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.

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.

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.

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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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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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.

Normal Memory Loss or Dementia?

By Madeline Vann, MPH | Medically reviewed by Lindsey Marcellin, MD, MPH 

Lost your keys? Don't stress — a memory glitch here and there often accompanies aging. Lost your way home? This could be signaling something more serious.

 

Is it just age-related memory loss — or the early signs of Alzheimer’s disease? Sooner or later, you will ask this about yourself, your spouse, or someone else in your family. But the question of whether you are noticing dementia signs is not an easy one to answer.

A certain degree of forgetfulness may accompany aging. Normal memory loss most often means that you have a harder time recalling new pieces of information, such as the name of a person you met for the first time last week.

“Typical signs [of dementia] are extreme forgetfulness, not just forgetting the keys here and there. Rather, forgetting where one is, whether or not one just ate, forgetting to put shoes on before going outside, and that sort of thing,” says Ross Andel, PhD, associate professor at the School of Aging Studies at the University of South Florida in Tampa.

So if you go for your daily walk and experience a little confusion about how to get home, should you worry? Many experts, like Andel, think it’s a good idea to err on the side of caution and get in touch with your doctor if you have moments of forgetfulness that worry you.

“The difference can be very subtle, and any suspicion should be consulted and/or confirmed by a professional, such as those working at memory clinics of Alzheimer’s disease centers,” he says. The advantage to working with an expert, such as a neurologist, is that an expert can give you memory tests that help determine whether your experience with memory loss is normal or not.

 

Dementia Signs that Indicate a Problem

Consider these red flags of memory loss and cognitive problems:

• Does it interfere with daily life? Everyone forgets a name, only to remember later — but if you’re consistently forgetting appointments, can’t remember how to cook foods you’ve always been able to cook, or people tell you you’ve asked them for the same information multiple times, those are more serious signs.
• Do you have trouble thinking things through? We’ve all made a mess of our accounting once or twice, but if you just can’t figure out how to balance your checkbook or plan the kind of trip you used to enjoy, it may be time to seek help. In fact, a recent study suggests that problems remembering how to handle money foreshadows an Alzheimer’s diagnosis by up to a year.
• Are you having trouble retracing your steps? Everyone misplaces their keys, but most people usually can go back over their steps to find them again. Dementia signs include an inability to retrace your steps to find lost items.
• Are you at a loss for words? We all know about the tip-of-the-tongue phenomenon, when a word you want is just out of reach. But frequently being unable to come up with the word or phrase you want can be a sign of Alzheimer’s disease.
• Do you lose your sense of place and time? Forgetting where you are, how you got there, the order of events, or even what day it is — these are all more than just “normal” signs of memory loss.

 

Other Causes of Forgetfulness

It’s natural to worry about dementia and Alzheimer’s disease as causes of your more-than-normal forgetfulness, but you should know there are some other possible causes, including:

• Alcoholism
• Dehydration
• Depression
• Head injury
• Medication side effects
• Protein deficiency
• Stroke(s)
• Vitamin B12 deficiency

When you talk to your doctor about your concerns about memory loss and the risk of Alzheimer’s disease, she should also ask questions that will help her find out whether there may be other causes of your problems.

“True dementia cannot be reversed whereas cognitive impairment due to other causes can be reversed" in many circumstances, says Andel.

So if you’re worried, talk to your doctor. At best, you will be reassured that your occasional forgetfulness is normal for your age — and at worse, you will be able to start early with dementia treatment and management strategies.

The Enigma of Early-Onset Dementia

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

The risk of being diagnosed with dementia increases with age — but for a small group of people, dementia symptoms start appearing as young as 35. 

 

Dementia is usually thought of as a health concern of the elderly — but for a few patients, a dementia diagnosis comes earlier. This loss of memory and cognitive abilities at a younger age is called early-onset dementia. Diagnosis of early dementia is a challenge, and dementia treatment is complicated by the demands of younger families and jobs.

“The majority of cases of dementia in the United States are in people over 65, and 50 percent are in people over 85 years old but … we’ve seen patients who have the disease at 35,” says Raj C. Shah, MD, medical director of the Rush Memory Center at Rush University Medical Center in Chicago.

As many as 6 percent of Alzheimer’s disease cases occur before age 65, usually in a person’s forties or fifties. Close to 60 percent of those cases are inherited — 13 percent appear in families in which three generations have developed Alzheimer’s disease. Alzheimer’s disease is the most common cause of dementia symptoms, but other causes of early-onset dementia include:

• Vascular dementia. Changes in blood flow to parts of the brain, often due to mini-strokes, can begin in mid-life.
• Frontotemporal dementia. A fatal disorder in which parts of the brain shrink.
• Parkinson’s disease. Motor skills — walking, balance, and the like — deteriorate because the brain stops producing dopamine.

The Complications That Come With Early Dementia

 

Early-onset dementia comes with complications that do not arise in later years, including:

• Difficult dementia diagnosis. Dementia is usually not a doctor’s first conclusion when a person starts to lose cognitive function in middle life — which means that it can take a while to arrive at a correct diagnosis. However, while the diagnostic process is taking place, dementia symptoms can wreak havoc on personal relationships and work obligations.
• Family. When people are diagnosed over age 65, they are usually finished with child-rearing responsibilities, but early-onset dementia can interrupt family life as adults in middle age may still be raising children, supporting young adults in college, and even caring for their own aging parents.
• Employment. Dementia treatment often focuses on helping patients stay as long as possible in the working world. Patients and families also have to work with employers to adjust workloads or tasks to suit abilities.
• Finances. The burden of early dementia combined with the possible loss of employment can cripple a family’s financial situation.
• Qualifying for services. Many services and funding programs are only available for people over age 65, which means patients with early onset dementia and their families have to work harder to get the support they need.

Handling an Early Dementia Diagnosis

 

“We have to take a slightly different approach to building the care plan,” says Dr. Shah. A care plan is a detailed approach to dementia treatment that creates a so-called web of services around the patient and his family. These services include a medical team, occupational therapists, support groups, and community services or agencies that can provide assistance.

Therapy may be necessary for the children and spouses of the dementia patient, who may experience significant anger, grief, and resentment over an early dementia diagnosis. The care plan has to be adjusted as the needs of the patient and family caregivers change.

There may be a perception that early dementia progresses more rapidly than later onset dementia, but this is likely because everything related to dementia treatment, including entering a nursing home, is happening at an earlier age rather than happening more quickly or severely.

Early onset dementia places a significant burden on families — but with the dedicated help of their medical team, friends, family, and coworkers, patients may be able to maintain quality of life for many years.

Can Caffeine Ward Off Alzheimer's?

By Marie Suszynski | Medically reviewed by Pat F. Bass III, MD, MPH

A hot cup of joe may do more than keep you awake through your next meeting. Research is finding that it may help prevent memory problems. 

 

Anyone with a family history of Alzheimer’s disease or dementia wants to do everything possible to avoid the diseases. Now, researchers have found that some protection may be as close as your coffee mug.

The Journal of Alzheimer’s Disease recently published a special supplement of key findings that suggest caffeine may help keep the brain functioning properly and help ward off Alzheimer’s and dementia.

Here’s what researchers are discovering about caffeine’s role in the brain and how it may protect against memory problems.

 

Key Research Findings About Alzheimer’s and Caffeine

Research shows that caffeine seems to have a big effect on adenosine receptors, which are found in brain cells. An imbalance of adenosine has been associated with neurological disorders like Alzheimer’s disease, and higher levels of caffeine intake seem to protect against Alzheimer’s disease. Researchers believe regular consumption of caffeine “normalizes” memory function, or protects against the loss of memory, especially among people who are under stress. And stress is a well-known cause of memory problems.

One study found that coffee drinking during the previous two decades was associated with a lower risk of developing Alzheimer’s disease. Another study of 1,409 people 65 and older found that drinking three to five cups of coffee a day meant a 65 percent decreased risk of developing Alzheimer’s disease, compared with consumption of little or no coffee.

Animal studies also found that caffeine had beneficial effects on the brain, but the research is conflicting. Some studies have concluded that moderate doses of caffeine helped memory, while high doses seemed to hurt it.

Though caffeine seems to help protect against memory problems, researchers aren’t convinced that it actually enhances memory. A review of studies of caffeine’s effect on memory in people who don’t have dementia found conflicting results — several studies that suggested it improved memory, while others found that it didn’t. At best, researchers say, caffeine may be mildly beneficial in this regard.

 

Applying the Research to Alzheimer’s Prevention

Although there’s no evidence that anyone can prevent Alzheimer’s disease, some doctors like Dharma Singh Khalsa, MD, the Tucson, Ariz.-based founding president and medical director of the Alzheimer’s Research and Prevention Foundation and author of Brain Longevity, believe that numerous lifestyle factors can have an important impact on the brain and be protective.

Nutrition, stress-management, exercise, mental stimulation, and possibly hormone therapy may all influence how healthy your brain is, Dr. Khalsa says. “Caffeine is the next level out. Caffeine is a mild stimulant — we think stimulation is synonymous with a better-functioning brain,” he explains, but adds that there’s no one magic bullet. Living a complete, healthy lifestyle is important for keeping your brain healthy.

 

Other Strategies to Thwart Dementia

While filling up your coffee mug every day may offer some protection, here are other important approaches to Alzheimer’s prevention.

• Eat a balanced diet with plenty of vitamins. Diets that focus on fruits and vegetables with little red meat, such as the Mediterranean diet, are associated with healthier brain function, Khalsa says. Getting enough B vitamins, fish oil, and vitamins C and E may also contribute to a healthy brain.
• Stop stressing. Lowering your stress level, particularly when you do it with exercise, is also part of the cognitive health picture, Khalsa says.
• Stay mentally active. Continue to constantly challenge yourself with new, stimulating experiences from travel to artistic expression to just enjoying nature. Learn to play a new musical instrument or dabble in a hobby you’ve always wanted to try.

Although caffeine looks promising and is easy to get, leading a lifestyle that includes a variety of brain-healthy practices is your best bet.

How Do Alzheimer's and Dementia Progress?

By HealthTalk Staff | Medically reviewed by Ed Zimney, MD

Learn about the seven stages of Alzheimer's and specific symptoms that typically arise during each period. 

The way the disease proceeds and the array of symptoms that arise over time can vary from person to person. For consistency, physicians use the following staging system to identify the progression of the disease:

 

Stage 1: No impairment

The person has no memory problems, no perceptible symptoms, and is functioning normally.

 

Stage 2: Very mild cognitive decline

Decline in memory or thought processing may be normal for the person’s age or may be the first signs of Alzheimer’s. The person may complain of memory lapses, such as forgetting familiar words or losing personal items, like glasses and keys. But these are subjective indicators, and problems probably will not be apparent yet to friends or family members.

 

Stage 3: Mild cognitive decline

The person may:

• Not remember the names of new people they are introduced to
• Have a noticeably impaired ability to work or interact socially
• Lose or misplace valuable items
• Have a marked inability to plan or organize

Stage 4: Moderate cognitive decline

The person may:

• Not recall recent events
• Be unable to perform relatively challenging mental tasks, such as counting backwards from 100 by 7s
• Have a diminished ability to do complicated everyday tasks, such as shopping and paying bills
• Not remember significant events in his or her own life
• Begin to be withdrawn, particularly in challenging situations

Stage 5: Moderately severe cognitive decline

The person may:

• Not remember important information, such as their address or telephone number
• Know where they are, the day of the week, the month, or the season
• Have trouble with less challenging mental tasks, such as counting backwards from 40 by 4s
• Need help choosing clothing appropriate for the season or the setting
• Retain knowledge about themselves, such as their own name and the names of their immediate family members
• Eat, use the toilet, and perform similar personal functions on their own.

Stage 6: Severe cognitive decline

The person may:

• Be unaware of their surroundings and recent events
• Know their own name, but not remember their own personal history very well
• Sometimes forget their spouse’s name, but distinguish familiar from unfamiliar people
• Need assistance to dress
• Have an abnormal sleep/waking cycle
• Need help using the toilet (wiping, disposing of toilet paper, or flushing toilet)
• Develop urinary or fecal incontinence
• Undergo personality changes, such as extreme suspiciousness
• Experience delusions or hallucinations, or exhibit compulsive, repetitive behaviors such as hand-wringing
• Wander and become easily lost

Stage 7: Very severe cognitive decline

The patient may:

• Lose their ability to speak coherently (although they may utter occasional words or phrases)
• Need help with eating, using the toilet, and personal hygiene
• Have general urinary incontinence
• Be unable to walk or sit without help
• Eventually, be unable to hold up their head or swallow