Dementia and hearing loss seem linked, researchers say

February 19, 2011

Dad began losing his hearing long before we recognized any signs of what turned out to be frontotemporal dementia. Now I’m wondering, thanks to recent headlines, whether his hearing loss is related to his dementia.

Dr. Frank Lin, from the Center on Aging and Health at Johns Hopkins Medical Institutions in Baltimore, published a paper saying hearing loss in older adults is associated with an increased risk of developing dementia. It might be that dementia is overdiagnosed in people who have hearing loss. Or, people with cognitive impairment may be overdiagnosed as having hearing loss. Lin says it’s possible one underlying neuropathologic process is shared by the two conditions. They could also be causally related, he told MedScape Today, “possibly through exhaustion of cognitive reserve, social isolation, environmental deafferentation, or a combination of these pathways.”

For his study, he worked with 639 people from ages 36 to 90 years, over an almost 12-year period. Fifty-eight of them developed dementia, including 37 cases of Alzheiemer’s disease. He says the risk of developing dementia increased linearly with the severity of baseline hearing loss. His work is published in the Archives of Neurology and concludes by saying, “whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.”

Isn’t that interesting — just the thought that, perhaps, treating/fixing hearing loss could possibly have an impact on the development of dementia?

Turns out that’s not a new idea. Other research, in the Journal of the American Geriatrics Society, has shown deficits in central auditory speech-processing may be an early manifestation of probable Alzheimer’s disease and may precede the onset of dementia diagnosis by many years.

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Meet the pericyte, a new player in Alzheimer’s

November 18, 2010

Cells in the brain called pericytes play a crucial role in the development of neurodegenerative diseases such as Alzheimer’s, according to research in the November issue of the journal, Neuron.

“For 150 years these cells have been known to exist in the brain, but we haven’t known exactly what they are doing in adults,” Dr. Berislav Zlokovic said in a news release from the University of Rochester Medical Center. “It turns out the pericytes are very important for helping maintain a brain environment crucial to the health of neurons. The pericyte offers us an exciting new target for new treatments for neurodegenerative diseases.”

Pericytes wrap around capillaries like ivy around a pipe, to help maintain the structural integrity of the tiny blood vessels. They play a central role in determining the amount of blood flowing in the brain and in maintaining the barrier that stops toxic substances from leaking out of the capillaries and into brain tissue. When researchers reduced the number of pericytes in the brains of laboratory mice, they observed a reduced blood flow, greater exposure to toxic substances, impaired learning and memory, and damage to neurons, or nerve cells. The mice experienced an array of problems that closely match the brain abnormalities experienced by people with neurodegenerative conditions, such as Alzheimer’s.

Read the news release.

Read the abstract in the journal, Neuron (including instructional video).

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Researchers explain link between type 2 diabetes and Alzheimer’s

October 14, 2010

Elderly people with Type 2 diabetes are twice as likely to develop Alzheimer’s disease–and now researchers think they know why.

A gene associated with diabetes is also found at lower-than-normal levels in people who have Alzheimer’s, according to research published in this month’s Aging Cell journal. Researchers from Mount Sinai School of Medicine used mice that were genetically engineered to have Alzheimer’s disease, and they discovered lower levels of the gene known as proliferator-activated receptor coactivator 1, PGC-1, which is a key regulator of glucose.

The research team led by Dr. Giulio Maria Pasinetti reported that the decrease might be causally linked to promotion of Alzheimer’s, because PGC-1 promoted the degradation of a specific enzyme known as beta-secretase. This enzyme is directly involved in the processing and eventually generation of beta-amyloid, an abnormal protein linked to Alzheimer’s and brain degeneration.

“This new research is of extreme interest, especially since approximately 60 percent of Alzheimer’s disease cases have at least one serious medical condition primarily associated with Type 2 diabetes,” Pasinetti says.

The next step is to determine if PGC-1 can be manipulated with drugs, to prevent the beta-amyloid accumulation in the brain.

The news release from Mount Sinai School of Medicine.

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More reason to walk — research shows it may preserve memory in old age

October 13, 2010

All of the Alzheimer’s Association’s “Walks to End Alzheimer’s” may be on to something.

New research suggests that walking at least six miles per week may protect brain size and, in turn, preserve memory in old age. A study published in the Oct. 13 online issue of Neurology says that brain shrinkage in late adulthood can lead to memory impairment–and tests the theory that regular physical activity can prevent that.

“Our results should encourage well-designed trials of physical exercise in older adults as a promising approach for preventing dementia and Alzheimer’s disease,” says lead author Kirk I. Erickson, PhD, of the University of Pittsburgh in Pittsburgh. He and his team worked with 299 adults with a mean age of 78 who tracked the number of blocks they walked each week. Researchers examined the association between gray matter volume, physical activity and cognitive impairment over the course of nine years.

The participants walked amounts ranging from 0 to 300 blocks. “Greater physical activity predicted greater volumes of frontal, occipital, entorhinal, and hippocampal regions nine years later,” the researchers concluded. “Walking 72 blocks was necessary to detect increased gray matter volume, but walking more than 72 blocks did not spare additional volume. Greater gray matter volume with physical activity reduced the risk for cognitive impairment two-fold,” the abstract says.

“If regular exercise in midlife could improve brain health and improve thinking and memory in later life, it would be one more reason to make regular exercise in people of all ages a public health imperative,” Erickson says.

The study was supported by the National Institute on Aging.

Neurology is the journal from The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals.

Read the abstract from the walking study.

Read about my experience as Memory Walk honorary chair.

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Those senior moments may not just be ‘old age’

September 16, 2010

I don’t know whether this is good news, or bad, but here’s what I know:

Dementia researchers from Chicago’s Rush University Medical Center are saying that “old age” may have nothing to do with why older people become forgetful.

“Our results challenge the concept of normal memory aging and hint at the possibility that these lesions play a role in virtually all late-life memory loss,” study author Robert S. Wilson says in a news release from the journal, Neurology, which published Wilson’s study online Sept. 15. “It appears these brain lesions have a much greater impact on memory function in old age than we previously thought.”

For the study, 350 Catholic nuns, priests and brothers were given memory tests annually for up to 13 years. Tests included word list recall, naming, verbal, number and reading assessments. After death, the participant’s brains were studied for lesions.

The study found that memory decline tended to be gradual until speeding up in the last four to five years of life. Tangles, Lewy bodies, and stroke were all related to gradual memory decline. Almost no gradual decline was seen in the absence of tangles. Both Lewy bodies and stroke approximately doubled the rate of gradual memory decline. Tangles and Lewy bodies were also related to rapid memory decline but explained only about one third of the effect.

“Understanding how and when these brain lesions affect memory as we age will likely be critical to efforts to develop treatments that delay memory loss in old age,” says Wilson.

The National Institute on Aging helped pay for the study.

It seems to support what’s known as mild cognitive impairment, MCI, sort of a precursor to dementia. People with MCI have memory problems that are not as severe as people with Alzheimer’s, and more of them go on to develop Alzheimer’s than those who do not have MCI.  Here’s the rub: no test can detect MCI. It’s more a diagnosis of exclusion.

“Mild cognitive impairment (MCI) is a disorder of the brain in which nerve cells involved in one aspect of cognitive processing (thinking abilities) are impaired,” according to the Mayo Clinic, whose neurologists first identified the characteristics of MCI. “Individuals with MCI are able to function reasonably well in everyday activities, such as managing finances and purchasing items at stores without assistance, but have difficulty remembering details of conversations, events and upcoming appointments. Most (but not all) patients with MCI develop a progressive decline in their thinking abilities over time, and Alzheimer’s disease is usually the underlying cause.”

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A new dementia concern — research shows stress may lead to Alzheimer’s disease

August 16, 2010

If you’re middle-aged and psychologically stressed, here’s something else to worry about: A long-term study in Sweden shows that stress in middle age may lead to the development of dementia, especially Alzheimer’s disease, later in life.

Researchers from the University of Gothenburg followed 1,415 women from 1968 to 2000. They were between the ages of 38 and 60 at the start of the study, and they answered three surveys in 1968, 1974 and 1980 to assess their levels of psychological stress. Stress was defined as a “sense of irritation, tension, nervousness, anxiety, fear or sleeping problems” lasting a month or more. One hundred sixty-one of the women developed dementia; the majority of the cases were diagnosed as Alzheimer’s disease.

Researchers found that dementia risk was 65 percent higher in women who suffered frequent stress in middle ages, with the risk rising incrementally the more often women answered they had “frequent” or “constant” stress on scientific surveys. Their work is published in the journal, Brain.

Lead author Lena Johansson, a research nurse in the university’s Institute of Neuroscience and Physiology, says in the abstract that additional work is needed to explore potential neurobiological mechanisms of the association.

Read the abstract from the journal, Brain.

Read the release from the Alzheimer’s Society.

Read the UK Press Association account.

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Spinal fluid test for Alzheimer’s raises interesting question

August 10, 2010

Today’s news of a new and accurate way of diagnosing Alzheimer’s disease through a spinal fluid test is both promising — and troubling.

Researchers writing for the Archives of Neurology told of a nearly 100-percent accurate test of cerebrospinal fluid for biomarkers that signal Alzheimer’s disease. The disease was confirmed in some of the study subjects through an examination of the brain after they died. What surprised the scientists was the presence of the Alzheimer’s disease signature in more than one-third of the cognitively normal subjects–suggesting that the disease “pathology is active and detectable earlier than has heretofore been envisioned,” the abstract says.

Dr. Steven DeKosky, dean of the University of Virginia medical school, told The New York Times “this is what everyone is looking for, the bull’s-eye of perfect predictive accuracy.”

Most experts believe that Alzheimer’s starts before symptoms become obvious, so having a way to identify victims early might lead to ways of slowing or preventing deterioration. Lots of drug studies are in various stages of experimentation and development for that purpose.

Here’s what’s a little troubling: Should doctors offer, and should patients accept, a test for a disease that has no treatment?

An accompanying editorial tackles this issue.

My thinking has always been that more information is better than less. However, as patients, we have to ask ourselves, what will we do with the information?

Say we are having memory troubles and fear Alzheimer’s. Would having such a test done (once it’s ready for prime time, that is) alleviate our fears? If the results said no, would it encourage our doctor to explore other causes? If the results said yes,  would knowing that make things worse for us–especially now, when there’s really not much that can help someone in the early stages of Alzheimer’s?

Maybe there will come a day when such a spinal fluid test would become something of a screening, like a mammogram to spot breast cancer or a colonoscopy to spot colorectal cancers. But we’re not there yet.

My other concern would be that a long term care insurance policy be firmly in place before the test. Because once someone is diagnosed with a dementia, good luck purchasing coverage. The costs of caring for someone with dementia are enormous. Without that coverage, I honestly don’t know how we would have cared for my father.

Read The New York Times article.

Read the abstract of the study.

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REM sleep disorder may signal dementia, Parkinson’s disease

July 28, 2010

My Dad for years had these crazy sleep patterns, where he’d startle just as he hit REM, the Rapid Eye Movement stage of sleep.

Of course I thought about that as I read of a new study in the journal, Neurology showing that an REM sleep disorder may signal dementia or Parkinson’s disease up to 50 years before the disorders are diagnosed. For the study, researchers used Mayo Clinic records for 27 patients who experienced REM sleep behavior disorder for at least 15 years before developing one of three conditions: Parkinson’s disease, dementia with Lewy bodies or multiple system atrophy, a disorder that causes symptoms similar to Parkinson’s disease.

The study found that the time between the start of the sleep disorder and the symptoms of the neurologic disorders ranged up to 50 years, with an average span of 25 years. Of the participants, 13 were diagnosed with dementia, 13 others were diagnosed with Parkinson’s disease and one person was diagnosed with multiple system atrophy.

“Our findings suggest that in some patients, conditions such as Parkinson’s disease or dementia with Lewy bodies have a very long span of activity within the brain and they also may have a long period of time where other symptoms aren’t apparent,” said study author Dr. Bradley F. Boeve.  His work did not give an indication how many people with REM disorder may go on to develop Parkinson’s or dementia.

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Ninety medications in development to treat Alzheimer’s, dementias

July 24, 2010

The Pharmaceutical Research and Manufacturers Association shares some encouraging news with its report on medicines to treat mental illnesses. Ninety drugs are in various phases of research to treat dementias, including one that is designed to remove beta amyloid protein from the brain and prevent or reverse progression of Alzheimer’s disease.

I count 11 drugs in what is called “Phase 3″ trials, the final step toward approval and licensing of a new drug.

So, progress is underway.

1 Comment | Alzheimer's, dementia, frontotemporal, FTD, Lewy body, prevention, research, treatment | Permalink
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More studies showing exercise can help stave off dementia, Alzheimer’s

July 14, 2010

Encouraging research being shared at the International Conference on Alzheimer’s Disease in Honolulu this week shows that exercise may be a powerful antidote to cognitive decline in Alzheimer’s and other dementias.

Physical activity has long been related to cognitive decline, through several long-term epidemiological studies, but up until now, published research has not been consistent, and several large studies failed to show an association. Most of the studies followed participants for fewer than six years and/or lacked substantial follow-up. In fact, a panel convened by the National Institutes of Health recently reported that no proof exists for ways of preventing dementia.

Researchers have yearned for a long-term study of people within the age brackets at higher risk for developing Alzheimer’s, in order to show a true relationship between exercise and cognitive decline. The Framingham Study, a population-based study that has followed participants residing in the town of Framingham, Massachusetts since 1948 for cardiovascular risk factors, is one such study, and it is now also tracking cognitive performance.

In work presented in Honolulu, Dr. Zaldy Tan of Boston’s Brigham and Women’s Hospital and Harvard Medical School, and colleagues, estimated the levels of 24-hour physical activity of more than 1,200 elderly participants from the Framingham Study. They included 742 females, within five years of age 76 in 1986 and 1987, and followed them for the development of dementia. They divided the participants into five groups based on level of physical activity, from lowest (Q1) to highest (Q5).

Over two decades of follow-up, 242 of the women developed dementia, including 193 with Alzheimer’s. The researchers found that participants who performed moderate to heavy levels of physical activity had about a 40 percent lower risk of developing any type of dementia. Further, people who reported the lowest levels of physical activity were 45 percent more likely to develop any type of dementia compared to those who reported higher levels of activity.

“This is the first study to follow a large group of individuals for this long a period of time,” Tan says in a news release. “It suggests that lowering the risk for dementia may be one additional benefit of maintaining at least moderate physical activity, even into the eighth decade of life.”

2 Comments | Alzheimer's, alzheimer's association, dementia, early-onset Alzheiemer's, frontotemporal, FTD, late-onset Alzheimer's, Lewy body, prevention, research, Uncategorized | Permalink
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