Category: Dementia

Previously ‘untreatable’ dementias could be managed with lifestyle changes.

Some types of dementia are actually a result of many tiny, unnoticed strokes damaging the brain over time, researchers at the Krembil Neuroscience Centre in Toronto, Canada, have found.

This suggests that this type of dementia could be treatable — probably through lifestyle changes.

The findings come from a study of five individuals who had their brains scanned over 16 consecutive weeks (Conklin et al., 2014).

The relatively frequent brain scans revealed that tiny spots were appearing on the MRI, which are characteristic of small strokes.

The appearance of the spots had not been noticed before because previous studies have scanned the brain at longer intervals — typically every year.

The spots did not produce any symptoms but, over time, it is thought the lesions can form into areas of white matter disease that are characteristic of dementia.

Around 50% of older individuals have this kind of white matter disease in their brains, although for many it is harmless.

For some patients, however, the disease can progress until the symptoms become severe.

Dr. Daniel Mandell, who led the study, said:

“We were surprised.

The findings suggest that the tiny, silent strokes are likely much more common than physicians previously appreciated, and these strokes are likely a cause of the age-related white matter disease that can lead to dementia.”

While there are no treatments for degenerative dementias, as this is vascular it may be possible to stop, or at least slow down, the process.

Dr. Frank Silver, Director of the Krembil Neuroscience Centre and one of the study’s authors, said:

“We don’t yet know whether these small strokes are responsible only some or most of the white matter disease seen in older patients.

But in those where it is the cause, the detection of white matter disease on brain imaging should trigger physicians to treat patients aggressively when managing stroke risk factors such as high blood pressure, diabetes, high cholesterol, cigarette smoking and lack of exercise not only to prevent further strokes, but also to reduce the development of cognitive impairment over time.”

New early warning test for dementia developed.

Scientists now think they can detect dementia before the symptoms appear by using a special type of MRI brain scan technique.

The new test — which uses arterial spin labelling — relies on measuring the blood flow in a certain portion of the brain.

The test is sorely needed because early diagnosis of dementia is very important to effective therapies.

The number of people worldwide affected by dementia is currently at over 35 million, and those numbers are expected to double over the next 15 years.

The study which supports the use of this new test included 148 elderly people, around half of whom went on to develop signs of dementia over almost two years (Xekardaki et al., 2014).

Amongst those who later deteriorated, there was reduced blood flow in certain key areas of the brain, as measured at the start of the research.

In particular, reduced flow (or perfusion) was seen in the posterior cingulate cortex, an area in the middle of the brain which is active when our minds are not concentrating on anything specific.

Dr. Sven Haller, one of the study’s authors, said:

“There is a known close link between neural activity and brain perfusion in the posterior cingulate cortex.

Less perfusion indicates decreased neural activity.”

The reason that some people do not notice any symptoms of dementia, despite reduced flow, is that other areas of the brain are able to take up the slack.

The brain has a remarkable ability to recruit its cognitive reserves to make up for deficits caused by age or injury, but only up to a point.

Eventually the cognitive reserves are exhausted and the patient begins to notice some of the classic signs of dementia, like memory loss.

The test of blood flow in this area of the brain may prove a cheap and effective way of spotting these changes before the symptoms become obvious.

Currently PET scans are used to try and spot early signs of dementia, but these expose patients to radiation and are not as easy to administer.

The big 5 lifestyle factors and more ways of preventing dementia.

By 2050 there could be as many as 16 million Americans living with Alzheimer’s disease, the most common form of dementia.

Some of the most frequent early symptoms of Alzheimer’s are short-term memory loss, getting lost and problems finding words.

Later on it can lead to mood swings, confusion, long-term memory loss and a withdrawal from friends and family.

Whilst there is no cure, there are a number of lifestyle and dietary factors that have been associated with preventing dementia.

(Click the links for details of each study.)

1. Keep the brain active

Traditional pastimes like cards and doing puzzles may help to increase brain volume, according to new research presented at the Alzheimer’s Association International Conference 2014.

In the study, along with a brain scan, 329 middle-aged people were surveyed to see how cognitively active they were: how much they played games, read books, went to museums and so on.

The results showed that people who played the most games — like crosswords, checkers, cards and puzzles — also had the largest brain volume.

Stephanie Schultz, the study’s lead author said:

“Our findings suggest that, for some individuals, engagement in cognitively stimulating activities, especially those involving games such as puzzles and cards, might be a useful approach for preserving brain structures and cognitive functions that are vulnerable to Alzheimer’s disease.”

2. Avoid being cynical

People with high levels of cynicism are more likely to develop dementia, according to a new study published in the medical journal Neurology.

In the study, conducted in Finland, 1,449 people were given tests of their cynicism that included questions like:

• “I think most people would lie to get ahead.”
• “It is safer to trust nobody.”
• “Most people will use somewhat unfair reasons to gain profit or an advantage rather than lose it.”

Eight years later, people who were high on cynical distrust were three times more likely to develop dementia than those low on that measure.

3. Take Vitamin E

Two recent studies provide evidence of the protective effects of Vitamin E against both mild to moderate Alzheimer’s disease and age-related memory problems.

Dr. Mary Sano, author of one of the trails, explained:

“This trial showed that vitamin E delays progression of functional decline by 19% per year, which translates into 6.2 months benefit over placebo.”

The study’s authors think that vitamin E can be recommended as standard clinical practice.

A second study carried out in Finland found that higher levels of vitamin E in the blood seemed to protect against memory disorders.

4, 5, 6, 7 & 8. The big five lifestyle factors

The big five lifestyle factors are the ones you’ve heard many times before, especially in relation to heart disease.

They apply to dementia just the same:

4. Take regular exercise.
5. Don’t smoke.
6. Maintain a low body weight.
7. Eat a healthy diet.
8. Low alcohol intake.

A 35-year study recently revealed that people who followed four or five out of these five healthy habits had 60% lower levels of dementia and cognitive decline with ageing.

Adopting just one of these healthy habits reduced the rate of dementia by one-quarter.

Exercise provided the largest protective effect against cognitive decline and dementia.

Dr Doug Brown, of the Alzheimer’s Society, commenting on the study, said:

“We have known for some time that what is good for your heart is also good for your head, and this study provides more evidence to show that healthy living could significantly reduce the chances of developing dementia.”

9. Take Vitamin D

Low levels of Vitamin D are substantially associated with developing Alzheimer’s and dementia in older people, according to the best study conducted so far.

The study, published in the journal Neurology, found that amongst those who had dementia, those low in Vitamin D were 53% more likely to develop the disease.

Amongst those who were severely deficient, the risk increased by 125%.

Similar increases in risk were seen for Alzheimer’s disease: low levels of vitamin D increased risk by 69% and severe deficiency by 122%.

10. Avoid sugar

Otherwise healthy people with high blood sugar levels are more likely to have memory problems, according to a recent study published in the journal Neurology.

This is not the first study to link higher levels of blood glucose with smaller brain structures, particularly the hippocampus.

Studies of those with type 2 diabetes and those with problems absorbing glucose have linked it with higher rates of Alzheimer’s and dementia.

The authors suggest sugar may have a toxic effect on the brain, particularly in its memory centres:

“Direct “toxic” effects of glucose on neuronal structures include disturbances of intracellular second messenger pathways, imbalance in the generation and scavenging of reactive oxygen species, or advanced glycation of important functional and structural proteins in the brain.”

Could playing games — both traditional and video games — help protect against Alzheimer’s disease?

Traditional pastimes like cards and doing puzzles may help to increase brain volume, according to new research presented at the Alzheimer’s Association International Conference 2014.

The findings build on previous studies which have linked playing video games to larger brain structures.

Stephanie Schultz and colleagues at two Alzheimer’s research institutes in Wisconsin examined 329 middle-aged people who did not currently have dementia, but many of whom were at risk because of their family history.

Along with a brain scan, they were surveyed to see how cognitively active they were: how much they played games, read books, went to museums and so on.

The results showed that people who played the most games — like crosswords, checkers, cards and puzzles — also had the largest brain volume.

Schultz said:

“Our findings suggest that, for some individuals, engagement in cognitively stimulating activities, especially those involving games such as puzzles and cards, might be a useful approach for preserving brain structures and cognitive functions that are vulnerable to Alzheimer’s disease.”

More detailed studies of specific cognitive activities, including games, would help further our understanding of how an active, healthy lifestyle may help delay the development of Alzheimer’s.”

Because of the design of this study we can’t tell if playing games is really affecting brain size.

For example, it may be that people with larger brains happen to play more games.

Super Mario

However, there is other research that has linked game-playing with larger brain volumes.

In a study published last year, German researchers had people playing video games for 30 minutes a day over 2 months (Kühn et al., 2013).

Their brain volumes were then compared with a control group.

People who’d been playing the game (Super Mario 64) had larger grey matter structures in areas of the brain associated with memory, spatial navigation, strategic planning and fine motor skills.

The study’s lead author, Simone Kühn, explained:

“While previous studies have shown differences in brain structure of video gamers, the present study can demonstrate the direct causal link between video gaming and a volumetric brain increase.

This proves that specific brain regions can be trained by means of video games.”

Image credit: JD Hancock

New test for disease which affects 115 million people around the world.

A set of 10 blood proteins which reliably predict the onset of Alzheimer’s has been identified by a new study.

It could lead to a relatively cheap and non-invasive test for the disease within a few years.

At the moment the early stages of Alzheimer’s can be difficult to tell apart from the normal ageing process, until it is too late.

Only around 10% of older people with mild cognitive impairment go on to develop dementia within a year.

One of the study’s authors, Professor Simon Lovestone, explained:

“Alzheimer’s begins to affect the brain many years before patients are diagnosed with the disease.

Many of our drug trials fail because by the time patients are given the drugs, the brain has already been too severely affected.

A simple blood test could help us identify patients at a much earlier stage to take part in new trials and hopefully develop treatments which could prevent the progression of the disease.”

The new test, which could be available within two years, can predict the onset of Alzheimer’s in the next year with 87% accuracy.

This would enable drugs to be prescribed earlier and likely improve outcomes.

Finding the right proteins

The study used blood samples from 1,148 people (Hye et al., 2014).

Some had Alzheimer’s, others a mild cognitive impairment and some were elderly controls without dementia.

By analysing the blood samples, they found 10 proteins that could predict the progression from mild cognitive impairment to Alzheimer’s.

The study’s lead author, Dr Abdul Hye, said:

“Memory problems are very common, but the challenge is identifying who is likely to develop dementia.

There are thousands of proteins in the blood, and this study is the culmination of many years’ work identifying which ones are clinically relevant.

We now have a set of 10 proteins that can predict whether someone with early symptoms of memory loss, or mild cognitive impairment, will develop Alzheimer’s disease within a year, with a high level of accuracy.”

Previous studies have found that PET scans and lumbar punctures can predict the onset of dementia, but the former is very expensive and the latter invasive.

A blood test would provide a more cost-effective and less invasive test for a disease which is thought to affect 115 million people around the world.

Image credit: Bev Sykes