits and vegetables, whole grains and lean meats, avoids spikes in blood sugar and is said to promote feelings of fullness. 

A U.S. National Institutes of Health conference convened last spring concluded that, for now, older age is the leading known risk factor for Alzheimer's disease. A gene variation is also tied to increased risk for the brain disorder, the NIH review said. Experts at the conference stressed that the general public should still focus on avoiding behaviors already linked to other chronic diseases. 

This new study looked at the effect of different diets on biomarkers associated with Alzheimer's, such as blood sugar levels, cholesterol and blood lipid levels. The researchers also tested memory after participants followed the assigned diets. 

Twenty healthy adults and 29 with mild memory problems that could be predictive of Alzheimer's followed either a high-fat, high simple-carbohydrate diet ("HIGH" diet) or a diet lower in fat and simple carbohydrates ("LOW" diet). 

After four weeks, healthy participants on the LOW diet had changes in biomarkers, including insulin and lipid levels in the blood, which were moving away from those normally associated with dementia. 

In participants with mild cognitive impairment, this diet had the opposite effect. 

Commenting on the study, Dr. Suzanne de la Monte, professor of neurosurgery and pathology at Brown University and Rhode Island Hospital in Providence, said it remains to be seen if the changes noted in this study actually translate, over the longer term, into differences in risk for developing Alzheimer's disease. 

The bottom line, though, is the same as it's been for eons: A healthy diet lowers your risk of type 2 diabetes, heart disease, cancer and maybe even Alzheimer's. 

That means staying away as much as possible from processed foods, de la Monte advised. 

A second study, in the same issue of the journal, also looked at biomarkers and found that different levels were associated with different measures of cognitive function associated with Alzheimer's disease. 

This finding could help improve diagnosis of Alzheimer's, which now relies mostly on clinical observation.

Forgetfulness About Paperwork, Medicines Might Herald Cognitive Decline

By HealthDay Staff

But one expert added that everyday forgetfulness isn't necessarily a sign that Alzheimer's is near.

 

MONDAY, June 6, 2011 (HealthDay News) — A new study finds that older people with mild cognitive impairment — sometimes a precursor to Alzheimer's disease — have a harder time remembering important dates and medications than those without cognitive problems. 

Mild cognitive impairment can be annoying but it isn't as severe as conditions that significantly disrupt daily life. It can, however, occur before serious conditions such as Alzheimer's disease and other causes of dementia. 

Patrick J. Brown of the New York State Psychiatric Institute and his colleagues looked at neurological test results, brain-imaging studies and other data from 229 people with no cognitive problems, 394 with mild cognitive impairment and memory problems, and 193 diagnosed with mild Alzheimer's disease. 

Those in the latter two groups had much more trouble with at least one kind of cognitive function, especially "assembling tax records, business affairs or other papers" and "remembering appointments, family occasions, holidays and medications," according to the study. 

"These findings show that even mild disruptions in daily functioning may be an important clinical indicator of disease and represent the latter phases of disease progression," the study authors wrote. 

Still, one expert not involved with the study cautioned that people shouldn't read too much into the findings. 

"Just because someone misplaces their keys or glasses, forgets an appointment or a dose of medication does not mean they have early Alzheimer's disease," stressed Dr. James E. Galvin, professor of neurology and psychiatry and director of the Pearl S. Barlow Center for Memory Evaluation and Treatment at NYU Langone Medical Center in New York City. 

He pointed out that the study was seeking to understand which individuals with mild memory problems (called mild cognitive impairment, or MCI) were likely to progress to Alzheimer's disease. 

"Everyone occasionally forgets," Galvin said. "It's when the forgetfulness becomes a consistent feature and in some way interferes with everyday activities that it is time to discuss with your doctor." 

The study was published in the June issue of the Archives of General Psychiatry.

Alzheimer's Risk Gene May Damage Brain Decades Before Symptoms Show

By HealthDay News

Scans indicate even young adults who have the gene have some white-matter deterioration.

 

WEDNESDAY, May 18, 2011 (HealthDay News) — A gene allele that increases the risk of Alzheimer's disease starts to damage the brain 50 years before symptoms of the disease appear, a new study suggests.

An allele is one of two or more forms of a gene.

In 2009, scientists concluded that the clusterin (CLU) gene boosts the chances of Alzheimer's disease by 16 percent, but it wasn't clear how it increased risk.

This new study concluded that the C-allele of the CLU gene impairs development of myelin, the protective covering around the axons of neurons in the brain. This impairs brain wiring and can make a person more vulnerable to the onset of Alzheimer's later in life.

About 88 percent of whites have the CLU C-allele, according to the University of California, Los Angeles (UCLA) researchers.

For this study, they used a newer type of MRI to map the connections in the brains of nearly 400 healthy adults aged 20 to 30. The scans revealed that participants with the CLU C-allele had lower white matter integrity than those with a different variant called the CLU T-allele.

The findings are interesting on several levels, according to senior study author Paul Thompson, a professor of neurology.

"For example, Alzheimer's has traditionally been considered a disease marked by neuronal cell loss and widespread gray matter atrophy," he said in a UCLA news release. "But degeneration of the myelin in white matter fiber pathways is more and more being considered a key disease component and another possible pathway to the disease, and this discovery supports that."

Understanding the effects of the CLU C-allele could lead to ways to intervene and protect the brain in the decades before Alzheimer's develops, Thompson suggested.

The study appears in the current online edition of the Journal of Neuroscience.

Little Evidence That Diet, Lifestyle Cuts Alzheimer's Risk

By Alan Mozes, HealthDay 

Until better data exist, experts still advise practicing good health habits.

Monday, May 9, 2011 (HealthDay News) — Numerous studies have attempted to link specific behaviors and health conditions to the onset of Alzheimer's disease, but scientists still can't say for sure that anything you do or don't do will prevent the brain disorder, according to a new U.S. review of recent research.

The U.S. National Institutes of Health convened a conference last spring to analyze 18 studies of potential risk factors, such as poor eating habits, chronic illness, smoking or little exercise, and development of Alzheimer's disease.

"Although we are not dismissing the potential or important role that these major risk factors might play in the development of Alzheimer's disease, at this time, with what we have currently, we cannot confirm any risk associations," said study lead author Dr. Martha L. Daviglus, a professor of preventive medicine and medicine at the Northwestern University Feinberg School of Medicine in Chicago.

"So we need to conduct more research, if we want to have the evidence in hand," she added.

The study, which summarizes the NIH conference results, is published in the May 9 online edition and September print issue of the Archives of Neurology.

For now, older age is the leading known risk factor for Alzheimer's disease, the study noted. A gene variation is also tied to increased risk, it said. 

An estimated 5.3 million Americans struggle with Alzheimer's, a figure projected to grow as the country's Baby Boomer population ages, the authors said. The disease is responsible for between 60 and 80 percent of dementia cases.

"What we're talking about here is something that is going to affect so many Americans in the years to come," said one expert, Catherine Roe, an instructor in neurology at Washington University School of Medicine in St. Louis. "In fact, there's going to be an explosion in the next 50 years, because everyone is living longer in general," she said.

The studies included in the NIH research review were conducted between 1984 and 2009 in English. Participants were at least 50 years old and living in developed countries.

Some of the studies looked into dietary influences, such as folic acid intake, Mediterranean diet and nutritional supplements. Others looked for a link between health problems, such as diabetes or high cholesterol, and Alzheimer's. Still others explored levels of physical activity or alcohol consumption and risk of Alzheimer's disease.

The NIH team found that, as a whole, the studies were "compromised by methodological limitations" that undercut the ability to draw a firm association between any particular behavioral habit and/or health condition and Alzheimer's.

The authors noted that such limitations resulted from the use of poor diagnostic criteria, poor knowledge of the inner workings of Alzheimer's disease itself, and/or the unreliability of patient-reported physical and mental health status.

Yet despite determining that the current quality of evidence is "inadequate" to draw causal linkages, Daviglus and her colleagues stressed that the general public should still focus on lifestyles that avoid behaviors already linked to other chronic diseases.

"People should follow a healthy lifestyle, which includes exercising, blood pressure control, not smoking, not becoming overweight, and trying to sleep properly," Daviglus said.

"And, of course, our recommendation is that it is very important that we make sure that, in the future, more well-constructed, well thought-out studies be conducted so that we can get better quality results that can confirm associations, when they exist, between risk factors that a large proportion of the population have and the onset of Alzheimer's," she added.

Roe agreed that "more quality research is needed," but added that, "I don't think it's a worse situation than in any other field of research. This is difficult and challenging work. And it costs a lot of money at a time when there's a funding crisis in science."

Still, a sense of urgency should prevail, Roe said. "Today the Baby Boomers are starting to hit the age where Alzheimer's comes into play," she noted. "And it's going to take a huge human toll and economic toll, if we don't find a way to treat it or slow it down. So it's very important that we do more and do it better."

Extra Pounds at Midlife May Boost Dementia Risk Later

By Kathleen Doheny, HealthDay

Being merely overweight in middle age raised risk by 70 percent compared to normal-weight peers, experts find.

 

TUESDAY, May 3 2011  (HealthDay News) — Being overweight during middle age may increase your risk of developing dementia later on, a new Swedish study suggests. 

Several studies have already linked obesity in middle age to dementia in later life, but it was unclear whether merely carrying some extra pounds in midlife was a risk factor. The new research suggests that even being overweight — defined as having a body mass index (BMI) of 25 to 30 — is linked with a higher risk of dementia. 

"Being overweight at midlife increased the risk of dementia in late life by more than 70 percent," said lead study author Dr. Weili Xu, a postdoctoral researcher at Karolinska Institute in Stockholm.

Being obese raised the risk even more, to nearly fourfold.

"Although the effect of midlife overweight on dementia is not as substantial as that of obesity, its impact on public health is significant," Xu said, noting that 1.6 billion adults worldwide are obese or overweight, including 50 percent of adults in the United States and Europe.

The study is published in the May 3 issue of Neurology.

In her study, Xu analyzed information from the Swedish Twin Registry. It included data on 8,534 twins aged 65 and older. Of those, 350 were diagnosed with dementia and 114 with possible dementia.

Thirty years earlier, the participants had provided what then must have seemed like mundane data: their height and weight.

That data would prove invaluable as Xu grouped them according to their BMIs, from underweight to obese (having a BMI higher than 30). Nearly 30 percent, she found, were either overweight or obese during midlife.

Further analysis showed that being overweight or obese in midlife independently increased the risk of later dementia, including Alzheimer's and vascular dementia.

About 26 percent of participants without dementia had been overweight at midlife, compared to 36 percent of those with possible dementia and 39 percent with diagnosed dementia.

And although 2.7 percent of seniors without dementia had been obese at midlife, 6.9 percent of those with dementia had been obese, as well as 5.3 percent of those with possible dementia.

When Xu analyzed twin pairs in which one had dementia in later life and one did not, she found the link to weight no longer significant, suggesting early environment and genetics also play roles in dementia.

Why the weight-dementia link? Several mechanisms could explain it, Xu said. A higher BMI is linked with diabetes and vascular disease, which is in turn related to the risk of dementia. Higher weight at midlife may reflect a long period of exposure to higher inflammation throughout the body, which has been linked with lower cognitive function.

Xu and her colleagues noted several study limitations, including the notion that BMI may not be the perfect measure of body fat composition.

They also noted that in terms of lowering dementia risk, it's never too late to start reducing body fat.

The study has a number of strengths, including the large number of people studied, according to Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center and professor of psychiatry and behavioral science at Albert Einstein College of Medicine in the Bronx.

Although the study finds a link between being overweight in midlife and dementia risk, it does not prove cause-and-effect, he said. Still, there is evidence that fatty tissue secretes inflammatory cytokines and other chemicals. These may have a direct effect on the brain, he said, inflicting damage to the neurons.

Dr. Gisele Wolf-Klein, director of geriatric education at the North Shore-Long Island Jewish Health System in Hyde Park, N.Y., said the study "is of great relevance in view of the growing epidemic of obesity in both the United States and Europe."

Alzheimer's Cases Could Double With New Guidelines: Expert

HealthDay News

TUESDAY, April 19 2011 (HealthDay News) — The first new guidelines in 27 years for the diagnosis of Alzheimer's disease could double the number of Americans defined as having the brain-robbing illness.

The guidelines, issued Tuesday by the Alzheimer's Association and the U.S. National Institute of Aging, differ in two important ways from the last recommendations, which have been in use since 1984. 

First, Alzheimer's is now being recognized as a continuum of stages: Alzheimer's itself with clear symptoms; mild cognitive impairment (MCI) with mild symptoms; and also the "preclinical" stage, when there are no symptoms but when recognizable brain changes may already be occurring. 

Second, the new guidelines incorporate the use of so-called "biomarkers" — such as the levels of certain proteins in blood or spinal fluid &madsh; to diagnose the disease and assess its progress, but almost exclusively for research purposes only. 

Still, the authors of the guidelines emphasized that these revisions are unlikely to change what happens in doctors' offices when diagnosing Alzheimer's or its precursors.

"It will not change practice," said Dr. Guy M. McKhann, one of the guideline authors, at a Monday press conference. 

MCI will, however, become a new diagnosis. And that could mean that the number of people considered to be on the new Alzheimer's continuum could double, said Marilyn Albert, another author, director of the division of cognitive neuroscience at Johns Hopkins. But how MCI is determined won't change. 

The new U.S. National Institute on Aging/Alzheimer's Association Diagnostic Guidelines for Alzheimer's Disease now recognize three clear stages of Alzheimer's disease. 

The first and most severe is Alzheimer's dementia, when patients are clearly cognitively and functionally impaired. This is to be characterized now not just by memory loss but also visual, spatial and judgment problems.

The new guidelines also make a clearer distinction between Alzheimer's dementia and vascular dementia (such as that caused by stroke), McKhann said. The diagnosis will still be made by a doctor, with help from someone who knows the patient and perhaps the patient him- or herself, but biomarkers may be called in "to augment our certainty about the diagnosis," said McKhann, a professor of neurology and neuroscience at Johns Hopkins University School of Medicine in Baltimore. 

Another stage, MCI, can represent an earlier phase of dementia and consists of modest impairments, primarily in memory, which can be a harbinger of full-blown Alzheimer's years down the road. In the research arena, investigators will be working towards standardizing biomarkers which indicate, for example, the presence of amyloid protein or nerve damage in the brain.

But for now, how diagnoses are made "will be extremely similar to what's been used in the last 10 years," said Albert, who added that "a very large number" of individuals with MCI do go on to develop Alzheimer's. 

"Older adults with MCI progress to dementia at a higher rate than those with no impairment, but progression is not inevitable," according to the Alzheimer's Association's online overview of mild cognitive impairment.

"Not everyone diagnosed with MCI goes on to develop Alzheimer's," the association noted.

The preclinical category was formulated for research purposes only, namely to study biomarkers that may be present in the blood or cerebrospinal fluid or evident on different imaging tests that would indicate the build-up of amyloid plaque or damage to nerve cells.

"The main conceptual point was to define Alzheimer's on the basis of the underlying brain changes rather than just requiring clinical symptoms," said Dr. Reisa A. Sperling, a neurologist at Brigham and Women's Hospital and associate professor of neurology at Harvard Medical School in Boston. "We thought our best chance for disease-modifying therapy was to detect evidence of the disease and intervene much earlier."

As in cancer and diabetes, McKhann pointed out, if you're trying therapies "only in people who have advanced dementia, the chances of them working is not very great."

"We're worried that there could be drugs around now that could be beneficial but that we could be using them too late in the disease course," added Albert. 

The new guidelines, summarized William Thies, chief medical and scientific officer of the Alzheimer's Association, "will result in little change in current clinical practice of medicine as applied to Alzheimer's disease. . . . [However] the new criteria are really extending the range of our ability to investigate this disease and eventually to find treatments that will be so necessary to avoid the epidemic of Alzheimer's that we see facing us."

The new guidelines appear in four papers in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

The 'Grey's Anatomy' Alzheimer's Test: Could You Pass It?

By Sharon Tanenbaum | Medically reviewed by Ed Zimney

Characters from the hit show are testing patient memory as part of an Alzheimer's disease clinical trial — but should you worry if the questions trip you up? 

 

Wednesday, March 30, 2011 — What did you do for Thanksgiving last year? Where did you go on your honeymoon? Starting at 100, count backward by seven. Remember the following three-word sequence: truck, cabin, spoon.

These are among the series of questions Derek Shepherd and Meredith Grey are asking of Alzheimer’s disease patients to determine whether they’re qualified for entry into a clinical trial on this season’s Grey’s Anatomy.

But if you’re sitting on the couch five minutes later struggling to remember the word “cabin,” should you worry about your own brain health? And just how accurate is such a test at gauging Alzheimer’s disease risk? Everyday Health asked leading memory experts for answers. 

What the Grey’s Memory Tests Means

 

Although the test used on the TV show is not identified by name, some of the questions, like the three-word memory sequence and counting back directive, are included in the Folstein Mini Mental State Examination (MMSE), a 30-point questionnaire introduced in 1975.

“It’s the most commonly used cognitive evaluation for memory loss,” says Cynthia Green, PhD, assistant clinical professor of psychiatry at Mt. Sinai School of Medicine in New York City. “It’s a screening test, so it doesn’t delve deeply into someone’s mental functioning across different areas of intellectual performance.” (Other types of MMSE questions include drawing certain pictures and performing a three-step command, such as “take a piece of paper, fold it in half, and place it on the floor.”)

Keep in mind that the questions used by Derek and Meredith in their fictional version of the test are just a sampling of the total number of questions that would be used in a real test. Otherwise the limited number of answers wouldn’t tell clinicians much. The questions portrayed on TV are such a small snippet that the results are not that significant for the average person, says Dr. Green. And the question of whether a patient can remember where she spent her honeymoon isn’t likely to be on a real test: “That’s more of a remote memory, which is usually retained until later stages of the disease,” Green notes.

 

Senior Moments vs. Real Red Flags

 

So why can’t you remember the above word sequence or where you parked the car at the supermarket? You probably just weren’t paying attention, or you were multitasking or just plain distracted. Such everyday “senior moments” aren’t enough to raise a red flag for dementia, says Green.

“Everybody forgets things once in a while. It’s important to forget, otherwise think how awfully full your brain would be. You wouldn’t be able to sleep at night,” says Laurel Coleman, MD, a geriatric physician in Augusta, Maine, and national board member of the Alzheimer’s Association.

What is concerning, according to Green: “When a change in memory lasts for four to six months, impairs your ability to function independently at work or at home, and if your family and friends notice a change in your abilities or behavior.” If you or a loved one experience any of these symptoms of possible dementia, you should talk to your doctor and get evaluated.

Even then, keep in mind that memory loss doesn’t automatically mean you have Alzheimer’s, which counts language problems, disorientation, and face-recognition issues among its other symptoms. “Memory loss can be a symptom of at least 75 different medical conditions,” says Green, including a vitamin B12 deficiency, thyroid disorders, emotional distress, depression, and side effects from medication.

Alzheimer’s is the most common form of dementia, accounting for about 70 percent of cases in people age 71 and older. But it strikes only five percent of people between 65 and 74. The younger you are, the more likely a memory-related issue is something other than Alzheimer’s.

“We worry so much about memory loss because it’s something we’re afraid of,” says Green. “But since there are so many different things that can cause it and many of those conditions are reversible, it’s important to seek evaluation, and to do it sooner rather than later.” 

The Role of Memory Tests in Real-Life Alzheimer’s Studies

 

Diagnosing Alzheimer’s disease is challenging, since the only way to definitively determine the presence of disease is by looking at brain cells after someone has died. Instead, doctors evaluate the likelihood of Alzheimer’s with a variety of tests that also seek to rule out other possible causes of dementia.

These can include a thorough medical history, complete physical examination, lab tests of blood, urine, and sometimes spinal fluid, and brain scans, in addition to cognitive testing. Doctors at specialized Alzheimer’s treatment centers can diagnose the disease with 90 percent accuracy, according to the National Institute on Aging. Read more about how Alzheimer’s is diagnosed here.

During the cognitive tests, clinicians check on a wide range of brain functions — assessing not just memory— but a patient’s calculation ability, attention, insight, judgment, and how they prioritize things, says Dr. Coleman. “We examine a variety of things because people think in so many different ways.” 

Clinical Trials for Alzheimer’s Disease

 

The fictional Grey’s Anatomy clinical trial highlights the importance of real-life research: According to the Alzheimer’s Association, there currently are more than 100 Alzheimer’s clinical trials that need 50,000 volunteers — with and without the disease — to participate. Such trials are studying new ways to detect, treat, and prevent Alzheimer’s and related types of dementia.

Although researchers can’t offer regular mental state exams by Dr. McDreamy, if you or a loved one is coping with an Alzheimer’s diagnosis, consider finding a study that may be right for you through the Alzheimer’s Association Trial Match program or on ClinicalTrials.gov. Research shows that people involved in studies tend to do somewhat better than people at a similar stage of Alzheimer’s who are not enrolled in trials, the association says.

Language Fluency May Ward Off Dementia

By Michael Smith, North American Correspodent, MedPage Today

The ability to learn and speak two languages in addition to one's native tongue appears to keep the brain in shape, protecting it from dementia.

 

Wed. Feb. 23, 2011 — Speak English? Parlez français? Habla espanol?

Those who can say yes, oui, or si to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Dr. Magali Perquin, of the Public Research Center for Health in Luxembourg, and colleagues. 

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Get a Memory Boost From These Foods

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Moreover, the effect appears to add up — more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

“It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study,” Perquin said in a statement.

The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called “cognitive reserve” — developed by intellectual activities — protects against dementia.

Indeed, a similar study from a Canadian group, presented at the annual meeting of the American Association for the Advancement of Science this month, showed that having two languages rather than one appeared to delay the onset of dementia.

The “use it or lose it model of cognitive function” has been gaining popularity for several years, according to Richard Lipton, MD, of Albert Einstein College of Medicine in New York City. With colleagues, Lipton showed in 2003 that such activities as chess, bridge and doing crossword puzzles appeared to protect against Alzheimer’s disease.

In that context, Perquin’s findings “are not surprising to me,” Lipton told MedPage Today.

But he cautioned that there are at least two other possible explanations for such data, including his own findings.

On one hand, he said, it’s possible that the intellectual activities themselves are not protective, but that being the sort of person who does crossword puzzles or learns several languages is the key factor.

On the other hand, he said, it may be that the causality is reversed — that incipient cognitive impairment impairs the ability to perform such activities.

But the study is “fascinating,” he added, and “as an optimist, I would like to believe it is completely true.” 

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Which Conditions Are Related to Dementia?

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The so-called MémoVie study in Luxembourg is a longitudinal analysis of cognition and its risk factors in the elderly and one of the aspects of the study is the effect of multilingualism.

Luxembourg, a small country in the heart of western Europe, has three official languages and a large number of people who speak several tongues.

For the analysis, participants in the MémoVie study were classified as having normal cognition, some cognitive impairment, or frank dementia, with the latter being excluded.

All told, 44 participants had cognitive impairment and the remaining 186 were cognitively normal, the researchers reported.

Participants had spoken — or currently spoke — two through seven languages; those with only two languages were considered the reference group for a multivariate analysis that adjusted for age and years of education, Perquin and colleagues reported.

Analysis showed that, compared with bilinguals:

• Participants who had spoken three languages were four times more likely to be protected against cognitive impairment.
• Those with four or more languages were even better off — they were six times less likely to develop dementia than those who mastered only their native tongue.

Perquin noted that more research is needed to confirm the findings and to see if protection is limited to thinking skills related to language “or if it also extends beyond that and benefits other areas of cognition.”

Common Causes of Dementia

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Alzheimer's disease is the best-known cause of dementia — but there are a slew of other causes, too. Do you know what they are?

 

Dementia is really a big umbrella term that covers a number of different conditions that cause dementia symptoms. Of these, Alzheimer’s disease is the most common and perhaps best known — but it’s not the only one.

“There are many different types of dementia,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa. “The most common types of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, and Parkinson’s disease. All types of dementia are characterized by abnormal neurodegeneration, that is, brain cells dying off in high numbers daily. In most cases, this leads to cognitive and behavioral deficits or, in Parkinson’s disease, to deficits in motor skills.”

One of the ways in which types of dementia are categorized is by where the damage to these cells is occurring in the brain.

Broadly speaking, types of dementia are grouped as cortical or subcortical. Cortical refers to dementias that originate in damage to the cortex — the outer, gray, wrinkled layer layer of brain tissue with which people may be most familiar. Subcortical dementia has its roots in structures below the cortex, inside the brain. The dementia symptoms vary based on whether the dementia is cortical or subcortical. Despite this distinction, dementias of all kinds often involve multiple parts of the brain, and there is ongoing debate as to whether this is a meaningful way to categorize dementia symptoms.

 

Cortical Dementia 

 

Cortical dementia is likely to result in dementia symptoms such as loss of memory, loss of the ability to recognize people, and difficulty recalling the right words for things or concepts. Cortical dementias include:

• Alzheimer’s disease. Alzheimer’s disease causes a loss of memory and ability to think clearly. It is a progressive disease, eventually leading to a loss of ability to complete tasks of daily living.
• Creutzfeldt-Jakob disease. Also sometimes called mad cow disease, Creutzfeldt-Jacob occurs when naturally occuring brain proteins called prions start to change shape. This leads to cognitive impairments such as loss of memory, changes in thought processes, and changes in behavior.
• Frontotemporal dementia. This type of dementia results from degeneration of cells in the frontal lobe; it's characterized by behavioral and language deficits at a relatively young age — as young as 40.
• Wernicke-Korsakoff syndrome. This type of dementia is due to a deficiency in thiamine (vitamin B1) but is also often related to a history of heavy alcohol consumption or to having AIDS, or acquired immunodeficiency syndrome. Memory is affected, and people with this dementia often tell untrue stories that they fully believe to be true. Physically, this dementia can interfere with a person’s ability to move smoothly.

 

Subcortical Dementia

 

Dementia symptoms associated with subcortical dementias include loss of motor skills and the ability to learn processes, resulting in a general sense of slowing down. These types of dementia include:

• Huntington’s disease. A rare, inherited cause of dementia, Huntington’s disease leads to problems with motion such as twitches and lack of balance or coordination and may also lead to changes in mood, personality, and behavior.
• Parkinson’s disease. Parkinson’s disease is characterized by the gradual loss of motor skills, or shakiness and tremors while in motion. People with Parkinson’s disease may eventually experience other dementia symptoms, such as loss of memory.
• Vascular dementia. Vascular dementia occurs as the result of loss of oxygenated blood to parts of the brain. This can be the result of a single stroke or many small strokes, in which case it is called multi-infarct dementia. Evidence shows that subcortical vascular dementia also has effects in the cortex, leading to cortical dementia symptoms.

Some types of dementia appear to affect both cortical and subcortical areas of the brain. Dementia with Lewy bodies falls in this group. This type of dementia occurs because clusters of a certain type of protein called alpha-synuclein form in the neurons in various areas of the brain, leading to impaired memory, motor skills, and mood. Dementia with Lewy bodies can resemble both Alzheimer’s disease and Parkinson’s disease — and Lewy bodies are often found in patients with other types of dementia.

These are only a few of the many possible causes of dementia — and it’s important to understand the cause of your dementia because it will affect treatment decisions.

8 Dementia Myths and the Truth Behind Them

By Madeline Vann, MPH | Medically reviewed by Pat F. Bass III, MD, MPH 

Maybe you've heard that drug abuse causes dementia, or that red wine will protect you from the disease. Here are the facts. 

 

Perhaps because Alzheimer’s disease and dementia are something of a mystery, there are a number of myths surrounding their causes. A few of these common myths hold some truth, but some are complete falsehoods that muddy the water about the roots of symptoms and how to prevent dementia.

Need help separating good dementia information from bad? We’ve gone to an expert to get the facts.

Myth No. 1: Dementia is caused by exposure to aluminum.

Cooking in aluminum pots and drinking from aluminum cans came under suspicion as a cause of dementia a number of years ago, when this myth first spread. But there is no truth to the fear, says Paul B. Rosenberg, MD, assistant professor of psychiatry and behavioral sciences in the division of geriatric psychiatry and neuropsychiatry at Johns Hopkins University School of Medicine in Baltimore.

“This was an inference from a type of dementia caused many years ago by aluminum that made its way into dialysis patients, but aluminum has nothing to do with dementia as we diagnose it now,” explains Dr. Rosenberg.

Myth No. 2: Dementia is caused by early drug abuse.

Rosenberg says this is an area that has not been thoroughly explored, but currently there are no data to support a connection between drug abuse and Alzheimer's or dementia. Drug abuse isn’t a healthy choice for many other reasons, however.

Myth No. 3: There is nothing you can do about dementia once you have it.

While dementia is by definition a progressive disease, there are steps you can take to slow its progress and find ways to compensate for your lost cognitive abilities in the early stages. Work with your doctor to find medications that might help address symptoms of dementia, and try to stay as physically, mentally, and socially active as possible.

Myth No. 4: Concussions in youth and middle age cause dementia.

News about the increased rates of early dementia in former football players has stimulated this myth, but the jury is still out, says Rosenberg. “There is a suspicion that concussions in young or middle age increase risk for dementia in old age, and we are trying to study this now.”

Myth No. 5: Red wine protects you from dementia.

“There is a little evidence that low-level social drinking — one drink or less per night — may be protective, but that finding is quite controversial,” says Rosenberg. The controversy arises because heavy drinkers tend to die young, skewing the data. Meanwhile, people interested in the protective benefits of resveratrol, a chemical found in red wine, should take heed: “You probably have to drink 20 bottles per night to get a good dose,” says Rosenberg.

Myth No. 6: If someone in your family has dementia or Alzheimer’s disease, you will have it too.

Not so, say the experts. Some forms of dementia do have a genetic component, especially if a close relative such as a parent or sibling has the disease — but as with many inherited diseases, you have some control over how inherited risk plays out in your own life. “Our evidence is that good heart health — exercise, controlling blood pressure and cholesterol — will help prevent dementia,” says Rosenberg.

Myth No. 7: Alzheimer’s disease and dementia are the same thing.

Alzheimer’s disease is the most common form of dementia, but there are other types of dementia characterized by different symptoms.

Myth No. 8: Gingko biloba can prevent memory loss.

For a while, researchers were looking at the herbal supplement gingko biloba as a way to slow or prevent memory loss — but studies have shown no effect on memory. “Gingko was a nice idea, but it didn’t work at all,” says Rosenberg.

These are just some of the myths that surround the subject of dementia. But remember, it's always advisable to get dementia information from reliable sources, such as your doctor, instead of relying on rumors about causes or ways to prevent dementia.